Predoctoral Internship Training Program in
Clinical & Community Psychology

Training Sites

Connecticut Mental Health Center

Eight program options (listed below) are available within the CMHC, one of which must be selected and designated on the Application Form which is to be used as a cover sheet for your application (see section on Application Procedures). Each training option is structured so that the fellow participates in a primary (3 days/week) and a secondary (1-1/2 days/week) placement site. The secondary sites available in relation to each training option are indicated at the end of the program descriptions. For all interns, one half day is reserved for Departmental seminars and related activities.

• Division of Substance Abuse
  
• Hispanic Clinic
  
• Neuropsychological & Psychological Assessment Service
• Acute Inpatient Unit
  
• Outpatient Services
  
• The Consultation Center
  
• West Haven Mental Health Clinic
  
• Young Adult Service
• Forensic Drug Diversion Clinic

The CMHC has the responsibility for providing comprehensive behavioral health services within the Greater New Haven area. Services offered include initial evaluation and assessment of prospective patients, emergency crisis-oriented services, outreach and engagement, short-term inpatient care, brief and continuing individual, family, couples, and group psychotherapy on an outpatient basis, rehabilitative programs, and a wide range of ongoing consultation and prevention programs. In addition, a number of research projects are sponsored by clinical, consultation, and research units at CMHC.

The opportunities for clinical training at the CMHC are rich and varied. Participation in the Outpatient Services in New Haven, the West Haven Mental Health Clinic, the Hispanic Clinic, the Young Adult Service, and the Division of Substance Abuse provides the opportunity for the enhancement of clinical skills through supervised individual, couples, family and group therapy as well as formal learning opportunities in psychodiagnostic and clinical assessment. Depending on placement site, interns have the opportunity to work with individuals diagnosed with various forms of psychiatric disorder, dual diagnoses of co-occurring psychiatric and addictive disorders, or primary substance abuse. Training in neuropsychological and comprehensive psychological assessment and consultation (with special emphasis on neuropsychology) is offered through placement in the Neuropsychological & Psychological Assessment Service. This experience also includes placements in the Inpatient Division and at Gaylord Hospital (a neurological rehabilitation setting), on a secondary basis. Participation in The Consultation Center provides the opportunity for experiences in prevention, health promotion, organizational consultation and staff development training, community program development and service system development and evaluation, as well as related prevention, evaluation, and services research. In addition, the CMHC offers specialized training in services to individuals with severe and persistent forms of psychiatric disorders including clinical, rehabilitative, and consultative interventions and serves as the lead agency for the managed service system (the Community Services Network) in Greater New Haven.

Because of the heterogeneous nature of the CMHC's faculty, staff, and clients, interns learn about the importance and implications of socioeconomic, cultural, ethnic, and racial issues in the process of individual, organizational, and community functioning and change. Considerable opportunities exist to work collaboratively and effectively in diverse interdisciplinary, cultural, and racial contexts with diverse professional staff within and outside the CMHC. Training also includes participation in seminars focusing on therapeutic and rehabilitative interventions, clinical and diagnostic assessment, and prevention and community-based interventions. Similarly, experiences in early detection, rapid assessment and intervention in crisis states, as well as more extended clinical evaluations, are available. To supplement this assessment experience, interns also complete a number of psychodiagnostic evaluations for either outpatients or inpatients depending on their particular placement sites. One also can participate in a variety of ongoing individual, organizational and community consultation services, and prevention programs provided by The Consultation Center. And finally, it is possible to become involved in a variety of research activities focusing on the analysis and evaluation of clinical processes and outcomes, of service delivery systems and models of care, and of preventive, community, and service system interventions.

CMHC Program Options:

Division of Substance Abuse (DSA)

Four pre-doctoral interns are selected for primary placement within the Division of Substance Abuse (DSA) in one of two training tracks: 1) Adult Clinical Services; 2) Clinical and Prevention Research. Interns in each track obtain intensive supervision providing a range of assessment and therapeutic services for a diverse patient population that shares a common behavioral problem. Several required and elective seminars on substance abuse assessment, treatment, prevention, and research are offered for pre-doctoral and post-doctoral psychology interns and addiction psychiatry interns. All DSA pre-doctoral interns meet regularly with a primary advisor, psychotherapy supervisors, assessment supervisor, and research mentor assigned from a faculty group of over 20 full-time psychologists who, together with faculty colleagues in psychiatry, epidemiology/public health, and medicine, comprise one of the most diverse, productive, and highly regarded programs in the world focused specifically on addiction.

1) DSA Adult Clinical Services (APPIC # 118315)

Two DSA interns have their primary placement at the Substance Abuse Treatment Unit (SATU) of the Connecticut Mental Health Center (CMHC). SATU is a large outpatient program that offers training in brief- and longer-term individual and group therapy for adults and young adults, and couples/family therapy. Specialized treatment programs exist for alcohol abuse, polysubstance abuse, dual diagnosis, criminal justice, and pharmacotherapies for opioid and alcohol dependence. Interns provide closely supervised psychotherapy, psychological testing, and clinical assessment services. In addition, there is a walk-in and evaluation service providing experience with more acute problems, crisis intervention, and rapid assessment and referral skills. Patients are strongly encouraged to become involved in 12-step meetings during and after treatment at SATU, but clinical services provided are not based on this model of recovery.

