Psychiatry and Behavioral Sciences
Adding Elective Rotations to Customize Your Training
As mentioned elsewhere on this site, we pride ourselves in being able to offer our interns tremendous flexibility in and around the core rotations of all three Specializations. In fact, there is almost no limit to the number of ways in which the internship year at Montefiore Medical Center can be customized! For example, an elective rotation may be added in order to fill a gap in an your training (e.g., working in the psychiatric Emergency Room as an elective for interns in the Child and Adolescent Specialization) or to expand upon your existing knowledge, skills, and abilities (e.g., learning how to apply CBT for patients with Insomnia through an elective in our behavioral sleep medicine program). Each intern matching with us will be encouraged to think of his or her own specific interests and/or training needs and goals when considering which (if any) electives to add to the core rotations.
In addition to choosing which electives to add, interns are also able to choose how to structure certain electives, depending on the Specialization. For example, interns in the Adult Specialization, the electives usually occupy either a half or full day per week for 6 months during the Adult Outpatient Psychiatry Department rotation, but certain electives can also be made (or combined) into full-time rotations for up to 1-2 months (with a corresponding reduction in the time spent on one or more of the other core rotations). For interns in the Child and Adolescent Specialization and the Combined Specialization, electives usually take place one day per week during the first 11 months of the academic year, and many can also be made into a more intense, 2-3 day rotations during the last month of the internship.
|2014-15 Interns and Faculty at the First Day Orientation Meeting.|
Current Elective Rotations
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 specific evidence-based interventions for substance abuse, including Motivational Interviewing and Harm Reduction and Relapse Prevention, while in the role of a consultant. Interns also 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. 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. Individual supervision of at least one hour per week is provided by a licensed psychologist: Dr. Alexis Briggie.
Anxiety and Mood Program (AMP) and the Adolescent Depression and Suicide Program (ADSP)
The Anxiety and Mood Program (AMP) at Montefiore Medical Center's Child Outpatient Psychiatry Department is a specialty program that offers evidence based interventions for children and adolescents with primary and comorbid anxiety, mood, and related disorders. AMP serves children and adolescent, ages 4 to 18 years old, and families from the surrounding Bronx communities. Interns will learn to conduct comprehensive intake assessments (e.g., ADIS) and will serve as primary therapists for youth experiencing anxiety (e.g., social anxiety disorder, generalized anxiety, separation anxiety disorder, panic disorder, phobias, OCD, PTSD), depression, tics, trichotillomania, and related concerns. During this rotation, interns will provide individual and family-based cognitive behavioral treatments (e.g., Coping Cat, Exposure/Response Prevention, Trauma-Focused CBT, Comprehensive Behavioral Intervention for Tics, Parent Management Training), and can elect to serve as co-leaders in Cognitive Behavioral Group Therapy for socially anxious adolescents, Behavior Regulation Movement Groups, or Skills Group for Adolescents with Eating Disorders. Interns will participate in multidisciplinary team rounds, and collaborate with teachers, school personnel, pediatricians, or other providers who may be involved in the child or teen's care. Interns also have the opportunity to participate in scholarly activities, including authoring articles, presenting at conferences, conducting research and leading workshops and in community service events for local groups.
The Adolescent Depression and Suicide Program is a specialty outpatient program within the Anxiety and Mood Program that serves 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 comprehensive diagnostic interviews and Dialectical Behavior Therapy. Interns serve as primary therapists for individual and family cases and co-therapists for DBT multi-family skills training and graduate groups. Interns also learn crisis intervention skills. Interns will receive individual supervision and participate in DBT consultation team.
Adult Psychiatric Inpatient Unit
The Inpatient Psychiatric Unit is a locked 22-bed unit within the general hospital for adult 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. Psychology Interns 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 unit for psychiatrists, neurologists, social workers, medical students, nurses and art therapists. Individual supervision of at least one hour per week is provided by a licensed psychologist: Dr. Sharon Spitzer.
Behavioral Sleep Medicine Program at the Sleep-Wake Disorders Center
The Behavioral Sleep Medicine Program at the Sleep-Wake Disorders Center provides interns with the opportunity to learn about the diagnosis and treatment of patients who have severe or long standing problems associated with sleep and waking. Interns can participate in the evaluation of patients who have insomnia, circadian rhythm disorders, nightmares, nocturnal panic disorder, narcolepsy and CPAP compliance difficulties, and learn cutting-edge treatments, such as CBT-I and Imagery Rehearsal Therapy (IRT) for Chronic Nightmares. Though mostly focused on work with adults, child and adolescent patients are occasionally seen. Interns can also observe polysomnography sleep studies. Interns are also given the opportunity to attend a weekly sleep-wake case conference. Individual supervision of at least one hour per week is provided by a licensed psychologist who is board-certified in behavioral sleep medicine: Dr. Shelby Harris.
