Behavioral Medicine Rotation B: Obesity and Cardiopulmonary Rehabilitation - The Miriam Hospital
Faculty Supervisor(s): Anna Schierberl Scherr, PhD (primary), Maria Buckley, PhD, & Jeffrey Burock, MD

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.  

Behavioral Medicine Clinical Services and Weight Management Program. Patients seen through the Behavioral Medicine Clinical Services are assessed and treated for problems such as chronic pain, obesity-related co-morbidities, 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 potential participants for adherence risk factors and co-leading a psychoeducational group for weight management as part of a multidisciplinary team of physicians, dietitians, a nurse, and an exercise physiologist. Residents will also carry an individual caseload consisting of patients with weight management issues/eating disordered behaviors and other psychiatric conditions commonly occurring in medical settings.

Cardiac and Pulmonary Rehabilitation. 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. 

The Miriam Hospital Inpatient Consultation-Liaison Clinic. 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. There is also a special emphasis on identifying medical and neurological issues which may be playing a role in the psychiatric presentation. 

The Pediatric Cardiology Rotation. The Pediatric Cardiology Rotation provides training with the Pediatric Psychology team providing integrated behavioral health services in Hasbro’s Pediatric Heart Center. Common referral questions include individual and familial adjustment to chronic illness, problems with adherence to medical regimens, preparation for medical procedures, transition to increased responsibility for their own medical care for children and adolescents with congenital heart disease, as well as complaints of cardiac symptoms often co-occurring with depression and anxiety.  Trainees on the rotation participate as part of an interdisciplinary treatment team that includes representation from disciplines of cardiology, psychology, nursing, and social work. Treatment provided is typically CBT-based individual and family therapy. Opportunities may also exist for didactic presentations to families, as well as consultation with the medical team.  In addition, trainees may participate in other interdisciplinary meetings (psychosocial team meeting, camp meetings, research meetings, echo conference) depending upon trainee availability and interest. 

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

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

[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 an outpatient primary care setting. 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. 

In the outpatient setting, the clinical psychology resident 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 comprehensive 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. Brief treatment, risk assessment, and early identification of mental health and substance use problems will be a focus. Residents will have the opportunity to provide open access, receive “warm handoffs” directly from primary care providers, and provide brief, evidence-based treatment to a caseload of veterans in primary care.

The clinical psychology resident will also be exposed to 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, 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.

VA Primary Care Behavioral Health Rotation A

Training experiences in Primary Care Rotation A include:

Metabolic Clinic. The clinical psychology resident will participate in a weekly interprofessional shared medical appointment for veterans with diabetes in the Primary Care Metabolic Clinic along with members of pharmacy, nutrition, and diabetes education. The clinical psychology resident will also conduct individual motivational enhancement sessions for diabetic nonadherence and obesity management as part of the Metabolic Clinic experience. 

Heart Failure Clinic. The Heart Failure (HF) Clinic is a weekly shared medical appointment that provides assistance for Veterans with HF who have recently been discharged from a hospital admission. Veterans with HF and their caregivers may attend four distinct sessions that are offered by a clinical pharmacist, a registered nurse, a behavioral psychologist, and a nutritionist. Sessions address stress management, disease coping, nutrition, and medication-related topics, and provide the Veteran with the necessary tools for HF self-management.  The psychology resident will facilitate the behavioral health sessions of the HF Clinic. These sessions include psychoeducational didactics addressing strategies for coping with HF and stress management. The resident will assist the Veterans with individualized symptom management as well.

MOVE! Weight Maintenance Group. The clinical psychology resident will co-facilitate a weekly weight maintenance group as part of the VA’s MOVE! Weight Management program. The resident will be the primary group facilitator and will lead the group in behaviorally-focused didactic presentations related to weight loss and maintenance, as well as in monitoring group progress, setting goals, and conducting weekly weigh-ins. 

Sexual Problems Clinic. The clinical psychology resident will participate in the Sexual Problems Clinic, which is an assessment and treatment program for sexual problems. The MHBSS Service, along with Urology and Endocrinology Service, provide a comprehensive approach to medical and psychological assessment and treatment of erectile dysfunction and other sexual problems in the Veteran population.  There will be an opportunity for the assessment/treatment of veterans in the Sexual Problems Clinic on an intermittent, as-needed basis (typically ranges 4-10 assessments per rotation).  In addition, one veteran may be selected for brief treatment. 

Bariatric Surgery Psychosocial Evaluations. The clinical psychology resident will have the opportunity on an intermittent, as-needed basis 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. Evaluations will be co-facilitated with the supervisor and recommendations for behavioral or psychosocial changes will be discussed with the Veteran in the evaluation session. The resident will share findings with the bariatric surgery team and may also have the opportunity to follow individual patients who would benefit from brief treatment to help facilitate behavioral changes necessary to achieve bariatric surgery eligibility.

VA Primary Care Behavioral Health Rotation B

Core description is the same as Primary Care A. However, supplemental experiences differ. Training experiences in Primary Care Rotation B include:

Metabolic Clinic. The clinical psychology resident will participate in a weekly interprofessional shared medical appointment for patients with diabetes in the Primary Care Metabolic Clinic along with members of pharmacy, nutrition, and diabetes education. The clinical psychology resident will also conduct individual motivational enhancement sessions for diabetic nonadherence and obesity management as part of the Metabolic Clinic experience. 

Pain School. The clinical psychology resident will learn how to conduct a pre-intervention pain-specific evaluation for the Primary Care Behavioral Health Pain School.  The resident will also learn to administer both individual and group Cognitive Behavior Therapy for Chronic Pain for Veterans living with chronic pain.  Finally, the resident will collaborate with members of primary care, pharmacy, physical therapy, and nutrition services to present the Primary Care Behavioral Health Pain School “Pain Panel.”

Smoking Cessation Clinic. The clinical psychology resident will have the opportunity to learn how to provide “open access” support to Veterans who are stopping smoking.  He or she will co-facilitate (with the Pharmacy service and PCBH Post-Doctoral Fellow) an evidence-based, standardized, group smoking cessation intervention that is short-term (i.e., four sessions) and aligned with motivational and cognitive-behavioral precepts.

The Primary Care Interprofessional Learning Clinic. The clinical psychology resident will participate in a weekly interprofessional shared medical appointment for Veterans presenting with complex medical, psychological, and/or psychosocial concerns.  The resident will learn how to conduct a comprehensive chart review and offer hypotheses, relevant information, and suggestions to the team during team precepting/rounding.  During the visit, the resident will contribute to the interview, offer to complete brief assessments of cognitive, behavioral, and other psychosocial issues, complete safety assessments, and develop appropriate safety plans.  Following the interview, the resident will offer suggestions to the Veteran, his or her treatment team, and other healthcare providers regarding their impressions and recommendations for appropriate referrals and follow-up care. 

Pre-Transplant Psychosocial Evaluation. The clinical psychology resident will have the opportunity to conduct pre-surgical evaluations for Veterans being considered for heart, lung, liver, or kidney transplants. The resident will learn to conduct a comprehensive evaluation of Veterans’ mental health and substance use histories, current adherence patterns, and social support resources as well as their understanding of their medical situation and transplantation procedures. Evaluations will be co-facilitated with the supervisor and recommendations for behavioral or psychosocial changes will be discussed with the Veteran and his or her support person in the evaluation session. The resident will share findings with the transplant team and may also have the opportunity to follow individual patients who would benefit from brief treatment to help facilitate behavioral changes necessary to achieve surgical eligibility.