Rotations

"The Bellevue Psychology Externship Program is currently undergoing substantial structural changes. Please check back at the beginning of December, 2009 for updated information. Thank you."

The externship year is divided into three four-month rotations. One of the three is on an Adult Inpatient Unit. This is the only rotation required of all externs. Externs on this rotation conduct individual psychotherapy, usually in a supportive modality or with the goal of enhancing mindfulness in the patient; they also run groups and provide assessments of patients as needed. This work is done under the close supervision of a psychologist on the Unit. Externs are an integral part of the multidisciplinary treatment team on the Unit. Like the rest of the team – attending psychiatrists, social workers, activity therapists and medical students – they are expected to participate actively in the Unit’s community meetings and multidisciplinary rounds

There are a number of other rotations to choose from. Externs are on rotation sites for different blocks of time depending on the days they are in the Hospital. All externs are in the Hospital on Mondays, and they are on their rotations from 9 a.m. to noon that day. Rotations are also from 9 a.m. to noon on Tuesdays and Thursdays. On Wednesdays and Fridays, rotations are from 1 p.m. to 4 p.m. Externs must arrange their schedule so they can be in the Hospital and on their rotations during those hours on the three days they are at Bellevue. The only exceptions to these hours are the rotations in the Psychiatric Emergency Room (CPEP) and the Crisis Clinic where the day begins at 8:30 a.m. Some rotations require the externs to work on particular days. When this is the case, it is discussed in the description of the rotation.

On each rotation site, the extern works closely with attending psychologists or psychiatrists who provide clinical and administrative supervision. Externs are responsible for a variety of clinical services on their rotations. They also participate in various team activities. The rotations discussed below are open to all externs, who rank their preferences before the training year begins.

Chemical Dependency Clinic

This rotation provides the extern with a variety experiences in substance abuse assessment and treatment. Working with a population of polysubstance-dependent individuals, the extern will gain experience in the psychological, social, cognitive, and medical sequelae of substance abuse. Externs on this rotation conduct intake interviews, individual and group psychotherapy, case management and occasional psychological assessments. Externs will also become familiar with the multiple issues related to the treatment of mentally ill chemical abusers (MICA). The population is typically male, age 30-50, and supported by public assistance.

Child/Adolescent Psychiatry Inpatient Units

There are two units that serve child and adolescent patients with acute psychiatric disturbances. The Child Unit treats children between the ages of four and 11 with illnesses related to developmental and psychiatric disorders. This unit also has an autistic classroom for children in this age range. The Adolescent Unit serves patients between the ages of 12 and 16 who present with a wide range of diagnoses, including psychotic and behavioral disorders. The extern functions as a member of a multidisciplinary team that includes psychologists, psychiatrists, psychiatry residents, social workers, activity therapists, and nurses. The extern attends morning rounds, participates in treatment planning, and attends case conferences and patient community meetings. The extern also conducts psychological evaluations for clarification of diagnoses and for help in making referrals to residential or state hospital placement, and assesses each patient’s academic and educational functioning.

Forensic Psychiatry Clinic of the Criminal and Supreme Courts of New York

The Forensic Psychiatry Clinic provides mental health evaluations for adult and adolescent criminal defendants. Two types of evaluations are conducted. The purpose of the first is to address questions of mental status and diagnosis; that of the second is to address questions of an individual’s “fitness to proceed” with a criminal trial. After receiving appropriate training, the extern will conduct clinical interviews with individuals who are to be evaluated. The interview is designed to assess mental status and clarify medical, psychiatric, substance abuse, educational, vocational, and criminal histories. When indicated, intelligence and personality testing is added to the interview. With the help of a supervisor, the extern will then formulate a diagnosis and write a concise summary of the findings. Externs have the opportunity to observe (but not conduct) “fitness to proceed” evaluations. In addition, they may attend on-site case conferences and weekly seminars on forensic topics. The Forensic Psychiatry Clinic offers interested externs exposure to a field that stands at the intersection of psychology and law. The Clinic is located at 100 Centre Street in the Manhattan Criminal Court building. Note that this rotation takes the extern off site.

