The VAMC Substance Treatment and Recover (STAR) provides a continuum of specialized substance abuse treatment services within a comprehensive treatment program for veterans with active substance use disorders. Services provided by interns may include intake assessment; inpatient and outpatient consultation; case management, treatment planning, and participation on a multidisciplinary treatment team; patient education, individual, and group therapies; and outreach.
The intern follows selected cases from initial contact, engagement in treatment, continuing care, and discharge. The intern has the opportunity for a variety of clinical experiences in the Substance Abuse Clinic Intensive Outpatient (SAC IOP) program, which is targeted for the veteran at a high risk for relapse and in need of a structured and supportive therapeutic milieu to provide ongoing stabilization and psychosocial rehabilitation. The intern will also provide continuing care in the SAC regular outpatient treatment program, which is targeted for maintenance of a drug-free lifestyle. SAC provides several special treatment tracks and/or groups, including extended opioid substitution therapy in addition to groups for women, PTSD, CMI, affect management, Seniors in Recovery, 12-step facilitation, and Native American veterans. Attention is given toward utilizing social and community support systems to bridge patients from formal treatment into extended recovery within the community. By the end of the STAR rotation, the intern will sharpen assessment, individual, and group therapy skills in the area of specialized substance abuse treatment.
The Health Psychology Clinic is a multidisciplinary treatment setting established to provide a psychological treatment interface to Medicine and Surgery Services. Four psychologists and one post-doctoral fellow comprise the Health Psychology Clinic faculty. Five interrelated components can identify the activities of the Health Psychology Clinic: patient diagnosis, patient treatment, patient education, staff education, and research. Consultation/liaison and Primary Care Mental Health is not a specific component of this Clinic. Rather, we place emphasis on effective and timely intervention following the diagnosis. Typically, we provide this on an outpatient basis.
Brief, goal-oriented therapy is the intervention mode most often employed in this setting. Knowledge of general psychology is important, as applied behavioral techniques across a variety of settings and circumstances require creativity, initiative, and understanding of developmental and interpersonal, as well as medical, contributors to the clinical picture.
Major and minor rotations of the psychology intern reflect an interface of the intern's interests and the clinic's opportunities. The intern can arrange emphasis with special populations or procedures. However, the intern should expect a general introduction to the wide arena of behavioral medicine. Participation in applied research activities is also an opportunity for a psychology intern on this rotation.
The Ambulatory Mental Health Clinic (AMHC) is a comprehensive outpatient mental health triage and care delivery unit with 18,000 plus visits per year. It is a busy, productive, active setting in which to hone psychotherapy and diagnostic skills.
A staff composed of four full-time psychologists, five full-time psychiatrists; a psychiatric social worker, an advanced practice psychiatric nurse specialist, a full-time and a half-time RN, and a psychology technician specializing in biofeedback are all available in the main clinic for supervision. The AMHC-Extended has a number of units which are attached, some of which have their own rotation available to interns. The Primary Care Mental Health Team is attached to the AMHC and consists of a psychiatrist, a psychologist, and a post-doctoral fellow. The Family Therapy Program is attached to the AMHC and is staffed by four psychologists. The AMHC also has a tele-psychiatrist and two tele-psychologist attached who specialize in providing mental health services to our smaller VA community based outpatient clinics (CBOC's). The Mental Health operations at the larger CBOC's are attached to the AMHC. Theoretical orientations are varied and include but are not limited to: cognitive behavioral, psychodynamic, humanistic, self-psychology, interpersonal process, transactional analysis, problem solving RET, and experiential. Evidence-based therapies (e.g., CPT, ACT, prolonged exposure, etc.) are practiced and taught to trainees.
Our setting is a topnotch, highly affiliated VA Medical Center with approximately 600,000 outpatient visits and 75 specialty clinics, which allows us access to an extremely diverse population. The AMHC provides consultation on patients referred from the other outpatient specialty clinics as well as from the admissions area and provides support to the Emergency Room.
Experiences available for the intern selecting this rotation include several options from which to choose:
a. Providing outpatient mental health consultation services for patients referred from other clinics, the admissions area, and the emergency room. These patients' diagnoses range the spectrum of DSM-IV and allow the intern an opportunity to hone their skills of interviewing, diagnosing, and making appropriate case disposition with feedback to the referring physician in a relatively brief period.
b. Intensive psychotherapy with a variety of cases including individual, groups, couples, and family treatment. In-depth psychotherapy supervision is a hallmark of this rotation, providing interns an opportunity to polish existing psychotherapy skills and acquire new approaches to understand and treat a multiplicity of patients.
c. Psychodiagnostic assessment experiences are available which utilize the extensive VAMC computer capabilities for objective testing and structured interviews as well as supervision of projective testing.
d. Experience with our psychoeducational classes providing a wide range of services for patients with different disorders. The primary care initiative developed by AMHC which includes a number of psychoeducational classes, is an award-winning program used as a model for other VA medical centers.
e. Biofeedback/Relaxation Training/Stress Management program experiences. Patients referred to this program include not only the more usual anxiety-based disorders but also many patients with physical disorders exacerbated by stress (headaches, GI disorders, etc.).
