Young Adult Services

Primary Placement:

A full year, 30 hour per week primary placement, which is always combined with a secondary placement in Child & Adolescent Services / West Haven Mental Health Clinic.

Secondary Placement:

Young Adult Services is not available as a secondary placement.

Primary Placement: One or two

Secondary Placement: None

The Young Adult Service is a satellite program of the Connecticut Mental Health Center that provides a comprehensive program of ambulatory psychiatric services to clients 18 to 25 years of age. Clients are almost always referred to the service by another provider, and they typically present with moderate to severe psychiatric disturbance characterized by:

1. affective disturbance
2. negative representation of self and others
3. aggressive behavior
4. self-injurious behavior
5. substance use
6. unstable interpersonal relations, and
7. disturbance in psychosexual development.

Emerging psychosis and bipolar mood changes are also relatively common. Most of the clients referred to the service have a history of childhood trauma, often with removal from their family of origin by the child welfare system. Most also have a history of psychiatric hospitalization, residential treatment, or out-of-home placement as a child with risk for recurrent psychiatric hospitalization as a young adult.

The Young Adult Service provides developmentally informed services designed to promote normative development as much as possible in the context of whatever psychiatric difficulty the client might be experiencing. The service presently has a capacity of approximately 80 clients. Twenty clients reside in transitional living programs where there is support and supervision available 24 hours a day, seven days a week. Other clients live independently in the community, alone or with family, friends, roommates, or a romantic partner. Some clients also live with their children. On any given day, several clients are homeless. The principles of developmental psychopathology guide the comprehensive program of assessment and intervention pursued with each client. An intensive, assertive, community-based approach to treatment that both targets problems and builds upon strengths is utilized by a mobile, interprofessional treatment team. Although the validity of all theoretical perspectives is acknowledged, the setting emphasizes the integration of a developmental perspective on psychopathology during emerging adulthood with a community perspective on service delivery. Every effort is made to integrate the best available empirical evidence into a multisystemic perspective on the assessment and treatment of clients this age.
Clinical services available through the Young Adult Service include:

1. intake-triage
2. crisis intervention
3. individual psychotherapy
4. group therapy
5. psychometric and focused risk assessment
6. family intervention
7. programs of positive behavioral support
8. pharmacotherapy, and
9. clinical consultation with professionals in other service delivery systems.

The program also offers an array of support services designed to promote normative development as a young adult. Other services include:

1. vocational-educational counseling
2. occupational therapy
3. social and recreational activity
4. peer support
5. residential support, and
6. rental assistance.

There is also a client support fund that can be used to help pay for costs associated with pursuit of specific treatment goals. Most clients have a primary clinician, an attending psychiatrist, and a vocational-educational counselor. Some clients also have a residential counselor and a peer counselor. Most clients have more than one contact with the program weekly.

A primary placement on the Young Adult Service offers psychology fellows a unique opportunity to learn about developmentally oriented psychiatric assessment and treatment of young adult clients with moderate to severe psychopathology making the transition from child to adult systems of care. When combined with a secondary experience on the Child and Adolescent Service of the Connecticut Mental Health Center, the placement affords fellows a developmentally oriented experience providing psychiatric services to children, adolescents, and young adults in an ambulatory setting. Because the Young Adult Service is located in the same building as the Child and Adolescent Service, applicants accepted for this placement become part of a psychology training group that typically includes three full-time faculty members, several postdoctoral fellows, and six to seven psychology trainees interested in developmental approaches to the assessment and treatment of psychopathology in clients 3 to 25 years of age.

While working as a member of an interprofessional treatment team, psychology fellows function as a primary clinician with responsibility to coordinate the care of five young adult clients, and they assist in the care of three to four additional clients through involvement in psychometric assessment, focused risk assessment, and behavioral consultation. Every effort is made to diversify clinical assignments in terms of age, gender, ethnic heritage, and presenting problem, and to address special interests of the fellow and gaps in prior training. Supervised experience in the delivery of clinical services to individual clients is used as the primary mechanism to expose fellows to clinical work with young adult clients in a local system of care. With support and supervision, fellows are responsible to conceptualize and coordinate a program of ambulatory assessment and treatment for their assigned clients.

