CORE TREATMENT ROTATIONS

Outpatient Level of Care (equivalent of one day, full year)

Interns are expected to carry a minimum caseload of four to five clients in this core rotation, throughout the year. However, interns must carry a total of approximately 10 cases at any one time throughout the year (including core and elective experiences), so they may choose to pick up more than five cases from this service. Interns are responsible for treatment for their clients, as well as case management and maintenance of appropriate documentation, including treatment plans. By the end of the year, interns are expected to prepare treatment plans that require minimal correction. In addition to training in therapeutic interventions, interns gain experience advocating for clients. Interns also gain experience consulting with professionals, agencies, and systems that impact on clients, e.g., child or adult protective services, school systems, legal system, medical professionals. Interns may complete their age distribution requirement in this rotation (geriatric or early childhood) by carrying at least one outpatient case in the designated age group.

As part of this experience, interns participate in a weekly, interdisciplinary team meeting. In all settings for this experience, interns work under the supervision of licensed psychologists, with whom the decisions about treatment interventions are made, and receive one hour of individual supervision per week. Psychiatric evaluation and management is available, and interns work collaboratively with psychiatrists and other team members.

Child track interns complete this rotation in the Child and Adolescent Outpatient Service (ages 3-17). This unit provides treatment for children with varying levels of disturbance. Clients present with a wide range of problems including family dysfunction, histories of trauma, depression, anxiety, conduct disorder, attention deficit hyperactivity disorder, psychotic disorders, learning difficulties, acculturation problems, and substance abuse. After an initial psychosocial evaluation, clients are assigned to an intern who develops, implements, and coordinates the treatment. Depending upon the age of the client and his/her needs, treatment may be more individually focused or more family focused. The decision as to treatment interventions is made by the intern and supervisor, in collaboration with the client and his/her family. Psychiatric evaluation and management is available as needed, and interns learn about the role that psychotropic medication plays in treatment. Interns are expected to engage in outreach activities as demonstrated by at least two home visits and at least two school visits during the year. Child track interns also participate for one semester in the intensive outpatient program, in which children are either “stepping up” or “stepping down” to partial care.

Adult track interns may complete this rotation in one of two settings. They may work within the Adult Outpatient Services of UBHC in Newark, where they will see a range of clients with a variety of presenting problems representing the full adult age spectrum. Or, they may work within University Correctional HealthCare (UCHC), the mental health service delivery system for the state prisons. In that case, interns can give their preferences as to one of three prison settings in which to work: Northern State Prison (for men), Edna Mahan Correctional Facility for Women, or the Adult Diagnostic and Treatment Center (for sex offenders). Within Northern State and Edna Mahan, clients present with a wide range of difficulties and diagnoses, and interns in this setting assess clients, and develop and implement a treatment plan. At the Adult Diagnostic and Treatment Center, interns learn a more specialized approach to this particular clinical population of repetitive and compulsive sex offenders. Nonetheless, in additional to their history of sexually offending behavior, these clients also bring a range of other difficulties which are addressed. UCHC is the setting in which the forensic sub-track intern completes this core outpatient experience.

Partial Hospital Level of Care (For child interns: equivalent of 1.5-2 days, 6 months; for adult interns: equivalent of 1.5 days, full year)

Partial hospital - milieu treatment programs provide a very different kind of experience than do out-patient services. Within these units, interns learn to work as part of a multi-disciplinary team, all of whose members are responsible for carrying out at least some elements of the treatment plan. In addition, milieu treatment programs typically have complex structures that interns must learn to manage and work with.

Child track interns gain this experience in the Child and Adolescent Partial Program, or Challenge Program. The Challenge Program is a comprehensive half-day, after-school, partial hospitalization program for children and adolescents ages 5-18. One of the classrooms is also full-day with an academic component. Children in this program have typically been psychiatrically hospitalized or have been in residential placement or are at risk for such in-patient settings. This is a uniformly seriously emotionally disturbed group of children, almost all of whom are on psychotropic medication. Many are receiving special educational services. All children in this program receive individual and family therapy in addition to group and milieu services. In this setting, the interns are assigned two individual cases and work more intensively with these two families twice a week. In addition, interns participate in the milieu setting one to two afternoons per week. Interns have opportunity to work as members of a milieu team composed of several clinical staff members who work with the same client. Interns also participate in a weekly, interdisciplinary team meeting. Supervision is provided individually by the Clinician Supervisor of the unit.