Behavioral Health Integration Program (BHIP)
The pediatric Behavioral Health Integration Program (BHIP) provides evidence-informed integrated behavioral health care for children and their families within Montefiore Medical Group. We provide Healthy Steps programming for prevention and intervention in children ages birth through age five, and treatment of (mild to moderate) anxiety, depression, attention/disruptive disorders and trauma-related issues in school age and adolescent children. This program exists in 19 pediatric primary care sites which serve an estimated 90,000 children. Working alongside pediatricians, a multidisciplinary team of psychologists, psychiatrists, and social workers provide behavioral health services across the pediatric lifespan (birth through 18 years). The emphasis is on population health, and thus all pediatric patients receive mental health screens during routine medical appointments which allows the program to identify children with mild to moderate behavioral health symptoms and intervene in a preventative fashion.
When selected as an elective rotation, the intern will be assigned to a specific primary care site and learn to work collaboratively with a team of pediatric medical and behavioral providers. Interns will be expected to complete brief assessments, based on the use of appropriate screeners and clinical interview, and conduct short term interventions for mild to moderate mental health problems. Coordination of care between the intern and primary care provider (PCP), as well as relevant systems such as school and community resources, will ensure a comprehensive approach to assessment and treatment. Individual supervision of at least one hour per week will be provided by a licensed psychologist (Carla Cirilli, PsyD; Teresa Hsu-Walklet, PhD; Dana Crawford, PhD). The intern will also have the opportunity to participate in monthly BHIP-wide meetings that offer professional development training.
Butler Center For Children and Families
The Butler Center is a dual-licensed clinic for primary care and mental health, addressing issues of child abuse and neglect. The mental health clinic, a satellite of COPD (Child and Adolescent Psychiatry) is a full service OMH clinic with a psychiatrist, two psychologists, a clinical social worker and SW interns placed by the National Center for SW trauma education and work force development. A one day a week rotation with the OMH clinic at CAC offers Psychology interns the opportunity to develop an essential awareness of how to treat trauma, whether it takes the form of sexual or physical abuse, exposure to domestic and/or community violence, a perilous immigration journey, or the living conditions of urban poverty. The ensuing symptoms of PTSD, anxiety disorders, depressive disorders and behavioral problems, including problematic sexual behaviors are addressed with evidence-based interventions such as: Tf-CBT or Trauma-focused CBT; Af-CBT or Alternative for Families in cases of coercive parental behavior and risk for physical abuse; Parent-Child Psychotherapy; PSB-CBT or Problematic Sexual Behavior CBT, a program of concurrent groups for parents and children; and SPARCS or Structured Psychotherapy for Adolescents Responding to Chronic Stress, an adolescent group treatment program.
Services are offered in English, Spanish and French responding to the needs of recent immigrants. Interns will also be able to familiarize themselves with the forensic part of the process of addressing abuse by observing some interviews conducted by a multi-disciplinary team (child protective service workers, forensic interviewers, pediatrician, nurse practitioners, detectives, social workers and ADAs or Assistant District Attorneys) although the bulk of the forensic phase now takes place mostly off-site. Two licensed psychologists are available to provide individual supervision for at least one hour a week Dr. Nicole Cox and Dr. Rachel Sheffet.
Children's Hospital at Montefiore (CHAM) – Behavioral Consultation Team
This one-day per week rotation 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 can choose from several different clinical opportunities which may include the creation and co-leadership of outpatient groups for children with chronic illness, conducting individualized CBT and DBT interventions for patients struggling to adhere to their medical regimen or adjust to illness, and liaisoning with the medical team to provide education about psychosocial issues in the pediatric population. Interns will also provide psychological assessment and consultation to children, families, and medical teams in the inpatient setting. Supervision is provided by Michelle Lupkin, Ph.D.
Child Outpatient Psychiatry Department (COPD)
The Child Outpatient Psychiatry Department is located in its own building just minutes from the entrance to the Moses Division Hospital. It serves a heterogeneous group of children and adolescent patients (ages 4-17) with diagnoses ranging from disruptive behavior disorders, anxiety and depressive disorders, psychotic disorders, adjustment disorders, and learning disabilities. Interns in the COPD will serve as primary therapists for individual and family cases (patients will be assigned across all ages and diagnoses), co-therapists for group therapy, and will conduct evaluations of children and adolescents. During this yearlong rotation, interns receive intensive training and supervision in family therapy, cognitive behavior therapy, psychodynamic therapy, and group therapy. Interns participate in multidisciplinary team meetings and also learn how to liaison with schools, foster care agencies, the Committee on Special Education and other relevant organizations.