Within a comprehensive treatment plan, psychology fellows at this site may utilize motivational, cognitive-behavioral, interpersonal, supportive-expressive, problem-solving, or psychodynamic approaches to psychotherapy with specific clients. The placement also allows for involvement in the delivery of parent intervention, group therapy, family intervention, and specialized trauma intervention. A primary focus on the experience as a primary clinician is complemented by experiences providing psychological testing, risk assessment, behavioral assessment, and positive behavioral intervention to several other clients. Psychology fellows also have an opportunity to collaborate with an attending psychiatrist, vocational counselors, special education staff, an occupational therapist, and child welfare workers. There are also opportunities to be exposed to

1. risk management in an ambulatory setting
2. ethical-legal decision making, and
3. administrative and clinical roles commonly assumed by professional psychologists in a setting of this nature.

The following evidence-based practices (EBPs) are used in this placement setting. Fellows generally have exposure to most of these EBPs, but they do not necessarily receive training or supervised experience in all of them. The EBPs include:

1. specialized trauma treatments
2. cognitive-behavioral therapies for depression, anxiety, anger management, and psychosis
3. (motivational interviewing
4. interpersonal psychotherapy
5. mentalizing-based treatment
6. applied behavioral analysis
7. expressive-supportive psychotherapy, and
8. transference-focused psychotherapy.

There are usually structured opportunities to learn about evidence-based treatments for exposure to complex trauma.

The psychological assessment experience for Young Adult Service fellows involves conducting comprehensive admission assessments. In addition to a clinical interview and record review, the psychology fellow typically will use standardized instruments to assess level of symptomatology and changes in symptoms over time.

Fellows also conduct three or four comprehensive psychological assessments over the course of the training year. There are three types of comprehensive assessments:

1. general assessments that include measures of cognitive abilities, achievement, executive functioning, vocational functioning, and personality;
2. behavioral assessments designed to better understand a specific pattern of behavior; and
3. specialized assessments that focus on substance use, self-harm, aggression toward others, sexual behavior, and other high-risk behaviors.

• Adrienne Allen, Psy.D., Primary Advisor
• Michelle Comas, Ph.D., Supervisor
• Thomas McMahon, Ph.D., Supervisor
• Michelle Silva, Psy.D., Supervisor
• Ellen Nasper, Psy.D., Supervisor
• Derrick Gordon, Ph.D., Supervisor
  

All the clinical work done on the Young Adult Service is supervised by an interprofessional treatment team comprised of clinical staff representing the disciplines of

1. psychiatry
2. psycholog
3. social work
4. nursing
5. occupational therapy, and
6. vocational rehabilitation.

Psychology fellows at this site attend two young adult treatment team meetings weekly. They also have four hours of individual supervision weekly. One hour is with their primary advisor, one hour is with a psychologist who serves as a clinical consultant concerning the assessment and treatment of assigned cases, one hour is with a supervisor who coordinates psychological testing, and one hour is with the psychologist who manages behavioral intervention for the service. Interprofessional huddles within the program to deal with problems that frequently occur in work with clients this age are common. All supervisors have expertise in developmentally oriented assessment and treatment of adolescents and young adults.

Psychology fellows at this site have structured opportunities to learn about trauma-informed treatment and applied behavioral analysis. They also have an opportunity to learn about management of clinical risk in an ambulatory setting and an opportunity to participate in administrative activities with their primary advisor.

In addition to the Core Seminar, psychology fellows at this site participate in an applied site-specific seminar that focuses on the psychiatric assessment of children, adolescents, and young adults. During the summer, the seminar is used to orient fellows to clinical work with children, adolescents, and young adults in the local system of care. During the remainder of the year, didactic presentations by faculty along with review of clinical material presented by trainees facilitates exploration of clinical issues frequently encountered in the developmentally oriented assessment and treatment of younger clients, including questions about culturally and linguistically sensitive delivery of clinical services. Participation in this seminar is a requirement for all fellows with a primary placement on the Young Adult Service.

In addition to the Core Seminar and site-specific seminar, primary fellows at this site may participate in case conferences to review the assessment and treatment of clients with complex clinical presentations whose needs are not being adequately addressed by the local system of care.

Applicants choosing the Young Adult Service as a primary placement must have an interest in working with clients 3 to 25 years of age in an ambulatory setting. They must also have previous experience working with adolescents or young adults in a clinical or educational setting. Competitive applicants usually also have an interest in clinical and scholarly work informed by the principles of developmental psychopathology. Previous experience working with preschool and school-age children is desirable but not necessary.

Applicants selected for this placement must successfully pass a background check conducted by Yale University. Because this placement is based outside downtown New Haven, previous fellows have found it is essential to have access to a car.