Geropsychology Rotation - Providence VA Medical Center
Faculty Supervisor(s): Pamela Steadman-Wood, PhD, ABPP, Jessica Cappellano, PhD, Marjorie Crozier, PsyD, Ron Smith, PhD
Located at the Providence VA Medical Center, the Geropsychology rotation is designed to introduce the trainee to the role of the geropsychologist in home-based and outpatient settings. The clinical psychology resident will spend 2-3 days in the General Outpatient Mental Health Clinic (CAPS), 1-1.5 days per week in Home-Based Primary Care (HBPC), and one day per week in the Integrative Health and Wellness Center providing an array of psychological services to older Veterans.
Providence VA General Outpatient Clinic (CAPS). The VA’s General Outpatient Mental Health Clinic—the Comprehensive Ambulatory Psychiatry Section (CAPS)-- provides Veterans with access to comprehensive, evidence-based mental health care with the goal of improving Veteran quality of life. This training experience will focus on individual therapy with older adult Veterans coping with a variety of medical and mental health concerns. Veterans seen in this clinic present with a variety of comorbid medical (chronic illness, chronic pain, etc.), and mental health (mood, adjustment, anxiety, trauma and substance use related disorders, grief, loss, relational issues, etc.) concerns. Treatment approaches include Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT), Interpersonal Therapy (IPT), Motivational Interviewing (MI) and Problem-Solving Therapy (PST). Opportunities for group therapy may also be available, depending on need and interest.
The CAPS training experience will also provide exposure to working with Veterans (and caregivers) with neurocognitive disorders. This may include brief cognitive testing and behavioral interventions. Clinical psychology residents may receive training in Resources for Enhancing Alzheimer’s Caregivers Health (REACH VA), an evidence-based psychosocial intervention to reduce caregiver burden. REACH VA focuses on providing psychoeducation on the disease process, enhancing stress management, and promoting problem-solving skills. In this context, residents will have the opportunity to develop non-pharmacological interventions to address problematic behaviors that may arise due to dementia. They will also assist family members in developing and achieving goals related to the care of their loved ones and themselves. Interventions will be conducted face-to-face and/or via telehealth. Opportunities to collaborate with geriatric psychiatry, geriatric primary care and neuropsychology may also be part of this training experience.
VA Home-Based Primary Care (HBPC). The VA is a leader in the provision of patient-centered medical home models of care, an emerging wave of service delivery. The VA HBPC program serves primarily older Veterans whose medical and psychiatric conditions are too complex to be managed effectively by traditional outpatient care. As such, all primary care is provided to them in their home by an interprofessional team of primary care providers, nurses, nutritionists, social workers, rehabilitation therapists, clinical pharmacists and psychologists. Government issued vehicles are used for home-visits. The clinical psychology resident will gain novel training experiences required to work in this complex health care delivery system.
Consultation questions are diverse and include managing chronic advanced illness (e.g., cancer, chronic obstructive pulmonary disease, cardiac disease, dementia, diabetes mellitus, and other neurological disorders); enhancing medical regimen adherence; reducing caregiver burden; assessing cognition, evaluating decision making capacity; and addressing issues related to aging and end-of-life.
The clinical psychology resident will be exposed to the interaction between physical and mental health and provide brief assessment and evidence-based treatment for a variety of presenting problems. Common presenting problems include adjustment disorders, anxiety-related disorders, chronic pain, insomnia, mood disorders, PTSD, substance use disorders, caregiver stress, bereavement/loss, issues related to aging, life transitions and death and dying.
Common evidence-based treatment approaches include Acceptance and Commitment Therapy (ACT), Mindfulness-based interventions, Cognitive Behavioral Therapies (CBT-I, CPT, etc.), Motivational Interviewing (MI), Problem Solving Therapy (PST), often with the additional challenge of adapting treatments to compensate cognitive impairment. Other innovative interventions such as the provision of telehealth services (i.e., telephone phone-based tobacco cessation) are also part of the unique service delivery experience on this rotation.
There is a large consultation component to this rotation. As such, residents will gain exposure to the role of a clinical psychologist as a consultant in a variety of ways (1) curbside consultation, (2) interprofessional team treatment planning and (3) treatment team and family meetings.
Clinical psychology residents may also gain experience with cognitive and capacity evaluations. Common referrals include identifying undiagnosed neurocognitive disorders, distinguishing dementia vs. depression, assessing capacities for health care management, independent living abilities, medical regimen adherence and optimizing strengths and weaknesses to inform treatment planning.
Clinical psychology residents will also have the opportunity to navigate the complex ethical and legal issues inherent to (1) a complicated patient population, (2) non-traditional care settings, and (3) working in an interprofessional team with diverse priorities, treatment targets, and demands. Clinical psychology residents will also be exposed to issues related to palliative and hospice care and end-of life.
VA Integrative Health and Wellness Center. The clinical psychology resident will provide group and individual consultation and psychotherapy services to older Veterans within the Integrative Health and Wellness Center at the Providence VAMC. The resident will demonstrate competence in evidence-based cognitive-behavioral therapies to treat chronic pain, sleep, mood, and other health behavior challenges. Specific interventions may include Cognitive-Behavioral Therapy for Insomnia (CBT-I), Cognitive Behavioral Therapy for Chronic Pain (CBT-CP), motivational interviewing, Mindfulness, and other interventions appropriate to an integrative health setting. The Resident will demonstrate competency in creating personalized health plans that are Veteran driven and reflect the individuals’ personal goals, strengths, and needs as well as health coaching around goals identified. The Resident may have the opportunity to participate in the development of additional integrative health programming and outcome data collection as available.