Virginia Treatment Center for Children Pre-doctoral Internship in ...

Virginia Treatment Center for Children
Pre-doctoral Internship
in Clinical Psychology
Director of Training: Donald P. Oswald, Ph.D.
804-828-9900 doswald@vcu.edu
Intern Coordinator: Natikki Velez
804.828.4393, nvelez@vcu.edu
The Virginia Treatment Center for Children is part of Virginia
Commonwealth University Medical Center (VCUMC), one of Virginia’s premier
academic medical centers. A vital component of Virginia’s community-based
mental health system, VTCC continually works to improve the mental health
of all of Virginia’s children, youth, and families through clinical services,
research, training and professional development.
VTCC is well-known within the field for its ability to successfully treat
complex emotional and behavioral disorders. A multidisciplinary team
administers all of the clinical programs and works with children, youth, and
families to develop and implement individualized treatment plans.
With a wide range of clinical services offered by a highly diverse,
professional staff of psychiatrists, psychologists, social workers, educators,
and occupational, recreational, art and music therapists, VTCC provides
acute and residential inpatient programs, a day treatment program, and
outpatient counseling services for children, adolescents, and their families.
VTCC also offers consultation services to local mental health clinics, schools,
juvenile justice centers, and pediatric clinics. In addition to clinical services,
the center reaches out to provide information to professionals in Virginia’s
mental health system, professionals in other fields, policy makers and
families through training, technical assistance and consultation services, as
well as research and program evaluation activities.
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The population served at VTCC includes children and adolescents and
their families from all regions of the state of Virginia. The children represent
a diversity of cultural backgrounds, ethnicities, ages, diagnostic categories
and severity of presenting problems. At VTCC, we are committed to giving
each child the best treatment possible and to extending to each family
respect and compassion. We are committed to including parents and
guardians actively in their child’s care — from the initial evaluation to
treatment to aftercare planning.
VTCC makes available to families a breadth and depth of clinical
experience that is unique among Virginia’s community of mental health care
providers. The clinical services offered at VTCC are widely known for their
excellence. As part of a university-based medical center, VTCC provides
advanced training and professional development for mental health clinicians.
In addition, through the Commonwealth Institute for Child and Family
Studies, VTCC conducts research and provides technical assistance for
Virginia’s community-based mental health care system.
VTCC was one of the first psychiatric hospitals in the nation to commit to
establishing an “aggression-free environment.” In 1990, the Joint
Commission on Accreditation of Healthcare Organizations (JCAHO) rated
VTCC in the top 10 percent of all the hospitals they accredit nationally. In
1992, VTCC won a national achievement award from the American
Psychiatric Association for its innovative programming. In 2003, VTCC
received a JCAHO rating of 98 out of a possible 100 points, the highest in
the VCU Medical Center.
VTCC officially became part of Virginia Commonwealth University (VCU)
Medical Center on July 1, 1991. Prior to this affiliation, VTCC existed for
almost 30 years as a freestanding public psychiatric facility, operated by the
Virginia Department of Mental Health, Mental Retardation and Substance
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Abuse Services, treating children and adolescents with serious emotional and
behavioral problems from across the state.
VTCC belongs to a network of hospitals located in downtown Richmond
that is operated by the VCU Health System. This network of hospitals is
licensed for 1100 beds and provides training facilities for VCU Medical
Center’s programs in allied health professions, basic health sciences,
dentistry, medicine, nursing and pharmacy. Located in the capital of Virginia
and only 100 miles from Washington, D.C., the medical center is
conveniently located to policy makers at both the state and national levels.
Training Philosophy
The Psychology Internship Program at VTCC is guided by the principle
that professional growth and learning occur as a result of participation in a
wide range of clinical and didactic experiences within a supportive
environment. The program is dedicated to enhancing each intern’s existing
clinical strengths, as well as identifying clinical skills that require additional
development. To ensure ready accessibility of faculty to interns, each intern
is assigned a preceptor at the onset of the training year. The preceptor
serves as the intern’s yearlong primary supervisor and liaison to the
psychology internship faculty.
