Adolescent Services

Overview

The Adolescent Service track provides interns with a unique training opportunity within the adolescent inpatient and intensive outpatient programs of Yale-New Haven Psychiatric Hospital (YNHPH). Training emphasizes understanding adolescents and adolescent psychopathology from a developmental and community context. Interns receive advanced training in Dialectical Behavior Therapy (DBT) with a broad range of demographically and diagnostically diverse adolescents and their families. Clinical activities occur within a multidisciplinary psychiatric setting, and include serving as primary clinician to adolescent inpatients, co-leading a variety of DBT therapy groups in the adolescent intensive outpatient program, supervising an advanced psychology graduate student, and conducting individual psycho dynamically-informed psychotherapy through the Psychiatry Department’s Long-Term Care Clinic.

Placement Options

This track consists of a single, full-time, twelve month placement within YNHPH’s Adolescent Inpatient and Intensive Outpatient Service.

Number of interns

One predoctoral intern will be selected into the Adolescent Services for the 2013-2014 academic year.

The Setting

Yale-New Haven Psychiatric Hospital is a 74-bed, acute care, psychiatric facility that consists of four main inpatient programs and several specialized step-down intensive outpatient/day hospital programs for adolescents and adults.

The Adolescent Inpatient Program of Yale-New Haven Psychiatric Hospital is a 15-bed acute-care, intensive, diagnostic evaluation and intervention program that serve adolescents between the ages of 12-21. The unit provides short-term inpatient treatment for adolescent and young adults with a wide range of diagnoses and presenting problems including sociality, mood disorders, psychoses, PTSD, developmental disorders, disruptive behavior disorders and substance use disorders. Comprehensive biopsychosocial assessment and treatment, intensive family consultation and crisis intervention are the core treatment modalities.

After discharge from the hospital, many adolescents continue to be followed in a brief (6 to 9-week) after-school intensive outpatient program, which is designed to help adolescents make the transition from inpatient treatment to their home, school, and community environments. The Adolescent Intensive Outpatient Program is comprised of two distinct treatment tracks: a General Track, and a specialized full model Dialectical Behavior Therapy Track for adolescents with a history of severe emotional dysregulation, persistent non-suicidal self-injurious behavior, personality disorder, depression, anxiety, disordered eating, and co-occurring substance abuse.

The Internship

Predoctoral interns train within the adolescent inpatient and intensive outpatient program for the entire year. The intern’s time is divided between each program, such that interns spend the majority of each morning treating adolescents and families on the inpatient unit, and afternoons co-leading DBT group therapies within the adolescent intensive outpatient program.

Within the inpatient unit, predoctoral interns function as a primary clinician on a multidisciplinary team with an assigned caseload of two adolescent inpatients. As a primary clinician, interns have the important role of overseeing and coordinating the inpatient evaluation, treatment, and discharge planning needs of their assigned patients. Interns work closely with attending psychiatrists and other multidisciplinary team members, and participate in daily treatment planning and review meetings. Within the inpatient unit, individual crisis intervention and intensive family therapy are the primary treatment modalities. As such, interns meet daily with individual patients, hold frequent family meetings, and regularly consult with local school systems and community child and family agencies. Within the inpatient unit, interns also have the opportunity to conduct admission assessments for newly hospitalized patients, and perform as-needed brief psychological evaluations for referred patients. The adolescent inpatient unit also serves as a training site for psychiatric residents, social work interns, and student nurses and hosts a weekly inpatient case conference to discuss issues related to adolescent development, psychopathology, differential diagnosis, clinical interviewing, and case conceptualization.

Within the Adolescent Intensive Outpatient Program (AIOP), interns participate in the program’s three day a week Dialectical Behavior Therapy track, which is designed around a 9-week curriculum covering the core modules of mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. The program enrolls adolescents between the ages of 12-19 who generally have not yet been able to benefit from more traditional, standard individual or intensive outpatient therapies and who exhibit symptoms of severe emotional dysregulation, persistent self-injurious behavior, unstable personality disorder, depression, anxiety, disordered eating, and/or co-occurring substance abuse. Within the AIOP, interns receive advanced training in DBT and co-lead a range of DBT group therapies including DBT skills training, diary card review, behavioral chain analysis, skills coaching, individual parent skills training, and a multi-family skills group. DBT training includes participation in a summer DBT training seminar, weekly DBT consultation group, and weekly individual DBT supervision.

Predoctoral interns also have the opportunity to conduct psychological diagnostic testing protocols during the year. Most diagnostic assessments include evaluations of newly admitted patients on the psychiatric inpatient units and patients who have been participating in treatment for longer periods in the intensive outpatient programs. 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. Predoctoral interns conduct structured diagnostic interviews, traditional full battery assessments, as well as brief forms of personality assessment and neuropsychological screening.

In addition to the adolescent-specific training experiences described above, all predoctoral interns at Yale-New Haven Hospital receive weekly supervised individual psychotherapy training within the Department of Psychiatry’s Long Term Care Clinic.

Scholarly Activity

One-half day per week of protected research time is provided to allow interns the opportunity to pursue and conduct clinical research within the Yale School of Medicine. Research training objectives are individually designed and achieved through an apprenticeship model where the intern works closely with a faculty mentor involved in a program of active research. Interns are matched with faculty mentors based on their shared interests and faculty availability. The faculty member serves as supervisor and role model, with the goal of integrating clinical and research skills as well as professional role identity.

Faculty

Dwain Fehon, Psy.D., Primary Advisor
Abby Lipschutz, Ph.D., Clinical Supervisor
Debra Nudel, Ph.D., Clinical Supervisor

Seminars and Specialized Training

In addition to the core didactic seminars within the Department of Psychiatry and general hospital-based seminars, Adolescent Service interns have the opportunity to attend the YNHH Dialectical Behavior Therapy Summer Seminar (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. Adolescent Service interns also have the opportunity to attend a weekly clinical case conference with Dr. David Greenfeld, senior consulting psychiatrist for the adolescent inpatient unit.

For Further Information

For more information about this placement site, please e-mail dwain.fehon@yale.edu.