f. Group psychotherapy experience is available in the main clinic as well as our Crisis Intervention Program. Daily, weekly, and monthly groups are available.
g. Intensive treatment experience with the PTSD-diagnosed patient is available on the unit with PTSD being the most common diagnosis in our AMHC population. The MHC treats combat-related PTSD, sexual trauma-related PTSD as well as PTSD from a variety of other experiences.
h. A monthly group for WWII Prisoners of War and their spouses is run by AMHC staff and available for participation. This is a good setting to better understand the long-term effects of PTSD as well as geriatric issues, including mortality.
i. One of the AMHC's RN's runs the weekly anti-psychotic injection program for patients managed on injectable anti-psychotic medication. Exposure to this model of management of psychotic patients is available.
j. Additional information in the theories and practice of the use of psychotropic medication is available from AMHC psychiatrists and/or our doctoral level clinical pharmacist.
k. The opportunity for training and supervision in Mental Health Administration is also available to interns in the AMHC.
Training is a priority in the AMHC. The AMHC psychologists enjoy supervising psychology interns and the intern's caseload with approximately two hours per week of supervision with a psychologist. Video recording of cases is encouraged and video recording equipment is available in each trainee room for this purpose. We keep caseloads at a level to allow interns time to investigate further the diagnoses and conceptualizing of the cases with which they will be involved. Training needs and interests figure prominently in the establishment of goals for the rotation.
The case mix of the AMHC is quite diverse, sometimes referred to as a "living DSM-IV.” Consultation will expose the interns to this diversity. We only refer the more functional patients with the skills to engage in a therapeutic relationship to the psychotherapy list. Interns are encouraged to select patients from the list who meet the training needs of that particular intern. There is normally a good range of diagnoses, types of patients, ages, and ethnic backgrounds represented on the waiting list. While most of the patients are male, there are typically some female patients available for treatment. Since most mental health clinics have a higher representation of female patients, many interns look forward to this opportunity to broaden their experience working with male patients. For the intern interested in broadening his/her group therapy skills there are a large number of groups from which to choose. The atmosphere of the clinic is supportive. Due to the high caliber of interns who have rotated through the clinic, there is always a positive anticipation by clinic staff when a new intern comes to the AMHC. The AMHC is a rotation where interns are encouraged to extend themselves to learn new skills while the clinic staff provides a supportive base out of which to function.
The Clinical Neuropsychology Service is comprised of a neuropsychologist, a postdoctoral neuropsychology fellow, and two psychology technicians/psychometrists. Referrals for evaluation, including both outpatient and inpatient requests for services, are generated by providers throughout the hospital, with the most frequent requests coming from ambulatory mental health care (both psychology and psychiatry), neurology, primary care, the Polyatrauma Clinic associated with Operation Enduring Freedom/Operation Iraqi Freedom, medicine, inpatient psychiatry, and neurosurgery. The clinic completes assessments on patients with brain injuries, suspected dementia, and a number of other CNS pahtologies affecting neurocognitive functioning.
The Clinical Neuropsychology Service is well equipped with a broad assortment of assessment instruments. The most commonly used instruments include the WAIS-IV, WASI-II, WMS-III/IV, portions of the Halstead-Reitan Battery, Wisconsin Card Sorting Test, RBANS, Dementia Rating Scale, MMPI-2, and an assortment of measures assessing effort/motivation. A personal computer is available in the laboratory for use in administering and/or scoring some assessment instruments as well as for writing reports.
Interns can expect to be involved in completing the clinical and collateral interviews, test administration and scoring, integrative report writing, consultation, patient feedback, treatment planning, and brief supporitve therapy involving adjustment to disability and/or cognitive rehabilitation. Interns on this rotation are encouraged to attend the weekly Neuropsychology Case Conference and Neurology Grand Rounds at OUHSC. Interns with only limited exposure to neuropsychology are invited to select this rotation, which will be individually tailored to meet their needs.
The Trauma and Deployment Recovery Services is a newly integrated interdisciplinary team from the former Post Traumatic Stress Recovery Program and the OEF/OIF/OND Readjustment Program. The focus of this program is to provide specialized outpatient services to veterans who are having difficulty coping with military related trauma. These veterans are at particularly high risk for PTSD and other anxiety disorders as well as depression and TBI. Along with helping returning veterans from the conflicts in Iraq and Afghanistan, veterans from previous conflicts are also served. Military Sexual Trauma is also an important emphasis.
The treatment team consists of four Clinical Psychologists, a full and two part time Psychiatrists, a Physician Assistant, and four Licensed Clinical Social Workers. The focus is on providing short term, evidenced-based treatment as part of an interdisciplinary treatment team. The primary treatment modalities are individual and group psychotherapy, but psychoeducational groups are also offered. The trainee may have an opportunity to be involved in outreach activities to OEF/OIF/OND veterans and training to community agencies and other treatment facilities about the needs of OEF/OIF/OND veterans.
