Psychology Internship and Postdoctoral Fellowship Overview
The Postdoctoral Fellowship Program in Clinical Psychology is administered by the Psychology Training Committee and resides primarily within the MEDVAMC Mental Health Care Line. The fellowship program offers nine postdoctoral positions. Seven of these are one-year clinical positions that provide emphasis training in the areas of Serious Mental Illness, Trauma/Anxiety Disorders, Primary Care Mental Health Integration, HIV/HCV Mental Health, and Lesbian, Gay, Bisexual, and Transgender Interprofessional Health. The Postdoctoral Fellowship Program in Clinical Psychology is currently APA accredited. We also have a two-year Neuropsychology Specialty Program that is directed by Robert Collins, Ph.D., ABPP-CN. The Neuropsychology Fellowship is also APA accredited. For specific information about the Clinical Neuropsychology Specialty Program is available HERE.
TRAINING MODEL AND PROGRAM PHILOSOPHY
The Psychology Postdoctoral Fellowship Program is based on a scientist-practitioner model of training. Fellows are expected to engage in clinical and didactic training 80% of their time and be actively involved in research 20% of the time. We view research and scholarly activities as informing and directing clinical practice and clinical practice, in turn, guiding research questions and activities. We view the vital inter-dependence of science and practice in clinical psychology as a core principle upon which the training system is structured. While our internship program is designed to provide a broad range of clinical experiences, the fellowship program aims to prepare Fellows for an advanced level of competency through focused training experiences in the clinical applications of psychology. This model of training fully supports the mission of the Department of Veterans Affairs by providing training and research opportunities that further the quality of clinical care provided to Veterans.
GOALS AND OBJECTIVES
The primary goal of the MEDVAMC Psychology Postdoctoral Fellowship Program is to provide a foundation in advanced clinical service delivery (and other relevant professional skill areas) to prepare our Fellows to become licensed psychologists qualified to work in public sector medical settings. This is accomplished by providing a systematic and sequenced program for developing advanced skills that expand and build upon the existing knowledge bases developed during graduate and internship training. By the completion of their training term, Fellows will have the preparation necessary to function as autonomous professional psychologists in a variety of settings, including VA medical centers and other public sector environments.
Training objectives include attaining advanced knowledge and skills in 1) comprehensive psychological assessment, 2) a broad range of psychological interventions, 3) strategies of scholarly inquiry, 4) relevant administrative and organizational activities, 5) consultation, program evaluation, supervision, and teaching, 6) professional issues and conduct, and 7) cultural and individual diversity competencies.
All Fellows work within their emphasis area, but also complete other clinical rotations and are expected to be involved actively in research and program evaluation activities. Fellows, working with their preceptors, must develop and follow an individualized training program with specific objectives, competencies, and time lines across the training term. In addition, competency attainment at advanced levels in core and specific areas must be demonstrated through work sample presentations and successful performance in broad competency areas as indexed by supervisory ratings on Fellow evaluation instruments.
DIDACTIC EXPERIENCES AND ADMINISTRATIVE OPPORTUNITIES
All Fellows participate in regular training and didactic opportunities including weekly Fellow seminars addressing advanced psychotherapy, assessment, professional development, and other related training topics, Baylor College of Medicine Psychiatry Grand Rounds, interdisciplinary MEDVAMC Mental Health Conferences, and multicultural/diversity training activities. A particular strength of our program is in the area of multicultural and diversity training. Our Multicultural and Diversity Sub-Committee (MDSC), fosters increased multicultural competence through Fellow-led diversity journal clubs, participation in the National VA Diversity video/teleconferencing series, staff heritage-exploration meals, a yearly Diversity conference, and regular cultural immersion outings. The MDSC also sponsors a mentorship match program, in which Fellows can be paired with staff psychologist mentors to facilitate personal and professional growth throughout the year. Fellows with particular interest in diversity issues may apply to participate as a committee member on the MDSC. Additional administrative opportunities include serving as a Fellow-Representative on the Post-doctoral Steering Committee and other major and minor rotations that can be developed with the Fellow’s training plan.
AREAS OF EMPHASIS
Serious Mental Illness
The Serious Mental Illness (SMI) emphasis area provides training opportunities to Fellows in developing advanced knowledge of theoretical models and empirical studies related to the etiology, epidemiology, and evidence-based interventions for Veterans with major affective disorders, severe schizophrenic spectrum disorders and other chronic psychotic disturbances. Fellows learn through direct clinical service delivery and educational seminars to assess, diagnose, and treat persons with SMI, develop knowledge of family systems, comorbidities, and support groups relevant to this patient population. There are also opportunities to engage in program evaluation, research, and administrative experiences.
