Behavioral Medicine Service

APPIC #118323

Overview

The Behavioral Medicine Service is a psychological consultation and intervention program integrated within specialized medical services of Yale-New Haven Hospital (YNHH) and the Yale Cancer Center/Smilow Cancer Hospital. Fellows train within multidisciplinary teams of physicians, surgeons, nurses, social workers, and psychologists and gain valuable experience in the provision of behavioral health consultation, psychological assessment, and behavioral health intervention with a broad range of medically ill patients. Emphasis is placed on understanding biopsychosocial factors that influence health and illness and applying this knowledge along with behavioral interventions to prevent disease, improve disease management, increase quality of life, and facilitate end-of-life planning and care needs.

Placement Options

PRIMARY PLACEMENT - This track consists of a single, full-time, twelve-month placement within YNHH's Psychological Medicine Service. (There are no secondary placements within YNHH).

Number of Fellows

Two doctoral fellows will be selected into the Behavioral Medicine track for the 2019-2020 academic year.

The Setting

The Behavioral Medicine Service, developed in 2008, is part of the Psychiatric Services of Yale-New Haven Hospital. The Service is a valued and integrated component of Yale-New Haven Hospital and Smilow Cancer Hospital. Clinical training for Behavioral Medicine fellows occurs within the inpatient units and outpatient care clinics of these major hospital centers.

The Internship

The goal of the Behavioral Medicine Service is to provide support and assistance to medical 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 patients and providers by improving access to behavioral health care for medically compromised individuals. Primary goals of this service are to: improve adherence to medical treatments; psychosocial issues and lifestyle and health behaviors (e.g., physical activity, dietary practices, sleep, tobacco and other substance use) affecting wellness; address issues of pain management, stress tolerance, addictions, and coping; and to help prevent the development of more serious mental health disorders through early detection and intervention.

Fellows divide their time between outpatient and inpatient programs at Yale-New Haven Hospital (i.e., Liver Transplant, Sleep Medicine) and Smilow Cancer Hospital (i.e., Palliative Care, Tobacco Treatment Service).

Within each of these placements, Behavioral Medicine fellows consult with medical providers and provide evidence-based assessment and intervention services to medically ill patients using evidence-based supportive, behavioral, cognitive-behavioral, and mindfulness-based therapeutic approaches.

Fellows also attend and participate in a number of weekly multidisciplinary meetings and case conferences. These include disease specific tumor board meetings, Palliative Care Interdisciplinary Team Meeting, Liver Transplant Recipient Review Committee, Liver Donor Advocacy Meeting, and a host of interdisciplinary seminars and workshops with advanced fellows in psychiatry, oncology, and internal medicine, depending on their current rotation.

Major Placements:

Fellows receive training within four major placements over the course of the year: Yale Cancer Center/Smilow Cancer Hospital (6 months), Tobacco Treatment (6 months) Liver Transplant (3 months) and Sleep Medicine (3 months).

Smilow Cancer Hospital (6 months)

Fellow 1

  • July-September, Smilow Cancer Hospital (Outpatient Clinics)
  • October-December, Smilow Cancer Hospital (Inpatient Palliative Care)
  • January-March, Tobacco Treatment & Sleep Medicine
  • April-June, Tobacco Treatment & Organ Transplant

Fellow 2

  • July-September, Tobacco Treatment & Sleep Medicine
  • October-December, Tobacco Treatment & Organ Transplant
  • January-March, Smilow Cancer Hospital (Outpatient Clinics)
  • April-June, Smilow Cancer Hospital (Inpatient Palliative Care)

Smilow Cancer Hospital Rotation (6 months)

The Yale Cancer Center and Smilow Cancer Hospital combine a tradition of innovative cancer treatment and quality care for patients. Yale Cancer Center is Connecticut's only cancer center designated as a Comprehensive Cancer Center by the National Cancer Institute—and one of only 49 in the nation. National Cancer Institute centers are national leaders in cancer research, prevention, detection, and treatment. Smilow Cancer Hospital provides patients with novel, state-of-the art cancer detection and treatment options within the context of patient-centered expert care.

