Denver Health Psychology Internship Program CHRISTOPHER SHELDON, PH.D. Chief Psychologist and Director of Internship Training ROBERT HOUSE, M.D. Director, Behavioral Health Services ARTHUR GONZALEZ, PH.D. Chief Executive Officer PHILIP MEHLER, M.D. Director, Patient Safety and Quality 2014-2015 Accredited by the American Psychological Association Member - Association of Psychology Postdoctoral and Internship Centers
Table of Contents CONTACT INFORMATION... 3 DENVER HEALTH... 4 THE PSYCHOLOGY INTERNSHIP PROGRAM... 4 MISSION AND PHILOSOPHICAL MODEL... 4 DIVERSITY... 5 PROGRAM ORGANIZATION... 5 THE FIVE MAJOR ROTATION COMBINATIONS ARE:... 5 OVERALL GOALS OF THE DENVER HEALTH PSYCHOLOGY INTERNSHIP PROGRAM... 6 EXPECTED EXPERIENCES DURING THE INTERNSHIP YEAR:... 7 PSYCHOLOGY INTERNSHIP FACULTY... 7 MAJOR ROTATIONS... 8 HEALTH PSYCHOLOGY... 8 ADULT MENTAL HEALTH OUTPATIENT SERVICE... 10 CHILD AND ADOLESCENT MENTAL HEALTH OUTPATIENT SERVICE... 11 INPATIENT ADULT PSYCHIATRY AND CONSULT-LIAISON SERVICE... 12 ELECTIVE EXPERIENCES... 13 NEUROPSYCHOLOGY... 13 HEALTH PSYCHOLOGY ELECTIVES... 14 Geriatric Integrated Primary Care... 14 Oncology Fellows Clinic/Oncology Breast Clinic... 14 Bariatric Evaluations/Clinic... 14 INPATIENT/OUTPATIENT PEDIATRIC ELECTIVES... 14 WESTSIDE INTEGRATED PRIMARY CARE PEDIATRICS... 15 HIGH RISK PEDIATRIC CLINIC... 16 PSYCHIATRIC EMERGENCY SERVICE (PES)... 16 MORE ABOUT THE PROGRAM... 16 BRIEF HISTORY OF THE INTERNSHIP PROGRAM... 16 DIDACTIC TRAINING... 17 SUPERVISION... 17 RESEARCH... 18 SALARIES AND BENEFITS... 18 ADMINISTRATIVE AND TECHNICAL SUPPORT... 19 APPLICATION INFORMATION & INSTRUCTIONS... 20 SELECTION CRITERIA AND APPLICATION PROCESS... 20 DENVER HEALTH INTERNS 2006-2014... 22 DENVER HEALTH 2012 FACTS... 23 DENVER HEALTH 2012 FIGURES... 24 DENVER AT A GLANCE... 25 POPULATION... 25 LOCATION... 25 CLIMATE... 25 HOUSING... 25 TRANSPORTATION... 25 APPENDIX A. PROGRAM GOALS, OBJECTIVES, COMPETENCIES AND EXPECTATIONS... 26 APPENDIX B. POLICY ON SOCIAL MEDIA AND ANSWERING MACHINES... 33 APPENDIX C. INTERNSHIP ASSESSMENT STANDARDS... 33 APPENDIX D. POLICY FOR UNSATISFACTORY PERFORMANCE, DUE PROCESS AND INTERN APPEALS... 34 2
Contact Information Denver Health Medical Center Behavioral Health Services 667 Bannock Street, MC 3450 Denver, Colorado 80204-4507 Phone: 303-436-6341 Fax: 303-436-6389 Christopher.Sheldon@dhha.org www.denverhealth.org Internship program website: http://denverhealth.org/forprofessionals/clinicalspecialties/mentalhealth/psychologyinternship.aspx The Denver Health Psychology Internship Program is fully accredited by: Commission on Accreditation Office of Program Consultation & Accreditation American Psychological Association 750 First Street, N.E. Washington, D.C. 20002-4242 Telephone: 202-336-5979 TDD/TTY: 202-336-6123 Fax: 202-336-5978 http://www.apa.org/ed/accreditation/about/coa/index.aspx Fully accredited since 1980 Last accreditation decision: July 2011 Next accreditation site visit: 2018 3
DENVER HEALTH Denver Health is a large, integrated health care system that is a national model for high-quality efficient care and is Colorado s largest safety net institution. Denver Health s long tradition of community involvement, civic responsibility and professional excellence are reflected in the institution s mission to: Provide access to the highest quality health care, whether for prevention, or acute and chronic diseases regardless of ability to pay; Provide life-saving emergency medicine and trauma services to Denver and the Rocky Mountain region; Fulfill public health functions as dictated by the Denver Charter and the needs of the citizens of Denver; Provide health education for patients; Participate in the education of the next generation of health care professionals; and Engage in research, which enhances our ability to meet the health care needs of Denver Health system patients. THE PSYCHOLOGY INTERNSHIP PROGRAM Mission and Philosophical Model The mission of the Denver Health Psychology Internship Program is to produce doctoral-level clinicians with a strong professional identity as psychologists. This mission is facilitated considerably by the rich, vibrant environment provided by Denver Health as a teaching hospital affiliated with the University of Colorado School of Medicine. The Psychology Internship Program is philosophically grounded in the practitioner-scholar model of professional psychology and accepts students from accredited doctoral programs in clinical or counseling psychology. Interns are expected to utilize critical thinking and analytical skills in applying empirical knowledge and relevant theoretical frameworks to the unique individuals with whom they work. Interns are encouraged to develop their own clinical approach within this overall framework. Faculty members who are practicing clinicians with the populations with whom the interns work serve as professional role models. The program integrates training in ethical practice, professional standards and evidence-based treatment into clinical practice. The program promotes knowledge of and respect for diversity, as well as continued learning and growth as core facts of professional identity. Interns bring their own knowledge and skills from a variety of strong doctoral programs. There is an expectation that interns will learn from each other and that the faculty will also benefit and grow professionally. The training atmosphere is one of teamwork and professional collaboration. Assessment and treatment are provided on multidisciplinary teams with the biopsychosocial model as an overarching framework. Psychology interns have frequent opportunities to interact with medical interns as well as with trainees in nursing, social worker and other professions. Consideration of psychological and social functioning in addition to biology improves the understanding of health and disease, as well as the ability of the team to align with and assist patients. Life span developmental models as well as applied understanding of cultural and individual diversity also bring valuable perspectives for many patients and populations. The Internship Program provides a core clinical curriculum in assessment and treatment, but can also be flexible to meet the training needs of individual interns. 4
