|
Hennepin
County Medical Center (HCMC) offers two clinical internship training tracks:
child
and adult. Usually, four internship positions are offered each year, typically
two in each track. While all interns specialize
with either adult or child populations, they rotate through other areas,
as they are expected to develop skills in assessment and intervention
along the developmental continuum.
Adult-track
interns are placed in the Adult Assessment Clinic for the entire training
year; child-track interns complete a three-month rotation as part of their
Adult Inpatient Psychiatry experience. Psychological consultation to medical
services is an important component of the Adult Assessment Clinic and
performed by all interns. In addition, both adult- and child-track interns
provide psychotherapy to adult patients in the Adult Therapy Clinic, where
adult-track interns spend a significant amount of time.
The Child
Adolescent Psychiatry Service (CAPS) is the home base for child-track
interns, who conduct intakes and assessments with children, adolescents,
and families on an outpatient basis the entire year. They also follow
therapy patients on the CAPS. Adult-track interns complete a part-time,
six-month rotation on the CAPS, primarily conducting intake interviews
but with the option of also doing assessment and intervention. Both adult-
and child-track interns provide consultation to pediatric inpatients on
the pediatric and other medical services.
In addition,
all interns are expected to complete 10 to 12 shifts on the Acute Psychiatric
Service (APS), the 24-hour walk-in facility adjacent to the hospital's
Emergency Department.
The HCMC Psychology
Internship Program offers interns the opportunity to tailor their training
experience in accordance with their individual goals for professional
development. If a desired training experience does not formally exist,
arrangements can often be made to develop appropriate and unique experiences
for the interns. Past trainees have cited this flexibility as one of the
many strengths of the training program.
• Adult Assessment Clinic
• Adult Evaluation Therapy
Clinic
• Adult Group Therapy
• Adult Inpatient Psychiatry
• Child Adolescent
Psychiatry Service (CAPS) — Assessment
• Child Adolescent Psychiatry
Service (CAPS) — Therapy
• Acute Psychiatric Services (APS)
• Neuropsychology
The Adult Assessment Clinic was established in 1998 to ensure timely provision
of psychological services to requesting physicians and other providers
in the Department of Psychiatry and throughout the medical center. The
clinic also provides a vehicle for training psychology interns in psychological
evaluation and health psychology con-sultation. Adult-track interns are
assigned to the Adult Assessment Clinic during the entire training year.
Child-track interns complete a three-month rotation.
Two main enterprises
are organized through this clinic. Staff psychiatrists from the inpatient
service frequently request psychological evaluations to aid in diagnostic
formulation and treatment planning. These requests may be for a "comprehensive
psychological evaluation" (a full interview and test battery leading
to an integrated report), intellectual screening, or personality testing.
The latter may be accomplished with objective personality tests such as
the MMPI-2, PAI, or MCMI-III, or with projective testing methods such
as the Rorschach Inkblot Test.
Also organized through
the Adult Assessment Clinic are requests for psychological consultation
from physicians elsewhere in the medical center. Psychology interns routinely
have opportunities to provide consultative services to patients on the
Burn, Orthopaedic, Surgery, and Neurosurgery units. (More detailed information
is provided
in the Health
Psychology Section.)
All
interns experience a year-long placement in the Adult Evaluation Therapy
Clinic. Adult track interns typically schedule 10-12 patients per week.
Child-track interns
usually schedule four patients per week. Interns are expected to carry
their adult therapy cases during their other rotations. A variety of psychotherapy
orientations are taught, including psychodynamic and cognitive behavioral
treatments. Both long-term and short-term approaches are used, as well.
Interns are taught to implement specific interventions using a variety
of treatment modalities. The current patient population includes many
individuals with severe psychopathology, and the challenge to develop
effective strategies for change is ever present.
Several opportunities for group therapy experience are available. All
interns are required to co-lead a group during their inpatient rotations.
Typically, they co-lead the inpatient, Interpersonal Skills (IPS) group
with a highly experienced psychiatric nurse. Interns also can arrange
to co-lead outpatient groups in the Adult Therapy Clinic, the Day Treatment
Program, or the Partial Hospitalization Program depending on the interest
and availability of staff and patients. Group supervision is held once
a week
for an
hour, and all interns and fellows are expected to attend for the full
year, even when they are not currently involved
in a group experience.
Interns from both the adult and child tracks complete a part-time rotation
on the adult inpatient psychiatric service. They function as members of
an interdisciplinary team that is led by the staff psychiatrist, but also
includes nurses, social workers, occupational therapists, recreational
therapists, medical students, and resident physicians. Interns participate
in team rounds, where they gain exposure to patients with serious psychopathology.
Interns also co-facilitate interpersonal skills groups. These groups meet
on a daily basis and are led by a psychiatric nurse who specializes in
group psychotherapy. Child-track interns participate in the Adult Assessment
Clinic (see separate description) during their adult inpatient rotation.
Adult-track
interns are assigned to the CAPS unit for a six-month, part-time rotation
where they will have a supervisor assigned to coordinate, oversee, and
supervise the experience. They conduct and write up diagnostic intake
interviews. In addition, they participate in consultation to pediatric
inpatients on medical services.
In addition to the activities described above, child-track interns conduct
individual and family therapy, generally carrying about eight child therapy
cases per week. They are expected to see their therapy patients during
their off-unit rotations, but are not expected to take new intake or assessment
cases during their Adult Inpatient or Acute Psychiatric Services rotations.