Through exposure to a wide range of presenting problems in a diverse
client population, the training program provides each intern with the
opportunity to develop professional skills and awareness of cultural and
familial influences on children’s development. In addition, interns gain a
working knowledge of the varied service systems designed to address the
needs of children and adolescents and their families and develop the skills to
influence those systems on the child’s behalf. Finally, in order to facilitate
the development of a professional identity, interns are encouraged to
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explore new ways of conceptualizing problems, new treatment techniques
and clinical interventions, and alternative personal styles in psychotherapy.
VTCC Clinical Psychology Internship Program
The internship program at the Virginia Treatment Center for Children,
fully accredited by the American Psychological Association since 1975, is
designed to provide training in the full continuum of care required to treat
children and adolescents with serious emotional disturbances. Six funded
positions are available each year in a training program that begins July 1
and ends June 30.
Description of Tracks
The Internship Program at VTCC includes three tracks: the Hospital Track,
the Community Track, and the Public Track. Each track exposes the intern to
a continuum of child mental health care services. The Community Track
places an emphasis on outpatient services in a community mental health
care setting, including services in a day treatment program. The Hospital
Track offers opportunities to work with the most seriously affected children
and adolescents in acute inpatient and residential treatment settings. The
Hospital track also offers rotations in pediatric consultation and liaison. Both
tracks offer considerable diversity in the level of severity of presenting
problems.
Public Track interns receive intensive training in working with rural and
underserved children and adolescents and their families. For half of the
year, they work one day per week at the District 19 Community Services
Board, a community mental health center serving the city of Petersburg and
six nearby counties. Potential experiences include working in the schools
and/or juvenile detention center, co-facilitating prevention and treatment
groups, and providing outpatient individual and family psychotherapy. At
the same time, interns spend one-and-one-half days each week at Woodville
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Elementary School, a part of Richmond Public Schools. Woodville Elementary
is located in the highest poverty, highest crime area of Richmond. Interns
conduct classroom observations, provide consultation to teachers and
administrators, and offer psychoeducational groups for teachers and
parents. In addition, interns provide mental health evaluation and
treatment services onsite to students and families at the school.
The other half of the year, Public Track interns work on the acute
inpatient unit at VTCC to develop expertise in working with children and
youth with a broad range of acute psychiatric problems. Throughout the
entire year, Public Track interns see individuals and families in outpatient
psychotherapy at VTCC. This training track is funded by the state of Virginia
and Public Track interns must repay the state by working in a community
mental health center in an underserved area of Virginia for one year after
completing their internship.
Prospective interns are encouraged to select the track that best matches
their interests and that best meets their training needs. Internship offers are
made for positions in a specific track, and interns apply to one of the three
tracks.
Each year psychology faculty poll interns to learn how many hours they
are putting into their internship experiences. Interns most recently reported
an average workweek of 50 hours. Time is generally proportioned as
follows: delivering clinical services (55 percent); attending treatment related
meetings (15 percent) and seminars (10 percent); receiving clinical
supervision (10 percent); and providing case management (10 percent).
Interns are involved in a wide range of activities in the programs described
on the following pages.
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Inpatient Clinical Programs
All interns participate on multidisciplinary teams that treat children and
adolescents admitted to the acute, residential and day treatment programs.
Interns function as primary therapists on assigned cases. The primary
therapist is the executive of a team of mental health professionals, providing
intensive individual and family therapy, consulting with psychiatrists
regarding medication, and developing and implementing an effective
treatment program and discharge plan. The primary therapist also is
responsible for behavior management consultations, community liaison
work, case management and case advocacy.
Acute Care Program
The Acute Care Program offers the greatest degree of structure and
therapeutic intensity for children and adolescents in need of short-term
intensive inpatient treatment. The interdisciplinary team at VTCC provides
superior diagnostic and psychopharmacologic evaluations and seeks to
quickly stabilize acutely affected patients.
