Behavioral Pain Management
Fellows have the opportunity to engage in clinical work at all levels of pain management within our system, from primary care-based interventions to specialty consultation in pain medicine, perioperative pain management, multidisciplinary clinics and neurosurgery. Clinical pain management services include conducting initial assessments and evaluations, collaborating with patients to improve treatment readiness, compliance and treatment planning/goals, providing evidence-based behavioral medicine treatment in individual and group formats, as well as leading psychoeducational lectures within various multidisciplinary clinics. Fellows also conduct evaluations on pre-surgical candidates within our unique Destination Spine program and pain medicine for spinal cord stimulators.
Fellows will also be very involved in the provision of programs aimed at supporting and educating primary care and specialty medicine providers and staff, as well as helping to develop further programming to promote chronic pain self-management throughout the system.
Primary Care Behavioral Health
We are currently offering four positions in our Adult Primary Care Behavioral Health Program (PCBH). The primary care clinics are family practice clinics, general internal medicine clinics, or a combination of the two. Primary care psychologists (and those in training) are viewed as valuable team members and are consulted for a variety of concerns, including depression, anxiety, acute stress disorder, smoking cessation, weight loss and treatment adherence for chronic diseases such as COPD, heart failure and diabetes. Fellows will provide targeted, evidence-based care through warm hand offs and brief episodes of treatment. Fellows collaborate with attending physicians, residents, psychiatrists, advanced practitioners, medical case managers, nursing staff and medical pharmacists routinely to deliver comprehensive, quality care to patients. Attendance at team huddles, provider meetings, and Medical Home meetings add additional interdisciplinary, team-based care opportunities.
Trauma Surgery, Adult ICU, and Physical Medicine & Rehabilitation
The fellow selected for this track will spend his or her time primarily in the inpatient setting, functioning in a consultation-liaison role, seeing adult patients in the medical, neuroscience, cardiac, surgical and trauma intensive care units (ICUs), and medical-surgical floors. Time will be split between work with trauma surgery patients and critical care patients. For both rotations, the fellow will function as a member of the care team, working with residents, fellows, medical students, midlevel providers and staff physicians to meet the needs of patients. Trauma surgery will involve work with patients admitted to our level one trauma center with traumatic and life-altering injuries, to screen for acute distress and coping, substance-related concerns and to facilitate additional treatment, as needed. In the medical, cardiac, surgical and neuroscience ICUs, patients are primarily seen for assessment and management of delirium, though patients with acute anxiety, acute and posttraumatic stress symptoms, or mood difficulties that interfere with or hinder medical care are also seen. Capacity evaluations are conducted when needed. The fellow will engage in chart review, screening, rounding, assessment, consultation, bedside intervention with patients and family members, psychoeducation and referral for appropriate follow up treatment. The fellow will also be involved in a post-ICU survivorship clinic, where patients are seen following ICU stay for assessment of post-intensive care syndrome concerns, as well as in the trauma follow-up clinic, on a case-by-case basis. Some time will be spent weekly conducting outpatient psychotherapy with patients that transition to outpatient care for difficulties following hospitalization. This will include evidence-based treatment for adjustment disorders, acute and posttraumatic stress, depression or anxiety. Close, collaborative work with medical teams, opportunities for informal and formal training of residents, fellows and medical students are important aspects of work in this track. The fellow will also be encouraged to participate in conducting research, including quality improvement projects and translational research. Several projects are already currently underway. The focus of this specialty track is on helping the postdoctoral fellow to develop skills to work as an inpatient, consultation-liaison psychologist with critically ill and injured adults. In addition, this track will help facilitate further knowledge and understanding of the role of medical/surgical, neurological and psychiatric factors and comorbidities and their relationship to delirium and recovery following an ICU stay. The fellow will become familiar with acute and long-term sequelae of delirium and severe trauma.
The psychology fellow will also have the opportunity for a minor rotation in a physical rehab setting, on the Danville campus. Geisinger Encompass Health Rehabilitation Hospital, Geisinger’s affiliated rehabilitation hospital with Encompass Health, serves the post-acute needs of individuals recovering from varying injuries and insults such as traumatic brain injury, stroke, brain surgery and medical delirium, as well as offers opportunities to be a part of joint commission disease specific (i.e, “stroke,” “brain injury,” “Parkinson’s disease,” “orthopedics”) certification programs that are based on up-to-date Clinical Practice Guidelines (CPGs). This setting is multidisciplinary in nature and postdoctoral fellows will have the opportunity to attend treatment team rounds and be an integral part of team conferences, as well as serve as liaison with medical professionals (mainly physiatry, pharmacy) and other allied disciplines, such as speech and language pathology, occupational therapy and physical therapy. There is also the opportunity to work alongside therapy specialties, providing co-treatment to more complex and behaviorally challenging individuals.
In this setting, postdoctoral fellows will continue to gain experience in bedside cognitive assessment, develop behavioral management strategies and carry out routine mood assessments and the delivery of brief therapeutic interventions, if needed, in order to assist treatment team in providing optimal personalized care to the individual and their family members. Additionally, there are five ongoing support groups (i.e., brain injury, stroke, amputee, Parkinson’s disease, spine) that postdoctoral fellow may wish to be involved in co-leading.
This post-doctoral fellowship is conducted within the Women’s Health Pavilion at Geisinger Medical Center in Danville, Pa. Medical specialties include OB, gyn, maternal fetal medicine, infertility, urogynecology and gynecological oncology. Inpatient services include labor and delivery and NICU care.
Based on an integrated care model, the fellowship provides intensive experience in assessing and providing short-term, targeted behavioral and cognitive interventions to a wide variety of patients. On the outpatient side, the fellow assesses and treats insomnia, sexual dysfunction, antenatal and post-partum anxiety and depression, chronic pelvic pain, infertility, interfering health behaviors, adjustment to major life transitions (childbirth, menopause) and perinatal loss. The fellow also consults on the inpatient Labor and Delivery Service for patients experiencing lengthy hospital stays due to pregnancy complications (e.g., premature rupture of membranes, preeclampsia) and provides stress and anxiety management strategies. In addition, the fellow staffs the more traditional mental health clinic up to four hours per week, thereby having the opportunity to carry a small case load of longer-term patients.
Optional rotations include staffing the multidisciplinary clinics for breast cancer and inherited risk for breast cancer.