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 Psychological Medicine Service.

Number of Fellows

Two to three doctoral fellows will be selected into the Behavioral Medicine track for the 2015-2016 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/Yale Cancer Center.

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 and the Yale Cancer Center 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 and the Yale Cancer Center combine a tradition of innovative cancer treatment and quality care for patients. A National Cancer Institute (NCI) designated comprehensive cancer center for over 40 years, Yale Cancer Center is one of only 41 Centers in the nation. Comprehensive cancer centers play a vital role in the advancement of the NCI's goal of reducing morbidity and mortality from cancer through scientific research, cancer prevention, and innovative cancer treatment.

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 psychotherapeutic services within the hospital's inpatient units 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 between the Yale-New Haven Transplantation Center's Liver Transplant program and the Smilow Cancer Hospital/Yale Cancer Center. Fellows also participate in two additional minor rotations over the course of the year: Consult Liaison Psychiatry and Neuropsychological Assessment.

Within each of the medical specialties, Behavioral Medicine fellows consult with medical providers and patients and provide evidence-based psychotherapeutic services to medically ill patients using a combination of supportive, cognitive-behavioral, and mindfulness-based therapeutic approaches. Fellows also attend and participate in a number of weekly multidisciplinary meetings and case conferences such as the Liver Transplant Recipient Review Committee, Liver Donor Advocacy Team, disease specific tumor board meetings, and the Palliative Care Interdisciplinary Team Meeting.

Major Rotations:

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/Yale Cancer Center, fellows provide care and consultation to referred patients from nearly every cancer-specific disease team (i.e., breast, gynecology, lung, melanoma, neuro-oncology, renal, medical-oncology, and palliative care) and have the chance to attend and participate in weekly disease specific tumor board meetings and Palliative Care Interdisciplinary Team Meetings.

A unique feature of the Cancer Center rotations is that fellows spend one-half day per week within each of three innovative integrated oncology clinics:

  • Head and Neck Clinic: Within the Head and Neck Cancer clinic fellows 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.
  • Menopause, Intimacy and Sexuality (SIMS) clinic: Within the Department of Gynecology-Oncology, fellows participate in a twice monthly clinic and 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.

Adolescent and Young Adult (AYA) clinic: Fellows participate in a developmentally-sensitive multidisciplinary program within the Department of Pediatric Hematology and provide individual and family consultation to AYA patients diagnosed with a range of hematologic and cancer-related diagnoses.

Minor Rotations:

In addition to the two primary clinical services described above, fellows receive training within two minor rotations: Consult-Liaison Psychiatry and Neuropsychological Assessment. 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 participate in a weekly supervised individual psychotherapy experience 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
Marisa Spann, Ph.D., Assessment 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 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.