The Medical Psychology rotations (i.e., Behavioral Medicine & Health Psychology) identified below are related, but each covers different aspects of psychology with medical populations. The Behavioral Medicine rotation offers uniquely behavioral medicine interventions with specific populations, while the Health Psychology rotation offers more traditional psychological interventions and assessments with medical populations and occasionaloutpatients having more traditional psychiatric problems. Each rotation may be offered as a distinct experience, or they may be blended, with the intern taking a primary in one and a secondary in the other. Long term therapy supervision is also available on most rotations.

Interns on this specialty rotation are exposed to various aspects of health psychology/behavioral medicine. During this placement, the intern participates as a team member of the interdisciplinary chronic pain program. There is ample opportunity to assess chronic pain patients, report evaluation findings and offer recommendations to the chronic pain board, as well as actively participate as a team member to develop patient treatment plans. In addition, interns are afforded experiences and training to provide psychological interventions to assist chronic pain patients in coping with their condition and improving their quality of life. Such interventions may include cognitive behavior therapy, marital therapy, relaxation therapy, self-hypnosis training and training in biofeedback.

As a member of the multidisciplinary diabetic education program, the intern’s primary responsibility is to teach patients via a psycho educational group about their recently diagnosed diabetes mellitus, the link between stress, depression and the management of diabetes, as well as introduce them to some basic relaxation techniques.

Additionally, the intern participates as member of the smoking cessation clinic. Patients are trained in behavioral and cognitive behavioral techniques, nicotine fading, and self-hypnosis to help them successfully quit smoking. The intern is trained to effectively conduct this clinic and will have the opportunity to be the primary facilitator for at least one 3-session clinic.

Supplementary experiences on this rotation may include participation as a member of the interdisciplinary palliative care team and the opportunity to provide psychological services to patients who have “terminal” illnesses and are no longer pursuing a “cure.” Assessment and treatment of patients presenting with sexual dysfunction may also be available. Participation in Neurology Group Medical Appointments (GMAs) as a co-facilitator with the staff psychologist is another viable option for interested interns.

Furthermore, interns can be involved with the Chronic Pain/PTSD treatment group. This service is conducted in partnership with the PTSD Clinical Team (PCT). The purpose of the treatment group is for veterans with comorbid PTSD and Chronic Pain to distinguish the difference between pain and suffering and to engage in value-based living. The therapeutic interventions are based upon the Acceptance and Commitment Therapy (ACT).

Training on this rotation includes the basic concepts of psychophysiology, clinical hypnosis, and psychotherapy with medical patients. The intern can receive training in stress management, understanding the form and physiology of stress, stress response control, psychosomatic concepts, and applications of these in short and long­term treatment. The intern is also exposed to a number of the assessment/evaluation methods including the MMPI-2, Beck Depression Inventory, Multidimensional Pain Inventory, Brief Pain Inventory, National Pain Data Bank Short-Form, Mental Status Exam, Male Sexual Dysfunction Structured Interview and Clinical Pain Interview.

Interns are expected to attend staff conferences and grand rounds, interacting with nurses, social workers, dietitians, residents, chaplains, pharmacists and physicians. Observations of various medical procedures (e.g., acupuncture, trigger point injections, facet injection, etc.) can be part of the intern's experience on this rotation.

This rotation involves primarily medical inpatients and outpatients, with some interventions with mental health outpatients also available. Referrals are received from the Primary Care Clinics, Specialty Clinics (e.g., oncology, rheumatology), inpatient medical wards, and a small amount from the Mental Health Triage team.  On this rotation, the psychology intern provides psychological assessment and very brief therapy to medical inpatients, rounds with the Psychiatry Consultation and Liaison Team, including visiting inpatients and discussing medical cases, conducts weekly rounds on dialysis patients, provides assessment and therapy services as needed, and attends discharge planning meetings on a medical inpatient ward as part of the interdisciplinary team, including providing input to the team about the psychological needs of the patient. Additional experiences on this rotation can include outpatient assessment and triage, behavioral medicine interventions and various psychotherapeutic treatments, psychological assessment, neuropsychological screening, consultation, and patient education.

