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Adult clinical and health psychology track

Internship is a pivotal year of transition from student to professional. Broad-based training is at the heart of our program, with an emphasis on clinical health psychology and integrated care. Adult clinical and health psychology interns will work consistently and collaboratively with other members of healthcare teams, play a critical role in interdisciplinary meetings and clinics, and be exposed to a wide variety of clinical populations and presentations throughout the training year. Interns on this rotation will also attend a series of evidence-based treatment seminars designed to aid interns in the development of knowledge and skill in the gold standard treatments for the most common behavioral and clinical health concerns. See the educational seminars information below for details.

For academic year 2020-21, we are adding two adult track positions to the four existing ones at Geisinger Medical Center (GMC) in Danville, Pa. These new positions will be primarily located in our northeast region (Wilkes-Barre/Scranton), which is a metropolitan area located approximately 60 miles northeast of Danville. The clinical experiences will be the same as those offered at GMC; however, interns located in the northeast will have greater opportunity to provide consultation, assessment and therapy to patients diagnosed with cancer at the Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center. Adult interns located at both the GMC and northeast regions are still within the same internship track and receive the same didactic seminars and other training opportunities as one cohort. Therefore, there is no separate APPIC code (all adult track applicants will use 153013). Applicants should state a preference for the primary region of their clinical experiences in their APPIC application, but interns with a strong psycho-oncology interest will be prioritized for the northeast location. 

Clinical experiences

Brief outpatient therapy clinic
Interns spend approximately one day per week throughout the training year providing evidence-based assessment and intervention in Geisinger’s Outpatient Psychiatry Clinic. Referrals are selected for interns to ensure a varied and to some degree, tailored, training experience. Supervisors learn about interns’ clinical interests and training needs at the start of each six-month rotation to inform the section and scheduling of cases. We aim for all interns to gain experience in providing evidence-based treatment for the mood and anxiety disorders, suicidality, posttraumatic stress disorder, obsessive compulsive disorder, insomnia and grief/end of life issues. We also distribute a wide variety of clinical health psychology referrals across interns’ schedules, with each intern’s specialty interests in mind. These include referrals for chronic pain conditions, chronic illness and related issues, weight management and disordered eating, and functional neurologic disorders.

Because interns will be coordinating care with other providers and services within the psychiatry department, at the beginning of the year, they will have the opportunity to shadow licensed clinical social workers in our Intensive Outpatient (partial hospitalization) Program, a psychiatrist performing electroconvulsive therapy (ECT), a team meeting on one of our inpatient psychiatry units, and outpatient medication management with an advanced practitioner or psychiatry resident. These experiences will give interns a sense of the mental health resources available within our system and an introduction to colleagues they will be working closely with through the year.

Clinical health rotations

Pre-surgical evaluations
Pre-surgical evaluation is a critical skill for clinical health psychologists, so all interns will receive training in bariatric surgery and/or spine surgery evaluations throughout the year. Given the volume of surgery cases for each of these specialties done at Geisinger each year and the yearlong nature of the experience, adult clinical and health psychology interns graduate with significantly greater knowledge and more experience with pre-surgical evaluations than most, giving them an edge when applying for clinical health postdoctoral fellowships and early career positions in healthcare.

Interns will be given a choice of pre-surgical evaluation training experiences, with an option available to participate in both.

Bariatric surgery evaluations
Geisinger is a Center of Excellence in bariatric surgery and performs up to 500 surgeries per year across the Geisinger’s service area throughout central and northeastern Pennsylvania. Clinical health psychologists are integral members of the multidisciplinary team, which also includes surgeons, physicians, advanced practitioners, nurses, dieticians and an exercise physiologist. This cohesive team meets monthly to ensure coordinated care for patients and to review and update guidelines for the comprehensive program offered to all patients. Psychologists participate in patient education, behavioral coaching for patients preparing for life after surgery, and offer individual and group therapy for pre- and post-surgical patients.