Diversity Recognition and respect for individual and cultural diversity is central to the mission of Denver Health and to the philosophical framework of the internship training program. 67% of patients at Denver Health are from ethnic minority groups. Overall our population self-identifies as 50% Hispanic, 30% Caucasian, 14% Black, 3% Asian and 3% as Other/Unknown. The population is largely low income, and the Psychology Internship Program incorporates consideration of poverty related stress into our didactics and clinical work. Denver Health employees receive yearly training on Cultural Diversity, Medical Interpretation and Translation Service, Understanding Sexual Harassment and Domestic Violence & Elder Abuse. Internship seminars cover gender, sexual identity issues, and diversity of age, religion, language, and working with refugees in addition to topics on racial and ethnic issues. Consideration of diversity issues is an integral part of all of our major rotations and is included as a regular part of supervision. At the same time, we remain mindful that, while an individual may have membership in certain identified groups, everyone should be approached as an individual who may or may not fit exactly with the average characteristics of individuals in these groups. Program Organization To promote successful completion of the mission, the program provides interns with several training experiences. The primary focus is supervised direct clinical service with at least two different populations. Interns observe experienced licensed psychologists working with patients and interacting with staff, learn about the perspective and methods of other professionals on the multidisciplinary teams, and participate in several hours per week of didactic training. As developing professionals within a teaching hospital, interns are expected to educate other professional trainees in medicine, nursing and other fields about psychology. Interns sometimes have the opportunity to supervise (under supervision of a licensed psychologist) psychology trainees. The Denver Health Clinical Psychology Internship is a generalist program in which all interns will learn about a variety of populations, intervention strategies, and scientific perspectives. However, each applicant selects populations with whom they want concentrated experience as part of the match process. The program is currently structured so that each intern is matched through the APPIC process with one of five designated combinations of major rotations. The five major rotation combinations are: Health Psychology with Outpatient Child and, Adolescent Mental Health Health Psychology with Outpatient Adult Mental Health Health Psychology with Inpatient & Consult Psychiatry (two internship positions) Outpatient Adult Mental Health with Inpatient & Consult Psychiatry Outpatient Child and Adolescent Mental Health with Inpatient & Consult Psychiatry Health Psychology, Outpatient Child and Adolescent Mental Health and Outpatient Adult Mental Health are six month major rotations. The Health Psychology major rotation has two clinical roles, one in integrated primary care and one as a health coach with Managed Care. On the Inpatient and Consult major rotations, the intern spends three months on the adult inpatient psychiatric unit and three months working with the Psychiatric Consult Liaison Service providing evaluation and 5
intervention for medical inpatients throughout the hospital. Applicants can apply to more than one of these major rotation combinations. Each of the five noted above has its own unique program code (see application information below) and the applicant can place more than one of the Denver Health program codes on his or her APPIC match list. Denver Health submits five different match lists to APPIC, and frequently will put an applicant on more than one of our match lists. Applicants should only ask to be considered for major rotation combinations for which they are a suitable fit and which would provide the applicant with a satisfactory internship experience. In addition, interns can request four to eight hours per week of elective experiences. Neuropsychology is an excellent learning opportunity that can provide useful skills post-internship. Many interns choose to work with the Psychiatric Emergency Service for one elective, as this provides an excellent opportunity to work with a sizeable volume of individuals with acute psychiatric disturbance. Other elective options include Oncology, Geriatric Primary Care, Assessment for Bariatric Surgery or in another medical specialty area depending on availability and supervision. Pediatric electives include Integrated Primary Care at the Westside Pediatric and Teen Clinic, group therapy and testing on the Adolescent Inpatient Unit, as well as outpatient child and adolescent psychological assessment. Support groups conducted by interns in recent years have included weight management, post-bariatric surgery support, pain management and diabetes management. The faculty will make every effort to be flexible in order for the internship to accommodate the clinical training and professional growth needs of each intern. The Denver Health Psychology Internship provides a structured sequence of learning with hands-on supervision by licensed psychologists. The intern is considered a developing clinician who brings skills, but can also benefit from a supervisory relationship with an experienced clinician. Seminars and case conferences cover a variety of topics and clinical training experiences. A minimum of two hours of individual supervision are scheduled each week. Additional supervision and case review of at least two hours per week is provided by individual supervisors or through the multidisciplinary team. Interns are closely supervised at the beginning of clinical rotations, including direct observation of interactions with patients. Interns have increasing autonomy as they demonstrate clinical abilities during the rotation and during the year. Elective experiences also receive clinical supervision. Peer supervision may also be an effective learning tool, and interns are expected to make presentations of selected clinical cases in seminars periodically during the year. Training experiences and supervision can be individualized as is appropriate to meet the specific training needs and goals of interns, within the constraints of the service requirements of the specific rotations and the availability of faculty. Overall Goals of the Denver Health Psychology Internship Program 1. Identification as a Psychologist as demonstrated by reflective practice and self-assessment informed by current psychology perspectives and by knowledge of and respect for other professions. 2. Entry-level doctoral knowledge of the science and practice of Assessment, Diagnosis and Case Conceptualization relevant to the major rotation populations. 3. Entry-level doctoral knowledge and abilities in Psychological Intervention. This includes effective relationships with clients, colleagues and co-workers as well as knowledge and 6
