VA Salt Lake City Healthcare System
Website Address: https://www.va.gov/salt-lake-city-health-care/work-with-us/internships-and-fellowships/psychology-training/
Director of Psychology Training
Renn Sweeney, Ph.D.
caroline.sweeney @ va.gov
Geropsychology Supervisor(s):
Erin Kube, Ph.D.
Lauren Masuda, Psy.D.
Bret Hicken, Ph.D.
Membership / Certification:
_X__ APA Accredited
_X__ APPIC Member
Training Program Components:
At the Salt Lake City VA Healthcare System we offer a 1 year postdoctoral fellowship in Geropsychology. Our internship program also receives funding from our GRECC (Geriatric Research Education and Clinical Center), so we offer internship rotations that support our generalist training in geropsychology. Geropsychology related internship rotations that we offer are Homebased Primary Care and the Geri-Med-Psych clinic. Each of these professional training experiences is described below (interns work in the clinics described below with our fellows):
1. Geopsychology Fellowship Track
This track provides general clinical psychology fellowship training, with an emphasis in geriatrics. Broadly, the geriatric training provided is consistent with the Pikes Peak Model for Training in Professional Geropsychology. Specific geriatric emphases include: 1) evidence-based assessment and treatment of psychological disorders among older adults; 2) biopsychosocial methods for managing disruptive behaviors associated with dementia; 3) neuropsychological assessment and dementia management; 4) behavioral medicine interventions addressing common problems among older adults, such as pain, disability, sleep, weight loss, smoking cessation, and medical compliance; 5) interdisciplinary consultation; 6) capacity assessments when there are questions about a patient’s ability to make medical decisions, perform other specific functions, or live independently; 7) development of clinical supervision competencies; and 8) identification of, understanding, and addressing ethical issues common among geriatric populations.
Fellows will provide psychological services across a variety of diverse clinical settings, including Home Based Primary Care (HBPC), outpatient geriatric primary care clinics, specialty geropsychiatry-medical clinic, primary care, and palliative care. Fellows will also gain experience working with multidisciplinary programs, including the Geriatric Research, Education, and Clinical Center (GRECC), the Office of Rural Health—Western Region, and the University of Utah, Division of Geriatrics. It is also anticipated that fellows will cross-train in some of the same training experiences as the health psychology fellows.
Fellows have the opportunity to participate actively as members of interdisciplinary teams in HBPC, Geriatric Primary Care clinics, the Clinical Resource HUB, and the Telehealth Dementia Care Consult Team. Rotations will be tailored to fit the individual needs and preferences of the fellow. Rotations may consist of a combination of geriatric experiences (approximately 75% of the fellow’s time) including Home Based Primary Care, outpatient geriatric clinics, Geriatric Medical Psychiatry clinic, or VISN 19 Clinical Resource HUB (an entirely telehealth-based rotation). Fellows will also have the opportunity to develop expertise in complementary areas of health psychology. Minor rotation experiences (approximately 25% of fellows time) may include primary care-mental health integration (PC-MHI), short-term therapy in primary care, MOVE program, smoking cessations program, inpatient rehabilitation, consultation and training for PACT team members, MH Consult, CBT for Chronic Pain or Insomnia, , and transplant and bariatric surgery evaluations (see Health Psychology section for descriptions). Fellows will select opportunities offered from the areas/supervisors listed above. Experiences can be designated as year-long or time limited.