Adult Services interns at SATU are offered the opportunity to gain supervised clinical experience applicable to varied psychiatric populations as well as specialized knowledge of substance abuse issues. The treatment orientations learned are varied, but typically emphasize motivational enhancement during the early phases of treatment, cognitive-behavioral approaches to promote change, interpersonal and group interaction approaches to sustain change, and integrative (specialized psychotherapy or combined psychotherapy/pharmacotherapy) models for dual diagnosis. The type of psychotherapy offered to patients depends on such factors as the severity of symptoms, readiness for change, focus of identified problems, the nature of support systems, and co-occurring disorders. Patients with a wide range of psychopathology are assigned to interns, and specialized opportunities for training are often available (e.g., Dialectical Behavior Therapy, Motivational Interviewing).

Primary placement interns in the DSA Adult Clinical Services track choose a secondary placement at one of the following CMHC outpatient clinical programs: Outpatient Services; West Haven Mental Health Clinic, or; Hispanic Services. See the descriptions for these programs listed below.

For more information about the DSA Adult Clinical Services track, please email donna.lapaglia@yale.edu.

2) DSA Clinical and Prevention Research (APPIC #118320)

Two interns have their primary placement within one of the two NIH-funded centers within Yale's DSA Research Division: 1) Psychotherapy Research Center (Bruce Rounsaville, PI); 2) Transtheoretical Tobacco Use Research Center (Stephanie O'Malley, PI) Both centers have several patient-oriented research projects evaluating empirically supported therapies and using structured diagnostic and clinical assessments. Interns choose 2-3 projects to develop new or enhance existing skills in the delivery of empirically supported, protocol-driven therapies, and in the assessment and interpretation of measures of patient psychopathology, behavioral outcome, and psychotherapy process.

Among the more commonly evaluated behavioral therapies for which training and supervision are provided include relapse prevention coping skills, motivational enhancement therapy, contingency management, 12-step facilitation, brief interventions, smoking cessation, relational parenting, risk reduction, as well as combined or integrative models for substance abuse patients with co-occurring disorders. Interns in the DSA Clinical and Prevention Research track also work closely with their primary advisor and research mentor to develop a training plan aimed at mastering the necessary skills required to conduct research on substance abuse which may include learning new research methods, statistical analyses for completed studies, or coordinating a pilot project. In addition to the required seminars for the internship, interns in this track attend treatment and prevention research seminars. There are many opportunities for postdoctoral training in clinical and prevention research in substance abuse at Yale.

Primary placement interns in the DSA Clinical and Prevention Research track have a secondary placement in the Division of Prevention and Community Research at The Consultation Center (TCC). This program focuses on evaluating a range of substance abuse primary and secondary prevention models across the life span. Please see The Consultation Center.

For more information about the DSA Clinical and Prevention Research track, please email samuel.ball@yale.edu.

Hispanic Clinic (APPIC #118318)

The Hispanic Clinic of the Connecticut Mental Health Center is a community mental health and addictions treatment provider that serves the Hispanic monolingual population of Greater New Haven and surrounding areas. The site is organized as a satellite clinic of the Connecticut Mental Health Center and is part of the Center's Outpatient Services. This placement provides an intern with a rare and exciting opportunity to receive intensive clinical training and preparation for working with an under-served and growing minority population. As all clinic clients are monolingual, fluency in Spanish is a requirement for working within this multi-service, specialty clinic.

The Hispanic Clinic is staffed by a multidisciplinary team of bilingual-bicultural clinicians that provide a comprehensive range of services to an adult population. These services range from diagnostic evaluation, pharmacotherapy, and psychotherapy in mental health, addictions, and co-occurring disorders. The predoctoral intern works in conjunction with the clinical interdisciplinary team and provides clinical services within the Ambulatory Specific Adjunctive Program (ASAP), a program designed to provide intensive clinical care within a group treatment modality.

Furthermore, the intern will have the opportunity to provide direct clinical services to an adult monolingual Latino population within a newly established system of care that is based at the Hispanic Clinic. The Connecticut Latino Behavioral Health System (CT LBHS) represents a regional initiative designed to expand the accessibility and quality of behavioral health services to the monolingual Latino community. The overarching goal of CT LBHS is to improve access to behavioral health care and to promote culturally relevant treatment alternatives. As such, this placement offers the intern a unique opportunity to offer clinical services within a larger organizational collaborative of behavioral health agencies and to learn about issues related to the development of a broader system of care.

Ample supervision is provided for all aspects of the intern's work, as well as opportunities to participate in seminars focusing on cross-cultural issues, addictions treatment, co-occurring disorders, community-based intervention, and prevention. Finally, opportunities exist for the intern to participate in on-going research projects based within the clinic, as well as within the broader context of the Center's Outpatient Services. The Hispanic Clinic offers one primary predoctoral placement and the intern can request a secondary training site at either: The Consultation Center, Outpatient Services at 34 Park Street, or the West Haven Mental Health Clinic. Based on the intern's training interests and needs, the secondary placement can be tailored to offer specialized training experiences with Latino populations.

Training Goals

The Hispanic Clinic placement offers the intern specific skill development that is relevant to assessment, intervention, consultation, and clinical research with Latino populations. The intern is expected to gain proficiency in the conceptualization of clinical issues based on a comprehensive and culturally informed assessment. Particularly, the training year will provide an opportunity for the intern to acquire further skill and knowledge in the following: 1) knowledge of diagnosis and psychopathology and differential diagnosis based on cultural nuances; 2) ability to adapt evidence-based interventions in a culturally specific manner; and 3) interpreting the results of various types of assessments taking into account cultural and linguistic issues. The intern will apply an understanding of relevant system, organizational, and faith-based issues to establish and maintain effective relationships through the utilization of cultural constructs with service recipients and partners. Moreover, while the Hispanic Clinic offers a primary clinical training experience, arrangements can be made to offer the intern additional mentoring and supervision related to the development of culturally-competent clinical research skills.

