Interprofessional Residency in Psychosocial Rehabilitation

The VA Connecticut Healthcare System (VACHS) offers training with an emphasis in Psychosocial Rehabilitation (PSR), a therapeutic approach that encourages individuals with severe mental illnesses (SMI) to develop his or her fullest capacities through learning and environmental supports. This funded training program resulted from a Veterans Health Administration (VHA) initiative first announced in 2002 as part of the U.S. Department of Veterans Administration’s 2002 national initiative to promote psychosocial rehabilitation training, research, and program development. The residency follows the scientist-practitioner model and is an interdisciplinary mental health program that offers training in clinical services, program development, research and education to applicants from related mental health disciplines including psychiatry, nursing, social work, and rehabilitation counseling in addition to residents. The residency at VACHS sponsors up to 5 trainees. There is an additional PSR/LGBT emphasis psychology training slot.

The residency is hosted by VA Connecticut Health Care System at the West Haven division. Residents report to their respective disciplines for matters of professional conduct and development. The residents are primarily based at the Errera Community Care Center (ECCC), but also interact with other programs in the Mental Health Service Line such as the Post Traumatic Stress Disorder Program, Inpatient Psychiatric Unit, the Psychiatric Emergency Room, Health Psychology Service, Geropsychiatry Service and Neuropsychiatry Program.

The residency experience is unique for resident and is comprised of clinical, program development, teaching and/or research opportunities. The residents participate as members of interdisciplinary teams for approximately 20 hours per week for their primary clinical placements for the duration of the training year. In addition to attending weekly seminars and supervision sessions, residents have several secondary requirements which average from two to six hours per week and electives (approximately ten hours per week) designed to round out their residency experiences. In all, approximately 40% of residents’ time is devoted to direct service delivery.

THE RESIDENCY PROGRAM



This residency enhances many components of the residents’ previous training and equips them with a specialized set of skills that have been demonstrated to be effective with individuals struggling with severe and persistent mental illnesses and recovery from substances abuse disorders, as well as those individuals struggling to reintegrate back into their communities. A goal for the residents is to engage in assessment, crisis intervention, psychotherapy and psycho-education, vocational rehabilitation, relapse prevention and planning, and rehabilitative skills training. An associated goal for residents when working with individuals, groups, and families, is to learn and then apply evidence-based psychotherapeutic and psycho-educational techniques. Our training philosophy is strongly based on the scientist-practitioner model. Residents are taught evidence-based practices such as Social Skills Training, Illness Management and Recovery, Acceptance and Commitment Therapy and Cognitive Processing Therapy. Using their knowledge and acquired skills residents engage in a scholarly pursuit that culminates in a presentation that each resident makes at a national conference. The practice of psychosocial rehabilitation is one in which staff and residents can provide leadership on interdisciplinary teams; consultation to providers and systems of care; program design, implementation and evaluation; and policy analysis and advocacy.

Residents integrate into the various clinical programs of the ECCC for the duration of the training year where they provide individual, group and/or family interventions (including bio-psycho-social assessment, psychotherapy, psycho-education, clinical case management, and program consultation, to name several.) Direct practice experiences are coupled with seminars that teach the principles and practices of evidence-based and evolving practices such as: Social Skills Training, Acceptance and Commitment Therapy, Illness Management Recovery, Supported Employment, supported housing, clinical case management, psychopharmacology, Boston University Psychiatric Rehabilitation Model, family psycho-education and psychotherapy models, Psychiatric Advanced Directives, Dialectical Behavioral Therapy, and Cognitive Processing Therapy.

 

THE RESIDENCY TRAINING EXPERIENCE



At the beginning of the training year, residents spend the first three weeks orienting to VACHS, the MHSL and the ECCC programs. Each resident spends one day with each ECCC program, attending rounds, meetings and groups; and shadowing staff members. Each resident meets with the primary preceptor from the clinical to the residency to learn about the role of and expectations for the resident with the program. At the end of the three week orientation period, residents discuss their impressions and training needs with the Director of Training and then submit their top three choices for primary placements. The Residency Training Committee then reviews resident selections and program fit before finalizing placements. Since the residency Training Committee often selects residents with a diversity of clinical interests, residents' first choices are most often honored.