Child and Adolescent Assessment Service
The Child and Adolescent Assessment Service within the COPD helps interns develop proficiency in child/adolescent psychological, diagnostic, 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.
Comprehensive Services Model (CSM) Program
The CSM is a program funded by New York City's Human Resources Administration (HRA) to provide evaluation and case management services to substance abusing public assistance recipients in the Bronx, with the goal of assisting them to engage in treatment, become clinically stable, and ultimately self-sufficient through employment. Interns selecting this rotation are able to conduct evaluations for employability, as part of a comprehensive case management program for substance abusing welfare applicants. Interns can also learn about disability and employability criteria and decision-making. Individual supervision of at least one hour per week is provided by Joanne Pearl, CSW.
The Eating Disorders Program at Montefiore (EDPM)
The Eating Disorders Program at Montefiore (EDPM) is a multidisciplinary, outpatient program with the Anxiety and Mood Program in the Child Outpatient Psychiatry Department and the Department of Adolescent Medicine at the Children's Hospital at Montefiore. This service provides evidence-informed care for children and adolescents presenting with anorexia, bulimia, and other eating disorders. All children and adolescents and their families will participate in comprehensive assessments and treatment with a team of specialists including psychologists, adolescent medicine specialists, psychiatrists, and social workers. The EDPM recognizes the importance of including families in the treatment of eating disorders in youth and incorporates them in every stage of care. In addition to interventions that target primary eating disorders, we provide comprehensive care that may also include treatment for depression, anxiety, PTSD, and personality disorders. Our goal is to help our patients control eating disordered symptoms and learn skills that will help them maintain this progress on an ongoing basis.
When selected as an elective rotation, the intern will become part of a multidisciplinary team of specialists working to treat patients with eating disorders. Interns will be assigned 1-2 cases and will co-lead 1 group specific to patients with eating disorders. Interns will collaborate with the medical team and participate in the initial comprehensive assessment of the patient. Interns will also participate in weekly rounds with the Adolescent Medicine team, including Dr. Susan Coupey and Dr. Nancy Dodson. Coordination of care between the intern, the treatment team, as well as relevant systems such as school and community resources, will ensure a comprehensive approach to assessment and treatment. Individual supervision of at least one hour per week will be provided by a licensed psychologist: Dr. Michelle Lupkin. The intern will also have the opportunity to participate in didactics specific to eating disorders and participate in ongoing research.
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 clinical 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. Supervision will be provided by Dr. Mark Celano, as well as other trainers in the program.
For interns interested in working with older psychiatric patients, they may 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 and comprehensive dementia assessments at the Center for the Aging Brain. Interns choosing this elective would also have opportunities to work with Holocaust survivors and participate in NIMH-sponsored research. Supervision is provided by geriatric psychiatrists Dr. Gary Kennedy, Dr. Alessandra Scalmati, and Dr. Mirnova Ceide.
Neuropsychology Assessment Service
Interns may elect to perform additional neuropsychological testing with adult, child, or pediatric inpatients and outpatients referred to the Neuropsychology Assessment Service. The Neuropsychology Service provides 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. These batteries are supervised by a licensed psychologist who is board-certified in neuropsychology: Dr. Bryan Freilich.
Next Steps/Health Homes Care Management Program
Next Steps is an innovative care coordination/care management program for high-risk, high-need Medicaid patients in the Bronx. The aim of the program is to help stabilize such patients by providing support, advocacy, and assistance with navigating the health care and social services systems, in order to improve access to all forms of ambulatory medical, behavioral health, and chemical dependency services, increase engagement and adherence to care, improve health outcomes, and reduce preventable hospitalizations and emergency department visits. Interns would learn about accountable care and health care reform during this rotation. Individual supervision of at least one hour per week is provided by Dr. Donald Bux.
Psychiatry AIDS Connected Ambulatory Program/HIV Clinic (PACAP)
Interns interested in working with patients with HIV disease (or their significant others) may be assigned cases in the Psychiatry HIV Program. Cases involve a wide range of Axis I and II pathology as well as deep socioeconomic, relational and health-related concerns, and are treated with a similarly wide range of therapeutic interventions as well as a close collaboration with psychiatry. Supervision is provided by Dr. Shahab Motamedinia.
Psychiatric Observation Suite (POS) - Psychiatric Emergency Room
The Psychiatric Observation Suite (aka the "Psych ER") is a five-bed crisis intervention service within the general Emergency Department, which is the busiest of all the city's hospitals, and the second-busiest emergency room 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. Individual supervision of at least one hour per week is provided by the medical director, Dr. Paul Jayson.