application of science and evidence-based interventions specific to the major rotation populations. 4. Knowledge and application of Practice Standards, including ethical and legal issues for the profession in Colorado as well as the ability to function effectively within the multidisciplinary team and the health care system. 5. Active application of knowledge, skills, and attitudes related to the complex dimensions of Individual and Cultural Diversity (e.g. age, gender, class/ses, culture, sexual orientation), and awareness of oneself as a cultural being. 6. Entry-level doctoral knowledge and abilities in Consultation, Supervision & Teaching. This includes providing consultation to the multidisciplinary team, participation in the teaching of other professional trainees and entry-level doctoral knowledge about supervision of other trainees (along with application of these supervision skills as available on the rotation). For more detailed information about the program goals, objectives, competencies and expectations, please see Appendix A on page 26. Expected Experiences During the Internship Year: 1. Treatment of patients across a range of problems and pathology. 2. Treatment of patients in several age groups. 3. Treatment of patients in a range of settings and levels of care (inpatient and outpatient medical clinics, inpatient psychiatric care, outpatient mental health, and acute care/emergency service). 4. Treatment of patients who are diverse with respect to racial and ethnic background, social and economic status, age, sexual orientation, religion and ability status. 5. Assessment and case formulation, including a minimum of four integrated psychological assessment batteries or the equivalent in partial batteries. 6. Participation on multidisciplinary teams including physicians, nurses, and social workers. 7. Clinical work with dual diagnosis patients (mental health, medical, substance use). 8. Interaction with multi-disciplinary teams and/or with community agencies as a consultant or resource. 9. Substantial responsibility for the delivery of professional psychological services on the units and clinics where interns work, given the individual intern's experience and training needs. 10. Opportunities to teach and to learn from other medical and psychiatric interns as well as other professional trainees. Psychology Internship Faculty Major rotation and most elective rotation supervisors are members of the Division of Psychology. Psychologists are licensed by the State of Colorado and are regulated by the Colorado Department of Regulatory Agencies and the Board of Psychologist Examiners. Most Denver Health psychologists have faculty appointments at the University of Colorado through our affiliation with the School of Medicine. Licensed Psychologists are privileged through the Denver Health Allied Health Professionals Committee to provide independent psychological services in specific areas of clinical competence and experience. In addition, psychology postdoctoral fellows at Denver Health participate as part of the program s training faculty. It is notable that seven of the current faculty members completed both their internship and their postdoctoral year at Denver Health and another psychologist did her postdoctoral training year at our institution. We currently have one intern from last year s cohort who is doing her postdoctoral work with our outpatient adult and child mental Health teams. 7
MAJOR ROTATIONS Health Psychology Interns on the Health Psychology major rotation will have two distinct roles. Part of the experience will be providing integrated psychological services within Denver Health primary care clinics. The intern will work side-by-side with primary care providers in a collaborative care model, providing brief assessments and interventions for both mental and physical health concerns. Denver Health s primary care clinics serve patients with all types of presenting conditions and cultural backgrounds. Most clinics predominately serve English- and Spanish-speaking patients with phone based interpreters available as needed. There are several clinics across the Denver area and interns will be placed where their services are needed and supervision by attending psychologists can be provided. Sessions are conducted in medical treatment rooms. Interns will be taught how to quickly triage for a variety of clinical presentations, provide brief assessment and interventions as able for any presenting condition, handle crises as they arise, and collaborate efficiently with medical providers. Common interventions appropriate for this brief-treatment setting include Supportive Psychotherapy, Cognitive Behavioral Therapy, Motivational Interviewing, Solution-Focused Psychotherapy, etc. Other interventions may be used as appropriate based on intern and/or supervisor experience. The other principal role for the health psychology intern will be working as a Health Coach in the Health and Wellness Department of Managed Care. Interns will provide support and intervention (usually telephonic or at times in person) for patients with chronic medical conditions and for those patients with a combination of medical and mental health issues. There may be opportunities to participate in a patient care improvement project or to develop a health psychology intervention group. The intern may be able to participate in interdisciplinary health psychology conferences and seminars. Supervising Health Psychologists: Jennifer Grote, Ph.D., is a licensed psychologist on the Managed Care and Integrated Primary Care Team. She received her undergraduate degree from Miami University and completed graduate degrees at Loyola University Chicago and the University of Denver. Dr. Grote completed her clinical internship and post-doctoral fellowship at Denver Health. She currently splits her time between supervising the Behavioral Health and Wellness Service within Managed Care and at the Westwood Clinic as part of the Integrated Primary Care Team. Her clinical interests include health psychology, child and adolescent psychotherapy, and women s care. Natalie Ritchie, Ph.D. is a licensed psychologist on the Managed Care and Integrated Primary Care Team. She is a graduate of the University of Illinois at Chicago clinical psychology doctoral program. She completed her predoctoral internship program as well as her postdoctoral year at Denver Health, and has continued as a staff psychologist with the Health and Wellness Program at Denver Health. She also provides integrated primary care in both English and Spanish at the La Casa Clinic. Her areas of interest include Health Psychology, Program Development and Implementation. 8
