Health Psychology/Behavioral Medicine Rotations

Health Psychology/Behavioral Medicine Track

Megan Pinkston-Camp, PhD, Track Coordinator

The primary purpose of the Health Psychology/Behavioral Medicine Track is to enable clinical psychology residents to develop specialized skills in evidence-based assessment and intervention to promote physical and mental health, prevent disease, manage chronic illness, and provide integrated care within interprofessional settings.  Clinical psychology residents work with a variety of patient populations to become familiar with psychosocial factors influencing adjustment and adaptation to chronic medical conditions, promote health behavior change, and develop skills for behavioral consultation and intervention in general medical settings, particularly in primary care. Learning to provide care within a variety of integrated medical settings, work as a member of interprofessional teams, and collaborate with other medical disciplines are major emphases of the residents’ training. In addition to learning models for consultation, collaboration, and provision of time-limited, evidence-based treatments, the clinical psychology residents will also develop specialized skills conducting long-term therapy with behavioral medicine patients in half-day weekly clinics that take place throughout the training year.

The Health Psychology/Behavioral Medicine Track is composed of the following rotations:

Behavioral Medicine Rotation A: Chronic Pain and Illness - The Miriam Hospital
Faculty Supervisor(s): Megan Pinkston-Camp (primary), Abigail Mansfield Marcaccio, Liz McLaughlin

The Chronic Illness and Sexual Health rotation at The Miriam Hospital provides a broad range of training experiences in behavioral medicine. Settings include The Miriam Hospital’s Immunology Clinic and Men’s Health Center and Lifespan’s Spine Center. The rotation emphasizes training in assessment, treatment and consultation skills for psychologists in medical settings. Training provides exposure to individual, as well as group, modalities of intervention and a variety of patient populations. The clinical psychology resident functions on multidisciplinary teams that may include psychology, psychiatry, a variety of medical specialties, clinical social work, nursing, nutrition and exercise physiology.  

The Clinical Behavioral Medicine Service of the Immunology Clinic at The Miriam Hospital provides clinical services tailored to the individual needs of patients diagnosed with HIV and chronic Hepatitis C virus. The clinic serves 1700 patients and is the largest medical provider of HIV care in the state of Rhode Island. Patients are often diagnosed with co-morbid mental health, substance use, and behavioral medicine concerns. Working with this patient population can offer a rich experience in cultural and clinical diversity among patients who experience significant stigma and barriers to accessing care. As HIV is now viewed as a chronic condition, the population is aging and experiencing health conditions such as obesity, heart disease, chronic pain, diabetes, and cancer similar to that of populations without HIV, and therefore there is a great need to assist patients with living healthy in addition to managing their HIV diagnosis, mental illness, sexual risks, and addictions.  

The Behavioral Pain Management Experience emphasizes training in assessment, treatment and consultation skills with patients with chronic pain in neck or back and concomitant psychological distress. The experience is within Rhode Island Hospital Spine Center which offers spine-specific physical evaluations, interventional procedures, spine surgeries, and physical and occupational therapy. The Clinical Psychology Resident is part of an integrated multidisciplinary team including physicians, NPs and PAs, nurses, physical therapists, massage therapists, and psychologists.   (1) In collaboration with the supervisor, residents conduct brief assessments of patients referred by Spine Center medical providers for evaluation and/or treatment. Chronic pain is frequently the presenting concern but it is necessary to also explore comorbid psychological or social factors, in order to determine disposition.  (2) In collaboration with the supervisor, residents conduct assessments of pre-surgical readiness for spinal cord stimulator surgery. The spinal cord stimulator is a medical device that may be indicated for certain patients with pain; residents learn about the device and learn how to carry out this unique type of pre-surgical evaluation. (3) Residents see individual outpatients for brief psychotherapy, frequently treating chronic pain but also treating other diagnoses/concerns as relevant. (4) With the supervisor, residents co-facilitate group chronic pain treatment using an evidence-based cognitive-behavioral framework (CBT with ACT principles).  (5) Other activities may arise such as exploring outcomes assessment, enhancing our group offerings, collaborating with the medical team in various ways, etc. 