GEROPSYCHOLOGY FELLOWSHIP ROTATIONS
HOME BASED PRIMARY CARE (HBPC)
Supervisor: Lauren Masuda, PsyD
The VA Home Based Primary Care (HBPC) program provides comprehensive, interdisciplinary primary care services in the homes of veterans with complex and chronic, disabling disease. In addition to primary care interventions, HBPC provides palliative care, rehabilitation, disease management, and care coordination services. HBPC targets veterans in advanced stages of chronic disease, particularly those at high risk of recurrent hospitalization or nursing home placement. Outcome measures have demonstrated HBPC to be effective in managing chronic disease and reducing inpatient days and total cost of care. Our HBPC team includes representatives from medicine, nursing, pharmacy, social work, occupational therapy, and dietetics. HBPC manages (1) patients with multiple interacting chronic medical problems requiring longitudinal intervention to maintain health status or slow functional decline, in order to reduce or delay institutionalization; (2) certain patients with relatively short-term problems, who need health services, home training, and home adaptation until they can be managed in an outpatient clinic; and (3) patients with advanced terminal illness who prefer palliative care. HBPC provides a unique opportunity for fellows to be part of a diverse team with opportunities to work collaboratively, co-treat clients when appropriate, foster effective communication and teamwork amongst providers, and help the team to cope with various challenges.
The postdoctoral fellow provides assessment and intervention to individuals and families to address psychological issues that are interfering with their medical care, compromising their health status and functional capacity, and/or reducing their quality of life. Issues include, but are not limited to: helping patients cope with grief, depression, anxiety, and other psychological issues related to the aging process; coping with chronic medical illnesses, and/or other life stressors; interventions to increase compliance with and adjustment to treatment regimens; and working with caregivers to improve patient well-being and treatment compliance. The postdoctoral fellow also provides comprehensive psychological, neuropsychological, and capacity evaluations.
OUTPATIENT GERIATRIC CLINICS
Supervisor: Bret Hicken, PhD
These weekly primary care clinics serve older Veterans with complex medical issues and are staffed by geriatric fellows, geriatricians, clinical pharmacists, and social workers, in addition to the psychology fellow. Veterans in these clinics frequently have co-morbid cognitive and mental-health issues as well as psychosocial challenges that complicate their care. Psychology fellows serve in a consult/liaison role in these clinics, consulting with the team and providing brief psychological and cognitive assessments during the appointment and Fellows may also provide instruction to staff on psychological issues. Time-limited interventions may also be incorporated during clinic or as follow up. Common issues that psychology fellows may address with Veterans include depression, anxiety, grief, pain management, sleep/insomnia, and adjustment to aging and chronic disease.
GERIATRIC MEDICAL PSYCHIATRY CLINIC
Supervisor: Bret Hicken, PhD
This weekly consultation clinic serves geriatric Veterans with complicated medical and psychiatric needs. Veterans referred to this clinic typically have significant mental health and/or cognitive issues and disruptive behaviors that have become difficult to manage for caregivers and providers. The philosophy of this clinic is “patient-centered” and “whole-person” in that we address the psychosocial, environmental, and medical factors that influence behavior. In addition to the psychology fellow, the clinic includes an attending physician and trainees from many disciplines such as psychiatry, geriatrics, and pharmacy. Psychology fellows function in a variety of capacities in this clinic. They may provide direct patient care in the form of brief psychological and cognitive assessments as part of the patient’s clinic appointment. They may provide brief intervention in clinic or arrange for a later appointment to address clinical concerns that require follow-up. Trainees also function in a consultation capacity by providing the team with observations, impressions, and treatment recommendations about psychological and cognitive issues. Over time, the fellow becomes a key leader in clinic, directing and providing training to housestaff and medical students about psychological issues.
VISN 19 CLINICAL RESOURCE HUB
Supervisors: Clair Rummel, PhD, ABPP & Erin Kube, PhD
The VISN 19 Clinical Resource Hub provides evidence-based assessment and treatment services to facilities in the VA Rocky Mountain Network (UT, MT, CO & WY) in order to enhance Veteran access to mental health and primary care services. The Telemental Health Team is comprised of psychologists, psychiatrists, advanced psychiatric nurse practitioners, and social workers that assist VA facilities across VISN 19 with provision of virtual mental health services.
