Clinical Rotations

Program graduates Drs. Colleen Jacobsen and Jennifer Muehlenkamp presenting at Association for Behavioral and Cognitive Therapies.

Major Adult Rotations

Adult Psychiatric Inpatient Unit
The Inpatient Psychiatric Unit is a locked 22-bed unit within the general hospital for adult, geriatric and adolescent psychiatric patients. This rotation provides an excellent opportunity for interns to be exposed to severe psychopathology, to work within a multi-disciplinary treatment team and to hone their psychological assessment skills.

Interns here serve as primary therapists for patients presenting with a range of affective, psychotic and neuropsychiatric disorders. Interns are responsible for conducting the initial diagnostic evaluation, providing individual and family psychotherapy, and working in close collaboration with the attending psychiatrist and social worker to monitor patients' responses to treatment and formulate disposition plans.

Interns also participate in the unit's group therapy program, as group leaders and peer supervisors. During this rotation, interns have the opportunity to perform brief psychological and neuropsychological assessments and to observe patients with unusual neurological and neuropsychiatric conditions.

This service is also a training ward for psychiatrists, neurologists, social workers, medical students, nurses and art therapists.

Adult Outpatient Psychiatry Department (AOPD)
The AOPD is a heterogeneous catchment-area clinic serving over 1,000 outpatients with a variety of psychiatric disorders. Disorders treated in this clinic include various mood and anxiety disorders, personality disorders, psychotic disorders and psychiatric disorders associated with HIV disease. Patients are seen in individual, group or family therapy, and many receive psychopharmacologic treatment as well.

Interns are responsible for all phases of outpatient psychiatric care, including structured assessment, diagnostic and treatment planning, and provision of psychotherapy. All interns are assigned to a treatment team led by an attending psychiatrist, attending psychologist, social workers and psychiatric residents, and receive comprehensive, one-on-one supervision from licensed psychologists with psychodynamic, cognitive behavioral and dialectical behavioral perspectives.

Interns may request supervisors with expertise in a specific theoretical orientation. Otherwise, interns are assigned to a variety of supervisors so that they may be exposed to a range of therapeutic approaches. Interns in the AOPD rotation see patients on a short-term basis but may elect to treat one or two patients for the entire year. Interns also co-lead therapy groups and work as part of a multidisciplinary treatment team.

Psychiatric Observation Suite (POS) - Psychiatric Emergency Room
The POS—also known as the Psychiatric Emergency Room—is a five-bed crisis intervention service within the general Emergency Department, which is the busiest of all the city's hospitals, and the seventh-busiest ED in the nation.

This rotation introduces interns to patients that are in an acute state of decompensation and distress. Interns learn to quickly diagnose patients, make triage and referral decisions, perform suicide and violence potential assessments, and do crisis intervention. Interns work closely with psychiatrists, nurses and social workers.

Addiction Psychiatry Consultation Service in Psychosomatic Medicine
The Addiction Psychiatry Consultation Service in Psychosomatic Medicine provides consultation liaison services to medically complex patients with admixtures of physical, mental, social and health problems admitted to the general hospital with substance use related-co-morbidity.

During this rotation, interns learn how to screen for addiction problems, differential diagnosis (e.g., delirium versus toxicity), withdrawal management, use of appropriate psychotropic medications, pain management in the addicted patient, and how to formulate and implement an appropriate treatment plan for patients with co-occurring medical and substance use problems.

Specific evidence-based interventions that are modeled and taught include Motivational Interviewing, Harm Reduction and Relapse Prevention. Interns are part of a busy and visible teaching service team, including Psychiatry Residents, Addiction and Psychosomatic Fellows, and first year medical students and psychology externs, and interact with a range of other disciplines and treatment teams throughout the hospital.

The service averages 80-100 patients per month, and interns typically conduct 10-15 written consultation reports and two-to-three follow-up visits with each patient during the hospital stay.

Major Child/Adolescent Rotations

Training Director Dr. Simon Rego with program graduate and current faculty member, Dr. Shelby Harris, presenting at Association for Behavioral and Cognitive Therapies.

Child Outpatient Psychiatry Department (COPD)
The Child Outpatient Psychiatry Department treats a heterogeneous group of children and adolescents (ages 4-17) with diagnoses ranging from disruptive behavior disorders, anxiety and depressive disorders, and psychotic disorders to adjustment disorders and learning disabilities.

During this rotation, interns receive intensive training and supervision in psychodynamic psychotherapy, family therapy, cognitive behavior therapy and group therapy. Interns have the opportunity to co-lead both the parenting and child components of the Incredible Years program for treating children with disruptive behavior disorders. Interns also learn how to liaison with schools, foster care agencies, the Committee on Special Education and other relevant organizations.

Adolescent Depression and Suicide Program (ADSP)
The ADSP is a specialty outpatient program serving depressed and suicidal teens (ages 12-19) and their families. Many of these adolescents have experienced significant abuse and have comorbid anxiety, substance-related, personality and disruptive behavior disorders.