Within Smilow Cancer Hospital, fellows complete two, three-month placements through the: (1) inpatient Palliative Care Service and (2) outpatient oncology clinics. During the inpatient rotation, fellows function as full-time members of the multidisciplinary palliative care consult team, attend daily rounds, and work closely with palliative care physicians, advanced practice nurses, social workers and chaplains. Fellows provide bedside consultation and brief evidence-based interventions to address issues related to pain, emotional distress and end-of-life.

Fellows also receive training within the hospital’s outpatient oncology clinics. Within these clinics, fellows provide co-located evidence-based individual psychotherapy to referred patients. Patients may be referred from any cancer-specific disease team and may be at any stage of illness. Patient are referred for a variety of reasons (e.g., emotional distress, pain, sexuality, body image, managing addictions, end of life concerns, etc) and may be seen individually or with a partner or other family member. Fellows have the chance to work closely with members of the patient’s oncology team (oncologists, advance practice nurses, and nurses), while attending disease specific tumor board meetings, Palliative Care Interdisciplinary Team Meetings, as well as Yale Cancer Center’s Grand Rounds and Schwartz Rounds.

During the outpatient oncology rotation fellows spend one-half day per week within the Adolescent and Young Adult (AYA) Clinic, a developmentally-sensitive multidisciplinary program within the Department of Pediatric Hematology. Within the AYA clinic, fellows provide individual and family consultation to AYA patients diagnosed with a range of hematologic and cancer-related diagnoses.

During the entire year, Behavioral Medicine fellows also participate in the Cancer Center’s Menopause, Intimacy and Sexuality (SIMS) Clinic. Within the Department of Gynecology-Oncology, fellows train in a monthly clinic and work closely with a faculty gynecologist and gynecology-oncology surgeon and perform brief behavioral health consultations with women who have a history of cancer and whose primary concern relates to sexuality, sexual functioning, body image, or menopause.

Organ Transplant Rotation (3 months)

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.

Within the Yale New Haven Transplantation Center, fellows gain valuable experience with issues related to organ allocation, patient selection, transplant ethics, and the psychological and neurocognitive functioning of patients with acute organ failure and end stage liver and kidney disease. Fellows play a number of important roles in the evaluation and on-going support of liver and kidney transplant candidates. Specifically, fellows provide co-located individual behavioral weight loss, drug and alcohol relapse prevention counseling, smoking cessation, and stress management and relaxation training to adult pre- and post-transplant patients.

Fellows also spend one-half day per week within a multidisciplinary Pediatric Hepatology Clinic and provide consultation along with physicians and nutritionists to patients and families coping with fatty liver disease. Finally, fellows also receive specialized training in the evaluation of live liver 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.

Sleep Medicine Rotation (3 months)

The Yale Sleep Medicine Center evaluates and treats patients with sleep disorders and sleep-related conditions. Accredited by the American Academy of Sleep Medicine, the sleep medicine program offers a coordinated approach to the management of a variety of sleep disorders and related conditions. The sleep medicine team includes physicians and psychologists boarded in sleep medicine in addition to other specialties such internal medicine, pulmonary disease, neurology and pediatrics.

Within the Sleep Medicine Program, fellows work closely with a board-certified sleep psychologist and within a multidisciplinary team while receiving advanced training in cognitive-behavioral therapy for insomnia (CBTI), an evidence-based treatment for insomnia that is the practice standard. Fellows also receive training in the evaluation and cognitive-behavioral treatment of other sleep-related disorders such as circadian rhythm disorders, narcolepsy, night eating syndrome and parasomnias. Behavioral sleep methods are also used to increase CPAP adherence for patients with obstructive sleep apnea. Fellows review sleep studies and learn about pharmacological ways to manage sleep disorders as well. They also participate in a half-day seminar and case conference sponsored by the Department of Pulmonary, Critical Care and Sleep Medicine and weekly Grand Rounds.

