Adolescent & Adult Intensive Outpatient Services

APPIC #118328

Overview

Located within Yale-New Haven Psychiatric Hospital’s (YNHPH) Intensive Outpatient Services, this placement provides fellows with the opportunity to receive comprehensive clinical training within two multidisciplinary intensive outpatient programs (IOPs) where the emphasis is on developing competencies for assessing and treating acutely ill and demographically diverse adolescents and adults. Fellows are taught to apply a range of theoretical orientations, including developmental/psychodynamic and cognitive-behavioral/dialectical behavioral theories. These inform case conceptualization and treatment planning. Clinical activities include serving as the primary clinician for a caseload of up to five adolescent and adult IOP patients; participating in interdisciplinary treatment team meetings; co-leading a variety of group therapies; convening family sessions; and conducting psychodiagnostic assessments, risk assessments, skills coaching, intake interviews, and peer consultation. Opportunities may also be available to supervise an advanced psychology graduate student. Above and beyond these core training activities, fellows also have the option to receive individual psychodynamically-informed psychotherapy training, on an elective basis, through the hospital's Long-Term Care Clinic.

Placement Options

PRIMARY PLACEMENT - This track consists of a single, full-time, twelve-month placement of which half time is in the YNHPH Adolescent Intensive Outpatient Program and half time is in the YNHPH Adult Intensive Outpatient Program. (There are no secondary placements within YNHH).

Number of Fellows

One doctoral fellow will be selected for this combined Adolescent & Adult Intensive Outpatient Services Track for the 2018-2019 academic year.

The Setting

The Intensive Outpatient Programs of Yale-New Haven Psychiatric Hospital treat adolescent and adult patients in a group-based setting. These individuals need more intensive intervention than is readily provided in outpatient settings, but do not require the level of supervision and support provided in an inpatient setting. About two thirds of newly admitted patients are referred to the IOPs for follow up treatment from one of the YNHPH inpatient units and about one third are referred from outpatient community providers

The Adolescent IOPis an afternoon, after-school program that treats adolescents between the ages of 12 and 18 with a variety of psychiatric diagnoses and presenting problems. The program provides services to teenagers who present with a variety of moderate to severe psychiatric conditions and environmental stressors. Common problems include disturbances in mood, thought processes, and behavior, as well as significant difficulties at home and/or at school. These adolescents are high risk and in an acute state, recently discharged from the hospital and needing a step down in care before participating in outpatient psychotherapy or, alternatively, are escalating at home and in need of more than weekly outpatient therapy to prevent hospitalization.

The Adult IOP is divided into four main treatment tracks: a General Psychiatric track for patients with mood, anxiety or psychotic disorders; a Dual Diagnosis track for patients with co-occurring psychiatric and substance use disorders; a general DBT track for patients with borderline personality disorder features who are struggling with chronic suicidal or self-destructive behaviors; and a substance-focused DBT track for patients with borderline personality disorder features and substance abuse or dependence. The DBT tracks provide comprehensive DBT that is modified for a group-based setting. The main modifications of these tracks from standard-model outpatient DBT include: conducting diary card review and behavioral analysis in groups; use of protocols for preventing contagion of crisis behaviors among group participants; participation in concurrent outpatient therapy; and targeting of problems in the outpatient treatment with the ultimate goal of discharge to an outpatient level of care.

The Internship

Adolescent Intensive Outpatient Program (12 months, half-time): The fellow will spend half of their clinical hours each week at the YNHPH Adolescent Intensive Outpatient Program (IOP) with responsibility for two cases. The fellow’s activities include: individual and family therapy, co-leading adolescent groups, participation in interdisciplinary team meetings, and consultation and collaboration with outpatient providers and schools. Given the general nature of the program, psychotherapy groups draw on and integrate multiple interventions, such as CBT, Motivational Interviewing, ACT and DBT. In order to help adolescents manage dysregulated affect and high-risk behaviors, groups focus on identification of goals and values, skills training in distress tolerance, emotion identification and problem solving, and attention to group process and dynamics. Through supervision and training, fellows gain knowledge of the developmental stages and issues prominent in childhood and adolescence. There is a particular emphasis on how trauma and impoverished backgrounds intersect with and effect developmental outcomes. Fellows strengthen their skills in case conceptualization to inform and guide the treatment. Fellows also develop particular expertise in running groups and understanding group processes.