Interns on the Health Psychology Rotation are also involved with the Veterans' Individualized Insomnia Program (VIIP). Through this service, veterans are provided psychoeducation on a variety of sleep-related topics, practice mindfulness/relaxation, and receive support in forming, tracking, and maintaining behavioral goals to improve their quality and quantity of sleep.

Therapeutic interventions on this rotation are typically cognitive-behavioral in orientation, but may include other psychotherapeutic interventions as indicated. Referrals to this service for treatment may include stress management, preparatory mourning of terminal patients), adjustment to medical illness (e.g., rheumatological disorders, diabetes), post cardiac surgery (education & support), and noncompliance with medical treatment. However, basic assessment and treatment for depression and anxiety are also common. Psycho-education is often used with individuals or groups to promote understanding about their particular disease process, enhance coping strategies, improve utilization of social support, reduce the effect of stress and maladaptive behaviors on health, and deal with the stress induced by illness. Individual and group psycho-education is also used for habit control of weight and/or smoking cessation.

Assessments are conducted to aid in the formulation of the treatment plan and can include structured interview (organ transplant assessment or interferon treatment), personality assessment (concomitant emotional disorders or emotional/psychological issues specific to presenting health problems,) mental status evaluations (capacity to make medical decisions) and neuropsychological screening, such as diagnosis of dementia.

Home Based Primary Care Program

Interns in the Health Psychology Rotation also have the option of a part-time rotation in Home Based Primary Care (HBPC). This program provides in-home primary medical care and psychosocial services for veterans whose chronic medical conditions have made it difficult or impossible for them to access the outpatient clinics for the medical care they need. The HBPC team utilizes an interdisciplinary approach to the management of patient issues. The team consists of a physician, nurse practitioners, occupational therapists, social workers, pharmacist, and psychologist. Training opportunities available to Psychology Interns include:

• Neuropsychological screenings and psychological assessments of patients and caregivers.
• Individual and family therapy for depression, anxiety, caregiver stress, end-of-life issues, and other forms of emotional distress.
• Training in behavioral interventions and environmental modifications focused on the management of psychological problems in patients with varying levels of cognitive impairment.
• Consultation with other program staff about methods of enhancing patient adherence to treatment regimens.

One Board Certified Neuropsychologist (ABPP) and a neuropsychology technician staff this clinical rotation in Neurology Service. This rotation provides training in neuropsychology with extensive experience in administration and interpretation of the Halstead-Reitan Neuropsychological Battery and other empirically based neuropsychological procedures for diagnostic purposes. In addition, training is provided in the Minnesota Multiphasic Personality Inventory (MMPI-2) correlates of medical populations. Intern experiences on this placement may include observation of the "WADA" procedure (i.e., cognitive testing during intra-carotid sodium amytal injection to determine lateralized brain functions prior to epilepsy surgery). Additionally, conducting neuropsychological research for presentation at national conferences is encouraged, especially if the dissertation is completed.

In this clinical area, patients are seen on a referral basis for neuropsychological evaluation. Referrals are received from all sub-specialties; however, primary activity involves Neurology, Primary Care, and Neurosurgery. Interns will attend Neurology staff conferences and Neurology Grand Rounds, as well as interact with nurses, social workers, dietitians, neurology residents, chaplains, and others. Research (usually dissertation) and case presentations are prepared and presented by the intern to the Psychology Grand Rounds twice yearly. Assessment and participation in an interdisciplinary Pain Management Program is also encouraged on this rotation. When possible, the intern is encouraged to observe medico-legal cases involving depositions and trial testimony. Observations of various medical procedures (e.g., electroencephalography, arteriography, nerve blocks, acupuncture, epidural steroid injections, etc.) are also an important part of the intern's experience on this rotation.

There are many rotations available through the North Little Rock Division. Nearly all of them have a focus on rehabilitation and the long range aspects of care. Like Little Rock, each rotation may be offered as a distinct experience, or they may be blended. Some restrictions may apply, but the training faculty will work diligently throughout the training year to make sure the internship experience addresses individual preferences and professional development needs

The Integrated Mental Health Rotation (IMHR) is tailored to best meet the individual training needs, interests and specialty focus of each intern. Specialty emphases available include IMHR-General Psychology, IMHR-Health Psychology, and IMHR-Neuropsychology. Located at the CAVHS North Little Rock Division, this rotation will provide ample training opportunities for interns to enhance their patient-care skills in a variety of milieus. Interns are encouraged to make training choices that take advantage of the plethora of available experiences in the Addiction Program Special Treatment Section (STS), Administrative & Program Evaluation (APE), Mental Health Clinic (MHC), NLR Neuropsychology, Post Traumatic Stress Disorder programs (PCT & DRRPT), and/or the Vocational Rehabilitation program.