During this rotation, interns learn to conduct semi-structured diagnostic interviews and to intervene intensively using dialectical behavior, cognitive behavior, brief psychodynamic and family systems therapies, as well as crisis intervention. Various group therapies are also employed, including parent training and the CBT Coping with Depression course.

Interns also have the opportunity to participate in academic activities, including authoring articles, presenting at conferences, conducting research and leading workshops at local schools regarding adolescent suicide.

Child and Adolescent Assessment Service
The Child and Adolescent Assessment Service helps interns develop proficiency in child/adolescent psychological and neuropsychological testing. At a minimum, interns administer five comprehensive psychological evaluations during the year, with more available for those interested in developing special expertise.

Referral questions typically include assessing for the presence and type of learning disabilities, assessing for the presence of a wide range of diagnoses and the potential need for medication, differential diagnosis, and evaluating the presence of neuropsychological deficits.

Supervision highlights the impact of cultural differences and bilingualism, and employs a developmental framework. Exposure to more traditional instruments, as well as newer, empirically-driven and computerized instruments, is offered. Training in the cross-battery approach to defining learning disabilities is integrated with more conventional theories.

Elective Rotations

ACS Family Treatment and Rehabilitation Program

The Family Treatment and Rehabilitation Program (FT/R) is dedicated to providing comprehensive child-centered, family-focused and strengths based services designed to address the safety and well-being of children and families in the Bronx impacted by a range of challenging family situations, including mental health and/or substance abuse concerns, domestic violence, trauma and poverty. The ultimate goal of the FT/R program is to support families whose children are at-risk for foster care placement. This is accomplished by bringing together formal and informal networks of individuals and agencies that work to support and strengthen families own capacity to meet its needs and nurture and care for their children in their homes. All families accepted into our FT/R program will receive a comprehensive family assessment, intensive case management, ongoing monitoring, and supportive service referrals. This rotation offers a broad array of clinical training opportunities, including opportunities to conduct comprehensive clinical assessments with adults and children, to provide ongoing supportive services to families, and to serve as an integral part of an interdisciplinary FT/R team, committed to maintaining the safety and well-being of children and families in the Bronx.

Behavioral Sleep Medicine Program - Sleep-Wake Disorders Center
The Behavioral Sleep Medicine Program specializes in the diagnosis and treatment of patients that have severe or long standing problems associated with sleep and waking. Interns have the opportunity to participate in the evaluation and treatment of patients that have insomnia, circadian rhythm disorders, nightmares, nocturnal panic disorder, narcolepsy and CPAP compliance difficulties.

Though mostly focused on work with adults, child and adolescent patients are occasionally seen. Interns can also observe polysomnography sleep studies, and are given the opportunity to attend a weekly sleep-wake case conference.

Butler Child Advocacy Center (CAC) Mental Health Team
The Butler CAC Mental Health Team offers interns the opportunity to develop an essential awareness of the field of child abuse prevention and treatment, as well as familiarity with the functioning of child protective services.

Interns will learn about trauma-focused cognitive behavior therapy, an evidence-based model of sexual abuse treatment, as well as therapeutic interventions for traumatic grief and the impact of physical abuse. Interns will work with children, adolescents and their families using a model that makes the non-offending parent or caregiver an integral part of the therapy.

Interns will learn about cases during the fact finding phase, through observation of forensic interviews, conducted by a multidisciplinary team of pediatricians and nurse practitioners, social workers, ACS workers, NYPD detectives (special victims unit) and Assistant District Attorneys. Interns will then be expected to carry cases in the mental health assessment and treatment phase. The model of intervention is Trauma-focused Cognitive Behavior Therapy. There will also be an opportunity to participate in leading adolescent or parent groups.

Children's Hospital at Montefiore (CHAM) Behavioral Consultation Team
The Behavioral Consultation Team at CHAM gives interns the opportunity to develop an understanding of the ways in which acute and chronic medical illness affect the lives of children and their families, using an ecological developmental model.

Interns will develop skills in the differential diagnosis of psychopathology in medically ill children. Interns create and co-lead outpatient groups for children with chronic illness, participate in individualized and group DBT interventions for patients struggling with adherence to their medical regimen, and liaison with the medical team and provide education about psychosocial issues in the pediatric population.

Interns also provide psychological consultation to children, families and medical teams in the inpatient setting. Interns will work in the department of pediatrics and have the choice to work in an interdisciplinary manner with members of the divisions of nephrology, adolescent medicine, obesity, endocrinology, rheumatology, transplant medicine, infectious disease, hematology and oncology.

Geropsychology
The Geropsychology Program elective offers interns the opportunity to learn about the special needs and challenges of geriatric patients. The geriatric population is faced with mounting health problems, issues relating to death and dying and a decrease in ability for independent living.

Interns interested in working with older psychiatric patients will be assigned cases in the Geriatrics service of the AOPD. If interested, however, interns may also create a more intense elective experience that would include providing care at area nursing homes, conduct home visits, and participating in an array of inter-professional seminars and case conferences conducted in collaboration with the training program of the Division of Geriatric Medicine.