Training Faculty:

Luis M. Añez, Psy.D.
Luis Bedregal, Ph.D.
Eric Frazer, Psy.D.
Christine Lozano, Psy.D.
Manuel Paris, Psy.D.
Michelle Silva, Psy.D.

For more information about this placement site, please email Manuel Paris at manuel.paris@yale.edu, Psy.D. or call (203) 974-5819. See relevant descriptions for further information on secondary placements.

Neuropsychological & Psychological Assessment Service (APPIC #118317)

These placements provide assessment experiences and training (principally neuropsychological) with diverse clinical and research settings.

The training is as follows:

Primary placement: CMHC Neuropsychological & Psychological Assessment Service

Secondary placements: Interns conduct neuropsychological assessments within diverse settings: (a) Gaylord Rehabilitation Hospital (a neurological setting; 1 day per week), (b) the Adler Geriatric Center (geriatric consulting; MCI and dementia assessments; 1 day per week for 6 months, (c) clinical research in a Parkinson’s Disease and dementia (AD) research facility, 1 day per week, (d) period handling of referrals received from the broader community by the Yale Department of Psychiatry Neuropsychological Assessment Service (forensic and clinical), and (e) the assessment of patients in various research protocols (e.g., TMS for hallucinations; hepatitis C treatment; prodromal Parkinson’s Disease; amyloid burden and AD treatment protocols).

The major focus is upon the development of neuropsychological assessment and consultation skills. This involves liaison with multidisciplinary teams, integration of diverse clinical data (patient history, medical, interview, and test results), and the communication of findings/recommendations.

Consultations involve both inpatient and outpatient cases. Interns refine their psychodiagnostic skills and gain a comprehensive understanding of the workings of a psychiatric treatment facility via exposure to diverse clinical issues (e.g., differential diagnosis, psychopharmacology, and disposition planning). Interns also participate in the neuropsychological components of several major research studies within CMHC, the Yale Department of Psychiatry, and neighboring research institutions.

Further neuropsychological training occurs via a one-day per week placement at Gaylord Hospital, a neurological rehabilitation setting. In that setting, assessments are undertaken on nonpsychiatric patients with brain compromise in a rehabilitative context. Supervision at Gaylord is provided by Dr. Richard Delaney.

Interns also consult to a geriatric service with regard to questions of mild cognitive impairment (MCI), early dementia, and differential diagnosis within dementia. In addition, interns handle occasional referrals from the community (e.g., civil forensic cases).

Neuropsychological training. In addition to the core seminars offered to all Yale interns, CMHC Psychological Assessment interns participate in a neuropsychological seminar throughout the year. This covers procedures, interpretation, brain-behavior relations and neuropsychological theory, neuropsychiatric conditions, psychometric issues, and ongoing research projects. Additionally, interns may attend Gaylord Rehabilitation Hospital neuropsychological seminars and rounds. Interns also typically attend elective seminars within the Medical School (e.g., on Dementia, Imaging, etc). Intensive supervision of all neuropsychological assessment activity is provided. After completion of their year at Yale, interns have typically gone on to neuropsychological postdoctoral placements in either neurological or neuropsychiatric settings, and several now hold faculty appointments in neuropsychology at various universities (e.g., Harvard, Brown, and Dartmouth).

Settings. The CMHC Inpatient Division accepts both voluntary and involuntary psychiatric admissions; the Outpatient and related divisions of CMHC treat large numbers of psychiatric patients annually. Patients are 18 years of age or older. Gaylord Rehabilitation Hospital treats neurological patients recovering from brain compromise (e.g., stroke, neurosurgery, trauma) on both an inpatient and outpatient basis. The Yale Department of Psychiatry Neuropsychological Assessment Service offers services to diverse settings via clinical and research contracts, and handles adult clinical and forensic referrals from the broader community. The Adler Geriatric Clinic assesses over 400 patients per year.

For more information about this placement site, please contact Dr. Keith Hawkins preferably by telephone at (203) 974-7831, or by email at keith.hawkins@yale.edu. To learn about the research interests of Dr. Hawkins, go to www.info.med.yale.edu and then click on "Find a Person". Next, click on, "Community of Science", and follow directions from there.

Acute Inpatient Unit (APPIC # TBA)

The Acute Inpatient Unit is a 26 bed adult (age 18+) service located on the fourth floor of the Connecticut Mental Health Center (CMHC). The unit serves as an integral part of CMHC's crisis, ambulatory, and community-based care system. Utilizing a multidisciplinary team approach, the unit provides comprehensive assessment, crisis intervention, symptom stabilization, and discharge planning to uninsured or under-insured residents of the local community. In addition, as daily operating needs and bed availability permits, two of the 26 beds may be used to provide medically managed detoxification from alcohol and/or opiates for patients enrolled in outpatient treatment within the CMHC service system. The unit's mean length of stay currently is six days. However, each patient's length of stay is determined by their specific care requirements and, as a result, may vary from one day to several months.

The psychology fellow is a valued member of a treatment team. Upon admission, each patient is assigned to a primary therapist and a team comprised of an attending psychiatrist, RN care coordinator, licensed clinical social worker, rehabilitation or occupational therapist, resident physicians, a social services discharge planning specialist, and trainees of various disciplines. In addition, clinicians from the nursing staff, including RNs and paraprofessional mental health assistants, are assigned to each patient and attend the daily team rounds on a rotational basis. A substance abuse rehabilitation counselor provides consultation and attends rounds on an as needed basis.

Within the context of team discussions, individualized outcome-oriented plans of care are developed, typically in direct collaboration with the patient and his/her outpatient care providers. The involvement of the patient's family and/or significant others is sought (in accordance with the patient's needs and wishes) to ensure that a comprehensive and workable plan is established.