Alison Lieberman, Psy.D. is a clinical psychologist on the Adult Outpatient Behavioral Health Team. She received her undergraduate degree from the University of Vermont and her masters and doctorate degrees from the University of Denver Graduate School of Professional Psychology. She completed her clinical internship at the Miami VA Hospital specializing in health psychology. Her interests include primary care psychology, oncology, geriatric psychology, health behavior change/wellness, individual and couples therapy. She also enjoys her involvement in training of psychology interns and medical students. Caroline W. Corrigan, Ph.D., is a licensed psychologist at the Level One Physicians Clinic, providing a mixture of co-located mental health and integrated primary care. She received her undergraduate degree from Wesleyan University in Middletown, CT. She obtained her Doctorate in Psychology at The Wright Institute in Berkeley, CA. Her clinical internship was completed at Denver Health Medical Center. Dr. Corrigan s interests and expertise include individual and couples psychotherapy, parenting and family relationships, stress management and wellness, health behavior change, and living fully with chronic medical conditions. The primary theoretical orientations for Dr. Corrigan are Psychodynamic and Cognitive/Behavioral. Samantha Pelican Monson, Psy.D. is a licensed psychologist on the Integrated Primary Care Team. She received her undergraduate degree from the University of Colorado Boulder and her doctorate degree from the University of Denver. Dr. Monson completed her clinical internship at the University of Colorado School of Medicine and her post-doctoral fellowship with the Colorado Health Foundation at Denver Health. She has worked at Denver Health s Lowry Family Health Center since 2009, providing behavioral healthcare to primary care patients and supporting the expansion of this innovative program across Denver Health. Her areas of clinical interest include physician-patient communication, adjustment to and coping with disease, and refugee mental health. Rachael Meir, Psy.D., is the Clinical Director of the Behavioral Health and Wellness Services department at Denver Health Managed Care and a health psychologist in the Intensive Outpatient Clinic for Denver Health s highest risk/highest utilizing adult patients. Dr. Meir received her undergraduate degree from the University of Colorado and her doctoral degree from the PGPS- Stanford PsyD Consortium in Palo Alto, CA. She is a member of the Motivational Interviewing Network of Trainers (MINT) and regularly trains a wide range of healthcare providers, mental health specialists, and other frontline staff on ways to improve the quality and effectiveness of communication and counseling with clients about health behavior change. Her general interests include: health psychology and behavioral medicine with a specific focus on chronic disease management, weight management and increasing engagement in physical activity. KC Lomonaco, Psy.D., is a full time Psychologist on the integrated primary care team at the Westside Adult Medicine Clinic. After completing her internship at the Universtiy of Boulder Wardenburg Health Center and receiving her doctoral degree from the University of Denver Graduate School of Professional Psychology, Dr. Lomonaco worked for several years as a bilingual integrated care psychologist at Clinica Family Health Services. She has interests in integrated primary care, Women s Health, Perinatal and Post-Partum Depression, Fertility treatment, Trauma, medical teaching, and health behavior change. 9
Adult Mental Health Outpatient Service This service provides assessment and psychotherapy to adults with a wide variety of psychiatric conditions that affect their daily living. The intern typically carries a large caseload and provides psychotherapeutic services as well as case management services. Interns may provide conjoint or group therapy but individual treatment constitutes the bulk of the clinical work. Interns may continue to treat patients they evaluated after the intake or may assist in referring to other appropriate services and locations. Patients also frequently have substance use problems and/or medical diagnoses that need to be included in the treatment plan. Psychological and neuropsychological evaluations are provided on a consultative basis. Prescribers are available for medication consultation and management on this service, and coordination of services with the prescribers is essential. Clinical supervisors theoretical orientations cover a wide range and supervisors are open to working with different orientations according to the intern s needs. Supervising Adult Mental Health Outpatient Psychologists: Alison Lieberman, Psy.D. is a clinical psychologist on the Adult Outpatient Behavioral Health Team. She received her undergraduate degree from the University of Vermont and her masters and doctorate degrees from the University of Denver Graduate School of Professional Psychology. She completed her clinical internship at the Miami VA Hospital specializing in health psychology. Her interests include primary care psychology, oncology, geriatric psychology, health behavior change/wellness, individual and couples therapy. She also enjoys her involvement in training of psychology interns and medical students. Daniel Schoenwald, Ph.D., is a licensed psychologist on the Outpatient Adult Mental Health Team. He received his undergraduate degree from the University of Michigan and his doctorate degree from Nova Southeastern University in Fort Lauderdale, Florida. Dr. Schoenwald completed his clinical internship at the Miami VA Hospital and his fellowship at the University of Miami School of Medicine. He maintained a private practice for 11 years in South Florida while he was also an adjunct professor at the Nova Southeastern University where he taught Adult Psychopathology and Group Psychotherapy before relocating to Denver in 2013. His clinical interests include psychopathology, psychopharmacology, and group psychotherapy. Trina Seefeldt, Ph.D., is a licensed psychologist and Team Lead for the Outpatient Adult Mental Health Team. She received her undergraduate degree in psychology from Loyola University of Chicago, and her Ph.D. in clinical psychology from the University of Utah. She provides both therapy and psychological testing services. Dr. Seefeldt has worked