Upon the child’s admission to the hospital, an interdisciplinary treatment
team joins with the family to evaluate him/her and develop an individualized
treatment plan. A primary therapist is assigned to monitor the child’s
progress during hospitalization. The treatment team works with the family to
stabilize the child and provide a smooth transition back to the family, school
and community environment. Active case management is a priority, and the
program’s emphasis is on stabilization and linking the child and family to
community services. Acute hospitalization generally lasts for three to seven
days.
Residential Treatment Program
The residential treatment unit offers a longer-term structured program
designed to serve school-aged children and adolescents, through age 17,
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who have long-standing emotional, behavioral, and psychiatric problems. A
primary focus of the program is family and community reintegration.
Treatment strongly emphasizes the development of coping and life skills to
help the child make a successful transition back into the community. The
program provides a 24-hour inpatient level of care in a therapeutic setting.
Day Treatment Program
The Day Treatment Program is designed for children and adolescents who
are able to continue living safely at home but who need more structure and
therapeutic support during the day than their schools and communities can
provide. Children and their families receive educational services,
psychotherapy services, and medication management at VTCC
The Residential Care and Day Treatment Programs are administratively
combined as the Extended Care Unit and include the following components:
• Comprehensive assessment to determine treatment needs and provide
diagnostic formulation
• Psychological evaluation
• Psychiatric evaluation
• Case management to coordinate with community agencies and schools
• Medication evaluation and monitoring
• Individual, family and group therapy
Evaluation Program
The Evaluation Program is a residential program that offers diagnostic
assessment services to assist communities in evaluating the emotional,
cognitive, behavioral and social needs of children and adolescents and to
develop intervention approaches to meet those needs. Psychology interns
assist in providing psychological evaluations to children and adolescents
participating in the VTCC evaluations program. There are two types of
evaluations:
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a) Brief Evaluation: Brief evaluations take 15 days. During this
period, the child/adolescent receives the same services available in
the residential program. In addition, the child/adolescent receives
a psychiatric evaluation, a medication trial if needed, an
occupational therapy screening, focused psychological testing, and
a curriculum-based assessment.
b) Standard Evaluation: Standard evaluations take 30 days. In
addition to the services available in the residential program, the
child/adolescent receives a psychiatric evaluation and history,
medication evaluation/re-evaluation, an occupational therapy
evaluation, a psychological evaluation, and an educational
evaluation.
Weekend On-call Duties
All therapists, including psychology interns, rotate through a weekend oncall
schedule to be available for crises or inpatient admissions. Interns serve
as therapist on-call for no more than four weekends per year.
Outpatient Clinical Programs
VTCC Outpatient Clinic
VTCC operates a large outpatient clinic serving children, adolescents, and
families from the Richmond metropolitan area. Public Track interns carry a
caseload of approximately four outpatient cases, providing individual and
family therapy and case management services. Participation in the clinic
provides additional opportunity for longer-term treatment and exposure to a
broader range of psychopathology.
The Outpatient Services Program offers a wide range of assessment and
treatment services for children and adolescents and their families.
Outpatient care reflects a family-focused philosophy emphasizing
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collaboration between the family and clinical staff. Program goals include
providing the clinical support and treatment needed for the child and the
family while they remain within their communities, and providing support
and follow-up for children and adolescents who have been discharged from
more intensive treatment programs.
Pediatric Consultation and Liaison Service
Interns in the Pediatric Consultation and Liaison Service (C&L) provide
clinical evaluation and intervention services to pediatric medical patients
hospitalized at VCU Medical Center who have psychosocial difficulties that
interfere with medical treatment. Trainees from both psychiatry and
psychology participate in this service. Medical teams refer patients who
demonstrate emotional, behavioral or psychiatric problems. The trainee’s
role is to assess the youth’s needs and to provide any immediate, short-term
intervention. Trainees are also on-call one day each week to the hospital’s
pediatric emergency department to assist in the evaluation of children and
youth, to contribute to decisions about safety, and to make
recommendations regarding hospitalization. Interns also serve as mental
health consultants to a pediatric craniofacial anomalies clinic within the
hospital. A multidisciplinary C&L team meeting is held each week. At this
meeting, trainees receive clinical supervision and participate in discussion
about C&L issues. Hospital track interns participate in the C&L service for a
year-long period.
