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    Training Tracks

    Outpatient Department Core Outpatient Training

    CPMC interns spend most of their time, regardless of their specific training track, in the CPMC Outpatient Department (OPD) and most of the educational offerings are provided in the OPD. After orientation is complete, interns begin to work on various tracks, however all interns spend a minimum of 70% (including didactic seminars) of their time during the entire 12-month training program in the Outpatient Department (OPD). This core training unifies the internship experience and offers broad and general training in clinical psychology. All goals and objectives, regardless of training track, apply to all interns and the program has a unitary training philosophy and model. The goal throughout the academic year is to provide each intern with a caseload of patients that varies demographically as well as diagnostically, (while still allowing opportunities to develop individual interests).

    Description of the Service and Demographics of the Patient Population
    The OPD serves approximately 375-450 patients at any given time during the academic year. The breakdown by sex for the OPD patients is approximately 65% female and 35% male. With respect to age, 65% of the patients in the OPD are adults age 18-64, and 19% of the patients are age 65 and older. Children age 4 to 12 comprise approximately 12% of the OPD patient population, and approximately 4% of the patients are adolescents age 13-17. The OPD’s patient racial and ethnic composition is approximately 54% Caucasian, 20% Asian/Pacific Islander, 14% Latino, 4% African American, and 8% of the patients identify as Mixed. Diagnoses of the OPD patient population range from serious chronic mental illness with psychosis, to patients suffering from depression, anxiety disorders, PTSD, ADHD, as well as other conditions. Interns in the OPD also see generally high functioning patients who are dealing with a stressful life event or wish to pursue psychotherapy in an affordable setting.

    Experiential Activities
    Interns provide a range of clinical services in the Outpatient Department and have the opportunity to work closely with psychiatric residents on many of their outpatient cases. Experiential activities in the Outpatient Department include:

    • Individual Psychotherapy
    • Couples Therapy
    • Intakes and Diagnostic Assessments
    • Crisis Intervention
    • Consultation
    • Psychological assessment
    • Group Therapy
    • Interdisciplinary Collaboration

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    Adult Outpatient Track

    Four interns per year are selected to work primarily in the Adult Outpatient Department. In addition to this core outpatient experience, the Adult Outpatient Track has three areas of concentration for interns to gain experience in specific clinical areas. These areas include Women’s Mental Health, Health Psychology and Program Evaluation.

    Areas of Concentration for Adult Track Interns

    Women’s Mental Health
    One intern works in the Women’s Mental Health and Wellness (WMH) service. This program has been providing essential services in multiple departments within the CPMC hospital system to underserved and at-risk perinatal women. This service provides treatment to women seeking therapeutic support for pre-conception planning, assisted reproduction, miscarriage, infant loss, pregnancy termination, or depression and anxiety during pregnancy and through the first year after delivery. The WMH program provides referrals to a variety of clinical support services for women and their partners including therapy and support groups, individual and couples psychotherapy, and psychiatric services.

    The intern assigned to this sub-track works on the WMH triage line screening callers for perinatal mood disorders. Additionally, he/she provides individual and couples psychotherapy to pregnant and post-partum women and their partners. The intern also works in the hospital’s Neonatal Intensive Care Unit (NICU) providing support and therapy to parents with a baby on that unit. The intern in this area of concentration has the opportunity to collaborate with psychiatrists, OBGYN’s, pediatricians and other health care providers in the care of their patients.

    Health Psychology
    The CPMC Health Psychology Program provides psychological services to patients and families with acute and chronic medical illness. Working in collaboration with healthcare teams, interns assist in evaluation, consultation, standardized screening and behavioral interventions to address a range of psychosocial problems. Psychology services are integrated with existing medical treatment to promote multidisciplinary treatment.

    One intern is assigned to a 24-week rotation on this service and provide an array of psychological services to medical patients (and family members as appropriate). Training experiences generally include brief consultation work, formal psychosocial assessments, cognitive screening evaluations, individual and/or group psychotherapy and educational lectures to patients or healthcare providers depending on the intern’s interests and available opportunities.

    Program Administration and Evaluation
    Two interns are selected to the Program Evaluation track. This track is appropriate for an intern who has an interest in a psychology career that involves administrative, leadership or organizational skills. The functions in this service include caseload assignment and monitoring, serving as a liaison between the intern group and the training leadership team, attendance at various committee meetings, serving as the intern representative on several committees and completing program development/evaluations projects.

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    Child and Adolescent Track

    Five Child and Adolescent interns are selected to work in the Outpatient Department with children, adolescent and adults. They also work in collaboration with the CPMC Child Development Center (CDC). In the OPD, the interns gain experience in conducting outpatient psychotherapy with children and adolescents as well as the opportunity to build their skills in collateral work with teachers, parents and other family members. All interns working in the child track also provide phone screenings and conduct intake evaluations on child patients in the Outpatient Department.