The Men’s Health Center at Miriam Hospital provides outpatient clinical and psychological care for sexual dysfunction.  The clinic treats men, women, transgender, and gender fluid patients, and provides consultation and treatment for sexual dysfunction, including low libido, difficulty with orgasm, erectile dysfunction, premature ejaculation, Peyronie’s disease, and coping with sexual sequalae from treatment for prostate, testicular, breast, and gynecological cancers.  Psychologists at the clinic see both individuals and couples.

Behavioral Medicine Rotation B: Obesity and Cardiopulmonary Rehabilitation - The Miriam Hospital
Faculty Supervisor(s): Maria Buckley (primary), Jeffrey Burock, Ernestine Jennings, Barbara Ruf

The Miriam Hospital's Behavioral Medicine Rotation B provides broad training in behavioral medicine by providing experience in assessment, individual and group treatment, and activities that promote chronic disease risk reduction and treatment. The clinical psychology resident functions on multidisciplinary teams that include psychologists, psychiatrists, physicians, clinical social workers, nurses, dietitians, pharmacists, respiratory and physical therapists and exercise physiologists.    

Patients seen through the Behavioral Medicine Clinical Services are assessed and treated for problems such as chronic pain, obesity-related conditions, smoking cessation, difficulty managing chronic medical conditions (e.g., arthritis, chronic fatigue, gastrointestinal disorders, endocrine disorders) and co-morbid sleep, anxiety and mood disorders. Patients are typically treated using cognitive-behavioral as well as acceptance based and self compassion frameworks that can include lifestyle modification, skills training for management of medical symptoms and emotional distress, mindfulness-based self regulation, and relapse prevention skills. Evaluations are done collaboratively between the clinical psychology resident and supervisor, and usually incorporate a comprehensive interview and data from self-report questionnaires.  

Clinical psychology resident participation in the Weight Management program includes evaluating patients for entry into a medically supervised weight management program. The residents will conduct a thorough evaluation of weight and lifestyle behaviors and assess program candidates for potential adherence risk factors, including mood disorders, eating disorders, or other psychosocial risk factors prior to entry into the program. The resident will also co-lead a psychoeducational group for participants in the weight management program, and will function as part of an interprofessional team of physicians, dieticians, a nurse, and an exercise physiologist.   

The Cardiac and Pulmonary Rehabilitation Behavioral Medicine Service provides training in conducting brief, targeted interventions for issues such as adjustment to cardiac and pulmonary disease, weight management, smoking cessation, anxiety and mood management, adherence to exercise and treatment regimens and stress management. The clinical psychology resident will receive training in presenting brief psychoeducational classes to Cardiac and Pulmonary Rehabilitation patients. The resident also has the opportunity to co-facilitate a quarterly Heart Transplant/LVAD support group meeting. The Cardiac and Pulmonary Rehabilitation services are multidisciplinary and offer the opportunity to collaborate and consult with physicians, exercise physiologists, pharmacists, respiratory and physical therapists, dietitians and nurses and to assist them in their delivery of patient care.  

On the inpatient Consultation-Liaison (C/L) service, the clinical psychology resident assesses and treats acute medical-surgical patients in the emergency room and during their inpatient stay at The Miriam Hospital. Consultations range from the assessment of more traditional psychiatric problems which may arise in medically ill patients (e.g., changes in mental status, depression, anxiety disorders, psychosis, suicidality) to the initiation of positive lifestyle modifications with the goal of long-term benefits. There is also an emphasis on treating psychiatric sequelae of neurological disorders and geriatric disorders, including dementia, Parkinson's disease, multiple sclerosis, and post-stroke sequelae. The trainee will also develop basic skills in the ability to read neuroimaging including Brain CTs and Brain MRIs. This experience includes both patient-centered and consultee-centered consultation, wherein the medical and nursing staff may be assisted in managing various behavioral difficulties in patients. The consultation-liaison service is multidisciplinary, consisting of psychiatrists, a psychiatric nurse, and trainees in each of these disciplines.  This service treats a high number of patients each day and the pace of the service may be faster than other sites. The service treats a wide range of patients from the Spanish and Portuguese community as well as a wide range in socioeconomic status.  Approximately 1/3 of the patients are consults in the emergency room setting and 2/3 of the patients are consults on the medical-surgical floors.  The service works closely with physicians from all other disciplines of medicine.