 

PRIMARY CLINICAL PLACEMENTS



The residents participate as members of interdisciplinary teams for approximately 20 hours per week for their primary clinical placements for the duration of the training year. In addition to attending weekly seminars and supervision sessions, residents have several secondary requirements and electives designed to round out their residency experiences (described below).

A number of distinct clinical programs are available to residents for primary placements. Within each of these programs, residents work closely with a wide range of allied healthcare providers (including: nurses, social workers, psychiatrists, occupational therapists, vocational specialists, recreational therapists, medical residents, dietitians, art therapists etc), family members, and other community partners. Each program provides a primary preceptor to facilitate administrative and clinical flow for the resident within the context of the team. Clinical supervision is provided by a licensed staff member from the resident's respective discipline. Primary placement opportunities include:




Psychosocial Rehabilitation Recovery Center (PRRC)
Vocational Services
Critical Time Intervention (CTI)
Healthcare for Homeless Veterans (HCHV)
Homeless Patient Aligned Care Team (HPACT)
The HUD-VA Supported Housing (HUD-VASH) Program
Mental Health Intensive Case Management Program (MHICM)
The ECCC Wellness Center
The Inpatient Mental Health Recovery Unit (8-East)
Veterans Justice Outreach Program



 

SECONDARY PLACEMENT OPPORTUNITIES

During the remaining 20 hours of the week, residents attend weekly seminars, supervisory sessions, and have several secondary experiences designed to round out their understanding and knowledge of community mental health and psychosocial rehabilitation. These secondary experiences include both the required and optional opportunities listed here:

Required:

· A rotation with the Behavioral Health Recovery Clinic (BHRC) "Recovery from the Start" where the residents are part of recovery-driven system transformation within VACHS. This is a project addressing client flow into and through the mental health services provided by the Neuropsychiatry Outpatient Firm (clinic). The residents participate in workshops that provide the initial portal into mental health services for new/transitioning Veterans. These workshops are “one stop shopping” that allow Veterans to meet one-on-one with a clinician and with a Peer Support Technician to discuss goals and needs, obtain a diagnostic clinical assessment, and orient the Veteran to mental health and other recovery-oriented services provided at VACHS. As part of the BHRC, PSR residents also have the opportunity to conduct assessments of homeless Veterans entering the system through the Errera Community Care Center programs. Specifically, residents provide diagnostic clinical assessments, conduct needs assessments, work on initial goal-setting, provide psycho-education to meet the Veteran’s expressed needs, help motivate Veterans to engage in treatment and assist in data collection and program evaluation. Each resident spends approximately four hours per week, for four months, in this rotation. Residents meet on Thursdays at 3 pm on the 7th floor of the building 1 at the medical center with Meg Stacy, Ph.D. the Local Recovery Coordinator to review cases and process their experiences. They also have the opportunity to lead rounds and facilitate discussions.

· Interprofessional Case Assessment Seminar: The Interprofessional Case Assessment Seminar meets monthly from October through July and is taught by Stephanie Lynam, Psy.D. and Amy Mester, LCSW. The seminar focuses on learning and applying the unique assessment skills of each discipline to effectively work in a collaborative manner to create and provide a comprehensive, recovery-focused, holistic and interdisciplinary approach to Veteran care. Throughout the year, fellows will be assigned to interdisciplinary teams where they will work with a number of different Veterans perform discipline specific assessments and collaborating with each other to foster interdisciplinary informed treatment. Time spent assessing Veterans will occur outside of the seminar meetings. The fellows are expected to work collaboratively with each other throughout the entire process of the assessment from beginning to end which includes deciding assessment tools, scheduling times to assess the Veteran, writing the assessment report and presenting feedback to the treatment team and the Veteran. Fellows will each be assigned at least one case as part of the interdisciplinary team (but likely more).

· Learning and facilitating evidence-based psychotherapy groups choosing from Acceptance and Commitment Therapy, Cognitive Behavioural Therapy for Psychosis, Illness Management Recovery and Motivational Interviewing.

· Formally learning the model and facilitating Social Skills Training groups in different settings.

· Designing, developing and implementing an Educational Dissemination Project (EDP) – that can be presented at the United States Psychiatric Rehabilitation Association's Annual Conference. An EDP can include designing a new psycho-educational group or program, research, an impact statement or a policy initiative.

Optional:

The list below includes activities that have been established by residents in previous years as well as new opportunities, but the resident may develop their own projects as well.