Treatment planning based upon a comprehensive admissions evaluation begins with the generation of a problem list. Patient-specific treatments are defined and evaluated on an ongoing basis to guide the patient's care throughout the hospitalization. Individual, group, family, occupational, recreational, milieu and pharmacological therapies are employed in accord with the specific needs of individual patients. In addition, the patient’s medical, housing, financial, social, and vocational needs are assessed, and comprehensive dispositional planning is undertaken to ensure that the patient is returned to the community in a safe and expeditious fashion. Pastoral counseling also is available by request.

Responsibility for coordinating and enacting the patient's overall plan of care rests with the primary therapist. Among senior members of other disciplines, the primary therapist may be a resident in psychiatry or a psychology fellow. The primary therapist role within a multidisciplinary team structure ensures that the psychology fellow obtains diverse treatment experiences and exposure to a wide range of clinical conditions during the year (several hundred patients are treated annually on the unit). Within the course of his or her year at Yale, the CMHC Inpatient Fellow will clinically manage, or observe, clinical problems reflecting the full panoply of DSM disorders.

Overall, the treatment philosophy of the unit is eclectic, reflecting the diversity of disciplines engaged in the treatment process, the breadth of clinical conditions and specific problems encountered, and the rich broader theoretical and research context of CMHC and the Department of Psychiatry.

The psychology pre-doctoral fellow will carry direct care responsibilities within the unit, including admissions assessment, presentation of the case formulation to the treatment team, treatment planning, direct care/therapy, group therapy, family meetings, and the writing of progress notes, discharge plans, and discharge summaries. In addition, the intern will have the opportunity to conduct psychological assessments, participate in psychoeducational programming, and assist in the formulation of behavioral management programs for patients on the unit. Supervision is provided both on the unit, and with affiliated Yale faculty. The Yale internship program offers regular weekly seminars, and an additional wide range of departmental elective seminars open to both psychology interns and psychiatry residents.

The Psychiatric Inpatient placement offers skill development relevant to assessment, intervention, consultation, and clinical research. Interns are expected to (a) acquire skills in differential psychopathological diagnosis; (b) develop the capacity to conduct a comprehensive admissions assessment; (c) refine their case formulation skills; (d) develop a capacity to present a case formulation and treatment plan to a multidisciplinary team; (e) clinically manage patients within a team context; (f) refine their individual and group therapy skills; (g) refine their medical record keeping, treatment plan writing, disposition planning and discharge summary preparation skills; (h) further develop their skills in psychological assessment; and (i) develop their sensitivity to cultural and diversity issues.

For more information about this placement site, please contact Dr. Keith Hawkins preferably by telephone at (203) 974-7831, or by email at keith.hawkins@yale.edu. To learn about the research interests of Dr. Hawkins, go to www.info.med.yale.edu then click on "Find a Person". Next, click on, "Community of Science", and follow directions from there.

Outpatient Services (APPIC #118319)

The CMHC Outpatient Services (OPS) provides mental health treatment to adult residents of New Haven with serious psychiatric disabilities. OPS maintains a continuous treatment program providing clinical services to clients who require longer term or ongoing care and provides occasional opportunities for briefer, more focused interventions. In addition to clinical case management, psychiatric rehabilitation, assistance in coordinating community services and supports, and psychopharmacologic treatment, OPS provides various forms of psychotherapy. Individual, group, and family therapy are offered either on-site or in the community. Most of the clientele who receive services at OPS experience multiple, co-occurring clinical problems as well as social stressors such as poverty, inadequate housing and benefits, and unemployment. OPS clinicians offer multifaceted clinical services that are focused not only on ameliorating psychiatric symptoms but also on helping persons with serious impairments to build their lives in the community.

Predoctoral psychology interns work as part of an OPS multidisciplinary treatment team – including nursing, social work, and psychiatry interns and staff - that bears clinical and administrative responsibility for a large number of clients. Team members, including psychology interns, practice within a primary clinician model, carrying their own individual caseloads, which are assigned by the team director. Team meetings provide an opportunity for group discussion of general issues, difficult cases, and administrative problems. Each team also includes an attending psychiatrist who is available to psychology interns and other team members for individual consultation about medications and any other medical issues that may emerge.

Psychology interns may choose OPS either as a primary or a secondary placement option. Those with a primary placement in OPS are expected to carry twelve client contact hours per week. The major portion of their clinical time is spent in the provision of individual treatment, with some time also devoted to group and/or family therapy. Interns with a secondary placement in OPS carry six clinical hours which are usually devoted to individual treatment, but may also include some group or family work. Training caseloads are selected to provide a variety of treatment experiences as well as focused experience in a diagnostic area of particular interest. In addition, interns may participate in outpatient psychological testing, generally completing between 2 and 4 psychodiagnostic evaluations over the course of their internship.

Training is given high priority in the Division. Abundant individual supervision is provided for individual and group treatment. Interns participate in a weekly clinical case seminar that also examines clinical, systems, and professional development issues, and in a variety of in-service clinical training seminars, in addition to the Department's regular core seminars. A number of opportunities for collaborative research with faculty members are also available in the OPS to interested interns.