Tobacco Treatment Rotation (6 months)

The Tobacco Treatment Service provides tobacco use assessment and intervention for patients treated at Smilow Cancer Hospital and Smilow-affiliated community-based Care Centers across CT, as well as patients referred by other teams across the Medical Center. The Service comprises a multidisciplinary team of psychologists, physicians, advanced practice nurses and clinical research staff and provides care that is integrated with patients’ oncology/medical treatments. Patients receive evidence-based pharmacological and behavioral tobacco interventions either in-person or via telemedicine.

The Service supports a number of clinical research projects. Currently, two NCI-funded clinical trials of smoking cessation interventions for individuals at high-risk for lung cancer or undergoing lung cancer screening are being conducted through the Service. Fellows have the opportunity to be trained in the delivery of manualized smoking cessation interventions for these trials. In addition, the Service received funding through the NCI Cancer Moonshot Initiative to increase access to and the effectiveness of smoking cessation interventions for individuals with cancer. Through this service implementation project, smoking cessation services have been expanded beyond the main cancer hospital to the community and enhancements have been made to the electronic health record to facilitate proactive tobacco use consultations for patients who report smoking when they present for oncology appointments. Fellows will have the opportunity to provide these consultations and deliver smoking cessation interventions via telemedicine.

Within the Tobacco Treatment Service, fellows work closely with the Director, a psychologist, to receive specialized training in motivational interviewing/enhancement techniques and cognitive-behavioral interventions to promote tobacco behavior change, and learn about evidence-based tobacco pharmacotherapies. Fellows participate in weekly Tobacco Treatment service rounds. Fellows also have the chance to participate in research activities conducted through the Service, either by serving as a study therapist or collaborating on scholarly projects.

Long Term Care Clinic (optional)

All doctoral fellows at YNHH have the option of receiving weekly supervised individual psycho-dynamically-informed psychotherapy training within the Long Term Care Clinic (LTCC). This is an outpatient psychotherapy training clinic operated by the Department of Psychiatry and YNHH. Individual patients are referred to this clinic by the Yale University Health Services, and as such, are typically members of the University community who are seeking insight-oriented psychotherapy for a variety of identified issues, most commonly related to developmental, relationship, mood, and anxiety concerns.

Within the LTCC, individual weekly supervision from a psychodynamic perspective is provided to guide the fellow in conceptualizing and implementing treatment from an insight-oriented therapeutic modality most appropriate to the assigned cases. Typically, doctoral fellows see one individual therapy patient in once-a-week psychotherapy for the full duration of their training year.

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: Cancer to Health Program, Cognitive Behavioral Therapy, Cognitive Behavioral Therapy for Insomnia, Dialectical Behavior Therapy, Meaning Centered Psychotherapy, Mindfulness-Based Cognitive Therapy, Motivational Interviewing and Enhancement Therapy, and Stress Management and Relaxation Training.

Psychological Assessment

Doctoral fellows at YNHH conduct a variety of brief and comprehensive psychological and neurocognitive diagnostic testing protocols during the year. Most diagnostic assessments include evaluations of newly admitted patients on the psychiatric inpatient units, patients who have been participating in treatment for longer periods in the intensive outpatient ambulatory services programs, and patients who are receiving care within the hospital acute inpatient and outpatient specialty medical services.

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. Doctoral fellows conduct structured diagnostic interviews, as well as brief forms of personality assessment and neuropsychological screening.

Diversity

At Yale-New Haven Hospital diversity and inclusion are important components of its organizational values. The hospital is committed to providing an environment of inclusion that supports the diversity of its patients, visitors, employees, business partners and communities. Serving the Greater New Haven area and surrounding Southern New England region, YNHH admits a diverse population of patients, both diagnostically as well as demographically. Racially, approximately 65 percent of patients admitted to the hospital are Caucasian, 15 percent Black, 15 percent Hispanic and 5 percent Asian. Nearly 60 percent of patient’s hospital costs are paid for through Medicare or Medicaid. The hospital is committed to providing the highest standard of care to all patients regardless of socioeconomic status, race, ethnicity, language, nationality, sex, gender identity, sexual orientation, religion, geography, disability and age.