The pre-surgical psychological evaluation typically occurs after patients have gone through a four-month long education process, during which time they have worked with the nutrition and weight management team to reach a pre-surgery weight loss and make required health behavior changes. All patients are required to undergo an evaluation and meet specific guidelines before they are considered ready to proceed with surgery from a behavioral perspective. For patients with complex mental health histories or other complicating factors, the evaluation may be conducted over a series of appointments and in coordination with other providers within and outside Geisinger.

Interns with special interest in weight management and bariatric surgery will have the opportunity to lead and co-lead educational and cognitive-behavioral therapy groups for bariatric surgery candidates and post-surgical patients, attend monthly multidisciplinary meetings, and collaborate with the Geisinger Obesity Research Institute on a clinical research project with the potential of leading to a presentation at a national conference and/or publication.

Spine surgery and spinal cord stimulator evaluations
Geisinger is also a Center of Excellence for spine surgery and is widely recognized for ProvenCare Lumbar Spine, an innovative program that standardizes high quality care and focuses on patient outcomes. Clinical health psychologists work closely with neurosurgery and pain medicine to identify patients who are most likely to benefit from spine surgery and spinal cord stimulator implants and to coordinate interdisciplinary care with primary care providers, physiatrists, physical therapists and other medical specialties.

All patients being considered for neuromodulation therapy (e.g., spinal cord stimulator) or for certain spinal procedures are referred for the pre-surgical psychological evaluation, which we view as an opportunity to provide patients education on the biopsychosocial model of pain and discuss behavioral pain management strategies that may be incorporated into their multidisciplinary treatment plan. As in all aspects of the behavioral pain services we deliver, data are collected, which means that interns with research interest in chronic pain and spine surgery have an opportunity to create a clinical research project that could lead to a presentation at a national conference and/or publication.

Integrated primary care
Each intern will have the opportunity to spend at least six months, one day per week in one of several Geisinger primary care clinics, providing brief behavioral intervention for a wide range of referrals, taking warm-handoffs from primary care providers and collaborating with multidisciplinary teams. Given our aging and increasing chronically ill population, interns will receive a number of health psychology referrals and have the opportunity to focus on health behavior change with patients.

Interns with special interest in integrated primary care and/or population health will have an opportunity to participate in ongoing, innovative clinical research and quality initiatives designed to enhance care and access to behavioral services to all patients in our region.

Multidisciplinary cancer clinics
Each intern will have the opportunity to do a six-month, half-day per week rotation in one of several multidisciplinary cancer clinics (options to be determined and will be announced by the time of our scheduled interviews – will most definitely include breast cancer, gastrointestinal cancer and likely others). These clinics begin with a multidisciplinary tumor board to review patients being seen in clinic and is attended by psychologists, surgeons, pathologists, radiologists, nurses, radiation oncologists, medical oncologists and medical residents/students. Following the meeting, each patient consults with several relevant members of the team and is screened for mental health concerns that could impact treatment decisions or response to treatment. Patients with positive scores on evidence-based screening tools or with other potential concerns based on chart review and team discussion will meet for consultation with the psychologist or psychology intern, at which time psychoeducation, treatment recommendations and or resources are provided to the patient and family as needed. Patients living locally and seeking follow up may be offered services in the brief outpatient therapy clinic.

Interns with strong interest in psycho-oncology may request primary clinical placement in our northeast region, as they will have greater opportunity to provide ongoing clinical care to individuals diagnosed with cancer and their families under the supervision of Dr. Brittany Williams, a behavioral medicine psychologist specializing in psycho-oncology.

Interdisciplinary specialty care clinic

Each intern will spend two mornings per week for six months working as a member of one of the following integrated specialty care clinics. Both experiences will primarily be based in outpatient clinics providing brief consultations and behavioral interventions; however, interns will have an opportunity to provide some inpatient consultations as well.

Women’s health
Interns on this rotation provide assessments and short-term targeted interventions for insomnia, sexual dysfunction, antenatal and post-partum anxiety and depression, chronic pelvic pain, infertility, interfering health behaviors, and adjustment to major life transitions (childbirth, menopause). Interns will also provide inpatient consultations on the inpatient labor and delivery service for patients experiencing lengthy hospital stays due to pregnancy complications and provide stress and anxiety management strategies.

