CORE ASSESSMENT ROTATIONS:

Acute/Crisis Evaluations (two months, two half-days per week for adult and child UCHC interns will get ER/acute assessment in the prison setting (stabilization unit)):

Interns in both General Adult and Child tracks spend time working in the Psychiatric Emergency Room housed in University Hospital. Individuals of all ages are seen in this unit for evaluation of possible admission to inpatient psychiatric units. Working alongside psychiatry residents and fellows, interns participate in the assessment of clients who walk in or are brought into the facility in a crisis state. In this context, decisions are made as to whether psychiatric hospitalization is required, whether the client should be seen for several sessions in the crisis clinic, or whether the client should be referred for outpatient services. Adult interns will see predominantly adult patients; child interns will be called when there are children to be seen in the ER. This rotation affords interns the important experience of learning how to assess and intervene in a psychiatric crisis situation, and to develop a level of confidence in their ability to manage such situations. Forensic interns obtain experience with crisis assessment in the prison setting, where decisions about admission to the stabilization unit are made, and initial treatment planning is done.

In addition to seeing ER cases, child track interns will participate with crisis walk-in clinic cases, as well in the work of the Children’s Mobilization and Response Unit, a state funded program designed to provide stabilization services to children and their families, where the child’s behavioral problem presents a risk for disruption of the current living arrangement. Within this unit, staff members respond within one hour to situations in homes and in schools. The threat of disruption to a current living arrangement may be in the child’s birth home, in a kin caregiver’s home, or in a foster home. The unit provides a 72-hour service, and then follows the child and family for up to 8 weeks while additional stabilization resources are put into place.

In both the Emergency Room and the Children’s Mobilization and Response Unit, interns observe the work of more experienced clinicians, gradually assuming more responsibility for direct assessment and intervention in the presence of these clinicians. Supervision is provided both in-vivo and individually as needed.

Outpatient Intake Evaluations (adult interns: rolling to build caseload; child interns: half day twice per week for 2 months):

In this experience, interns learn to take histories, conduct mental status exams, form diagnostic impressions, and formulate cases for the full range of presenting problems from adjustment reactions to major and chronic psychiatric difficulties. Initially, the experience is an apprenticeship one, in which interns participate in joint intake assessments with senior staff, before taking on clients on their own.

Child track interns fulfill this required experience in the UBHC Child and Adolescent Outpatient Service, while general adult track interns fulfill this requirement in the UBHC Adult Outpatient Service. The forensic adult intern fulfills this requirement in one of the prison settings in UCHC. Supervision is initially done in an apprentice fashion, where interns observe and participate in intakes with senior staff. Interns then are given responsibility for conducting intakes independently and provided supervision for this activity. Within the child track, this experience begins with interns first observing senior staff and then conducting intake interviews with new clients and families through the use of our one-way mirror, with the rest of the interns present. There is an opportunity to discuss the cases as well as the various interviewing styles and techniques.

Psychological Testing (half day, full year):

All students are expected to devote an average of one half day per week throughout the year to formal psychological testing. Weekly individual supervision is provided for the testing experience. The testing requirement can be met in several ways, depending upon the skill level and interests of the students.

Because students in different graduate programs have vastly different levels of training and experience in testing, basic skills in testing are assessed by the testing coordinator at the beginning of the internship year. Students who require further training and/or experience to establish these basic skills are provided with testing assignments designed to develop these skills. For interns in the child track, these testing assignments typically come from our Child and Adolescent Outpatient Service or our Child and Adolescent Partial Care Service. For interns in the adult track, the testing assignments come from Adult Outpatient Services, Adult Partial Hospitalization Services, Adult Acute Partial Hospitalization, Adult Inpatient Services, and the Adult Developmental Disability Service. The forensic sub-track intern will have some of his/her testing experience within the prison setting, but may elect to have much of their testing in UBHC as well. Interns may elect to have experiences with the assessment of individuals who are outside their developmental specialization, and non-forensic track interns may elect to have some experience in the prison setting.

If we assess that students have those basic skills at the beginning of the internship year, the required testing rotation takes the form of specialized or advanced testing experiences that are chosen by the intern. Within each of these experiences, we intend to develop basic competencies in the following areas for any student completing our internship program:

• Preparation of written reports that are useful to those receiving them (e.g., parents and teachers, therapists).

• Effective communication of testing results orally to clients, parents, clinicians, and school personnel.

• Preparation of at least two basic reports with minimal correction. Interns receive weekly individual supervision of their testing experience.

Interns who have demonstrated basic skills as a result of our assessment at the beginning of the internship year may continue with general child or adult evaluations, or may select from the following specialized testing concentrations to fulfill their testing requirement:

• Cognitively-focused evaluations:: focused on assessment of learning disabilities, mental retardation, and other special needs, with interaction with schools concerning the educational needs of children. In addition, there are occasional assessments of adults with suspected learning disabilities.

• Emotional/personality-focused testing: interns who wish to gain experience with a range of a combination of objective and projective instruments, including MMPI-2, PAI, thematics, the Rorschach, and drawings, may choose this elective. The focus will be on developing an understanding of clients that will inform treatment interventions. Interns may choose to evaluate child and/or adult clients.

• Neuropsychological assessments: If interns are interested in obtaining some general neuropsychological expertise, they may choose a few cases with this as a focus within UBHC. However, NJMS and University Hospital programs in neuroscience and neurosurgery also provide excellent advanced opportunities for training in neuropsychology, both adult and pediatric. Interns who desire to gain expertise in neuropsychological assessment may elect to do a year-long rotation in neuropsychology through the Neurological Institute. The rotation requires at least one full day a week, and includes a didactic experience with the neuropsychology faculty. Patients for neuropsychological assessment cases are drawn from a wide variety of neurological and psychiatric populations, including head trauma, epilepsy, multiple sclerosis, Huntington's disease, and others. Some inpatient cases call for brief bedside assessment procedures, and other cases require full batteries. Interns from each track can focus on evaluating patients primarily within the age range of their interests.

• Student Affairs: Interns electing this experience focus on examining medical students who present with cognitive and/or emotional issues, and formulating educational and/or treatment recommendations. Occasionally, a case is also picked up for short-term treatment.

• Fetal Alcohol Syndrome Clinic/Child Evaluation Center: Interns focus on the psychological examination of children with fetal alcohol syndrome or other pediatric concerns, as part of a multidisciplinary team. They may occasionally sit in with professionals from other disciplines, such as developmental pediatricians making these diagnoses.

• Chec clinic/Resource home screening evaluations for DYFS (child protective services): Interns participate in screening children who are entering child protective services, and who are often being removed from their homes, and placed into resource homes. These children are screened for their cognitive and treatment needs.