· Wellness Center – group or individual work 

· Wellness Center – clinical research

· PTSD Outpatient Firm – carry 2-3 clients

· PTSD Firm co-facilitate 1 group

· Coordinate and facilitate monthly training for Peer Specialists

· Facilitate a weekly Illness Management and Recovery group in the PRRC program.

· Facilitate Wellness Groups in the Substance Abuse Day Program, PRRC or Positively Silvers (55+) program

· Facilitate and design a Community Reintegration Program group

· Conduct research with the Northeast Program Evaluation Center

· Conduct a waitlist group for the Compensated Work Therapy program

· Develop a vocationally oriented group
        Adjustment to Disability
        Stigma in the Workplace
        Job Club

· Behavioral Health Recovery Clinic research

· Behavioral Health Recovery Clinic program development 

· Leeway, local nonprofit AIDS organization, co-facilitate psycho-educational group

· Legion Woods, local permanent supported housing program partnered with VA, Columbus House and The Connection (two community agencies). Provide clinical case management support.

· Inpatient unit recovery programming

· Annual homeless count - participate in one evening of community canvassing

· Participate with homeless outreach and engagement teams

· Provide consultation to a peer provider

· Work on housing development and community policy initiatives

· Liaison with community partners

· Facilitate arts programming (music and art)


Each resident’s training plan is individually tailored to meet specific training needs to develop competence in a full range of community mental health and psychosocial rehabilitation skills. After orienting to the programs and opportunities available, residents meet with faculty to select placements and design their training plans. Each resident receives supervision from several faculty members during the year. In addition, each resident is part of a coordinated training experience in which the residents regularly interact with each other and have a weekly meeting to discuss their training experiences, and development of professional identity and competence.

Resident and Program Evaluation

Resident progress is assessed by clinical supervisors during the course of informal and formal supervision.  Written and oral feedback is provided to residents at 4-months, 8-months, and at the conclusion of 12-months of training.  Residents review each evaluation form with the appropriate supervisor(s) before evaluation forms are signed by both faculty members and residents.  Though the process of supervision may provide the primary feedback to the resident regarding progress toward goals and the development of targeted skills, the formal evaluations are considered essential for overview and the mutual communication of resident and supervisors regarding progress.  Training plans should be revised accordingly to reflect new goals and objectives.   This process is highly interactive between the resident and faculty.  It is also further structured and monitored by the Residency Training Committee, which meets monthly.

Residents are also asked to evaluate the supervision provided by supervisor and primary preceptor at 4-months, 8-months and 12-months.  At each four month interval, residents are also asked to complete the Professional Identity and Confidence Survey.  The resident is also invited to complete program evaluation about the residency that looks at orientation, didactics and rotations.  The form is used for feedback to the program. 

Additional opportunities for residents to provide feedback to the training committee may also become available from time to time.  Residents are encouraged to provide honest and open feedback about their training experiences on all of these forms.

Seminars



Principles of Psychosocial Rehabilitation (Required): This weekly didactic seminar mirrors our training philosophy on the scientist-practitioner model is taught by Sandy Resnick, Ph.D., and Marcia Hunt, Ph.D. and is designed to provide participants with a broad and thorough understanding of community mental health and PSR interventions, principles, theories, and current research. Seminars focus on the current evidence-based practices for people with severe mental illness, ethics and boundaries (and how they differ from those in traditional mental health), and other relevant topics. Readings are provided to enhance discussion during seminars. In the second half of the seminar, participants are encouraged to teach at least one seminar on an area of interest, and to submit abstracts for talks to be given at conferences such as the United States Psychosocial Rehabilitation Association yearly conference. If applicable, time is devoted to teaching the mechanics of giving PSR presentations, and providing feedback to participants as they rehearse these talks for presentation for larger audiences.

The Leadership in Public Mental Health Systems (Required): This monthly seminar series is co-facilitated by Anne Klee, Ph.D and Allison Ponce, Ph.D. as an elective for the Department of Psychiatry of the Yale School of Medicine. It is comprised of discussions on leadership, management styles and professional development. The sessions are typically held in the leader's office. Participants meet with a range of leaders and managers, who lead discussions on topics ranging from mentoring, decision-making, workforce development, career paths, negotiation styles and politics in organizations to leadership in education and community organizations.

