Adult Inpatient Services / Inpatient Services Unit

Overview

The Inpatient Services Unit is based at Connecticut Mental Health Center (CMHC), which serves adults who experience a wide range of serious mental health concerns. As an academic-based community mental health center, CMHC offers not only a broad range of traditional mental health services, but many other wellness oriented programs or treatments designed to enhance recovery for those with mental illnesses. The internship experience is based on providing crisis intervention, symptom stabilization, and individual and group psychotherapy to adults through an interdisciplinary team model with an emphasis on helping clients develop and achieve goals designed to maximize their mental health.

Placement Options

PRIMARY PLACEMENT - A full year, 50 hour per week primary placement, with no additional secondary placement.

SECONDARY PLACEMENT - Adult Inpatient Services is not offered as a secondary placement.

Number of Fellows

Primary Placement: 1

The Setting

The Inpatient Services Unit is designed to provide inpatient mental health services to adults who experience serious mental illness and live in the New Haven catchment area. CMHC’s treatment model is firmly grounded in the concept of recovery. This involves a focus on empowerment as well as individualized, person-centered treatment to help individuals achieve their highest potential. The recovery emphasis at CMHC is built around the principle that for a mental health system to provide the best care, it must include not only clinical services but also a range of other opportunities including housing and residential services, employment and social supports, and avenues for creative expression. Furthermore, from a recovery-oriented foundation, CMHC seeks to partner with individuals and the community to foster hope and increase the opportunity for all individuals to live lives of personal meaning.

The Inpatient Services Unit is a 20-bed adult (age 18+) service that serves as an integral part of CMHC's crisis, ambulatory, and community-based system of care. The Inpatient Services Unit, utilizing a multidisciplinary team approach, provides comprehensive assessment, crisis intervention, symptom stabilization, treatment and discharge planning to uninsured or under-insured residents of the local community. Each client’s length of stay is determined by their presenting problem and specific care requirements. As a result, the stay may vary from a few days to several months or longer.

Upon admission, each client is assigned to a primary clinician and a team comprised of an attending psychiatrist, psychiatry resident, medical students, nurses, social workers, mental health assistants, and trainees of various disciplines. Within the context of team discussion, individualized outcome-oriented plans of care are developed, typically in direct collaboration with the client and his/her outpatient care providers. The involvement of the client's family and/or significant others is also sought (in accordance with the client's needs and wishes) to ensure that a comprehensive and workable plan is established.

Client-specific treatments are selected and evaluated on an ongoing basis to guide the client's care throughout the hospitalization. The client’s medical, housing, financial, social, spiritual, and vocational needs are assessed to inform the type and level of services that are optimal. Individual, group, occupational, recreational, milieu and pharmacological therapies are employed in accord with the specific needs of the clients. Comprehensive disposition planning is undertaken to ensure that the client is returned to the community in a safe and expeditious fashion.

The Internship

This Adult Inpatient Services (AIS) placement offers skills development in assessment, treatment, consultation, and clinical research. The fellow will clinically manage and observe clinical problems reflecting the full spectrum of psychiatric disorders. The fellow will carry direct care responsibilities within the unit as a primary clinician. Responsibility for coordinating a client's overall plan of care rests with the primary clinician (who may be a staff social worker, staff nurse, resident in psychiatry, or the doctoral psychology fellow).

As a valued member of the multidisciplinary treatment team on the Inpatient Services Unit, the fellow will acquire or further develop their skills in: comprehensive admissions assessments; differential diagnosis; case formulation; treatment planning; case presentations; individual and group psychotherapy; positive behavioral support planning; disposition planning; and preparation of progress notes and discharge summaries.

The fellow will also have the opportunity to administer psychological assessments, participate in psycho-educational programming, provide case management, and assist in the formulation and implementation of positive behavioral support plans for clients on the unit and possibly other units or with consultation opportunities to outpatient teams, such as the Forensic Team or ACT Team. Fellows also have the opportunity to lead groups on the unit based on unit needs and the fellow's expertise.

The fellow plays a central role within the psychology service on the unit, which is overseen by a variety of faculty members based at CMHC and also includes two part-time doctoral fellows.

There is also an opportunity to see one or two individuals for outpatient psychotherapy at CMHC if this is an interest of the fellow and if the fellow demonstrates they are capable of completing all inpatient requirements and have the time to also follow the duties required for completing expectations of the provision of some outpatient psychotherapy. This experience offers the opportunity to diversify the training experience and work with individuals on a different part of their recovery journey. This enables the fellow to collaborate with an outpatient team at CMHC, adding further depth to the training experience and knowledge of how outpatient interdisciplinary teams operate within the CMHC system. In some experiences the fellow may be able to follow a patient within the inpatient setting and then follow them to the outpatient setting once they are discharged to the community and an outpatient team.

