Young Adult Services

APPIC #118321

Overview

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 24 years of age. A primary placement on the Young Adult Service offers psychology interns a unique opportunity to learn about developmentally oriented assessment and treatment of young adult clients with moderate to severe psychopathology making the transition from child to adult systems of care. Given the focus of this training option, applicants must have previous experience working with adolescents or young adult clients in a clinical or education setting.

Placement Options

The Young Adult Service is only available as a primary placement for the full year at 30 hours per week.

Applicants who choose the Young Adult Service as their primary placement always have as their secondary placement the Child & Adolescent Services / West Haven Mental Health Clinic.

Number of Interns

Primary Placement: One or two

Secondary Placement: N/A

The Setting

The Young Adult Service, a satellite program of the Connecticut Mental Health Center, provides a comprehensive program of ambulatory psychiatric services to clients 18 to 24 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 (a) affective disturbance, (b) negative representation of self and others, (c) aggressive behavior, (c) self-injurious behavior, (d) substance abuse, (f) unstable interpersonal relations, and (g) 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 75 clients. Fifteen clients live 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, either alone or with family, friends, or a sexual partner. On any given day, a significant number of 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 the strengths is utilized by a mobile, interdisciplinary 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 (a) intake-triage, (b) crisis intervention, (c) individual psychotherapy, (d) group therapy, (e) psychological assessment, (f) family intervention, (g) programs of positive behavioral support, (h) pharmacotherapy, and (i) 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 available include (a) vocational-educational counseling, (b) occupational therapy, (c) social and recreational activity, (d) peer support, (e) residential support, and (f) 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.

The Internship

A primary placement on the Young Adult Service offers psychology interns 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 West Haven Mental Health Clinic, the placement affords interns 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 West Haven Mental Health Clinic, applicants accepted for this placement become part of a psychology training group that typically includes two full-time faculty members, a postdoctoral fellow, and six to seven predoctoral interns interested in developmental approaches to the assessment and treatment of psychopathology in clients 4 to 24 years of age.

While working as a member of an interdisciplinary treatment team, primary interns function as a primary clinician with responsibility to coordinate the care of four young adult clients, and they assist in the care of three to four additional clients. Every effort is made to diversify clinical assignments in terms of age, gender, ethnic heritage, and presenting problem. Every effort is also made to match special interests of the intern while also making assignments that allow interns to address gaps in their training. Supervised experience in the delivery of clinical services to individual clients is used as the primary mechanism to expose interns to clinical work with young adult clients in a local system of care. With support and supervision, interns are responsible to conceptualize and coordinate a program of ambulatory assessment and treatment for their assigned clients.

Within a comprehensive treatment plan, primary interns 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, specialized trauma intervention, and Dialectical Behavior Therapy (DBT). A primary focus on the experience as a primary clinician is complemented by experiences providing psychological testing, behavioral assessment, and positive behavioral intervention to several others clients. Primary interns 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 (a) risk management in an ambulatory setting, (b) ethical-legal decision making, and (c) administrative and clinical roles assumed by professional psychologists in a setting like this.

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: (a) Dialectical-Behavior Therapy (DBT), (b) cognitive-behavioral therapies for depression, anxiety, and anger management, (c) motivational interviewing, (d) mentalizing-based treatment, (e) applied behavioral analysis, (f) expressive-supportive therapy, and (g) transference-focused therapy.

Scholarly Activity

Primary interns at this site have options to pursue one of three scholarly activities. They can participate in a psychotherapy development project being pursued with mothers of preschool children, they can assist with a systematic review of the literature on a topic relevant to the assessment and treatment of this age group, or they can assist with a program evaluation or quality improvement project.

Faculty

Thomas McMahon, Ph.D., Primary Advisor
Nakia Hamlett, Ph.D., Supervisor
Michelle Silva, Psy.D., Supervisor
Jane Shepard, Ph.D., Supervisor
Sheryl Silverstein, Ph.D., Supervisor
David Tate, Ph.D., Supervisor
Rita McCleary, Psy.D., Supervisor

Supervision

All of the clinical work done on the Young Adult Service is supervised by an interdisciplinary treatment team comprised of clinical staff representing the disciplines of (a) psychiatry, (b) psychology, (c) social work, (d) nursing, (e) occupational therapy, and (f) vocational rehabilitation. Primary interns at this site attend two young adult treatment team meetings weekly. They also have three hours of individual supervision weekly. One hour is with their primary advisor, one hour is with a licensed psychologist who serves as a clinical consultant concerning the assessment and treatment of assigned cases, and one hour is with the psychologist who manages behavioral intervention for the service. Interdisciplinary huddles within the clinic are common to deal with problems that frequently occur in work with clients this age.

Seminar & Specialized Training

Primary interns at this site have structured opportunities to learn about Dialectical Behavior Therapy and applied behavioral analysis. They also have an opportunity to participate in administrative activities with their primary advisor.

In addition to the Core Seminar, primary interns at this site participate in an applied seminar that focuses on the psychiatric assessment of children, adolescents, and young adults. During the summer, the seminar is used to orient interns 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 with complementary review of clinical material presented by trainees are used to explore clinical issues frequently encountered in developmentally oriented assessment and treatment of younger clients. Participation in this seminar is a requirement for all interns with a primary placement on the Young Adult Service.

In addition to the Core Seminar and site-specific seminar, primary interns at this site can participate in a monthly Dialectic Behavior Therapy training program, and they can participate in monthly case conferences with consulting psychologists who have expertise in the assessment and treatment of (a) pervasive developmental disorders and (b) problematic sexual behavior.

Applicant Qualifications

Applicants choosing the Young Adult Service as a primary placement must have an interest in working with clients 4 to 24 years of age in an ambulatory setting. They must also have previous experience working with adolescents or young adult clients in a clinical or education setting. Previous experience working with preschool and school-age children is desirable but not necessary.

For Further Information

For further information, contact Dr. Thomas McMahon at thomas.mcmahon@yale.edu.