The rotation will be divided into two 3-month modules with both a primary placement and a secondary placement ( selected for each module. The IMHR was specifically designed with the intent of providing  every intern with long-term treatment experiences (e.g., psychotherapy, group therapy, etc.).

Selection of an addictions placement consists of involvement in two Intensive Outpatient Treatment programs and an Outpatient Aftercare program. Psychology's involvement within these units is primarily through group psychotherapy; but can also include opportunities for patient education, treatment team participation, referral for vocational screening and rehabilitation, program development and evaluation, as well as research.

Additional substance abuse treatment experiences are available to interested interns through a rehabilitation Domiciliary. The program focuses on vocational and social rehabilitation for patients who have completed an acute treatment program. Long-term therapy experience is available, as is an option for involvement in evening group therapy experiences. The Addiction Program is staffed by an interdisciplinary team including two full-time psychologists and one part-time psychologist.

The Administration training experience, as a secondary placement only, is designed to give the intern an opportunity to view and gain training in administration, supervision, and management. The intern's experience may include work with program development, workforce enhancement, Process Action Teams or other aspects of the Total Quality Management program of the Central Arkansas Veterans Healthcare System. The various psychologists serving in administrative roles can serve in the supervisory capacity for those selecting this placement. 

A primary or secondary placement in the MHC will consist of individual therapy, group therapy, and personality evaluations of psychiatric outpatients. An interdisciplinary team of more than 40 providers (i.e., psychologists, pharmacists, psychiatrists, social workers, & nursing staff) plus support personnel staff the MHC.

Diagnoses of MHC outpatients range from relatively mild problems (e.g., adjustment disorder) to more severe psychopathology such as schizophrenia, personality disorders, and dual diagnoses. The diversity of the patient population is broad in scope extending from the young adult to elderly veterans and includes both males and females of various ethnic, educational and occupational backgrounds. The length of the Integrated Mental Health Rotation was specifically designed to allow interns opportunity to gain experience in providing some form of long-term therapy. Therapeutic approaches for group, couple, and individual therapy include, but are not limited to Cognitive Behavioral Therapy, Dialectical Behavior Therapy , and Interpersonal Psychotherapy.

The MHC offers several group experiences that interns can facilitate or co-lead. To meet the demands of the population served, most new patients with mood disorders are initially placed in a 12-week structured psychoeducational CBT group. Additional group opportunities available in the MHC include anger management, bi-polar, insomnia, Dialectical Behavior Therapy skills, pain management, and OIF/OEF (Operation Iraqi Freedom; Operation Enduring Freedom) vet support groups. Maintenance groups are commonly offered for ongoing support subsequent to the initial intervention group series.

Intern competency forms, which are reviewed with interns at the beginning of the rotation, are used to rate interns at the end of the rotation. Weekly supervision provides ongoing feedback on performance. Interns are evaluated on competencies in therapy and assessment through direct observation, supervision, audio tapes, progress notes, and assessment reports.

Fellowship trained Neuropsychologists and a psychometrician technician staff this clinical rotation in Mental Health Service. This rotation provides training in neuropsychology with extensive experience in the administration and interpretation of a flexible battery approach, including training in empirically based neuropsychological procedures for diagnostic, treatment, and rehabilitation purposes.

Psychological assessment will be utilized to increase the understanding of the behavioral expression of brain dysfunction, assist in diagnostic clarification, and provide recommendations for treatment and recovery oriented interventions. Whether the novice in mental status examinations or the advanced neuropsychology student, skill development goals are specifically suited to the abilities of each intern. No prerequisite experience or training is required. Training in cognitive rehabilitation for individuals with Traumatic Brain Injury and associated psychoeducational groups for families are also available.