Presenting therapy concerns include behavioral problems and parenting
concerns, as well as a full range of serious psychiatric disorders. Various
therapy orientations are taught including psychodynamic, cognitive behavioral,
family systems, and parenting skills training, and students are taught
to tailor their interventions to the specific needs of the child
in the context of his or her particular life situation. Adult-track interns
are not expected to take child therapy cases.
All interns
complete a rotation on the APS. Nationally recognized, the APS was the
first hospital-based center to be certified by the American Association
of Suicidology. Interns usually work 10-12 eight-hour shifts in this 24-hour,
multidisciplinary center, answering suicide and crisis phone lines, and
providing crisis evaluation services to walk-in patients as well as to
patients brought in by family, police, or ambulance. Interns work alongside
their APS supervisors until they are ready to function more independently.
While
not a required part of the training, many interns have chosen to gain
experience with neuropsychological testing. The Psychiatry Department
has three neuropsy-chologists who provide assessment of adult, adolescent,
and pediatric patients from all hospital departments to assist in diagnosis
and treatment planning. Patients with head injury, cardiovascular disease,
Parkinson's disease, Huntington's disease, substance abuse, epilepsy,
learning disorders, mental retardation, multiple sclerosis, HIV infection,
carbon monoxide poisoning, developmental disorders, cortical and subcortical
dementias, and psychiatric disorders are regularly assessed. Interns conduct
testing and have the opportunity to write reports or participate in research
under the supervision of one of the neuropsychologists.
Trauma Services
Burn Center
Pediatrics
Pediatric Brain Injury Team
Huntington's Disease Clinic
Minnesota Regional Sleep Disorders Center
Obesity and Eating Disorders Program
Hennepin Women's Mental Health Program
(HWMHP)
Health Psychology
consultation has become a focus of our training program in recent years.
Physicians, nurses, and other health care providers have become increasingly
aware of the role psychological factors play in the acute care and long-term
management of many medical disorders. At HCMC, psychologists are important
consultants and members of multidisciplinary teams serving the complex
treatment needs of patients receiving services through a number of specialty
clinics and programs. Interns are encouraged to round out the training
year by selecting from the many specialty training experiences available
at HCMC. If a particular training experience does not formally exist,
arrangements can often be made to develop appropriate and unique experiences
for the intern.
HCMC is a Level I Trauma Center that provides comprehensive services to
accident victims with multiple injuries. Psychological consultation and
intervention are built into the critical pathway for patients admitted
with new spinal cord injuries and are commonly sought for multiple trauma
and burn patients. Psychologists are involved in assessing emotional status
and providing counseling and family support. Presenting problems include
acute stress disorders, adjustment disorders, depression, delirium, and
personality disorders. Consultation to nursing staff regarding behavior
management issues is requested on occasion as well.
The HCMC Burn Center is a 16-bed intensive care unit that provides comprehensive
care to adults and children with thermal injuries (burns, frostbite, and
hypothermia) as well as patients requiring specialized wound care. The
Burn Center is part of the HCMC Trauma Services, but is also independently
certified by the American Burn Association (ABA). As part of the team
approach to patient care, psychologists attend weekly rounds and offer
consultation to other team members. Psychological services are made available
to patients and families to help them cope with the often traumatic circum-stances
of the injury, the immediate and long-term psychosocial aspects of the
physical trauma, and the post-discharge adjustment to everyday life.
The Child Adolescent Psychiatry Service (CAPS) is in close physical proximity
to the large inpatient and outpatient pediatric service. Pediatricians
and pediatric nurse practitioners from the Growth and Nutrition Clinic,
Asthma Clinic, other specialty clinics, and general Pediatrics make referrals
for assessments, therapeutic interventions, and consultation. Staff and
students regularly receive referrals from the Adolescent Clinics, which
serve adolescents as well as adolescent parents and their young children.
In addition, during their CAPS rotations, adult and child track interns
provide consultation regarding children hospitalized on the general or
intensive care pediatric units. Referral issues often include assessment
of suicide risk, behavior management issues on the unit, difficulties
with medical compliance, general adjustment concerns, and provision of
education and support to children and families following traumatic accidents.
Working with this team offers a rich opportunity for interns wishing to
obtain training and experience in the assessment and treatment of children
with acquired brain injuries. This multidisciplinary team manages the
acute, rehabilitative, and follow-up care of children and adolescents
who have sustained brain injuries. Psychologists and neuropsychologists
on the team perform assessment of the patient, participate in family and
school conferences, and provide counseling as needed to assist the patient
and family in coping with problems arising from the brain injury.
HCMC's Regional Huntington's Disease Clinic offers patients and their
families comprehensive neurological, psychological, genetic counseling,
neuropsychological, and social services. Psychologists participate in
the early diagnostic and patient/family educational interventions, as
well as provide ongoing individual, marital, and family psychotherapy.
All Huntington's patients are evaluated on an annual or biannual basis
with a specially tailored battery of neuropsychological tests.
The Neurology Department at HCMC includes the Minnesota Regional Sleep
Disorders Center. This four-bed inpatient unit conducts polysomnographic
sleep studies on patients suffering from various sleep disorders, including
narcolepsy, REM behavior disorder, sleep apnea, night terrors, sleep walking,
dissociative disorders, and sleep cycle disturbances. Clinical and research
opportunities exist for interns interested in the diagnosis and treatment
of sleep disorders.
The Obesity and Eating Disorders Program is an interdisciplinary team
that includes professionals from the departments of Internal Medicine,
Surgery, Nutrition, and Psychiatry. Psychologists perform evaluations
of potential bariatric surgery patients, provide evaluation services for
medical and psychological interventions, and provide or coordinate further
psychological care.
|