    Child Development Center (CDC)
    Description of the Service and Demographics of the Patient Population
    The CDC is a comprehensive, multi-disciplinary outpatient clinic serving children with a wide array of developmental, learning, and behavioral/emotional issues. The population reflects the enormous diversity of the city of San Francisco including a varied socio-economic and ethnic/cultural mix. The patient population is from age 3 – 17 years of age. The diagnoses include Disruptive Behaviors (including ADHD), Depression or Dysthymia, Anxiety Disorders (including PTSD), and Autistic Spectrum Disorders. Each year there are approximately 20,000 outpatient visits to the CDC. Interns will work with developmental pediatricians, child psychiatrists, speech therapists, educational therapists, physical therapists, and occupational therapists.

    Areas of concentration within this setting include school-based outreach in a preschool or elementary school, pediatric consultation/liaison on medical units, neuropsychological assessment, psycho-educational testing, and psychotherapy in a community clinic. The community sites associated with the CDC provide psychological services to a population that faces issues related to poverty, lack of insurance, poor access to mental health services, community trauma, and immigration.

    Experiential Activities
    Interns working in the CDC provide individual psychotherapy with children and adolescents and also do collateral work with parents, caregivers, teachers, and other providers. There is a strong emphasis on parent involvement, behavioral management, and collateral contact with teachers and other providers.

    • Individual Therapy
    • Family Therapy
    • School-based Interventions
    • Intakes and Diagnostic Assessments
    • Collateral Interventions with Parents
    • Psychological/Neuropsychological Assessment
    • Psycho-educational Assessment
    • Consultation
    • Community Outreach and Advocacy
    • Interdisciplinary Collaboration
    Areas of Concentration for Child Track Interns

    Primary Care
    One intern will work in the Joint Venture Health Program, a collaborative effort between UC Berkeley School of Public Heath, the North East Medical Services, and CPMC. This intern will provide psychological services in a primary care setting serving children and families from low-income families.

    Preschool Outreach
    One intern is selected to provide therapy, psycho-education, and consultation to teachers in a community-based pre-school setting.

    Neuropsychological/Psycho-educational Testing
    One intern will work in conjunction with the Pediatric Assessment Psychologist
    providing assessments to children.

    Community Clinic
    One intern will provide consultation and therapy services at the Marin Community Clinic, a pediatric health clinic for children and families in Marin County.

    Pediatric Consultation Liaison Service
    One intern will provide consultations with providers around behavioral health issues with medical pediatric inpatients. Brief interventions are provided to patients at the bedside as well as support and consultation to their parents. The intern will have the opportunity to participate in multidisciplinary hospital rounds and pediatric Grand Rounds.


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    Adult Inpatient Track

    In addition to the core adult outpatient experience, one intern is assigned to work yearlong on the Adult Inpatient Mental Health Unit (Unit 23). The intern electing to train on this track provides intake evaluations, individual, group, and family therapy and crisis intervention to psychiatrically hospitalized inpatients.

    Description of the Service and Demographics of the Patient Population
    The inpatient setting is a 16-bed locked hospital unit providing 24-hour evaluation, support, stabilization, and treatment for people with a psychiatric illness. Patients on this unit are typically hospitalized for a brief period of time (average length of stay is 5-10 days) and approximately 700 patients are admitted per year. The clinical population for the inpatient unit is drawn from a wide socio-economic spectrum ranging from the poor and indigent to the upper middle class. The demographics by sex are approximately 50% female and 50% male. Patient demographics with respect to race are 45% Caucasian, 30% Asian, 15% African American, and 10% Latino with an age range of 18 and up. 40% of diagnoses are psychotic illnesses, 50% are mood disorders, and 10% are organic disorders. Many of the patients on the inpatient unit also have co-morbid substance abuse diagnoses.

    Experiential Activities
    The psychology intern is an active part of this interdisciplinary team, which also includes attending psychiatrists, psychiatric residents, social workers, occupational therapists, nurses and medical students. In daily rounds, the intern contributes a psychological perspective to the discussions regarding the care and progress of patients and becomes proficient in a medical model of mental health. The intern also facilitates group therapy two times per week and participates in weekly individual and group supervision and case conferences. The intern is regularly assigned a patient, which requires directing the initial interview, collaborating with the team on diagnosis and treatment planning, contacting family members (which may include family sessions), assessing acuity daily, and planning discharge. Interns see their patients in daily psychotherapy sessions. In addition, each of these aspects of the work requires the intern to provide clear, timely communications to all parties and accurate documentation of events, which culminates in the dictation of a discharge summary.

    • Crisis Intervention
    • Individual Therapy
    • Family Therapy
    • Intake and Diagnostic Evaluations
    • Group Therapy
    • Psychological Assessment
    • Consultation
    • Interdisciplinary Collaboration

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