The Fellow in the SMI area works with the preceptor throughout the year and typically has rotations of varying lengths with the other supervisors within the emphasis area. The Fellow is expected to devote a minimum of 50% time throughout the training year to this emphasis area. Additional rotations outside of the emphasis area are encouraged and can be arranged as mutually acceptable with any psychology staff member approved to serve as a supervisor. These additional rotations may not exceed 25% (i.e., 10 hours) of a regular work week.
Fellows in the SMI emphasis area will gain:
The primary training sites for this specialty area occur on our Mental Health Inpatient Units, Psychosocial Rehabilitation & Recovery Center, and General Mental Health Clinic. Fellows in this area have the following emphasis area supervisors: Amy Cuellar, Ph.D., Deborah Mullins, Ph.D., Quang (Charlie) Nguyen, Ph.D., Justin Springer, Ph.D., Karen Waldman, Ph.D., and Joyce McKinney, Ph.D. Please see the Training Staff section for supervisor background descriptions.
SMI fellows are responsible for supervised group therapy leadership for Veterans with different types of complicated affective disturbance. Individual therapy cases are also selected from the aforementioned programs. Fellows will also provide supervision of interns and practicum students who may serve as co-therapists in groups or as individual therapists for patients. This supervision will occur under the supervision of the fellow’s direct supervisor.
Fellows choosing a rotation with Dr. Cuellar in the PRRC will have the opportunity to learn how to deliver recovery-oriented services to a population with serious mental illness. Fellows will learn and become adept with the principles and application of psychiatric rehabilitation that focuses on helping Veterans achieve self-identified goals for recovery, better psychosocial functioning, and greater integration in their communities. Fellows will conduct screening assessments that focus on helping Veterans identify recovery goals, individual recovery coaching sessions to help them problem solve around goal achievement, and psychoeducational and skills-based groups, such as Social Skills Training for Schizophrenia, Illness Management & Recovery, and Wellness Recovery Action Plan development. There may also be an opportunity to engage in research activities.
SMI fellows can choose an additional emphasis with Veterans and their families through a rotation with Dr. Deborah Mullins. Family involvement is an important focus of mental health care within the VA. Trainees will have several opportunities to develop their skills with Veterans and their families as part of this rotation. This rotation provides supervision in Family Therapy and Family Consultation for patients with chronic and serious mental illness and their families. Behavioral Family Therapy is a structured approach to working with these families and consists of 5 components: engagement of the family; assessment; education; communication skills training and special problems. Family Consultation provides education about mental illness, support, advocacy, advice, skills training and referral to mental health resources, depending on the needs of the family. Trainees will also have the opportunity to engage in time limited, problem focused individual therapy and work within a multidisciplinary environment.
Additional opportunities to work with Veterans with SMI are available with Drs. Charlie Nguyen and Joyce McKinney through the General Mental Health Clinic.
The Acute Recovery Treatment Environment (ARTE) Inpatient rotation under Dr. Springer provides fellows with exciting opportunities to develop professional skills on the MEDVAMC's primary, 32-bed acute psychiatric specialty unit. During Veteran hospitalization, the primary aims of the unit are to foster and support recovery journeys and to assist Veterans with successful, safe transition to outpatient services. The ARTE inpatient rotation offers fellows opportunities to engage in a variety of ongoing treatment and administrative activities related to delivery of evidence- and recovery-based services to Veterans on the ARTE unit. Clinical responsibilities include involvement in a multi-disciplinary team, treatment planning, development of recovery-based case conceptualization, best practice staff-Veteran interactions, and evidence-based group psychotherapy [e.g., SAMHSA toolkit implementation, CBT for psychosis (CBTp), DBT Skills, and Family Education, Social Skills Training, and Cognitive Rehabilitation]. Clinical opportunities include behavioral assessment, aggression prevention, team feedback, as well as individual psychotherapy consistent with the Veterans' individualized treatment plans and recovery objectives. Additional opportunities include assessment to support decision-making/track Veteran progress, Care Monitoring Meetings, and examination of relevant peer-reviewed literature to improve practices.