General adult track interns complete a 12-month rotation, which may be divided among two different milieu treatment settings as listed below. The forensic sub-track intern completes this rotation in one of the University Correctional Health Care Residential Treatment Units (described below).

Partial Hospital Program for Severely Mentally Ill

This program provides clinical case management and rehabilitation services for clients with a history of severe and persistent mental problems. Treatment occurs within a therapeutic community that establishes a safe, supportive environment in which clients can maintain or improve their functioning. Clients typically attend five days a week from 9:00 a.m. to 3:30 p.m. They participate in clinical groups, illness management and recovery groups, and pre-vocational work activities related to food services, engraving, and clerical projects. These activities prepare clients for responsible roles in the community. Opportunities for interns include co-leading psychotherapy groups and psychoeducational groups, and participation in other aspects of the milieu treatment program.

This program also has a MICA track for clients presenting with severe and persistent mental illnesses and comorbid substance use disorders. Clients may participate in 12 step-oriented groups as well as dual diagnosis groups, which provide integrated treatment approaches to address mental illness and addiction concerns. Treatment integrates psychiatric and daily partial care with the twelve-step model used in Alcoholics Anonymous and Narcotics Anonymous meetings. Group treatment is an important modality in this elective rotation, and interns have opportunities to co-lead psychotherapy groups and psychoeducational groups.

The acute component of the adult partial hospitalization program treats clients presenting with acute psychiatric symptoms. Typically clients are in crisis and may be suffering from acute psychotic, depressive, or manic episodes. Most clients referred have been recently discharged from inpatient psychiatric wards and are having difficulty maintaining stability after their return to a stressful community environment. The structure and relative safety of the day hospital's therapeutic environment can restore stability and prevent re-hospitalization. Interns in this rotation may conduct individual and group psychotherapy. The acute partial hospital makes extensive use of group therapy, and so the intern can design and run groups of various types, e.g., dual diagnosis groups, relapse prevention groups, illness management and recovery groups, and psychoeducation groups.

University Correctional HealthCare Residential Treatment Units (RTU) and Transitional Care Units (TCU)

Within the prison setting, seriously mentally ill inmates are treated in the Residential Treatment Units, and are separated from the general population. The RTU and TCUs provide structured psychosocial rehabilitation and psycho-educational programs, with individual and group counseling, supportive therapeutic activities, and psychiatric and medication monitoring. Like the patients in UBHC’s Adult Extended Partial Hospitalization Program, inmates in the RTUs suffer from severe and persistent psychiatric disorders, and typically stay more than a year. There are RTU and TCUs both at Northern State and at Edna Mahan Correctional Facility for Women, and interns may elect to work in one.

Group Treatment (one time limited group)

All interns are expected to participate in leading or co-leading at least one group therapy program during the course of the internship year. This requirement can be met in most of the core therapy settings and in many of the elective settings.

Interns can co-lead groups in the Adult Outpatient Services, the Child and Adolescent Outpatient Services or in the Child and Adolescent Partial Care Program, and in the group therapy programs of the Partial Hospital Program for Severely Mentally Ill Adults, the Partial Hospital Program for Mentally Ill Chemical Abusers, the Adult Acute Partial Program, and in the UCHC RTU’s. Finally, as will be noted below, many of the elective experience provide opportunities to participate in conducting group therapy.

On average, inmates’ length of stay on the TCU is less than three months (90 days). Interns in this rotation are the primary therapists and are part of the treatment team which meets on a weekly basis. The ages of the identified patients span the entire adult age range. Interns are responsible for treatment, case management, and maintenance of appropriate documentation, including regular treatment plans.

Supervision for the group therapy experience is typically of an apprentice nature, in that the intern is co-leading a group with a more experienced clinician, with whom the issues in the group are discussed before and after the group meetings. However, there are also opportunities for interns to conduct specialized groups with other interns, and then specific supervisors are assigned for this purpose.

Mock Orals

All interns participate in a mock oral examination in the spring of their internship year. Interns prepare a formal written report on a treatment case that is reviewed with the primary supervisor of that case. Then the intern is assigned to an examination committee of two people, generally one person within the UBHC system who has not supervised the intern’s work and another person who is on the voluntary faculty and not a regular UBHC employee. The oral examination is an opportunity for interns to learn about this process, which is similar to the NJ licensing examination as well as to the ABPP exams. Interns receive feedback on both the written report and their responses to the discussion. Interns cannot “fail” this oral examination, but will receive constructive feedback that may help them in ultimately getting licensed.