Chesterfield County Community Mental Health Center
Chesterfield Mental Health Center is a community mental health center
offering an array of outpatient services a suburban setting located 20
minutes south of VTCC. The setting provides Community Track interns with
an opportunity to learn about the challenges and rewards of working with
children and adolescents and their families in a community mental health
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center context. Interns have opportunities to utilize a variety of therapeutic
approaches, from brief, solution-focused interventions to play therapy to
supportive therapies. In addition to this direct service, collateral services
include case management and consultation with agency colleagues and
professionals in the community. Interns in the Community Track spend 17
hours a week at Chesterfield, including one evening to accommodate family
work. They typically schedule 9 to 10 outpatient contact hours each week.
Assessment Service
Referrals for psychological evaluations are managed by the Psychology
Assessment Service and assigned to interns on a rotating basis. Referrals
come from any of the VTCC units, including the outpatient clinic. Interns
receive weekly supervision in intellectual and personality assessment and
conduct an average of one evaluation per month.
Group Therapy
There are opportunities to learn about and provide group therapy during
the internship year at VTCC. A variety of groups are provided to children and
adolescents across VTCC’s clinical programs. Interns have the opportunity to
participate in one or more of these groups during the year as process
observers and co-leaders. In recent years, the following groups have been
offered:
• Adolescent Process Group
• Survivor Groups
• Social Skills Groups
Supervision
When interns enter the training program, they are assigned a preceptor
who serves as a primary support and liaison to the faculty. Each intern’s
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preceptor provides supervision and mentoring throughout the year and
coordinates clinical activities for the intern.
On-site supervisors are available for all of the clinical experiences that
involve psychology interns. Interns receive at least three hours of individual
supervision weekly. Therapy rooms are equipped with one-way mirrors and
video equipment to allow video-recording of sessions and live supervision,
and faculty members emphasize observation and review of video for training
purposes.
The psychology training faculty shares a general family and systems
perspective on the patients seen at the treatment center; however, they
utilize a variety of psychotherapeutic approaches to facilitate changes in the
system. These approaches include family therapy, cognitive behavioral
therapy, play therapy, and others. The intern will be provided with the
opportunity to use all of these approaches, as appropriate to the needs of
their patients.
Seminars and Clinics
A variety of didactic and experiential seminars are offered to interns at
VTCC. These include:
Family Therapy Seminar
This seminar presents a multisystemic model of family therapy and
reviews structural, strategic, Bowenian and other therapeutic approaches.
Other topics in family therapy are offered depending on the interests and
training needs of the interns. The seminar includes didactic and experiential
training in the summer months and, for the remainder of the year, is
devoted to live group supervision of family therapy cases in a family therapy
clinic forum described below.
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Family Therapy Clinic
The Family Therapy Clinic provides an opportunity for trainees and
clinical supervisors to learn more about families and how to help families
make healthy changes. The clinic utilizes a live-supervision model in which a
trainee works with a family in one room and the family therapy team views
the session through a one-way mirror and offers live consultation from an
adjacent room. Trainees participating in the Family Therapy Clinic include
the disciplines of psychology, social work and psychiatry. A licensed clinical
psychologist and a licensed clinical social worker provide supervision.
Individual Therapy Seminar/Supervision Seminar
This twice-monthly seminar has a brief didactic component but is
primarily experiential. Faculty members present an overview of models of
change in psychotherapy and clinical supervision. Each intern presents an
individual therapy case, including video-recorded therapy sessions, twice
during the year for peer review. Toward the end of the year, interns also
have the experience of supervising a case presentation and discussion. The
goals for the seminar are:
• To provide didactic and experiential instruction in looking at relationship
and process-oriented dynamics in individual psychotherapy.