Adult Intensive Outpatient Program (12 months, half-time): The fellow will serve as a primary clinician for up to four Adult IOP patients in the Dialectical Behavior Therapy for Substance Use Disorders (DBT-SUD) track. Activities involve: co-leading a variety of DBT therapy groups, including skills training, diary card review, behavioral analysis, and skills coaching; telephone skills coaching; weekly consultation team meetings; risk assessment and management; family sessions; consultation to outpatient providers; and orientation and commitment interviews for prospective DBT patients. In addition, the fellow provides DBT-oriented supervision to an advanced psychology graduate students. In the Adult IOP, fellows will develop DBT competencies for working with patients with Borderline Personality Disorder and other co-morbid conditions, such eating disorders, substance use disorders, dissociation, and schizoaffective disorder. The fellows will also develop proficiencies in: applying behavioral strategies and structured protocols, DBT-oriented case management and consultation, dialectical clinical formulation, and observing personal limits in order to maintain wellbeing and avoid burn out. Additional clinical activities include: co-leading cognitive-behavioral, psychodynamic, and topic-focused groups. The latter cover family issues, managing bipolar symptoms, and discharge planning.

Long Term Care Clinic: All YNHH doctoral fellows have the option of receiving weekly supervised individual psychotherapy training within the Long Term Care Clinic (LTCC). This is an outpatient psychotherapy training clinic operated by the Department of Psychiatry and YNHH. Individual patients are referred to this clinic by the Yale University Health Services, and as such, are typically members of the University community who are seeking insight-oriented psychotherapy for a variety of issues, most commonly related to developmental, relationship, mood, and/or anxiety concerns.

Within the LTCC, individual weekly supervision from a psychodynamic perspective is provided to guide the fellow in conceptualizing and implementing treatment from an insight-oriented therapeutic approach most appropriate to the assigned cases. Typically, doctoral fellows see one individual therapy patient in once-a-week psychotherapy for the full duration of their training year.

Evidence-Based Practices:
The following evidence-based practices (EBPs) are used in this placement setting. Fellows generally have exposure to most of these EBPs though do not necessarily receive training or supervised experience in all of them. The EBPs include: Dialectical Behavior Therapy, Dialectical Behavior Therapy for Substance Use Disorders, and Cognitive Behavior Therapy.

Psychological Assessment:
Doctoral fellows at YNHH conduct a variety of brief and comprehensive psychological and neurocognitive diagnostic assessments during the year. Most diagnostic assessments include evaluations of newly admitted patients on the psychiatric inpatient units, patients who have been participating in treatment for longer periods in the intensive outpatient ambulatory services programs, and patients who are receiving care within the hospital’s acute inpatient and outpatient specialty medical services. Each assessment involves administering and interpreting a variety of instruments, participating in individual testing supervision, consulting with the treatment team about the implications of test results for the patient's treatment, providing feedback to the patient in consultation with the treatment team, and writing a final report. Doctoral fellows conduct structured diagnostic interviews, a minimum of two traditional full battery assessments, as well as brief forms of personality assessment and neuropsychological screening.

Long Term Care Clinic:
All YNHH doctoral fellows have the option of receiving weekly supervised individual psychotherapy training within the Long Term Care Clinic. The Long Term Care Clinic is an outpatient psychotherapy training clinic operated by the Department of Psychiatry and YNHH. Individual patients are referred to this clinic by the Yale University Health Services, and as such, are typically members of the University community who are seeking insight-oriented psychotherapy for a variety of identified issues, most commonly related to developmental, relationship, mood, and/or anxiety concerns.

Within the LTCC, individual weekly supervision from a psychodynamic perspective is provided to guide the fellow in conceptualizing and implementing treatment from an insight-oriented therapeutic approach most appropriate to the assigned cases. Typically, doctoral fellows see one individual therapy patient in once-a-week psychotherapy for the full duration of their training year.

Evidence-Based Practices

The following evidence-based practices (EBPs) are used in this placement setting. Fellows generally have exposure to most of these EBPs though do not necessarily receive training or supervised experience in all of them. The EBPs include: Dialectical Behavior Therapy, Dialectical Behavior Therapy for Substance Use Disorders, and Cognitive Behavior Therapy.

