APPIC #118323

Overview

The Behavioral Medicine Service is a psychological consultation and intervention program integrated within specialized outpatient medical services of Yale-New Haven Hospital (YNHH) and the Smilow Cancer Hospital. Fellows work within multidisciplinary teams of medical providers (consisting of physicians, surgeons, nurses, and social workers) and gain valuable experience in the provision of behavioral health consultation, psychological assessment, and behavioral health intervention to a broad range of medically ill patients. Emphasis is placed on understanding the psychosocial factors influencing adjustment and adaptation to chronic medical conditions, and on developing skills for behavioral consultation and intervention in an academic medical setting.

Placement Options

This track consists of a single, full-time, twelve-month placement within YNHH’s Behavioral Medicine Service.

Number of Fellows

Three doctoral fellows will be selected into the Behavioral Medicine track for the 2014-2015 academic year.

The Setting

The Behavioral Medicine Service is a part of the Psychiatric Services of Yale-New Haven Hospital. Developed in 2008, the Behavioral Medicine Service has become a valued and integrated component of the Yale-New Haven Transplantation Center and the Smilow Cancer Hospital.

The Yale-New Haven Transplantation Center (YNHTC) provides expert, comprehensive and compassionate care for adult and pediatric patients throughout the world who are candidates for organ transplantation. The YNHTC specializes in liver, kidney, pancreas and heart transplantation; and is the region's leader in the evaluation and treatment of advanced liver disease.

The Smilow Cancer Hospital is the only NCI-designated Comprehensive Cancer Center in Southern New England. It is a new state-of-the art facility that offers a full range of patient support services to address the physical, emotional, and spiritual needs of patients. Smilow Cancer Hospital is a new facility designed to be warm and welcoming for patients and their families. Special features, including a roof-top healing garden, a reflection room, open spaces, and thoughtful artwork, help create a calming, peaceful environment.

The majority of the doctoral fellow's clinical training occurs within the outpatient care clinics of these two programs, however, fellows also have the opportunity to perform consultations and provide counseling to hospitalized patients as well.

The Internship

The goal of the Behavioral Medicine Service is to provide support and assistance to medical care providers and their patients so that the patient’s emotional and mental health needs can be addressed within the context of their overall medical care. The service operates under the premise that integrated behavioral medicine has the potential to benefit both patient and physician by improving access to behavioral health care for medically compromised individuals, improving adherence to medical treatments, targeting lifestyle and psychosocial issues effecting wellness, addressing issues of pain management, stress tolerance, addictions, coping, and by helping to prevent the development of more serious mental health disorders through early recognition and intervention.

Fellows divide their time training between the Yale-New Haven Transplantation Center’s Liver Transplant program and the Smilow Cancer Hospital. Fellows also participate in three additional minor rotations over the course of the year: Bariatric Surgery, Consult Liaison Psychiatry, and Neuropsychological Assessment.

Within each of the medical specialties, Behavioral Medicine fellows consult with medical providers and patients and provide psychotherapy to medically ill patients using a combination of supportive, cognitive-behavioral, and mindfulness-based therapeutic approaches. Interns also attend and participate in a number of weekly multidisciplinary meetings and case conferences such as the Liver Transplant Recipient Review Committee, Melanoma Tumor Board, and the Palliative Care Interdisciplinary Team Meeting.

Major Placements:

Within the Liver Transplant program, fellows gain valuable firsthand experience in issues related to organ allocation, patient selection, transplant ethics, and the psychological and neurocognitive functioning of patients with acute liver failure and end stage liver disease. Fellows play an important role in the evaluation and support of liver transplant candidates by providing individual behavioral weight loss, drug and alcohol relapse prevention counseling, and stress management and relaxation training to pre and post-liver transplant recipients. Fellows also receive specialized training in the evaluation of living donors, and participate in the program's Donor Advocacy Team. Within the transplant program, fellows attend and participate in weekly multidisciplinary meetings and case conferences such as the Liver Transplant Recipient Review Committee and the Donor Advocacy Meeting.

Within the Smilow Cancer Hospital, fellows provide care and consultation to referred patients from the breast, gynecology, lung, melanoma, neuro, and medical-oncology services. Fellows also spend one-half day per week within the head and neck cancer clinic and receive specialized training in the assessment of high-risk patients and the use of brief Motivational Interviewing techniques to engage patients in smoking cessation and alcohol reduction services. Fellows also participate in a monthly Menopause, Intimacy and Sexuality clinic within the gynecology-oncology service. Within this clinic, fellows work closely with a faculty gynecologist and gynecology-oncology surgeon and perform brief individual behavioral health consultations with women who have a history of cancer and whose primary concern relates to sexuality, sexual functioning, body image, or menopause. In certain cases, fellows may also follow some of these patients for brief individual or couples behavior therapy to address targeted areas of concern. Within the Smilow Cancer Hospital, fellows also have the chance to attend and participate in weekly Tumor Board Meetings and Palliative Care Interdisciplinary Team Meetings.

Minor Rotations:

In addition to the two primary clinical services described above, fellows receive training within three minor rotations: Bariatric Surgery, Consult-Liaison Psychiatry, and Neuropsychological Assessment. Within Bariatric Surgery, fellows work closely with a faculty psychologist and receive training in pre-surgical evaluation and behavioral weight loss to bariatric surgery candidates. Within the Consult-Liaison service fellows provide consultation and ongoing bedside psychotherapy and support to hospitalized medically-ill patients. Doctoral fellows also have the opportunity to conduct brief neuropsychological assessments within the Psychiatric Consult-Liaison and Liver Transplant Programs to aid diagnostic understanding and patient selection. Most diagnostic assessments involve 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 within the Behavioral Medicine Service also have the option to receive weekly supervised individual psychotherapy training within the Department of Psychiatry's Long Term Care Clinic.

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: Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Motivational Interviewing, Motivational Enhancement Therapy, and Mindfulness-Based Cognitive Therapy.

Scholarly Activity

One-half day per week of protected research time is provided to allow fellows 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 fellow works closely with a faculty mentor involved in a program of active research. Fellows 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
Benjamin Toll, Ph.D., Clinical Supervisor
Kathi Croce, Ph.D., Clinical Supervisor
Donna DiCello, Psy.D., Clinical Supervisor
Carrie Lukens, Ph.D., Clinical Supervisor
Stacey Salant, Ph.D., Clinical Supervisor
Marney White, Ph.D., Clinical Supervisor

Seminars and Specialized Training

Behavioral Medicine fellows attend and participate in weekly core didactic seminars held within the Department of Psychiatry, and weekly general hospital-based seminars for fellows and other psychology trainees based at YNHH. In addition, Behavioral Medicine fellows also have the opportunity to attend weekly multidisciplinary seminars and case conferences with advanced psychiatry fellows, residents and medical students within the Department of Psychiatry’s Psychosomatic Medicine Fellowship program.

Numerous additional didactic health and medicine related case conferences, seminars, and grand rounds are offered through the Yale-New Haven Transplantation Center,Yale Cancer Center, and Yale School of Medicine. Participation in these optional activities is at the discretion of the fellow and their primary advisor as their schedule permits.

Behavioral Medicine fellows are also invited 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.

For Further Information

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