for more than a decade with underserved populations, including individuals experiencing homelessness and incarcerated individuals. Her areas of treatment interest include parenting issues, couples/family therapy, personality disorders, and depressive and anxiety disorders. The primary theoretical orientations Dr. Seefeldt works from are Integrative (psychodynamic, systems, and cognitive-behavioral). Susan Bennett, Ph.D., is a psychologist in the ACUTE Center for Eating Disorders and Adult Outpatient Behavioral Health. She is also Assistant Professor in the Department of Psychiatry at the University of Colorado School of Medicine. She received her undergraduate degree from Regis University. She received her Masters and Doctorate degrees in Counseling Psychology at the University of Denver. Her Internship and Postdoctoral training were completed at Denver Health Medical Center. Dr. Bennett s specialty and research is in the area of Adult Eating Disorders. She also practices as a generalist providing therapy to the underserved. 10
Child and Adolescent Mental Health Outpatient Service The Outpatient Child and Adolescent team provides psychological evaluation and therapy for children, adolescents and families. The team consists of three psychologists, one psychiatrist, one clinical nurse specialist, one psychology intern, and two psychology externs. The intern is an integral member of the team and is involved in all levels of treatment as well as general team functions. Patients are thoroughly evaluated at intake. The patient is then referred for a medication evaluation as needed and provided with outpatient psychotherapy services as appropriate. The children seen have a wide variety of behavioral and emotional disorders, ranging in severity from adjustment disorders to major mental illnesses. Many of our patients have experienced traumas, come from low income communities, and/or present from culturally diverse backgrounds (e.g. Latino, African American, and immigrants from around the world). Therapy modalities include individual, family, and parenting interventions. Evidence-based practices are incorporated into treatment with children and families. These may include, but are not limited to, Cognitive- Behavioral Therapy, Trauma-Focused CBT, Alternatives for Families CBT, and Dialectical Behavior Therapy. Interpretation services are available and often utilized. Common diagnoses include mood disorders, anxiety, PTSD, ADHD, and disruptive behaviors. Case coordination and consultation are provided through communication with physicians, school personnel, and other individuals involved in the lives of the children. Psychological testing may be completed as part of the major rotation or as an elective. The team psychiatrist is a resource for consultation and medication evaluations. Supervising Child and Adolescent Psychologists: Laura Jacobs, Psy.D., is a Psychologist and the Outpatient Child/Adolescent Team Leader. She received her Doctoral Degree in Clinical Psychology from the University of Denver and has been a licensed Psychologist since 1999. Dr. Jacobs is an Instructor in the Department of Psychiatry at the University of Colorado School of Medicine. Her areas of treatment interest include trauma in young children, school-based mental health, firesetting, and self-injurious behavior in youth. The primary theoretical orientations Dr. Jacobs works from are Cognitive-Behavioral and Family Systems. Colleen Fischer, Ph.D., is a licensed psychologist on the Child/Adolescent Outpatient Mental Health Team. She received her undergraduate degree at the University of Wisconsin-Madison. She received her Doctorate in Counseling Psychology at the University of Oregon and completed postdoctoral training at New York Presbyterian Hospital of Columbia and Cornell. Dr. Fischer's areas of treatment and research interests include depression and anxiety disorders in children and adolescents, neuropsychological and psychological assessment, and self-injurious behavior in youth. Dr. Fischer utilizes empirically-supported treatments and a strength-based approach in her work with youth and their families. Christopher Sheldon, Ph.D., is the Chief Psychologist and Psychology Internship Training Director. He is also an Associate Professor of Psychiatry at the University of Colorado School of Medicine. He received his undergraduate degree from the University of Texas at Austin. He received his Doctorate in Clinical Psychology at the University of Texas Southwestern Medical Center. Dr. Sheldon's research areas include mood and anxiety disorders in children, self-injurious behavior in youth, and improving the identification and treatment of psychiatric disorders in 11
primary care. The primary theoretical orientations Dr. Sheldon works from are Cognitive Behavioral, Developmental and Psychodynamic. Inpatient Adult Psychiatry and Consult-Liaison Service During this major rotation, interns will have a split experience, with three months on the Adult Inpatient Psychiatric Unit and three months on the Psychiatric Consult-Liaison Service. While on the Adult Inpatient Psychiatric part of this rotation, interns work with patients who have major psychiatric disorders (including bipolar disorder, schizophrenia, and major depression with or without psychosis) and/or substance use disorders. Many patients are admitted with psychosis and/or suicidal urges or behavior. The average length of stay is brief, sometimes less than a week. The psychology intern provides inpatient group psychotherapy (open to all patients) and individual psychotherapy for selected patients. The focus of psychotherapy varies but includes supportive psychotherapy, cognitive-behavioral therapy, dialectical behavioral therapy, and interviewing for diagnostic clarification. Psychological testing may also be provided to assess intellectual functioning, assist in differential diagnosis, or to determine a patient s personality and character structure. The intern helps the team (i.e., attending psychiatrist, psychiatry intern, social worker, and nurses) develop treatment and discharge plans, and participates in decisions regarding the need for involuntary treatment. A psychiatric intern or intern provides psychopharmacologic treatments and coordinates medical care under the supervision of the attending psychiatrist. Finally, the psychology intern provides supervision of treatment and assessment for the psychology extern. Supervising Inpatient Adult Psychiatry Psychologist: Position Vacant Recruitment in Progress Attending Psychiatrists: Abraham Nussbaum, MD; Abby Lozano, MD; Gareen Hamalian, MD, MPH; and