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. 

Primary Care Behavioral Health (PCBH) Rotation A - Providence VA Medical Center
Faculty Supervisor(s): Tracy O'Leary Tevyaw (primary), Elizabeth Chattillion, Karen Oliver

Primary Care Behavioral Health (PCBH) Rotation B - Providence VA Medical Center
Faculty Supervisor(s): Caitlin Burditt (primary), Kevin McKay

[Please note that clinical psychology residents would complete only one of the PCBH rotations for the training year.]

The PCBH rotations are designed to introduce the trainee to the role of the psychologist in primary care-mental health integration within outpatient settings. Clinical psychology residents serve as a member of an interprofessional treatment team comprised of primary care providers, psychologists, psychiatrists, social workers, clinical pharmacists, nurses, nurse practitioners, nutritionists, and physical therapists. The clinical psychology residents will spend four and a half days per week in outpatient primary care. In the outpatient setting, the clinical psychology residents will develop a working knowledge of the function and role of a psychologist within a complex medical system. The development of assessment skills required to determine when brief treatment in primary care or referral to more intensive treatment in the mental health service will be emphasized in the context of an open access model, depression care management program, and disease specific consultation and treatment. The clinical psychology residents will be exposed to the interaction between physical and mental health and provide brief evidence-based treatment for a variety of presenting problems. The Veteran population is diverse, and Veterans often present in primary care with complicated medical and psychological issues. Common presenting problems include depression and other mood disorders, anxiety, PTSD and stress reactions, substance abuse, adjustment disorders, chronic pain, diabetes and other metabolic conditions, obesity, caregiver stress, cognitive impairment, coping with medical illness, and bereavement and loss. Common treatment approaches include cognitive behavioral therapy, motivational interviewing, coping skills training, problem solving, and acceptance-based approaches. 

Opportunities to participate in interprofessional psychoeducational groups are also a focus. On both rotations, the residents will co-facilitate an interprofessional shared medical appointment for Veterans with diabetes in the Primary Care Metabolic Clinic. The clinical psychology residents will also conduct individual motivational enhancement sessions for diabetic nonadherence and obesity management as part of the Metabolic Clinic experience. 

On PCBH Rotation A, the resident will co-facilitate a weekly weight maintenance group as part of the VA’s MOVE! Weight management program and a monthly interprofessional shared medical appointment for Veterans with congestive heart failure. They will also participate in the Sexual  Health Clinic, which is an interprofessional assessment and treatment program for sexual problems. There will be an opportunity for the assessment/treatment of patients in the Sexual Health Clinic, including presurgical psychological evaluations.  Finally, they will have the opportunity to conduct psychosocial evaluations for Veterans who have been referred for bariatric surgery. The resident will learn to conduct a comprehensive evaluation of Veterans’ mental health, weight and eating behaviors, substance abuse history, home environment, and social support system, to determine if a Veteran is an appropriate candidate for bariatric surgery.