Patients are seen on a referral basis for neuropsychological evaluation and/or rehabilitation. Referrals are received from Physical Medicine & Rehabilitation, Primary Care, Substance Abuse Treatment, Post Traumatic Stress Programs, Mental Health Clinic, and the Domiciliary. Additional interdisciplinary efforts include participation in Vocational Capacities Clinic team and the Spinal Cord Injury Clinic team. Interns are encouraged to attend staff conferences, team meetings and Grand Rounds. The intern may also participate in program evaluation and administration. If the dissertation is complete, neuropsychological and rehabilitation research for publication or presentation at national conferences will be supported through time allowance, statistical support, manuscript editing and/or mentoring.

The PTSD Clinical Team (PCT) offers mental health services to an outpatient population of PTSD-diagnosed veterans, their families, and significant others. In addition, the PCT provides psychotherapy to veterans residing on the Residential Rehabilitation Treatment Programs (RRTP) PTSD unit. Mental health services are provided by psychiatrists, licensed psychologists, advanced practice nurses, and licensed clinical social workers. Services include medication management, individual psychotherapy, group psychotherapy, marital therapy, psychological testing, consultation, and patient education.

The PCT uses Acceptance and Commitment Therapy (ACT) as its therapeutic framework. ACT is a behaviorally based intervention that addresses avoidance of internal events and the role that language plays in human suffering. The therapy specifically uses a number of experiential interventions to help patients make full, mindful contact with previously avoided private events (thoughts, feelings, memories, sensations) and to make vital life enhancing choices. The PCT rotation will provide a combination of didactic and supervised clinical experience in the use of ACT with PTSD patients.

Interns interested in this rotation would agree to participate as a co-facilitator/trainee in group psychotherapy sessions. There are three group series: (1) for veterans residing in the RRTP-PTSD, (2) for veterans whose trauma occurred in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF), and (3) for pre-9/11 veterans. Other training opportunities include conducting individual therapy, performing functional analytic/case conceptualization interviews, participating in a weekly experiential group for staff practicing ACT, and doing supervised readings on Relational Frame Theory (RFT), the basic science underlying ACT.

The PCT has been approved to do community-based workshops for returning OEF/OIF veterans and their spouses/significant others. We anticipate conducting monthly workshops in which ACT processes/skills are introduced to and practiced by workshop participants. Also, the Central Arkansas Veterans Healthcare System has recently purchased virtual reality equipment. We plan to integrate this technology into our ACT treatment programs. Interns will have the opportunity to participate in community workshops and virtual reality treatment protocols.

As part of the IMHR, the PCT is available as a primary (24 hrs per week), secondary (12 hrs per week), or with special request, full-time (40-hour per week) placement.

The PTSD DRRTP provides a variable-length residential program with emphasis on improving management of PTSD symptoms, psychosocial rehabilitation, increasing awareness, identification and management of self-defeating behaviors, education, and improving quality of life. An interdisciplinary team composed of social workers, a recreational therapist, an occupational therapist, social service assistants, two staff psychologists and an APN provide services to the unit.

Interns choosing this placement will be actively involved in the delivery of treatment that includes elements of cognitive behavioral therapy, cognitive processing therapy exposure therapies and mindfulness. Examples of treatment programming include Living Despite Trauma Group (a structured approach emphasizing the role of past trauma on current behavior), Seeking Safety (an integrated group treatment for PTSD and substance use disorders), Transitions Group (designed to help recently discharged veterans make the transition to civilian life using existing skills with an emphasis on values), and Prolonged Exposure Therapy (individual therapy for appropriate patients).

A primary goal of the PTSD DRRTP rotation is to provide the intern with a structured philosophy of treatment that focuses more on improved quality of life rather than mere symptom reduction. Furthermore, the skills learned on this rotation can be implemented readily to other patient populations with whom the intern may work. In addition to participating in program groups, interns will also be exposed to issues common in program development and gain increased understanding of the role of an interdisciplinary team. Although most therapeutic activities are group-oriented, there is the possibility of structured, brief individual psychotherapy.

For interns choosing the PTSD DRRTP as a primary placement within the Integrated Mental Health rotation, involvement will be in all the activities described above. This includes participation in Living Despite Trauma groups, Seeking Safety groups, Transitions groups, Focused Breathing groups, and all Interdisciplinary Team staff meetings. Brief, structured individual therapy may be included. Interns may also receive supervised training experience in Prolonged Exposure Therapy if they so choose. Interns will participate in the admission process including interview and screens for mental status, PTSD symptoms, depression, and quality of life. It is expected that the intern will become more independent as the rotation progresses and independently (with supervision) lead some of the groups in the program.