Applicants who choose Outpatient Services as their primary placement will have a secondary placement within the Community Services Network (CSN). The CSN is a consortium of 18 local community-based not-for-profit organizations providing a broad variety of psychiatric rehabilitation services, including residential, vocational and social programming to individuals served within OPS and other clinical settings. CMHC is the lead agency for the CSN, and the supervising psychologists for this placement provide the administrative oversight to the network. Additional information about the CSN may be found at: www.communityservicesnetwork.org

Secondary placement within the CSN offers training opportunities in the development, provision, and evaluation of community-based clinical and rehabilitative services for individuals with serious mental illnesses. The training experience involves involvement with the overall administration of the network. Each intern focuses on two or three specific initiatives chosen from among a diverse range of programs based on his or her interests and training needs. Roles and responsibilities of the intern will vary according to the chosen initiatives, but typically will involve participation in clinical consultation and/or training to the paraprofessional rehabilitation staff, program development, administration, evaluation, research and/or strategic planning initiatives. Interns will join existing CSN committees (e.g., a service system coordination committee, a vocational services committee) relevant to their area(s) of responsibility and will be supervised by core psychology faculty members associated with the CSN. It is anticipated that at the end of the training year, interns will have developed an array of skills pertinent to service administration and will have an enhanced framework for understanding the varied roles of psychologists in public sector mental health.

For more information about Outpatient Services, please email thomas.styron@yale.edu.

The Consultation Center (APPIC #118314)

The Consultation Center (TCC) is a multidisciplinary service, research, and training site that is a cooperative endeavor of the Department of Psychiatry, Yale University School of Medicine, the Connecticut Mental Health Center, and The Consultation Center, Inc. The mission of The Consultation Center is to promote the development and mental health of individuals and families; prevent psychological symptomatology, substance abuse, and other problem behaviors; and enhance the effectiveness of behavioral health and other human service organizations and service systems.

To accomplish this mission, faculty and staff at The Consultation Center: 1) develop and implement prevention and mental health promotion programs to individuals and families across the life span, 2) conduct prevention and community research and evaluations of community programs, 3) provide services to promote mental health and adaptation of persons with prolonged psychiatric and/or substance abuse disorders and their families, and 4) provide training, consultation, and technical assistance to professionals and organizations to enhance their effectiveness and the quality of service delivery to the community. The Consultation Center carries out its mission through its six service components – Children’s Programs, Adolescent Programs, Adult and Elderly Programs, Program and Service System Evaluation, Family Violence Programs, and the Program on Male Development. The research mission of The Center is reflected by its seven research areas – Stress and Coping Research; Resilience Research; Evaluation Research; Urban Education, Prevention, & Policy Research; Child Development and Epidemiological Research; Family Violence Research; and HIV Prevention and Mental Health Research.

Placements at The Consultation Center are arranged on a primary basis with a secondary placement in one of the other service units, or on a secondary basis for interns applying for a primary placement in another clinical setting. Primary interns spend approximately 3 days/week at the Center, and secondary interns approximately 1.5 days/week. The Center typically accepts three primary interns and two to three secondary interns. Training occurs across multiple modalities, including: seminar experiences, applied project activities, and regular supervision. Psychology interns at The Center work closely with faculty and professional staff within the context of applied training experiences that are referred to as projects. Interns are matched to their projects during the initial orientation period and remain involved with them throughout the training year. A typical primary fellow carries two to four such projects, and a secondary fellow carries one to two such projects throughout the year. Projects involve either a 6-hour or 12-hour commitment each week, with the latter referred to as double projects.

a. The Consultation Center Seminar

In addition to the core Departmental seminars offered within Psychiatry, a weekly seminar at the Center provides predoctoral psychology interns a strong foundation in the theory, methods, and principles of prevention and community-based research and practice. A copy of last year’s seminar syllabus is available online (http://theconsultationcenter.org). The focus is wide-ranging though strongly influenced by the fields of community psychology and prevention science. Topics include: an introduction to prevention and health promotion models, theory and practice of consultation and training, program development, organizational development, ethics, professional development, and human diversity. Seminar instructors include faculty and staff from The Consultation Center, and individual modules utilize a range of formats from didactic presentations to experiential/applied activities.

b. Investigators Group

Center faculty as well as pre- and postdoctoral interns participate in a monthly Investigators Group meeting in which manuscripts and grant submissions in preparation are subjected to a rigorous internal peer review process. This meeting serves to (1) facilitate the quality of articles and grant submissions, (2) provide experiential opportunities for interns to develop and further refine their manuscript development and grant writing skills, and (3) enhance the academic productivity of the Division.

c. Division of Prevention and Community Research

The Consultation Center also provides leadership for the Division of Prevention and Community Research (DPCR), one of the six research divisions of the Department of Psychiatry. The DPCR is dedicated to conducting theory-based, interdisciplinary prevention research studies in community settings. Research investigations are aimed at: a) identifying risk and protective processes underlying substance use/abuse and psychiatric symptoms or disorders which may serve as the basis for subsequent community-based preventive interventions; b) examining the effectiveness of interventions to promote adaptation and resilience or to prevent substance abuse and psychiatric symptoms; and c) developing models for the dissemination of science-based programs. Investigations are conceptualized within ecological, developmental, and cultural contexts, often involve multiple levels of analysis, ranging from the individual to the family/group to the community, and employ both quantitative and qualitative research methods. Additional information about the DPCR is available online.

A monthly Divisional Forum is also attended by faculty and pre- and postdoctoral interns in which investigators from across the university or from other universities present aspects of their research work and its relevance to prevention science. In addition, the Division sponsors an annual Departmental Lecture in which a noted scholar in the prevention field is invited to present original research and then discuss the presentation with faculty and interns. Finally, a biennial Divisional Conference is sponsored that on a major theme related to prevention research and policy that draws about 300 members of the university and the community.