• To address a need for training in long-term therapy.
• To learn how to provide constructive supervision.
• To develop a cohesive and supportive peer group to talk about cases.
Assessment Seminar
The assessment seminar provides interns with the opportunity to refine
their assessment and diagnostic skills via an in-depth review of assessment
data. There is an emphasis on projective assessment, particularly the
Rorschach. Although primarily didactic through the summer months, this
seminar emphasizes case presentation, protocol analysis, and discussion for
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the remainder of the training year. Guest lecturers provide training in
specialized areas of psychological assessment, such as assessment of
trauma, assessment of autism spectrum disorders, assessment of substance
abuse, and empirically validated assessment.
Cultural Diversity Seminar
Through this seminar, interns have the opportunity to increase their level
of comfort and sensitivity in working with a diverse population. Generally,
we feel more at ease with the familiar, so working with people from different
cultural backgrounds challenges us to address issues of difference. The
Cultural Diversity Seminar is based on the premise that we become more
adept at meeting these challenges if we have opportunities to contemplate
and practice talking with one another about how differences influence
interactions and communication with team members and clients. We also
develop our skills by exploring our own cultural heritage and the ways we
are influenced by our unique histories. Through this process, we sometimes
become aware of long-held biases and stereotypes that we might wish to
question.
This 6 session, 90-minute seminar is experiential and discussionoriented,
and includes both psychology interns and psychiatry fellows,
allowing for a multidisciplinary experience. This seminar is offered at the
beginning of the training year to form a basis for discussion of diversity
issues in other seminars and in clinical supervision throughout the year.
Family of Origin Seminar
The Family of Origin Seminar provides a day-and-a-half long opportunity
for psychology interns and psychiatry fellows to explore the family issues
they bring to the therapy process. The first day of this training is designed to
offer trainees the opportunity to share information about their own families;
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the second half-day focuses on the clinical relevance of family of origin
issues. In this confidential seminar facilitated by adjunct faculty, interns are
encouraged but not required to explore and share their own family of origin
issues with the lens of the family therapist and as they relate to their clinical
work.
Play Therapy Seminar
This daylong seminar is a fun training day with a focus on play therapy
with children. The day involves a combination of lectures, viewing videotapes
and discussion. Interns are introduced to theories about the curative factors
of play therapy, the stages of traditional nondirective play therapy, as well
as several structured play therapy interventions.
Treatment of Trauma Seminar
This seminar on the treatment of trauma in children and adolescents
begins with two day-long sessions that include didactic material, skills
training, and experiential exercises. The seminar is designed both to provide
interns with skills and exercises that can be applied immediately in their
work with children and to introduce them to advanced areas for further
exploration and training. The content of the workshop includes information
about Dialectical Behavior Therapy (DBT), relaxation skills, an introduction
to Eye Movement Desensitization and Reprocessing (EMDR), and specialized
play therapy with traumatized children. The Treatment of Trauma seminar
also meets monthly to provide additional training in evidence-based
treatment of trauma, including Trauma-Focused Cognitive Behavioral
Therapy, Abuse-Focused Cognitive Behavioral Therapy, and Seeking Safety.
Community Mental Health Seminar
The Community Mental Health seminar meets monthly to address issues
in providing services to children and families in underserved rural and urban
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areas. The seminar addresses such areas as working in systems of care,
behavioral health structures and funding, working with the foster care
system, and mental health advocacy. Guest lecturers from underserved
rural and urban areas help to give the participants a well-rounded view of
different approaches to working with the underserved and the development
of local systems of care.
Ethics Seminar
Two seminar sessions in the summer months are devoted to issues related to
professional ethics. The seminar includes a review of the American
Psychological Association Ethical Principles of Psychologists and Code Of
Conduct, with particular attention to issues likely to arise in a child mental health
facility. A second session focuses on recent developments in the literature on
professional ethics and psychology.
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