Melanie Rylander, MD Psychiatric consult/liaison referrals are made when psychiatric issues affect patient presentation or management for inpatient medical patients. A typical consult may address issues such as capacity to participate in treatment decisions, assessment of danger to self or others, treatment compliance, differential diagnosis, certification status, or medication recommendations. Consult requests come from a variety of inpatient services including medicine, surgery, intensive care, rehabilitation, dialysis, obstetrics, pediatrics, and the correctional care medical facility. The psychology intern serves as a member of the Psychiatric Consult Liaison (C/L) Service team which includes attending psychiatrists, psychiatry interns or interns, psychiatric nurse practitioners, and medical students. The psychology intern is assigned consults to be performed individually or in collaboration with other team members. In addition to direct patient interviews, consults often require clarification of referral questions, gathering of collateral information, psychoeducation, and facilitating communication between patients and primary care team members. There are some opportunities for brief psychotherapy. Neuropsychological evaluations are provided by the intern when C/L cases require further objective evaluation. These evaluations will consist of brief screening batteries that can be completed, scored and reported to the medical team on an expedited basis. 12
Supervising Consult-Liaison Psychologists: Christopher Pierce, Ph.D., is an Assistant Professor in the Department of Psychiatry at the University of Colorado School of Medicine and he received his doctoral degree in Medical (Clinical) Psychology from the University of Alabama at Birmingham. Dr. Pierce specialized in neuropsychology during his Internship at the University of Washington School of Medicine. He completed his Residency in Neuropsychology and Rehabilitation Psychology from the Rehabilitation Institute of Michigan. Dr. Pierce specializes in adult and geriatric patients. His research interests include the effects of psychostimulants on cognition, visual neglect and attention, and general neurocognitive assessment. Thomas Dunn, Ph.D., is a licensed psychologist with the Consult Liaison Team. He received his undergraduate degree from Allegheny College and his Ph.D. from the University of Cincinnati. He completed his internship at the Salt Lake City VAMC. Dr. Dunn is an Associate Professor of Psychological Sciences at the University of Northern Colorado. His research interests include malingering, deception, the neuropsychological functioning of student veterans and topics in medical psychology. Attending Psychiatrists: Robert House, MD; Philippe Weintraub, MD, Craig Holland, MD ELECTIVE EXPERIENCES Denver Health is a large and diverse medical center with virtually unlimited opportunities for elective experiences. The faculty aims to support the interns in meeting their training objectives and in obtaining specialty training experiences without becoming overextended. Our interns consistently let us know that the elective opportunities and the flexibility we give our interns in their elective selections is a notable strength of the Denver Health internship. Although the availability of electives can vary somewhat from year to year depending on the availability of supervision, interns can usually choose from the following electives: Neuropsychology On the neuropsychology elective, interns will have the opportunity to perform in-depth neurocognitive evaluations with patients having complex histories of neurological disorders, medical conditions, psychiatric disorders, and substance abuse that are affecting their ability to function adequately. Referrals for neuropsychological evaluations come from a variety of sources including primary care, neurosurgery, psychiatry (inpatient and outpatient), neurology, rehabilitation, Denver CARES (substance abuse treatment), medical units within the hospital, and other outpatient medical services. Interns will learn a traditional, comprehensive neuropsychological battery and gain increasing autonomy as they demonstrate mastery over interviewing and test administration. Interns will further develop their skills in case conceptualization and report writing through collaboration with the supervising neuropsychologist. Supervising Psychologist(s): Christopher Pierce, Ph.D. 13
Health Psychology Electives Geriatric Integrated Primary Care In the geriatric primary care clinic the psychology intern will work one half day per week with a multi-disciplinary team led by a physician specializing in geriatric primary care. The intern provides consultation, brief assessment, interventions, coordination of care, family and patient education, and referrals. The psychology intern will work collaboratively with geriatric physician and other members of the geriatric team including pharmacists, nurses, care coordinators, social workers. Supervising Psychologist(s): Alison Lieberman, Psy.D. Oncology Fellows Clinic/Oncology Breast Clinic In the Oncology Fellows Clinic as well as in the Breast Clinic, the psychology intern serves as a consultant for one half day per week providing integrated care to hematology/oncology patients in the form of consultation, brief assessment, interventions, coordination of care, family and patient education and referrals. The multi-disciplinary team includes medical oncology fellows, physician attendings, nursing and social work. Supervising Psychologist(s): Alison Lieberman, Psy.D. Bariatric Evaluations/Clinic The psychology intern works with the supervising psychologist to conduct presurgical evaluations with patients to determine candidacy for bariatric surgery. The intern may also serve as a consultant one half day per week to the bariatric clinic providing integrated care to patients who are pre or post-bariatric surgery in the form of consultation, brief assessment, interventions, coordination of care, family and patient education and referrals. In prior years some interns have conducted pre or post-operative bariatric support groups. Supervising Psychologist(s): Alison Lieberman, Psy.D. and Caroline Corrigan, Ph.D. Inpatient/Outpatient Pediatric Electives The elective can be a 3 or 6 month experience based on the interest of the intern (though only one intern can complete the elective rotation at a time). On the Adolescent Inpatient Unit interns have the opportunity to co-lead a Dialectical Behavior Therapy group one day per week. As experience and comfort with leading groups is gained, the intern will take a more active role in leading the session. Interns also have the opportunity to administer psychological testing on the Adolescent Inpatient service. Testing includes achievement testing (Wide Range Achievement Test), cognitive testing 14