Applied Professional Training Experience

Psychology interns receive applied professional training through project assignments under the supervision of Center faculty and staff. Potential projects include: provision of clinical and prevention services in an alternative high school setting; family violence education programs for mandated offenders; program evaluation of mental health or prevention programs and services; technical assistance to human service agencies; consultation to schools regarding peer mediation or substance abuse prevention; research on risk factors for mental disorders and health-related problems; and preventive intervention research. As noted earlier, primary interns typically train in the context of two to four year-long projects, and secondary interns typically train within one to two year-long projects. The mix of projects is tailored to provide interns with a range of applied training experiences throughout the year – developing competencies in multiple areas while also providing opportunity for new or novel experiences to complement previous training.

Supervision and Advisement

Psychology interns are assigned a primary advisor and individual project supervisors for each of their projects throughout the year. The advisor serves as the fellow’s primary faculty contact. Advisors meet regularly with interns to ensure that individual training goals year are being met, to discuss issues related to professional development, and to serve as a resource when individual needs or questions arise. Project supervisors oversee the training of interns within the context of the assigned projects, and also may provide individual, group or team supervision, depending on the nature of the specific project. They also serve as an additional training resource for interns in matters related to professional development, practice, and scholarly work.

Overview of the Training Year at The Consultation Center

Project Selection Process: At the beginning of the year, advisors meet with interns individually to discuss training goals and career objectives and to review the list of potential projects for the year. Faculty and project supervisors also meet with interns and discuss the particular projects that are offered. Interns indicate their preferences for project offerings to their advisor within the first two-weeks of the internship year, and faculty match projects to interns based upon these preferences while ensuring a broad training year that supports the needs and interests of the interns.

Attendance at Center and Departmental Seminars and Meetings: Interns participate in the weekly seminar at The Consultation Center, as well as weekly Departmental activities including the Departmental seminar sequence and monthly colloquium series. Monthly meetings at the Center include: a center-wide staff meeting, the Division of Prevention and Community Research forum, and Investigators Group meetings.

Project-related Activities: The remaining Center-related activities are focused primarily within project assignments. Interns work closely with project supervisors and professional staff to become acquainted with the training, roles, and expectations of their particular projects. Project-related time may include individual and group supervision on project-related tasks, as well as independent work specific to the particular demands and requirements of individual projects.

Evaluation of Psychology Interns: Psychology interns receive ongoing feedback during the course of the year from their project supervisors and advisor. In addition, quarterly formal evaluations are completed during the training year that serve as opportunities to review progress on training goals and address progress toward core competency areas.

Secondary Site Pairings for Interns in Primary Placement at The Consultation Center:

Two CMHC sites serve as potential secondary placements for psychology interns that have a primary placement at The Consultation Center – the West Haven Mental Health Center (WHMHC) and Outpatient Services (OPS). Interns spend approximately 1.5 days per week at these clinical settings throughout the training year. Secondary placement at WHMHC provides interns with an opportunity to work in an outpatient clinic of the Connecticut Mental Health Center that provides a full array of community-based psychiatric services to children, adolescents, and families living in the nearby town of West Haven.

Secondary placement at OPS provides interns with an opportunity to work in a community-based outpatient treatment setting that is part of a comprehensive community mental health center that serves adult residents of greater New Haven with serious psychiatric disabilities. OPS maintains a continuous treatment program providing clinical services to patients who require longer term or ongoing care and a time-limited program for focused interventions which are relatively brief.

The Consultation Center as a Secondary Placement Site:

The Consultation Center also serves as a potential secondary site for psychology interns with a primary placement at either the Hispanic Clinic or the Division of Substance Abuse (DSA) Clinical and Prevention Research Track. The Hispanic Clinic of the Connecticut Mental Health Center is a community mental health and substance abuse clinic that serves the Hispanic monolingual population of greater New Haven. Primary interns at the Hispanic Clinic with a secondary placement at the Center are matched to one to two projects for a total of 1.5 days per week.

The DSA Clinical and Prevention Research Track offers psychology interns the opportunity to be involved in one of the NIH-funded centers within Yale's DSA Research Division. DSA secondary interns at The Consultation Center participate in research activities in the Division of Prevention and Community Research and are matched with a faculty supervisor at The Consultation Center to work on research involving substance abuse and prevention related activities.

For more information about placement at The Consultation Center, please email derrick.gordon@yale.edu and/or visit The Consultation Center Website at http://www.theconsultationcenter.org.

West Haven Mental Health Clinic

The West Haven Mental Health Clinic (WHMHC) is a satellite clinic of the Connecticut Mental Health Center that provides community-based psychiatric services to children, adolescents, and adults living in the City of West Haven. The clinic serves an ethnically diverse, economically poor population of clients with a broad range of presenting problems. The presence of child and adult treatment teams within the same clinic offers unique opportunities for coordination of services both across the life span and across generations.

In this community-oriented setting, the WHMHC offers a full complement of outpatient services to children, adolescents, and adults with acute and chronic psychiatric difficulty. Almost all clients are involved with other service-delivery systems. Many of the adults are involved in other programs funded by the Connecticut Department of Mental Health and Addiction Services, and many of the children and adolescents are involved with the special education system, child protective services, or the juvenile court system. Although the validity of all theoretical perspectives is acknowledged, the setting emphasizes the integration of developmental perspectives on psychopathology, family systems theory, and a community perspective on service delivery.

Services available at the clinic include intake-triage, crisis intervention, individual psychotherapy, group therapy, family therapy, marital therapy, case management, psychological assessment, and pharmacotherapy. The clinic also has a Dialectic Behavior Therapy (DBT) program and a dual-diagnosis program for clients with concurrent psychiatric and substance use problems. The adult component has formal links with clinical and rehabilitation programs that target individuals with chronic mental illness, and the child component has formal links with several school-based programs and an interagency collaborative that coordinates community-based services being provided to children living in stressed, fragile family systems.