Neuropsychology Consultation Service

Externs on this rotation gain experience in neuropsychological assessment instruments and techniques in the context of testing a wide array of psychiatric, neurological and medical inpatients and outpatients with a variety of neurological, psychiatric and other disorders. The extern gathers background information from the chart, and discusses the case with the referring clinician (and, when appropriate, family members as well). In collaboration with a supervisor, the extern determines the appropriate tests to give, sets up appointments with the patient, and carries out the testing. The extern then reviews results and their interpretation in supervision, writes the test report, and gives feedback to the referring clinician and patient. Sometimes individual batteries include personality as well as neuropsychological tests. Intensive supervision emphasizes both normative and qualitative interpretations of standard neuropsychological instruments, with particular focus on the integration of neuropsychological results with pertinent psychodiagnostic findings. There is a weekly meeting for externs (and interns) to discuss cases and learn various neuropsychological instruments, as well as weekly teaching seminars with other neuropsychology groups.

Pain Management Clinic

The Bellevue Pain Treatment Center treats patients with a variety of chronic pain syndromes, including neuropathy, back pain, pain due to trauma, and end-stage cancer. Chronic pain patients come to the clinic with a high incidence of psychopathology, including depression, anxiety, symptoms of post-traumatic stress disorder, and personality disorders. Patients are seen on an outpatient basis and clinical responsibilities include consultation, evaluation, and psychotherapeutic treatment. The Pain Center uses a multi-disciplinary model in which the most common approach is a combined medical and psychological intervention. The psychotherapy is primarily time-limited and consists of an integration of psychoanalytic/ psychodynamic, cognitive, behavioral, and experiential approaches, including stress reduction, relaxation training, meditation, and guided imagery. There is also weekly group therapy. In addition to addressing the sequelae of living with chronic pain, treatment includes the evaluation and treatment of co-morbid personality and psychiatric disorders and screening for substance abuse in patients receiving opioid treatment. The extern is an integral member of a multi-disciplinary team and the clinical work will often include collaboration with physicians, psychiatrists, and other specialty clinics. The rotation provides the opportunity to work at the intersection of medicine and psychology, and for the extern to learn or further develop therapeutic skills in mind/body and psychosomatic medicine. A portion of the rotation may also include working with neurology patients from the Neurology Service and cancer patients from the Cancer Center. For this rotation, externs must be in the clinic on Tuesday and Friday mornings, and preferably either Tuesday or Friday afternoon as well.

Pediatric Psychiatry Unit

The Pediatric Psychiatry Unit provides consultation-liaison services to the Pediatrics Department, which serves preschoolers, school-age children, and adolescents who receive their outpatient medical care at Bellevue. Externs evaluate and diagnose psychiatric problems and psychological reactions to medical illnesses in these children. Externs perform intake assessments, mental status examinations, and offer a variety of consultation services to physicians, families and schools. They also conduct psychological assessments of preschoolers, school-age children, and adolescents. Pediatric Psychiatry is involved with the Hospital’s child protection team and social service teams, the Pediatrics Department, schools, and other community services. Externs work as members of an interdisciplinary team of child psychiatrists, psychologists, social workers, child psychiatry and pediatric fellows and residents, and psychology interns. The extern gains exposure to intellectual, educational, neuropsychological, and projective assessments, diagnostic interviewing techniques, mental status exams and integration of medical presentation, crisis intervention, and disposition case planning.