Interns choosing this elective would also have opportunities to work with Holocaust survivors and participate in National Institute of Aging-sponsored research. Supervision is provided by psychologists and psychiatrists with special expertise in this area.

Neuropsychology Assessment Service
The Neuropsychology Assessment Service provides assessment and treatment planning for individuals of all ages in both inpatient and outpatient settings. Interns may participate in assessments as part of their outpatient and/or inpatient rotations. Interns may also have the opportunity to observe brain mapping and Wada (intracarotid sodium amobarbital procedures).

During this rotation, interns develop expertise in the assessment and diagnosis of the cognitive and behavioral effects of various neurological and psychiatric disorders, including traumatic brain injury, dementia, stroke, multiple sclerosis, brain tumors, lupus, epilepsy, learning disabilities and attention deficit disorder.

Psychiatry AIDS Connected Ambulatory Program (PACAP)
The PACAP outpatient treatment services individuals living with HIV/AIDS and comorbid psychiatric disorders. The program also provides services to family members of these patients. Cases involve a wide range of Axis I and II pathology not limited to health-related concerns, and are treated with a similarly wide range of therapeutic interventions.

Interns have the opportunity to conduct intake assessments, provide individual psychotherapy, and co-lead groups.

Research Elective
The psychology faculty at Montefiore is actively engaged in areas of research such as anxiety, depression, personality disorders, behavioral health services utilization, cognitive behavior therapy, dialectical behavior therapy, adolescent suicide and neuropsychology.

Interns have historically participated in all aspects of research, including: literature review, study design, subject recruitment and data collection, data analysis and dissemination of findings.

In addition, interns may be mentored in applied clinical research using case studies or groups treated with evidence-based therapies and assessed using empirically-based measures.

Interns have frequently presented data at scientific conferences and have also served as first authors and co-authors on numerous scholarly papers and book chapters.

School-Based Mental Health Program
The School-Based Mental Health Program is located at a nearby elementary school. Students are referred by pediatricians at the school-based health clinic, teachers, school administrators and guidance counselors. Attendance at therapy appointments is improved due to ease of access.

During this rotation interns provide individual, family and group therapy. There are opportunities to become involved in the Incredible Years Program or the Dialectical Behavior Therapy program. If interested, there is an opportunity to gain exposure to primary and secondary prevention interventions by working with a class to provide class-wide social-emotional learning interventions, consult with teachers regarding classroom management, and help establish and modify classroom token economies.

Substance Abuse Treatment Program (SATP)/New Directions Recovery Center (NDRC)
The SATP and NDRC are two off-site treatment programs. The SATP treats opioid-dependent patients in a comprehensive methadone maintenance program, and the NDRC treats adults with addictions to other substances in an outpatient setting. Most of these patients are polysubstance abusers, and have comorbid mood and/or anxiety disorders, personality disorders or adjustment difficulties. Many have chronic medical disorders.

During this rotation, interns may be involved in assessment, consultation, individual therapy and group treatment. Interns will learn psychotherapeutic approaches for substance abuse patients in various phases of recovery, from patients who have newly entered treatment to patients who have been abstinent for many years. These psychotherapeutic approaches include motivational interviewing, acceptance and commitment therapy, cognitive behavioral therapy, and psychodynamic therapy.

Supporting Healthy Relationships Program
The Supporting Healthy Relationships Program is a unique opportunity to gain experience working on a federally-funded marriage education research program serving married couples in the South Bronx. This program is designed specifically to enhance relationship skills and strengthen marriages for low-income couples in the greater New York metropolitan area.

The curriculum utilized is John and Julie Gottman’s Loving Couples Loving Children, which was shaped by the Gottmans’ many years of research on marital functioning. Using a didactic, prevention-based approach, the program teaches relationship skills in a group format.

This rotation offers a broad array of clinical training opportunities, including opportunities to conduct clinical assessments with couples and individuals, co-lead relationship education groups, design and lead groups on topics of intern’s choice, provide ongoing supportive services to couples, as well as contribute to marital research/program evaluation projects, as available.

Transplant Psychiatry Service
The Transplant Psychiatry Service provides consultations to all the solid organ transplant teams at the medical center. Psychiatrists, consultation liaison fellows, social workers and psychologists are key participants in the multidisciplinary team that evaluates patients with congestive heart failure, liver diseases and kidney failure.

Psychology interns have the opportunity to work with adult organ transplant patients and their multidisciplinary treatment team. Interns provide both general psychotherapy and behavioral medicine interventions to support the transplant candidate through this process.

University Behavioral Associates (UBA)
UBA is an innovative managed care company founded by the Department of Psychiatry at Montefiore, which delivers behavioral health services to a large population in the Bronx.

Interns in this elective learn about models of managed care, utilization review and reimbursement methodologies. Interns can also elect to rotate at UBA’s comprehensive case management program for substance abusing welfare applicants.