Home-Based Primary Care Rotation - Providence VA Medical Center
Faculty Supervisor(s): Pamela Steadman-Wood (primary), Jessica Cappellano, Marjorie Crozier
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, physical therapists, clinical pharmacists and psychologists. Government issued vehicles are provided 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, congestive heart failure, coronary artery 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) and Reminiscence Therapy, 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) curb side consultation, (2) interdisciplinary 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.
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. Residents will also be exposed to issues related to palliative and hospice care and end-of life.
VA Integrative Health and Wellness Center. The Resident will provide group and individual consultation and psychotherapy services to 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 will actively participate in the development additional integrative health programming and outcome data collection as available.