Theoretical orientations and corresponding interventions are mostly cognitive and cognitive-behavioral. The rotation places an emphasis on learning evidence based practices for the treatment of PTSD.
The OKC VAMC’s Family Mental Health Program offers a wide variety of services to veterans and their families/support persons. The major goals for the Family Mental Health Program rotation are for the intern to: 1) Understand the rationale for intervention at the family level in addressing an individual’s symptoms, 2) Become familiar with various evidence-based treatments for couples, 3) Develop skills in assessing family strengths and problems and conducting family/couples therapy, 4) Gain experience with family psychoeducational interventions for veterans with a mental illness/PTSD and their family members.
This rotation offers the following opportunities:
- Couples/family therapy (offered both independently or as a co-therapist).
- REACH Program (a psychoeducational program for veterans living with a serious mental illness/PTSD and their family members).
- SAFE Program (a support and educational program just for family members of people living with PTSD/mental illness).
- Core 4 Communication (psychoeducational class focused on interactive skills practice to assist Veterans in improving their interpersonal communication).
- Couples Tune-Up (prerequisite psychoeducational class for couples who wish to pursue couples therapy; topics covered include individual wellness, communication, conflict management, and boundary setting).
- Journey through Loss (psychoeducational class for veterans who have experienced the death of a loved one and adult family members who have experienced the death of their veteran).
- AMHC outpatient mental health consults (walk-in/triage clinic)
**Opportunities may differ based on major and/or minor rotation
Theoretical orientations and corresponding interventions vary and depend on the needs of the couple/family, though the rotation emphasizes learning evidence based practices for working with couples and families.
The Psychiatry Inpatient Unit of the Oklahoma City VAMC is the main inpatient mental health teaching facility for the University of Oklahoma Health Sciences Center. The primary purpose of the unit is to admit and treat veterans who have significant psychiatric issues and require brief, inpatient stabilization. The secondary purpose of the unit is to train students from the various health sciences disciplines (psychology, medicine, nursing, pharmacy,social work, etc.) in providing appropriate patient care in an acute, inpatient setting.
With respect to training in psychology, our goal is to individualize each interns training experience, within the framework of a supportive and nurturing environment, in order to maximize growth in areas of weakness and refine areas of strength. The experiences offered on this rotation are directly applicable to crisis intervention, work with acutely psychotic patients, the chronically mentally ill, traumatized veterans, geriatric populations, and patients with personality and substance abuse disorders. For those interns who are interested, there is also an opportunity to receive training in the administration of an inpatient psychiatric unit. The expectation is that by the end of the rotation the intern will be competent and comfortable in providing state of the art psychological services on any inpatient psychiatric unit.
The purpose of the Geropsychology Rotation is to offer training and experience in meeting the mental health needs of older adults. The unit’s emphasis is on meeting those needs with older adults who have physical problems threatening their level of independent functioning. The majority of the rotation is on the Community Living Center (CLC), a 23-bed unit that fits between a nursing home and an intensive rehabilitation program along the continuum of care. Typically, veterans in the CLC have recently lost some physical, occupational, or cognitive functioning and are expected to be capable of significant recovery to avoid placement in a nursing home. The intern participates in an interdisciplinary team setting designed to assist the veteran in recovery to as independent a lifestyle as possible.
The rotation also offers training and experience on an 8-bed Palliative Care Unit (PCU). Outpatient training and experience is offered through a Home-Based Primary Care Program as well as a home telemental health program.
- The rotation offers the following activities:
Assessments (neuropsychological bed-side screenings, MSE's, psychosocial evaluations, some formal testing).
- Individual therapy (brief Cognitive Behavior Therapy, problem solving, adjustment to illness, change in lifestyle, behavior modification, pain management, relaxation training, etc.).
- Group psychotherapy (cognitive rehabilitation, stress management, problem solving, etc.).
- Home visits (Home-Based Primary Care Program).
Home telemental health services.
- Readings in geriatrics (with the psychology supervisor and the Geriatric Journal Club).
In the OKC VA, Primary Care is the patient’s first point of entry into the health care system and the place patients typically look for treatment for most of their health care needs. In fact, research indicates that over half of all visits to primary care settings have a psychosocial component. The Primary Care Mental Health Clinic is an integrated program consisting of a psychologist, a psychiatrist, a RN Case Manager and a Post Doctoral Fellow located on site in the Primary Care Clinics. We provide “front line” triage and assessment for patients referred by PCPs and/or those who screen positive for depression, PTSD, anxiety, and alcohol misuse. We provide some short-term behavioral counseling as well as provide several psychoeducational groups for patients wanting to learn to manage their anxiety, depression, and sleep problems. We also work with the Diabetes Education Team in educating patients about the psychosocial aspects of managing their disease and provide the behavioral health component for the Quick Assess Medical Appointment Clinic. Interns who rotate in PCMH will learn how to provide abbreviated clinical services in an integrated model, consult daily with Primary Care Providers, and develop basic knowledge necessary for working in a medical setting including basic medical terminology, common medical disorders, psychological comorbidities, and frequently prescribed medications.