The West Haven Mental Health Clinic is only available as a secondary placement. Applicants who choose The Consultation Center, the Hispanic Clinic, or the Division of Substance Abuse as their primary placement may choose the WHMHC as their secondary placement. Applicants who choose the Young Adult Service as their primary placement always have the West Haven Mental Health Clinic as their secondary placement. Every year, there are four to six psychology interns with a secondary placement at the clinic. Predoctoral psychology interns with a primary placement at The Consultation Center, the Hispanic Clinic, or the Division of Substance Abuse are required to maintain a balance in clinical work being done with adults versus children and adolescents. Psychology interns with a primary placement on the Young Adult Service only work with children and adolescents to create an internship experience that focuses on the delivery of psychiatric services to children, adolescents, and young adults.

Within this structure, clinical assignments are varied to provide the broadest experience possible while also allowing for pursuit of personal interests in particular populations. Previous experience working with children is not required for acceptance, and all interns are encouraged to use the placement to address gaps in their clinical experience. Clinical supervision is provided by faculty who have experience working with children, adolescents, adults, groups, and families. All psychology interns with a secondary placement at the West Haven Mental Health Clinic also participate in an applied seminar on psychiatric assessment and intervention with children, adolescents, and young adults.

Please note that funding and licensing requirements for the child component of the West Haven Mental Health Center mandate that anyone who works with children must have a physical examination and successfully complete criminal background and child protective services checks. Guidelines outlined by the Connecticut Department of Children and Families prohibit the university from allowing people who have been convicted of certain types of felony charges from working in a licensed psychiatric clinic for children.

For more information about this placement site, please email thomas.mcmahon@yale.edu

Young Adult Service (APPIC # 118321)

The Young Adult Service (YAS) is a specialty service within the Connecticut Mental Health Center (CMHC) that provides intensive psychiatric services to individuals 18 to 24 years of age whose psychosocial development has been disrupted by persistent psychiatric difficulty. Clients referred to the service typically present with moderate to severe psychiatric disturbance characterized by affective disturbance, psychosis, behavioral dyscontrol, self-injurious behavior, substance abuse, negative self-image, unstable interpersonal relations, disturbance in psychosexual development, learning problems, and other developmental difficulty. Clients typically have a history of psychiatric hospitalization, residential treatment, or out-of-home placement as a child, or they are at risk for recurrent psychiatric hospitalization as a young adult because of the recent onset of a primary psychotic or bipolar mood disorder.

The Young Adult Service provides developmentally informed, recovery-oriented services designed to promote normative development as much as possible in the context of whatever psychiatric difficulty the client might be experiencing. The service has a capacity of approximately 65-75 clients. Fifteen of the clients reside in transitional living programs operated by a collaborating agency. The others live in the community alone, with family, friends, or a romantic partner. The principles of developmental psychopathology guide assessment and intervention of the target population. An intensive, assertive, community-based approach to treatment that both targets problems and builds upon the strengths of clients, their families, and their community is utilized. A full range of clinical and case management services are offered by a mobile, interdisciplinary treatment team with expertise in the assessment and treatment of children, adolescents, and young adults. Treatment planning is individualized and comprehensive, and services are delivered at the clinic, at the transitional living facility, and in the community. All clients have more than one clinical contact weekly. Autonomous decision-making, vocational-educational intervention, and preparation for independent living are important dimensions of all treatment plans.

The YAS is only available as a primary placement. Interns in placement on the Young Adult Service function as a primary clinician with responsibility to coordinate the care of five young adult clients, and they assist in the care of others. Clinical assignments are varied to provide the broadest experience possible with this specific population while also allowing for pursuit of personal interests in clients with a particular clinical presentation. Within a comprehensive treatment plan, motivational, cognitive-behavioral, interpersonal, supportive-expressive, problem-solving, and psychodynamic approaches to psychotherapy are utilized. The placement also allows for involvement in the delivery of parent intervention, group therapy, family intervention, specialized trauma intervention, Dialectical Behavior Therapy (DBT), behavioral consultation, and vocational-educational consultation. Interns also assist, on a limited basis, with psychological testing.

The West Haven Mental Health Clinic (WHMHC) is always the secondary placement for applicants who choose the Young Adult Service as their primary placement. The Young Adult Service and the West Haven Mental Health Clinic are located in the same building. Please see the section above for information about the secondary placement at the West Haven Mental Health Clinic. Given the focus of this training option, interest in the principles of developmental psychopathology and previous experience working with adolescents or young adults diagnosed with serious psychiatric difficulty is desirable.

For more information about this placement site, please email thomas.mcmahon@yale.edu

Forensic Drug Diversion Clinic (APPIC # 118322)

Caroline J. Easton, Ph.D., Director

The Forensic Drug Diversion Training Program in Law & Psychiatry offers training in both the areas of assessment and evidenced-based interventions for offender populations diverted from corrections & criminal justice settings into substance abuse treatment. A placement in this Division affords an opportunity for experiences in clinical interventions, forensic substance abuse assessments, and research. The mission of the forensic drug diversion program is to provide best practice procedures and offer evidenced-based therapies to substance abusing clients with criminal justice involvement. Moreover, the goal is to decrease substance use and recidivism rates among substance dependent populations with criminal justice involvement while promoting pro-social behaviors and increasing the overall health of this population.