Training opportunities for fellows on this rotation include:
• Dementia Caregiver Education & Support: Fellows have the opportunity to provide evidence-based caregiver support virtually to caregivers caring for rural Veteran’s with a neurocognitive disorder. Services include education on dementia, behavioral interventions for managing disruptive behaviors associated with dementia and stress management techniques. Fellows may have the opportunity to complete the REACH-VA Caregiver Support training and implement it during this rotation.
o Telehealth Dementia Care Consult Team: Fellows also have the opportunity to attend consults with the interdisciplinary team (geriatrician, geriatric social worker, pharmacist) that provides comprehensive evaluation of neurocognitive disorders to older rural Veterans. This will allow the opportunity to introduce caregiver support and gain a better understanding of each member’s role on the team.
• Geriatric Tele-Psychotherapy:
o Outpatient Geriatric Tele-Mental Health: Fellows have the opportunity to carry a small caseload of older Veterans referred for evidence-based individual psychotherapy delivered via VA Video Connect to Home or via Clinical Video Telehealth to VA Clinic. Patients present with a variety of primary concerns, including depression, anxiety, PTSD, grief and adjustment to disability. Fellows can hone their skills at adapting evidence-based treatments to meet the needs of older adults and learn how to effectively implement treatment via telehealth.
o Tele-PCMHI & Health Psychology: Fellows have an opportunity to receive geriatric consults directly from primary care providers (in general PACTs across CO & UT) pertaining to a variety of concerns, including cognitive functioning, chronic disease management, adjustment to medical illness, depression, alcohol use, sleep disturbances, and dementia care management. Fellows can refine their skills in brief assessment, consultation, and care management around normative and non-normative age-related concerns that arise in primary care. They can also learn to deliver geriatric-informed brief psychotherapy and adapt evidence-based interventions to meet the needs of older adults in primary care via telehealth. There may be opportunities to develop and/or facilitate group interventions aimed at meeting the unique needs of older adults or their caregivers within primary care. Fellows may also have an opportunity to provide vertical clinical supervision to a psychology intern while on this rotation.
Didactic Training Offerings:
Special attention is paid to ensure that the geropsychology competencies are trained. We start out with teaching the Pikes Peak Model. Then didactics and experiential training touch on all competencies as defined by the Pikes Peak Model. Didactics above often touch on multiple competencies, but have tried to highlight the main competencies trained in each didactic.
Pikes Peak Model – knowledge
Normal Aging and Development Theories – Knowledge Base
Resiliency and Aging – Knowledge Base
Multicultural Issues in Aging – Attitude/Skill
Geropsychology Ethics – Skill/Attitude/Knowledge
Cognitive and Mood Assessment Dementia Evaluation – Skill/Attitude/knowledge
Capacity Assessment – Skill/Attitude/knowledge
Mild Cognitive Impairment – Skill/knowledge
Geriatric Neuropsych Assessment – Skill/knowledge
Managing Challenging Behaviors – Skill/knowledge
Anxiety in Older Adults – Skill
Interpersonal Therapy for Older Adults – Skill
ACT for Older Adults – Skill
Screening/Brief Assessment on Medical Teams – Skill/knowledge
Sleep/CBT-I in Older Adults – Skill
SMI/Psychosis in Older Adults – Skill
Meaning Centered Therapy – Skill/knowledge
Caregiving – Attitude/knowledge
Live Reviews/Reminiscence Therapy – Skill/knowledge
Disability in Aging – knowledge/skill
Driver’s Education – knowledge/skill
Hording/Compulsive Buying – Skill
Elder Abuse – Skill/knowledge
Bereavement – Skill/knowledge
Geriatric Nutrition – Skill/knowledge
Telehealth and Older Adults – Skill/knowledge
Hospice and Palliative Care – knowledge/skill
PTSD in Later Life – Skill/knowledge
Sexuality and Aging – knowledge
Language Disorder in Older Adults- knowledge
Pain in Older Adults – Skill
Geriatric Psychopharmacology – knowledge
Challenging Personality Issues in Older Adults – knowledge