The Trauma/Anxiety Disorders emphasis area provides training opportunities to fellows in developing advanced knowledge of theoretical models and empirical studies related to the etiology, epidemiology, and treatments for Veterans with PTSD and related anxiety problems such as panic disorder and generalized anxiety disorder. Fellows learn through direct clinical service delivery and educational seminars to assess, diagnose, and treat these patient populations. Fellows also will advance their understanding of how psychiatric and medical comorbidities impact treatment and learn to incorporate family systems and support groups in treatments with this patient population. There are also opportunities to engage in program evaluation, research, and administrative experiences.
Fellows in the Trauma/Anxiety Disorders emphasis area work with the preceptor throughout the year and typically have rotations of varying lengths with other supervisors within the emphasis area. Fellows must commit a minimum of 50% time throughout the training year to this emphasis area. Additional rotations outside of the emphasis area are encouraged and may be arranged as mutually acceptable with any psychology staff member approved to serve as a supervisor. These additional rotations may not exceed 25% (i.e., 10 hours) of a regular work week. Fellows in the trauma emphasis area will work with Veteran populations from the Gulf, Vietnam, and Korean wars, and returning Veterans from Operation Iraqi Freedom/Operation Enduring Freedom/Operation New Dawn (OEF/OIF/OND).
Fellows in the Trauma/Anxiety Disorders emphasis area will gain:
PTSD Clinical Team (PCT):
Primary opportunities for this emphasis area are provided through the PTSD Clinical Team (PCT). This program provides specialized care to Veterans with PTSD and related disorders. The PCT provides evidence-based outpatient psychotherapy to Veterans who have PTSD and related disorders. Treatments include prolonged exposure therapy, cognitive processing therapy, imagery rescripting, and stress inoculation training. Coping skills and process groups are also available. The goal of treatment is to reduce the intensity of symptoms and to maximize social and vocational functioning. Psychiatric comorbidity is common in this patient population and includes substance abuse/dependence, mood disorders, personality disorders, and psychotic disorders.
The primary supervisors for the PTSD emphasis area are Drs. Beckner, Dunn, Teng, Thompson, and Williams. Please see the Training Staff section for supervisor background descriptions.
Women's Inpatient Specialty Evaluation & Recovery Program (WISER)
The Women’s Inpatient Specialty Environment of Recovery (WISER) rotation provides fellows with a unique opportunity to work with women Veterans in a trauma-informed, intensive 4-week long inpatient program. WISER provides comprehensive evaluation and intensive specialized treatment using evidence-based treatments, such as, Dialectical Behavior Therapy Skills, Cognitive Processing Therapy, and Seeking Safety. Fellows have the opportunity to: attend treatment team rounds (multidisciplinary meeting with each individual patient on the unit lasting approximately 1.5 hours); co-facilitate and potentially lead a 1.5 hour process group each day; conduct individual psychotherapy specific to the individualized treatment plan of the Veteran; conduct and interpret psychological evaluations(mini-reports); participate in other evidence-based groups such as Cognitive Processing Therapy, Seeking Safety, and DBT; and participate in research with IRB approved protocols for evaluation of clinical outcomes.
Returning OEF/OIF Veterans Environment of Recovery Program (ROVER)
This rotation provides opportunities to work with male combat Veterans from the OEF/OIF era in a trauma-informed, intensive 4-week long inpatient program. This program provides comprehensive evaluation and intensive specialized treatment using evidence-based treatments, such as, Dialectical Behavior Therapy Skills, Cognitive Processing Therapy, and Seeking Safety. ROVER Veterans typically have a diagnosis of PTSD, substance abuse (SUD), interpersonal difficulties and/or personality disorder. Fellows will have the opportunity to: Attend Treatment Team Rounds (multidisciplinary meeting with each individual patient on the unit lasting approximately 2 hours); Participate in Treatment Team staffing where patient applications are reviewed for acceptance into the program; Co-facilitate and potentially lead a 1.5 hour process group each day; Conduct individual psychotherapy specific to the individualized treatment plan of the Veteran; Conduct and interpret psychological evaluations (mini-reports); Attend Patient Care Monitoring (Wednesday only); Participate in other evidence-based groups such as Cognitive Processing Therapy, Seeking Safety, and DBT; and participate in research opportunities with protocols for post-treatment evaluation.