The psychology faculty at Montefiore Medical Center has an active research program in anxiety and depression, personality disorders, behavioral health services utilization, cognitive behavior therapy, dialectical behavior therapy, adolescent suicide, and neuropsychology, and applied clinical research using case studies or groups treated with evidence-based therapies and assessed using empirically-based measures. Interns interested in clinical research opportunities can elect to protect 4-6 hours of time for mentored research on a variety of research projects, with proportionate reductions in the clinical load. 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. 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. Research mentors include: Drs. Simon Rego, Sandra Pimentel, Amanda Zayde, Scott Wetzler, Laurie Gallo, Michelle Lupkin, and Jenny Seham.
Rose F Kennedy Children's Evaluation and Rehabilitation Center (CERC)
Rose F Kennedy Children’s Evaluation and Rehabilitation Center (CERC), in the Department of Pediatrics in the Albert Einstein College of Medicine provides interns with the opportunity to work in the Group Attachment Based Intervention (GABI) an intensive parent-child intervention developed for families with birth to three children, when there is a concern about a parent’s ability to parent due to an array of psychosocial stressors. Families are referred to GABI by pediatricians, ACS, Family Court and other preventive agencies. GABI is part of CERC which consists of a multi-disciplinary team of developmental behavioral pediatricians, psychiatrists, psychologists, and social workers, among other developmental specialists. Interns will learn how to conduct a trauma-informed clinical intake, including administering the Adult attachment Interview (AAI), the Parent and Child – Adverse Childhood Experiences Questionnaires , and behavioral health screenings. Interns will participate in GABI which include child-parent psychotherapy, parent groups, child groups and video feedback sessions. Group supervision is provided by two licensed psychologists (Drs. Anne Murphy and Marilina Rufino) and a licensed social worker (Brooke Allman, LMSW).
Substance Abuse Treatment Program (SATP)/New Directions Recovery Center (NDRC)
These are two off site treatment programs: the SATP treats opioid dependent patients in a comprehensive methadone maintenance program; NDRC treats adults with addictions to various substances in an outpatient setting. Interested interns may elect a one-day per week rotation, including assessment, consultation, individual therapy, and group treatment. There are opportunities to gain experience in Acceptance and Commitment, Cognitive Behavioral, Family Systems, Integrative, Motivational Interviewing, and Psychodynamic interventions. Supervision is provided by Dr. Dan Sullivan Dr. Nora Moore.
Supporting Healthy Relationships Program
This is a unique opportunity to gain experience working on a federally-funded relationship education research program serving couples in the South Bronx. The program, called Supporting Healthy Relationships (SHR), is designed specifically to enhance relationship skills and strengthen relationships for low-income couples in the greater NYC area. The curriculum utilized is Drs. John and Julie Gottman's Loving Couples Loving Children which was shaped by Gottman's many years of research on marital functioning. The curriculum has also been modified to fit our diverse community by adding aspects of Dr. Sue Johnson's Emotionally Focused Couples Therapy and the Prevention and Relationship Enhancement Program (PREP by Stanley & Markman). While most clinicians work with couples using therapy as an intervention, our program encourages a clinician's role in prevention, before couples are distressed. This rotation offers a broad array of clinical training opportunities. We provide 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. Supervision will be provided by Dr. Traci Maynigo, as well as other trainers in the program.
Transplant Surgery Programs
The psychosocial service to the Transplant Surgery Programs provides consultation to all the solid organ transplant teams at the medical center. Psychiatrists, psychologists, consultation liaison fellows, and social workers are key participants in the multidisciplinary team that evaluates patients with congestive heart failure, liver diseases, and kidney failure. Interns will have the opportunity to carry a small caseload of transplant patients for individual psychotherapy, meet weekly for supervision, attend meetings for psychiatric/medical consult (when needed), attend selection meetings, observe and participate in multidisciplinary teams as they make crucial decisions related to transplant listing and treatment planning, participate in bedside evaluations/interventions, co-lead existing intervention/support groups, lead one or two psycho-educational group meetings on a topic of interest to them and pertinent to the patient population (mindfulness, reward planning, cognitive restructuring, insomnia, weight management, interpersonal effectiveness, etc.), and attend multidisciplinary psychiatric didactic meetings. The schedule for this rotation is flexible, and, within reason, can be tailored to an intern’s availability. The psychologist is on site Tuesdays, Wednesdays, and Thursdays, so the intern must be available for supervision on one of those days. Individual supervision of at least one hour per week is provided by Dr. Meredith Townes and Dr. Paula Marcus.
University Behavioral Associates
University Behavioral Associates is an innovative managed care company founded by the Department of Psychiatry at Montefiore Medical Center which delivers behavioral health services to a large population in the Bronx. Interns choosing this elective learn about models of health care reform, managed care, utilization review, and reimbursement methodologies. Interns may also get involved with any of the ongoing research projects being run at UBA. Individual supervision of at least one hour per week is provided by Dr. Scott Wetzler.