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, as part of a recovery-oriented model of care: person-centered planning, peer support, supported housing, supported employment, psychodynamic therapy, strengths-based case management, integrated treatment for co-occurring disorders, social skills training, dialectical behavior therapy, cognitive behavior therapy, acceptance and commitment therapy, wellness recovery action planning, family psycho-education, and psychopharmacology.

Psychological Assessment

The psychological assessment experience for AIS fellows involves routinely conducting a number of brief assessments to assess the presence and severity of symptoms or change in symptoms over time. In addition to a clinical interview and record review, the psychology fellow typically will use standardized symptom measures. Fellows will also conduct at least two comprehensive assessments in positive behavioral support planning, which includes development of the plan and following up in plan implementation. The positive behavioral support planning includes weekly behavioral rounds and follow-up supports for the teams and individuals involved. It also may include extra training that must be provided for the teams, staff, and person in recovery.

Diversity

The Adult Inpatient Unit placement offers a rich, diverse experience. As the program focuses on serving individuals with serious mental illness, fellows have the opportunity to learn, from a social justice perspective, about the unique needs and challenges that individuals with these illnesses face in our society. The clients being served also represent the richness of the New Haven community with diversity that may include: race, ethnicity, culture, gender, gender identity, sexual orientation, socio-economic status, geography, country of origin, and disability status. There is also a rich diversity among the staff on the inpatient unit, as well as interdisciplinary students who, in addition to psychology, come from the disciplines of social work, rehabilitation, psychiatry, pharmacy, theology, and nursing. The interdisciplinary environment creates a very rich systemic training experience with exposure to diverse perspectives and a variety of theoretical or intervention approaches.

Scholarly Activity

The fellow’s scholarly activity on the AIS will be connected to the Behavioral Intervention Service. The Behavioral Service implements Positive Behavioral Supports on the inpatient units and some outpatient teams and they are also engaged in evaluating the outcomes of the service and the utility of PBS itself. Many projects that have been completed relate to implementation of PBS as a foundation for working with adults with SMI from a recovery and trauma-informed foundation, provision of PBS with individuals with personality concerns in order to reduce behaviors of concern and build lives of meaning, and working with and developing a specific model of PBS to more widely share with other programs in service to adults with SMI. This clinical consultation service offers a great opportunity for experience with cutting-edge technology in the support of those with SMI and also serves as a fantastic mechanism for advancing the literature base in the area of PBS for adults with SMI.

Faculty

Erika Carr, Ph.D., Primary Advisor

Laura Yovienne Sikes, Ph.D., Supervisor
Debra Bond, PhD, Supervisor
Thomas Styron, Ph.D., Supervisor
Allison Ponce, Ph.D., Supervisor
Mark Hillbrand, Ph.D., Supervisor

Supervision

Supervision is provided by the fellow's primary advisor as well as by numerous other full time and voluntary faculty. The fellow is provided with at least four hours of individual and group supervision each week with licensed psychologists from a range of theoretical orientations. The exact nature of each supervisory relationship is determined by the supervisor-fellow dyad but normally will include discussion of clinical material, the fellow's role on an interdisciplinary team, research and scholarship as it applies to the clinical work, and professional development issues. Fellows will also gain supervision hours through case conference opportunities which enrich their work on a regular basis.

Seminars

In addition to the core seminar series, the fellow in this placement participates in two additional weekly seminars based at CMHC. One is a didactic and interactive seminar focusing on the topics related to the delivery of care on an inpatient unit. The other is a continuing clinical case conference, which provides an opportunity for trainees to present and discuss clinical material related to work with their clients at CMHC and to further develop relationships with fellow trainees and seminar leaders.

Applicant Qualifications

Strong applicants for this placement generally have experience working with adults with serious mental illness in both inpatient and outpatient settings. Fellows who match with this placement usually have an interest in community-based and recovery-oriented services and their future goals often include doing clinical work with people who have significant mental health problems and/or conducting research related to serious mental illness. It is not necessary, but helpful to have prior inpatient experience and training with people who experience psychosis, trauma, and dual diagnoses.

Applicants selected for this placement must be able to successfully pass background checks conducted by Yale University and the State of Connecticut.

For Further Information

Contact Dr. Erika Carr at erika.carr@yale.edu or 203-974-7854