General Mental Health Clinic
Opportunities to provide time-limited individual and group therapy to Veterans with trauma and related anxiety disorders are available through the General Mental Health Clinic. Dr. Ashley Clinton, Charity Hammond, and Ellen Teng can provide these supervised opportunities.
Primary Care Mental Health Integration
The primary care emphasis area provides training opportunities to fellows in developing advanced knowledge of theoretical models and empirical research related to the bio-behavioral etiology and epidemiology of co-morbid medical and psychiatric disorders, as well as, evidence-based interventions for Veterans with these conditions. Fellows learn through direct clinical service delivery and educational seminars to assess, diagnose, and treat individuals with co-morbid medical and psychiatric illnesses in an interdisciplinary team setting. Trainees have many opportunities to plan and coordinate activities with primary care providers, nursing, psychiatry, social work, and psychology. There are also opportunities to engage in research, program evaluation, and administrative activities consistent with the trainee's interest and past experience.
The primary training site for the Primary Care emphasis area is in the Primary Care Mental Health Integration Program (PCMHI). The primary care fellow spends a minimum of 20 hours per week involved in behavioral health treatment. Potential rotation supervisors for this emphasis area include 5 psychologists. Each psychologist provides expertise in a specific area that offers specialized training experiences in addition to the provision of behavioral medicine services for mood, anxiety, and adjustment disorders. Candy Smith, Ph.D. is the Program Director of the Behavioral Health Program. Kaki York-Ward, Ph.D. (Associate Director of the General Mental Health Program) conducts pre-surgical evaluations for organ transplants. Paul Sloan, Ph.D., specializes in pain management. Angelic Chaison, Ph.D. has a specific focus treating anxiety disorders. Allison Sweeney, Ph.D. provides services within the Women's Clinic. Daniel DeBrule, Ph.D. is the Health Behavior Coordinator and is working with trainees in the MOVE! (weight loss) program and is involved in smoking cessation. The PCMHI includes five psychiatrists, three registered nurses, two licensed clinical social workers, three physician assistants, one nurse practitioner, and supports three medical residency/fellowship positions. This diversity provides psychology trainees with an interdisciplinary work environment. In the first year of operation (Fiscal Year 2009), the PCMIH program provided mental health care to approximately 4500 individual Veterans. In Fiscal Year 2011 (the 2011-2012 academic year) the PCMHI program provided services to over 10,000 individual Veterans.
Below is a sample of some of the many opportunities in intervention and research:
HIV/HCV Primary Care Mental Health Integration
The HIV and HCV emphasis area allows the fellow to develop advanced and specialized training skills in the Specialty Clinics within Primary Care Mental Health Integration (PCMHI). The special emphasis area in HIV/HCV and substance use provides training opportunities to fellows in developing advanced knowledge of theoretical models and empirical research related to the bio-behavioral etiology and epidemiology of co-morbid medical and psychiatric disorders, as well as evidence-based interventions for Veterans with these conditions with a special focus on application of these skills to infectious disease populations. Fellows will be expected to participate in the national HIV/HCV core curriculum didactic training designed to promote the scientist-practitioner model shared by the overall fellowship program. They will also learn through direct clinical service delivery and local educational seminars to assess, diagnose, and treat individuals with co-morbid infectious diseases and psychiatric illnesses in an interdisciplinary team setting. Trainees will have many opportunities to plan and coordinate activities with infectious disease providers, nursing, psychiatry, social work, and psychology. The training is intended to foster clinical independence for future employment in a medical setting. The fellow in the HIV/HCV emphasis area works with preceptor, Kaki York-Ward, throughout the year and with other supervisors for rotations within the emphasis area.
Training in the special emphasis area of HIV/HCV and substance use is based in the Behavioral Health Program’s (BHP) Infectious Disease Clinic within the Primary Care Mental Health Integration (PCMHI) Program with joint training opportunities in the Substance Disorders Treatment Program. Additional minor rotations are offered through our existing training sites, including the General Mental Health Clinic and PTSD Clinical Team. Dr. Kaki York-Ward is a board certified Clinical Health Psychologist and the Associate Director of General Mental Health, charter member of MEDVAMC’s Health Promotion and Disease Prevention Committee, and the organ transplant psychologist for this facility. Other supervisors who would support the training of the fellow include the following: Dr. Candy Smith is the program director of Behavioral Health Programs and the PCMHI and is a psychologist with special training in management of substance dependence disorders. Drs. Chloe Hoang and Rachel Wells, psychologists in the General Mental Health Clinic (GMHC), deliver Motivational Interviewing and Mindfulness Based skills to Veterans with anxiety and substance abuse/dependence issues. Dr. Timothy Baker, psychiatrist in the GMHC, delivers psychiatric and substance abuse treatment to veterans with HIV. Through other established rotations, fellows in the new emphasis area will also have opportunities to conduct neuropsychological assessments for HIV-related dementia. The program also includes collaboration with physicians, nurses, social workers and pharmacists within the specialty clinics. This diversity provides psychology trainees with an interdisciplinary work environment.