(WISC-IV, WASI-II), autism spectrum assessment (ADOS-2), projective assessment (Rorschach Inkblot Test, House-Tree-Person Test), and objective testing (MMPI, MACI). Initially, the intern will be observed conducting evaluations, but autonomy will increase as skills are demonstrated. The intern will collaborate on case conceptualization with the supervising psychologist and write their own reports. The intern will collaborate with the treatment team of attending physicians, psychiatry interns, nurses, and social workers and provide feedback about the testing results within 24 hours of completion of testing. On the Child/Adolescent Outpatient Mental Health Team the intern will have the opportunity to administer, score, and interpret psychological tests (including cognitive, academic, projective, and some neuropsychological measures) for a wide range of diagnostic concerns/presentations. In addition to administration and interpretation, the intern will complete a comprehensive written report and provide feedback on the testing results to youth and their families. Initially, the intern will be observed conducting evaluations, but autonomy will increase as skills are demonstrated. Supervising Inpatient/Outpatient Pediatric Psychologist(s): Megan Twomey, Ph.D., is a licensed psychologist on the Inpatient Adolescent Psychiatric Unit. She received her Undergraduate Degree from Luther College, Decorah, IA and her doctorate degree from Colorado State University, Fort Collins. Dr. Twomey completed her clinical internship at Denver Health Medical Center. She provides individual, family, and group therapy as well as psychological testing services. Her areas of treatment and research interest include mood disorders, behavior disorders, autism spectrum disorders, anxiety disorders, and self-injurious behavior. Colleen Fischer, Ph.D., is a licensed psychologist on the Child/Adolescent Outpatient Mental Health Team. She received her undergraduate degree at the University of Wisconsin-Madison. She received her Doctorate in Counseling Psychology at the University of Oregon and completed postdoctoral training at New York Presbyterian Hospital of Columbia and Cornell. Dr. Fischer's areas of treatment and research interests include depression and anxiety disorders in children and adolescents, neuropsychological and psychological assessment, and self-injurious behavior in youth. Dr. Fischer utilizes empirically-supported treatments and a strength-based approach in her work with youth and their families. Westside Integrated Primary Care Pediatrics The Pediatric Primary Care Clinic at Denver Health s Westside Community Clinic provides outpatient based primary care and consultative services to children and adolescents. The multidisciplinary team includes board certified pediatricians, physician assistants, nurses, and care coordinators. The population is predominantly Hispanic and many families have Spanish as their preferred language. Trainees who rotate through this clinic include medical, physician assistant and nursing students, as well as medical residents. Psychology faculty and trainees can provide valuable assistance in assessment of behavior problems, developmental status/cognitive functioning, and mental health status. Interventions can address medical compliance, disease management, behavior management, and mental health concerns. Psychology can also provide patients with psycho-education about wellness strategies, sleep hygiene, and normal developmental milestones/expectations. Supervising Psychologist(s): Laura Jacobs, Psy.D. 15
High Risk Pediatric Clinic High Risk Pediatric Clinic provides comprehensive primary care services for children with complex and costly medical presentations. The clientele is diverse including Hispanic, Black, Caucasian, and Asian children. Although there are patients across the pediatric age range, nearly half are under the age of six. This clinic includes pediatrics, physical therapy, nutrition, patient navigators, pediatric neurology and pediatric rehabilitation on the multidisciplinary team. Medical and other trainees rotate through this clinic on an ad hoc basis. Frequent diagnostic presentations include cerebral palsy, Down s syndrome, severe asthma and various developmental disorders. Psychology can be of particular value in behavior management, parent-child conflict, and supportive psychotherapy. Psychiatric Emergency Service (PES) Supervising Psychologist(s): Chris Sheldon, Ph.D. There is a self-contained Psychiatric Emergency Service adjacent to the Denver Health Medical Emergency Room. Interns commit to a full day in the PES which includes the psychiatric/alcohol/drug Emergency Services and the Mobile Crisis Team. The psychology intern will work with professional staff (psychiatrists, medical interns, nurses, and psychologists), will evaluate cases, provide crisis interventions and arrange dispositions. The intern will also participate in admission of patients to the adolescent and/or adult inpatient units. The PES provides a rich clinical experience with a wide variety of patients in acute crisis. The intern will learn how to do rapid emergency evaluations and refine their clinical decision making skills. Intern will receive close supervision by the attending psychiatrist, with a licensed psychologist available when needed. MORE ABOUT THE PROGRAM Brief History of the Internship Program The Denver Health Psychology Internship Program was initiated in 1968 with two interns. The development and expansion of the program was facilitated by grants from the National Institute of Mental Health from 1969 until 1976, and from the City and County of Denver beginning in 1973. There are currently six internship positions, funded through the Department of Behavioral Health Services as well as through the Department of Managed Care. The program received provisional accreditation from the American Psychological Association in 1978 and has been fully accredited since 1980. The program had a site visit and was awarded seven years full accreditation in 2011. In 2007, the official job title was changed from Psychology Intern to Psychology Resident to promote recognition within a medical setting of the extensive prior clinical training our program participants have had prior to starting at Denver Health. 16