To accomplish this mission, faculty and staff within the Forensic Drug Diversion Training Program in Law and Psychiatry provide training opportunities with the following populations: 1) Men diverted from corrections via the alternative drug intervention–ADI; 2) Men with co-occurring substance abuse and domestic violence via providing 12 weeks of an integrated substance abuse-domestic violence intervention founded, in large part, in cognitive behavioral therapy (CBT); 3) Marijuana dependent young adult offenders who are offered 12 weeks of CBT and rewards to decrease use and improve legal outcomes); 4) Marijuana dependent juvenile offenders who partake in 4-6 months of treatment utilizing the cannabis youth treatment (CYT) model with case management and educational services; and 5) Women with histories of trauma who are diverted from corrections and offered intensive case management while using the evidenced-based seeking safety interventions, CBT, and motivational enhancement therapy (MET).

The clinic provides intensive training and supervision to assure that the fellow is adhering to best practice procedures and is competent in administering these interventions to substance abusing forensic populations. Interns will be trained across the following evidenced-based therapies (cognitive behavioral therapy-CBT, motivational enhancement therapy-MET, Seeking Safety, Cognitive Processing Therapy, Contingency Management (CM)-Reward System). Sessions will be taped and rated for treatment fidelity (adherence and competence). Moreover, the clinic also provides intensive case management services and communication with the New Haven Court System.

Interns will also be provided with the opportunity to learn how to perform forensic substance dependency evaluations for the court within corrections or for community defendants via the court ordered Connecticut Statute 17a-694. The Court Clinic, within the Law and Psychiatry Division, has full responsibility for all "forensic substance dependency" evaluations in the south-central part of Connecticut, involving three judicial districts, amounting to approximately 250 evaluations per year. Evaluations are used as the initial forensic experience for interns in the program. Interns will learn report writing and have exposure to the experience of testifying in court. The forensic drug diversion interns will perform the evaluations with supervision by a licensed clinical psychologist. This evaluation is authorized under Connecticut statutes to perform forensic substance dependency evaluations. These examinations allow the interns a "gentle" introduction to working with attorneys, observing prisoners in jail settings, and testifying under conditions that are relatively routine. The program provides one to two evaluations per week of this type under close supervision.

Supervision for these responsibilities is provided in several ways. First, all accepted cases have been screened by Dr. Caroline Easton and other senior faculty and staff. Second, two seminars are scheduled weekly when all cases currently being evaluated are reviewed and discussed by Division faculty and interns. In addition, 2 hours of individual supervision is provided weekly. Following the group discussion, a report is drafted with the final report also reviewed by Dr. Easton and/or other appropriate faculty/staff. During the early stages of the program, the faculty may accompany the interns to observe the evaluations and court hearings, and subsequently review the testimony (where applicable). As the interns become more experienced, they work more independently, although the faculty continues to monitor and review all assessments and reports.

Seminar for Scholarship & Coursework

Scholarly activities are promoted through a number of teaching and research seminars. Interns will attend the Scholarship Seminar which focuses on selected forensic topics. The purpose of the seminar is to focus on scholarship and understanding the link between substance use, criminal behavior and violence. Interns are required to publish a case review in the Legal Digest section of the Journal of the American Academy of Psychiatry and Law or publish a scholarly article related to forensic drug diversion from various existing data bases that utilize state of the art comprehensive assessments.

Other coursework/seminars are a part of a fellow’s weekly schedule, including , a review of important legal cases impacting substance abuse and mental health; the Addiction and Special Populations Class (focus on multicultural competence, ethics, and professional conduct among substance abusers with co-occurring criminal justice involvement), a selection of relevant and timely topics; The Forensic Substance Dependency Class (introduction to the Connecticut Statute 17a-694 with case presentations and integration with professional conduct, ethics and multicultural competence) and the Competency to Stand Trial Clinic. One of the most popular weekly classes is the Friday Law & Psychiatry Seminar where interns, students and faculty gather to discuss cases that are currently being evaluated.

The American Academy of Psychiatry and Law Annual Conference

Each year the Law & Psychiatry Division encourages interns’ attendance at the annual AAPL conference and workshops on assessment and risk management. Interns are encouraged to prepare submissions for the AAPL Annual Meeting to occur shortly after completion of the training year.

Secondary Site Pairings for Interns in Primary Placement at Forensic Drug Diversion/Law and Psychiatry:

Three CMHC sites serve as potential secondary placements for psychology interns that have a primary placement at the Forensic Drug Diversion Program in Law and Psychiatry: the West Haven Mental Health Center (WHMHC), The Consultation Center (TCC) and Outpatient Services (OPS). Interns spend approximately 1.5 days per week at these settings throughout the training year.

Secondary placement at WHMHC provides interns with an opportunity to work in an outpatient clinic of the Connecticut Mental Health Center that provides a full array of community-based psychiatric services to children, adolescents, and families in the nearby town of West Haven. The fellow would be assigned cases with individuals or families that not only have psychiatric and potentially co-occurring substance abuse problems, but who also coincidentally have criminal justice involvement.

A fellow with a secondary placement at The Consultation Center (TCC) carries either one (12 hours/week) or two projects (6 hours each/week) throughout the year. The Consultation Center carries out its mission through its six service components – Children’s Programs, Adolescent Programs, Adult and Elderly Programs, Program and Service System Evaluation, Family Violence Programs, and the Program on Male Development. The TCC also undertakes a wide range of prevention, health promotion, and evaluation research programs. Involvement in service and/or research projects is possible.

A secondary placement at OPS provides interns with an opportunity to work in a community-based outpatient treatment setting that is part of a comprehensive community mental health center serving adult residents of greater New Haven with serious psychiatric disabilities. Again, the fellow in this placement would work with adults who also have co-occurring criminal justice involvement. OPS maintains a continuous treatment program providing clinical services to patients who require longer term or ongoing care and a time-limited program for focused interventions which are relatively brief.

For more information, contact: Dr. Caroline Easton at caroline.easton@yale.edu.

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