Below is a sample of the many opportunities in intervention and research within this emphasis:
Interprofessional Lesbian, Gay, Bisexual, Transgender Health Care
The LGBT Fellow will develop advanced skills in psychological assessment and interventions specific to the LGBT Veteran population, and engage in scholarly empirical inquiry, program evaluation, consultation, supervision, and teaching.
The MEDVAMC has several primary training sites that provide integrated care to Veterans and offer wonderful training opportunities to the LGBT Fellow. Supervisors from various disciplines with specific interest and expertise in LGBT health will participate in the Fellow’s training. These include the Primary Care HIV and HCV specialty clinics, which offer comprehensive interprofessional care and the General Mental Health Clinic (Kaki York, PhD; Timothy Baker, MD). Jeff Pixler, LCSW specializes in working with transgender Veterans and Kristin Lahey, LMFT focuses on family systems with LGBT Veterans. Additional training opportunities are available through Inpatient Psychiatry (Rayan Al Jurdi, MD), the Women’s Inpatient Program (Deleene Menefee, PhD), Women’s Health Clinic (Allison Sweeney, PhD) and Substance/Addictions Clinic (Daryl Shorter, MD).
Clinical experiences include conducting assessments, individual psychotherapy, group psychoeducation, psychotherapy, and support groups. These skills are taught through a variety of teaching methods with the primary modality being experiential learning from direct clinical service delivery. Trainees learn about LGBT informed care through didactic seminars led by providers directly involved in delivering these treatments and are provided with empirical readings from the literature. The Fellow will also receive supervision on a regular basis (i.e., weekly minimum of 2 hours of individual supervision).
The MEDVAMC Psychology Training Program has a number of other established rotations that provide excellent interprofessional training opportunities. Clinical training within most of these rotations involves coordinating Veterans’ care in a collaborative environment consisting of social workers, nurses, physicians, and psychiatrists. The Fellow will also have the opportunity to interact with medical students, residents, and social work interns from other programs.
Michael R. Kauth, PhD, is Co-Director of the South Central MIRECC and LGBT Program Coordinator for Patient Care Services in Central Office. He will serve as the primary supervisor for the LGBT Fellow throughout the training year. Dr. Kauth is well-known as an educational leader in the VA and as a sexology scholar. He has published a variety of journal articles and book chapters on homosexuality and sexual orientation, as well as a single-authored book on the evolution of same-sex attraction. Dr. Kauth has guest edited a special issue of the Journal of Psychology & Human Sexuality on the evolution of human sexuality and guest edited a special issue of the International Journal of Sexual Health on Veterans’ sexual health and functioning. Dr. Kauth is Director of the Human Sexuality course for first year medical students at Baylor College of Medicine, where he is an Associate Professor of Psychiatry. Dr. Kauth also hosts a quarterly sex research seminar for Houston area researchers, scholars, and students that draws an interdisciplinary faculty from the VA, Baylor, UT School of Public Health, University of Houston, Walden University, and MD Anderson. Most recently, Dr. Kauth was appointed to a .375 FTE position (along with Jillian Shipherd) as an LGBT Program Coordinator for Patient Care Services. He leads LGBT training initiatives, serves on national workgroups on LGBT issues, and advises Patient Care Services on policy and procedures related to LGBT Veteran care.
A number of teaching opportunities are available to the LGBT Fellow, including presenting in the National VA Diversity video/teleconference series, participating and presenting in the Sexuality, Science & Sandwiches sex research seminar series, assisting with a Human Sexuality course given to 1st year medical students at Baylor College of Medicine, and providing consultation and educational workshops to interprofessional audiences across medical and psychiatric clinics. The Fellow would also have a number of unique opportunities to learn about systemic and administrative processes within VA through working with Dr. Kauth on national LGBT training activities and workgroups.
Program Consultation and Accreditation
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