The Internship Program is represented within the Behavioral Health operating budget and is administered by the Chief Psychologist and Training Director together with the other members of the Psychology Internship Faculty. Didactic Training A wide range of formal learning experiences are provided. Psychiatry Grand Rounds from the University of Colorado School of Medicine brings in nationally prominent physicians and psychologists to speak on a variety of topics of current professional interest; these are available through closed circuit video or are at times attended in person by the Training Director and the psychology interns. Denver Health also brings in outside speakers to address particular learning needs. In addition, our internship program collaborates with other area programs through the Psychology Internship Directors of Colorado (PITDOC) to provide training experiences of general interest. Denver Health psychologists provide formal didactic training on a number of topics in which they have knowledge and experience. These include presentations on evidence-based interventions, health psychology, psychological and neuropsychological assessment, brain and behavior, diversity and supervision. Denver Health physicians and community professionals, also make seminar presentations to the psychology interns during the year. Finally, the interns themselves are expected to contribute didactic presentations to their fellow interns and to interested faculty members. There is an expectation of at least one formal seminar presentation by each intern before the end of the year to which other health care professionals are generally invited. In addition to didactic seminars, faculty and interns are expected to provide clinical case presentations to illustrate real world assessment and treatment issues. Attendance at the seminars and case conferences is mandatory. Supervision Each intern receives at a minimum two hours of scheduled individual supervision and four hours per week total supervision time. In addition, group supervision and case review through the multidisciplinary team occurs on a regular basis (on some teams several times per month, on some teams daily). On site supervision is provided by the staff psychologists assigned to the clinical service on which the intern is working. On teams for which a physician is the onsite supervisor (e.g. the Psychiatric Emergency Service), a psychologist is also assigned as a supervisor for issues that warrant input from a psychologist. The interns also meet as needed" or curbside with their supervisors, and the Training Director is also available for consultation regarding issues or cases. Supervisors are always available by pager. Denver Health also provides graduate practice opportunities for doctoral psychology students from several area institutions including the University of Denver, the University of Colorado and the University of Northern Colorado. These externs are placed on the inpatient and outpatient units twelve to sixteen hours each week. Some psychology interns have an opportunity to develop their supervisory skills by providing supervision to one or more of these externs (under supervision of a licensed psychologist). The faculty will provide didactic training in supervision as well as supervision of supervision by the licensed psychologist; the licensed psychologist maintains clinical responsibility for these cases. 17
Research Although supervised clinical experience is the primary focus of the Denver Health Internship, participation in research is encouraged and supported for interested program participants. Interns in recent cohorts have joined existing research teams at Denver Health and have established successful collaborative research relationships. Several peer reviewed publications have been generated and have been helpful in obtaining postdoctoral fellowships with a strong research component. Current research groups in adult behavioral health include integrated primary care, telephonic behavioral activation therapy and the psychiatric emergency service population. There are active pediatric research groups in adolescent substance use and in adolescent self-harm. Research teams are multidisciplinary and may be led by a physician. Requests for a research elective should be submitted in writing to the Training Director and should include the nature of the project, the mentor and the time requested (generally between four and eight hours per week). The Training Director will present this plan to the psychology faculty for approval. Please note that interns are not able to use the Denver Health population to recruit participants for their own research studies or for their dissertation. Salaries and Benefits Six intern positions are currently budgeted according to specific tracks as noted above. The institution has nondiscriminatory policies and practices in recruitment and retention of interns and staff. Diversity consistent with the population served at Denver Health is valued. Denver Health generally receives over 200 completed applications annually, from which about 35 are selected to attend on-site interviews with the faculty and current interns. On-site interviews allow the applicant to tour the facility and to meet the Chief/Training Director as well as the other faculty members. The interviews give our faculty the opportunity to observe responses to our questions and interpersonal interactions. The intern salary is currently $23,400. As an employee of Denver Health there are also first-rate benefits, which include the following: 7 Paid Holidays: New Year s Day, Martin Luther King Day, Memorial Day, Independence Day, Labor Day, Thanksgiving Day, and Christmas Day. Paid Time Off (PTO): These include 160 hours of PTO, used for both vacation and sick leave). PTO may be restricted in the first ninety days (leave time is generally granted for Thanksgiving), and may only be used as it is accrued. PTO may also be restricted at change of rotation time or in the last two weeks of the internship year. Any time off is subject to the prior approval of the clinical supervisor, the unit manager, and the Training Director. The program requires one year of full time employment for graduation; any unused PTO is paid out at the end of the internship year. Three days of administrative leave to attend graduation, dissertation defense or conferences is available. Medical, Dental & Insurance Programs: Health, vision, and dental insurance coverage is provided at competitive rates, with family coverage available. Life insurance and disability coverage are provided at no cost to the intern. Professional liability coverage is provided and paid for by Denver Health. 18