Interns choosing the PTSD DRRTP as a secondary placement within the Integrated Mental Health rotation will have the opportunity to participate in the Living Despite Trauma, Seeking Safety and Transitions groups.  Interns will be exposed to psychoeducational approaches to treatment that focus on the identification and treatment of self-defeating behaviors, identifying treatment goals focused on symptom management and improving quality of life, and the role of awareness (Focused Breathing) in the overall program philosophy. While the secondary rotation does not capture the "total package" of learning an approach to treatment and the philosophy of the PTSD DRRTP, interns will be exposed to a military-related PTSD population and learn how to use elements of self-defeating behaviors and awareness as part of an overall treatment approach, as well as being exposed to some elements of program development. As in the primary placement, interns are expected to gain increased independence and confidence in service delivery as the rotation progresses. Brief, structured individual therapy is usually not an option in the secondary rotation.

The emphasis of the Psychosocial Rehabilitation Rotation is to promote the development of clinician leaders and educators capable of providing state-of-the-art, psychosocial rehabilitation that meets standards developed by USPRA and JCAHO. The aim of the rotation is to implement value based and evidence-based practice, as well as expand knowledge and skills in working with people with serious mental illness (SMI) so that they may attain self-defined meaningful lives. Recovery-focused psychosocial rehabilitation enables individuals to transcend limits imposed by mental illness, social barriers, and stigma, so that personal goals and aspirations can be achieved. As such, PSR is both a conceptual framework for understanding psychiatric disabilities and a consumer driven system of care.

With a goal of meeting specific knowledge and practice competencies, interns will develop individualized learning plans for the rotation, defining it through the Psychosocial Rehabilitation & Recovery Center. Additionally, the rotation will include exposure and orientation to the various VA and community settings where veterans with SMI are served. Training will involve clinical assignments (involving individuals, caregivers, & families), educational dissemination projects, didactic seminars, group supervision, including mentoring from veterans, PSR Fellows, and interdisciplinary preceptors. Additionally, discipline specific supervision will be provided to enhance understanding and participation in interdisciplinary treatment teams.

Placement in the Vocational Rehabilitation Program will provide the intern with experience in dedicated programs, such as the therapeutic residence, remunerative work (i.e., compensated work therapy & supportive employment), incentive therapy (i.e., a hospital based work therapy program) and the vocational evaluation and treatment program, which encompasses vocational evaluations, work hardening, vocational training, and activity therapy. Interns will gain practical experience in psychoeducational assessment, vocational assessment, on-site mentoring, counseling, and/or retirement planning. They will be actively interacting with other program’s team members, including vocational rehabilitation counselors, vocational rehabilitation specialists, and manual arts therapists.

Additionally, VRP experience will merge with programs across the Medical Center, such as Psychosocial Rehabilitation Recovery Center, Addictions, PTSD, Mental Health Clinic, Behavioral Medicine, Primary Care, Psychiatry, Medicine/surgery, Traumatic Brain Injury, Spinal Cord Injury, and Physical Medicine/Rehabilitation. Interdisciplinary evaluation and treatment experiences are offered via the Spinal Cord Injury Clinic (SCI) and Vocational Capacities Clinic (VCC), which involve physicians, pharmacists, social workers, occupational therapists, and physical therapists.

For the purpose of instruction and/or evaluation, interns can utilize available educational information and the services of the veterans’ onsite computer laboratory. A number of additional educational services are also offered in work adjustment and job search skills, as well as through a practical series of vocational interventions for homeless veterans. Across the rotation, interns can learn how to effectively network with appointed liaisons to other VA’s and community agencies that provide rehabilitation and affiliated services. Cooperative programs between the VRP, the Department of Education and the University of Arkansas (Little Rock & Fayetteville) allow for additional classroom instruction and tutoring in basic educational skills. In sum, selection of a VRP placement allows the intern to interface with the programs of interest, perform as a valued team member, and complete the desired psychology specialty requirements