Adult cystic fibrosis clinic
Funded by a three-year mental health coordinator grant through the Cystic Fibrosis Foundation, clinical health psychology provides mood and anxiety screening, assessment and brief intervention to adults attending quarterly outpatient clinic appointments and bedside consultations while hospitalized for “tune-ups” and disease exacerbations. Interns will be a critical member of this multidisciplinary team, which includes a multidisciplinary meeting with pulmonologists, a nurse coordinator, a respiratory therapist, a dietician and a social worker.

Elective clinical opportunities

Functional neurologic condition/psychogenic none-epileptic seizure clinic
All interns will likely get some exposure to functional neurologic conditions during the year, but those who are interested in gaining a deeper understanding of the biopsychosocial factors contributing to them and evidence-based cognitive-behavioral therapy (CBT) intervention for their treatment can dedicate a half-day per week for six months to working with these referrals from Geisinger neurology’s accredited Level IV Epilepsy Center.

Transdiagnostic Acceptance and Commitment Therapy (ACT) Group
Interns interested in getting a deeper understanding of ACT and its implementation in a group therapy format have the opportunity to co-lead this weekly group for individuals who are struggling with anxiety, depression and other forms of suffering.

Women’s Group
Interns interested in learning group management skills and how to apply cognitive-behavioral therapy (CBT) in a group format have the opportunity to co-lead this weekly group for women with adjustment, relationship, mood and anxiety concerns.

Educational seminars
During orientation and over the first month of clinical training, adult track interns attend a series of trainings in clinical skills. These include:

  • Motivational interviewing (attended with child and neuropsychology tracks)
  • Suicide risk assessment and intervention (attended with neuropsychology track and first-year psychiatry residents and involves simulated interviews with standardized patients and direct observation/feedback)
  • Cognitive behavioral therapy for insomnia (CBTi)
  • Cognitive behavioral therapy for chronic pain
  • Cognitive behavioral therapy for psychogenic non-epileptic seizures
  • Exposure-based therapies for PTSD
  • Collaborative assessment and management of suicidality (CAMS)

In addition, interns will attend eight hours of didactic seminars per month on a variety of clinical topics focused primarily on adult populations and professional development topics. Topics include but are not limited to:

  • Cultural awareness
  • Ethical and legal practice series
  • Psychopharmacology series
  • CV preparation, postdoc/job applications, interviews and salary negotiation
  • LGBTQ affirmative assessment and therapy
  • Acceptance-based therapy approaches
  • Healthcare reform
  • Neurocognitive screening
  • Adult ADHD assessment and CBT for ADHD
  • Integrated primary care
  • The aging brain
  • Substance abuse/addiction

Adult clinical and health psychology and neuropsychology interns also attend a weekly Biopsychosocial Case Conference designed to discuss challenging clinical cases from a biopsychosocial approach.

Supervision

In accordance with APA accreditation requirements, all interns are provided four hours of supervision per week. Adult clinical and health track interns receive at least two hours of individual therapy per week and are assigned a primary supervisor, who will often serve as research preceptor as well. Additional individual supervision is provided within specific rotations. In addition, the Biopsychosocial Case Conference, counts as one hour of weekly group supervision. The final of the four hours is provided in a separate group supervision format, the agenda of which will be determined by the cohort and led at times by the training co-director, Dr. Campbell, to discuss general issues related to the internship.

Clinical research, quality improvement and program development

Adult clinical and health psychology interns are provided four hours of dedicated time per week to participate in an ongoing project or, in some instances, initiate a small project with existing data. Interns will work with their supervisors to determine an intern’s readiness to take on a project once they demonstrate proficiency with clinical and administrative responsibilities.

“Adult clinical and health psychology interns receive the specialized clinical training and professional skills they need to hit the ground running in the next stage of their career as a psychologist in healthcare. The growth I see in our interns year after year is truly inspiring and the reason I love my role as an educator and mentor."