Scholarly Activity

Four hours per week of protected time is provided to allow fellows with the opportunity to design and conduct a scholarly project of their choice. Individual project objectives are coordinated with the primary advisor, and/or another faculty mentor involved in a program of active research. Fellows may design a project with faculty within their primary training placement, or request to be matched with other Yale faculty based on their shared interests and faculty availability. The fellow’s scholarly activity can take many forms. In consultation with the faculty advisor, the fellow may choose to engage in an ongoing research project, evaluate a clinical service or program, or help design and implement a new project that will benefit the individuals receiving services within the YNHH system.

Recent faculty mentors have included Drs. Kathy Carroll (Division of Substance Abuse), Dwain Fehon (YNHH), Lisa Fucito (YNHH), Michael Hoge (Psychiatry), Robert Kerns (VA Medical Center) and Ruth McCorkle (School of Nursing).

Faculty

Dwain Fehon, Psy.D., Primary Advisor, Chief Psychologist
Lisa Fucito, Ph.D., Secondary Advisor; Director, Tobacco Treatment
Kathi Croce, Ph.D., Site Supervisor, AYA Clinic
Susan Rubman, Ph.D., Site Supervisor, Organ Transplant
Lynelle Schneeberg, Psy.D., Site Supervisor, Sleep Medicine
John Cline, Ph.D., Voluntary Faculty Clinical Supervisor
Carrie Lukens, Ph.D., Voluntary Faculty Clinical Supervisor
Amit Oren, Ph.D., Voluntary Faculty Clinical Supervisor
Marisa Spann, Ph.D., Voluntary Faculty Assessment Supervisor

Supervision

Fellows have weekly individual supervision with their primary advisor, secondary advisor, and additional site supervisors, and outside voluntary faculty supervisors. Fellows also participate in a weekly BMED group supervision meeting, and receive as-needed individual or group psychological assessment supervision. Fellows may receive additional individual supervision for optional clinical activities, such as training within the Long Term Care Clinic. Formal evaluations are completed three times a year that serve as opportunities to review progress on training goals and address progress toward mastering core competencies.

Seminars and Specialized Training

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

Behavioral Medicine fellows also have the option 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.

Applicant Qualifications

Strong applicants for this placement generally have prior experience working within medical settings with individuals diagnosed with serious or chronic medical illness, and/or working with individuals on lifestyle and health behaviors that negatively affect health. These applicants will also have experience conducting evidence-based therapies (e.g., cognitive behavior therapy) and have some basic experience with neuropsychological assessment. Fellows who match with this placement typically have a strong interest in the provision of clinical care and/or scholarship related to behavioral medicine or clinical health psychology and show promise for developing into leadership roles.

Applicants selected for this placement must successfully pass background checks conducted by Yale University and Yale-New Haven Hospital.

For Further Information

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

Dwain Award

Dr. Dwain Fehon, Director of YNHH's Behavioral Medicine placement, accepts the Society of Behavioral Medicine's, "Excellence in Behavioral Medicine Training Program Award" from SBM president, Dr. James Sallis (left), March 2017.

Typical Fellow Schedule

Behavioral Medicine Service Schedule Photo

Download the typical schedule for a fellow in Behavioral Medicine.

Abir Presentation

Abir Aldhalimi, PhD (class of 2016) presenting her scholarly project at the Association of Psychologists in Academic Health Centers annual conference in Detroit, Mich, March, 2017.

Rebecca Project

Rebecca Saracino (class of 2017 - right) congratulates Behavioral Medicine fellow Devika Jutagir (class of 2017) as she presents her scholarly project at the American Psychosocial Oncology Society conference in Orlando, Fla., February, 2017.

David Conference

David Finitsis, PhD (class of 2016) discusses his scholarly project at the American Psychosocial Oncology Society conference in Orlando, Fla., March 2017.