Psychiatric Emergency Room

The Comprehensive Psychiatric Emergency Program (CPEP) is the gateway to the psychiatric inpatient services at Bellevue. CPEP teams evaluate more than 700 patients a month. In addition to providing triage services, psychiatric evaluations and extended observations in the CPEP Emergency Room, CPEP is also home to the Mobile Crisis Outreach program and Interim Crisis Clinic, and crisis residence services. CPEP serves a cross-section of patients with a breadth of psychiatric presentations from across the metropolitan area. In CPEP, the psychology extern serves as a primary clinician and member of a multidisciplinary team that includes psychiatrists, psychologists, social workers and nurses. The trainee has primary responsibility for the care of the patients assigned to him or her, including the diagnostic evaluation, mental status exam, and formulation of an appropriate disposition plan. In the Interim Crisis Clinic, the trainee also serves as primary clinician for short-term crisis intervention services in an outpatient setting while the patient is awaiting community outpatient follow-up. Psychology trainees may also have the opportunity to go out into the community with the Mobile Crisis Unit to conduct psychiatric evaluations. Educational opportunities include in-depth rapid psychiatric assessment, psychopharmacology, and DSM-IV differential diagnosis. The training will focus on refining interviewing techniques, conducting mental status exams, and brief psychotherapeutic crisis interventions. To assist evaluations, the trainee may also administer brief cognitive screenings. Multidisciplinary rounds are held each day at 8:30 AM. Concurrent supervision is provided for each case by experienced psychiatrists and psychologists. Each trainee also receives weekly group supervision and participates in seminars and case conferences with observation of live interviews.

Psychiatric ER’s Interim Crisis Clinic

Patients released from CPEP, the Comprehensive Psychiatric Emergency Program, are often referred to the Interim Crisis Clinic where the psychology extern serves as a primary clinician engaged in short-term crisis intervention services in an outpatient setting while the patient is awaiting community outpatient follow-up. The psychology extern is responsible for continued evaluation of the patient’s condition, the elaboration of the patient’s psychosocial history, the continued assessment of the patient’s risk of harming himself or others, psychotherapeutic interventions, and assistance for long term follow up. Educational opportunities include in-depth psychiatric assessment, psychopharmacology and DSM-IV differential diagnosis. The training will focus on brief psychotherapeutic crisis interventions, refining interviewing techniques, and conducting mental status exams. The trainee may also administer brief cognitive screenings to assist in the evaluation. Multidisciplinary rounds are held each day at 8:30 AM. Concurrent supervision is provided for each case by experienced psychiatrists and psychologists. The trainee receives weekly group or individual supervision and participates in seminars and case conferences with observation of live interviews.

Recovery Clinic

The Recovery Clinic offers comprehensive multi-disciplinary treatment in a medically supervised outpatient setting for patients diagnosed with co-occurring disorders. Patients attend either the rehabilitation component, a day-treatment program in a modified therapeutic community (TC) setting, or the clinic/buprenorphine component, a less structured twice-per-week modality. Most patients attending the rehabilitation component suffer from major mental illness and polysubstance abuse/dependence. They present to the program at various stages of drug and alcohol recovery and psychiatric stability. Personality disorders, trauma, criminality, cognitive impairments and psychosocial difficulties such as homelessness, disenfranchisement, and poor social support are common. Patients in the clinic/buprenorphine modality are less impaired, but also present at various stages of drug, alcohol and psychiatric stability. Personality disorders, trauma, unemployment, major life changes and interpersonal difficulties are typical. This rotation offers the opportunity to learn to work with patients who suffer from various severities of mental illness and drug and alcohol addiction. The work is conducted in the context of an intensive therapeutic milieu. Externs gain experience conducting individual and group therapy, intake evaluations, case management and, on occasion, psychological assessments. Externs are active participants in the multidisciplinary treatment team.

NYU/Bellevue World Trade Center Medical Monitoring & Treatment Program

The World Trade Center (WTC) Medical Monitoring and Treatment Program (MM&TP) provides ongoing medical and psychiatric monitoring and treatment to eligible workers and volunteers (first responders) who were involved in the rescue, recovery, and restoration activities following the attacks on the WTC. This rotation provides the extern with a variety of experiences in the monitoring, assessment, and treatment of the psychological conditions associated with occupational exposure to the events of 9/11/01. Working with a population of first responders (NYPD officers/law enforcement, EMT’s, DOT, and DOB personnel, and other rescue and recovery workers), the extern will gain experience in the psychological, social, cognitive, and medical sequelae of occupational and related exposure to potentially traumagenic stressors, including PTSD and other anxiety disorders, depression, and substance/alcohol-use disorders.Externs on this rotation conduct monitoring interviews and individual psychotherapy.Possibilities for psychological assessments, couples, and group psychotherapy also exist.The extern will receive at least one hour each week of supervision from staff psychologist.For this rotation, externs must be available on Tuesdays or Fridays from 10am-2pm.