Psychological Assessment

Doctoral fellows at YNHH conduct a variety of brief and comprehensive psychological and neurocognitive diagnostic assessments during the year. Most diagnostic assessments include evaluations of newly admitted patients on the psychiatric inpatient units, patients who have been participating in treatment for longer periods in the intensive outpatient ambulatory services programs, and patients who are receiving care within the hospital’s acute inpatient and outpatient specialty medical services. Each assessment involves administering and interpreting a variety of instruments, participating in individual testing supervision, consulting with the treatment team about the implications of test results for the patient's treatment, providing feedback to the patient in consultation with the treatment team, and writing a final report. Doctoral fellows conduct structured diagnostic interviews, a minimum of two traditional full battery assessments, as well as brief forms of personality assessment and neuropsychological screening.

Diversity

At Yale-New Haven Hospital diversity and inclusion are important values. The hospital is committed to providing an environment of inclusion that supports the diversity among its patients, visitors, employees, business partners and communities. Serving the Greater New Haven area and surrounding Southern New England region, YNHH admits a diverse population of patients, both diagnostically as well as demographically. Racially, approximately 65 percent of patients admitted to the hospital are Caucasian, 15 percent Black, 15 percent Hispanic and 5 percent Asian. Nearly 60 percent of patient hospital costs are covered through Medicare or Medicaid. The hospital is committed to providing the highest standard of care to all patients regardless of socioeconomic status, race, ethnicity, language, nationality, sex, gender identity, sexual orientation, religion, geography, disability and age.

Scholarly Activity

Four hours per week of protected time is provided to allow fellows the opportunity to design and conduct a scholarly project of their choice. Individual project objectives are coordinated with the primary advisor, or another faculty mentor involved in a program of active research. Fellows may design a project with faculty within their primary training placement, or request to be matched with other faculty in the Yale School of Medicine based on their shared interests and faculty availability. The fellow’s scholarly activity can take many forms. In consultation with the faculty advisor, the fellow may choose to engage in an ongoing research project, evaluate a clinical service or program, or help design and implement a new project that will benefit the individuals receiving services within the YNHH system. Within the Adolescent & Adult track, fellows also have the opportunity to co-review manuscripts for research journals and to assist with the annual Yale NEA-BPD Conference.

Faculty

Amber W. Childs, Ph.D., Primary Advisor & Assessment Supervisor
Seth Axelrod, Ph.D., Secondary Advisor
Emily Cooney, Ph.D., Clinical Supervisor
Debra Bond, Ph.D., Clinical Supervisor
Connie Nickou, Ph.D., Clinical Supervisor
Megan Warner, Ph.D., Clinical Supervisor

Supervision

The fellow has weekly individual supervision with a primary advisor and additional clinical supervisors. He or she also participates weekly in DBT consultation team meetings and adolescent rounds, receives assessment supervision as needed. Fellows may receive additional individual supervision for optional clinical activities such as with the Long Term Care Clinic. Formal evaluations are completed and serve as opportunities to review progress on training goals and address progress toward achieving the required core competencies.

Seminars and Specialized Training

In addition to the internships Core seminar and a hospital-based seminar with other YNHH fellows, the Adolescent & Adult Intensive Outpatient fellow also attends the Dialectical Behavior Therapy Summer Seminar during July and August. This seminar covers theory, formulation, and major strategies of Dialectical Behavior Therapy (DBT) as it is applied to treating severe borderline personality disorder in outpatient and day hospital settings. Attendees actively engage the material through discussions of cases and video examples, skills practice, self-monitoring and problem solving exercises, and role play.

Applicant Qualifications

Strong applicants for this placement generally have prior experience working with adults and adolescents, including individuals who struggle with high-risk impulsive behaviors. In addition, strong applicants will have experience conducting evidence based therapies including at least some components of Dialectical Behavior Therapy (i.e., DBT skills groups, consultation team, phone consultation, and/or individual therapy). Fellows who match with this placement typically have strong interests in treatment and/or scholarship related to adolescent psychopathology or personality pathology and show promise for developing a leadership role in the field.

Applicants selected for this placement must successfully pass background checks conducted by Yale University and Yale-New Haven Hospital.

For Further Information

For more information about this placement site, please e-mail amber.childs@yale.edu and/or seth.axelrod@yale.edu.