Consultation Seminar (Required): Meaghan Stacy, Ph.D., Local Recovery Coordinator, provides training and discussion of consultation at the individual, team, and system levels. This monthly, hour-long seminar includes didactic components and opportunities to discuss and get group feedback about residents’ consultation efforts. Other Discipline Directors of Training serve as discussants to provide multiple perspectives.

Individual Process with Training Faculty (Required): Residents meet biweekly with a faculty member to discuss program matters including administrative needs, educational plans, professional development, and systems issues.

Diversity Seminar (Required): Meets monthly over the course of the year for all post-graduate residents at VACHS. Topics and speakers are selected to increase self-awareness and improve delivery of care.

MEDICAL ROUNDS/MEETINGS (Elective)




Yale School of Medicine, Department of Psychiatry Grand Rounds (Elective): Held weekly at the Connecticut Mental Health Center involve didactic presentations on a wide variety of mental health topics and medical illnesses (respectively) by both local and visiting scholars.

Interdisciplinary Comprehensive Pain Management Rounds (Elective): Residents can participate in the Interdisciplinary CPMC Rounds that are held weekly on Monday mornings for 60-90 minutes. Participating disciplines include experts from Anesthesiology, Neurology, Nursing, Physical Therapy, Pharmacy, and Psychology. There are two goals of this meeting. The primary goal is to develop comprehensive and integrative assessment and treatment plans for referred patients. Pre-doctoral psychology interns and post-doctoral residents are responsible for presenting results of a comprehensive pain assessment of patients referred to the CPMC. This presentation informs the development of the assessment and treatment plan. The Interns and Residents are subsequently responsible for documenting this discussion and plan and for coordinating implementation of the plan. The second objective of this meeting is an educational one. In addition to the exchange of knowledge as a function of the case discussions, members of the team volunteer to provide brief (typically 20-30 minute) presentations on a pain-relevant topic of interest.

Yale School of Medicine - Psychiatry Electives

Yale Department of Psychiatry publishes elective courses open to trainees in the department. There are over 25 courses offered yearly and cover a broad range of topics including: (several on) psychotherapy, psychiatric epidemiology, neuropsychology testing, and psychiatry and the law.

Yale School of Medicine, Department of Psychiatry Division of Mental Health Services and Treatment Outcomes Research. Facilitated by Robert Rosenheck, M.D. and held monthly at the ECCC for the Yale School of Medicine and VA community. Speakers come from all over the country to present.

VACHS Mental Health Service Line Educational Meetings

The Mental Health Service Line offers seminars to the entire service on relevant clinical topics for practitioners on the second Thursday of each month from 10 am -11 am. This past year topics have included: Supported Employment, Vicarious Traumatization, Smoking Cessation, New Neuroleptics, Disaster Response Training and Clinical Neuroscience of Combat Stress in OIF Service Members.




Application Process

Application Review begins: January 1, 2017

Successful completion of an accredited program.


1.              U.S. Citizenship.


2.              Successfully meet mandatory requirements for appointment as a Federal Employee, including, but not limited to: willingness to participate in the government's drug testing procedures and consent to participate in fingerprinting and a background check to verify your application information and/or criminal history. Applicants who do not successfully pass this background check and/or drug test are ineligible for our program. Successfully meet mandatory requirements for appointment as a Federal. A male applicant born after 12/31/1959 must have registered for the draft by age 26 to be eligible for any US government employment, including selection as a paid VA trainee. Male applicants must sign a pre-appointment Certification Statement for Selective Service Registration before they can be processed into a training program. Exceptions can be granted only by the US Office of Personnel Management; exceptions are very rarely granted.

  

APPLICATION PROCESS:

Application review begins on January 1st and continues until all positions are filled.  

To apply, please send the following:

  1. A letter of interest describing career goals and how the features of the program as described will facilitate the realization of these goals
  1. Curricula Vita 
  1. 3 letters of recommendation

  

Application materials can be sent in one package or separately to the attention of

Anne Klee, Ph.D., CPRP

Director, Interprofessional Fellowship in Psychosocial Rehabilitation

anne.klee@va.gov

(203) 479-8035

Errera Community Care Center of VA Connecticut

114 Boston Post Rd, 2nd floor

West Haven, CT  06516

 

APPLICATION SELECTION:

  • All completed applications are reviewed by the Training Committee.  Based on a systematic review of all applications, a subset of candidates are invited to interview.