On PCBH Rotation B, the resident will conduct individual and group for treatment of chronic pain, as well as pre-intervention pain-specific evaluations for the Primary Care Behavioral Health Pain School.  Clinical psychology resident will also have the opportunity to conduct assessment of Veterans who are being considered as organ transplant candidates. Evaluations involve taking a comprehensive medical, psychiatric, substance abuse, and social history of the Veteran, as well as interviewing the candidate’s “support person.” Residents will also gain experience co-facilitating a weekly smoking cessation group in primary care along with members of the Pharmacy Service. Finally, residents will also participate in the Interprofessional Trainee Clinic, which offers comprehensive treatment to Veterans in primary care who present with complex concerns, given their medical, psychological, and/or social history.  Residents will serve as psychology representative to the interprofessional team, which includes trainees from social work, pharmacy, and family/internal medicine. 

Women & Family Medicine Rotation - The Miriam Hospital
Faculty Supervisor(s): Maggie Bublitz (primary), Chrystal Vergara-Lopez

The Women’s Medicine Collaborative is an outpatient department of the Miriam Hospital and a comprehensive, multidisciplinary center dedicated to meeting the unique health care needs of women across the lifespan. Women’s Primary Care, part of the Women’s Medicine Collaborative, provides care related to the health and well-being of women 18 years and older. At Women’s Medicine Collaborative Primary Care, the clinical psychology resident will develop a working knowledge of the function and role of a psychologist within a complex medical system treating female patients. The clinical psychology resident works with their supervisor to evaluate and treat adult female patients who are referred by the clinic’s primary care providers (PCPs) for mental health and behavioral medicine services, and also provide consultation services for medical staff when in the clinic. Female patients may present with traditional mental health concerns, acute medical conditions, chronic medical illnesses, and Women's Health-specific issues, including menopause-related, cancer treatment-related, and/or other sexual health concerns.   

Clinical Psychology Residents will spend four days at the Women’s Medicine Collaborative. Residents will complete psychosocial assessments, brief evidence-based interventions, and will assist with collaborative care activities including reviewing a patient registry and preparing for huddles with primary care providers. Residents will also participate in weekly team meetings and group supervision. Opportunities to participate in and co-facilitate Lifestyle Medicine and Postpartum Mom’s groups may also be available during the rotation.

Clinical-Research Focused 12 Month Experience

Unlike the four-month rotations described above, the Clinical-Research rotations are 12- month long experiences providing concentrated clinical-research training in a specialty area. During the first eight months of training, time is spent as follows: 50% time research, 20% behavioral medicine clinical experience, and 10% didactics. In the last 4 months of training, time is spent as follows: 60% research, 40% out-of-track clinical experience. The clinical-research rotations are designed for residents with prior experience and training within the specialty areas offered, and who are planning a research-oriented career in the specialty area.

Obesity Clinical-Research Rotation - The Miriam Hospital
Faculty Supervisor: Rena Wing, J. Graham Thomas 

The Obesity clinical-research rotation is a focused 12-month long experience providing concentrated clinical-research training in the specialty area of obesity. During the first eight months of training, time is spent as follows: 50% obesity clinical-research, 20% inpatient hospital consultation-liaison service, 20% outpatient behavioral medicine clinical work, and 10% didactics. In the last four months of training, time is spent as follows: 60% obesity clinical-research, and 40% out-of-track clinical experience.

This research- focused rotation takes place primarily at The Miriam Hospital’s Weight Control and Diabetes Research Center. The aims of the research within the Center are to expand knowledge of the causes and consequences of obesity, develop innovative and effective treatments for weight loss and weight maintenance, and offer quality obesity treatment to the community through ongoing clinical trials. The clinical psychology resident will participate in ongoing studies related to these areas, the development of grants and manuscripts and the facilitation of clinical research weight management groups.

Clinical psychology residents on this rotation will also receive clinical training in behavioral medicine through assessment, treatment and consultation activities. The clinical activities on this rotation are designed to provide training that can complement the resident’s research in obesity while also enhancing the clinical psychology resident’s exposure to broad based behavioral medicine training. Clinical experiences typically include training in integrated primary care and inpatient consultation-liaison settings, and/or specialized behavioral medicine settings (e.g., behavioral sleep medicine, smoking cessation, cardiac rehabilitation).