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Adult Rotations

Diagnostic Evaluation Center (DEC)
(Various faculty supervisors)
    The DEC is the portal to the various clinical services offered at WPIC. Psychiatric emergency patients of all ages and types are seen in the Diagnostic Emergency Center (DEC), where they are evaluated and dispositions are made under the direct supervision of attending faculty. Patients and professionals calling with crises or requests for Outpatient, Direct Admission, or Mobile Crisis services are served by the WPIC Call Center. Both the DEC and the Call Center are open 24 hours a day, seven days a week. The rotation at the DEC offers valuable experience in psychiatric phenomenology, diagnostic dilemmas, and principles of care management in an emergency room setting.

Behavioral Medicine Program
(Marsha D. Marcus, PhD; Linda J. Ewing, PhD, RN; Michele Levine, PhD)
     The focus of the Behavioral Medicine Program is the integration of behavioral science with biomedical knowledge and techniques to promote behavior changes that enhance health or ameliorate disease. Current offerings include assessment and treatment of smoking, mood, and eating behaviors in pregnant and postpartum women. In collaboration with the faculty, interns may design individualized rotations with a minimum duration of six months.

Center for Overcoming Problem Eating (COPE)
(Jennifer Wildes, PhD; Eric Rickin, MD; Alexis, Fertig, MD; Elizabeth B. McCabe, PhD; Jill Gaskill, CRNP; Marsha Marcus, PhD)
     The Center for Overcoming Problem Eating (COPE) provides assessment and treatment for children, adolescents, and adults with anorexia nervosa, bulimia nervosa, and other eating problems. The COPE care continuum includes a 20-bed inpatient unit, a partial hospital program, and intensive outpatient services. Treatment modalities include cognitive behavioral therapy, dialectical behavior therapy, interpersonal therapy, family therapy, and pharmacotherapy. Training opportunities are available at every level of care. Six-month, half-time rotations are encouraged to enable interns to follow patients from intake through discharge.

Psycho-Oncology Clinical Service and BioBehavioral Medicine in Oncology Program, UPMC Cancer Centers
(Ellen Beckjord, PhD; Andrea Croom, PhD; Amy Lowery, PhD; Ellen Ormond, PhD; Kevin Patterson, MD; Donna Posluszny, PhD; Susan Stollings, PhD; John Schmidt, PhD)
     The Psycho-Oncology Clinical Service and Biobehavioral Medicine in Oncology Program provide psychological/psychiatric assessment and intervention for cancer patients and their families in both the inpatient and outpatient medical setting. Treatment can vary from short-term consultation for emotional distress and specific cancer-related symptoms to long-term psychological support and end-of-life care. For the intern, this means active engagement in mental health care as part of a multidisciplinary health care team. Interns will begin their training by shadowing senior psychologists working in both inpatient and outpatient medical settings. Under supervision, interns will be assigned their own inpatients and outpatients to improve their skills in both assessment and intervention strategies, as well as skills related to communicating with other health care professionals. Interns will attend case conferences and seminars as scheduling allows and will be assigned directed readings to enhance understanding of medical aspects of cancer and its treatment. Interns who decide to complete a 6-month rotation with the service will have the opportunity to participate in at least 2 specialized rotations, which include behavioral sleep medicine in cancer care, assessing and treating cognitive deficits caused by cancer and/or its treatment, and palliative care psychology where interns will be exposed to a wide variety of medical conditions. If interested, interns can also receive experience with stem cell transplantation evaluations and psychopharmacology for patients with cancer.

Behavioral Sleep Medicine
(Brant Hasler, PhD; Daniel J. Buysse, MD)
     The goals of this rotation are to provide exposure to the common adult sleep disorders seen in clinical practice; to teach the basic clinical assessment of patients presenting with sleep symptoms; and to introduce the principles and basic techniques of behavioral treatment for sleep disorders, focusing on insomnia. This rotation occurs in the clinical sites of the UPMC Sleep Medicine Center, which includes sites at WPIC, Falk Medical Building, and UPMC Montefiore. Interns selecting this rotation first shadow an experienced sleep clinician to gain familiarity with evaluation procedures. They are then assigned their own evaluations of new patients supervised by faculty clinicians. Interns have the opportunity to conduct behavioral interventions and short-term follow-up with their patients. For motivated interns whose schedules permit, a secondary goal is to introduce the basics of polysomnography (PSG) in the assessment of sleep disorder patients. Weekly PSG "reading sessions" help to establish familiarity with physiological assessment of sleep patients.

Psychotic Disorders Inpatient Care
(Gretchen L. Haas, PhD; Charles Kahn, MD)
     This rotation provides intensive training in the assessment and treatment of individuals with psychotic disorders. The intern is provided an opportunity to work on any of the 3 units: the Transitional Recovery Unit (TRU), the acute care unit (9th Floor) and the Comprehensive Rehabilitation Unit (CRU). The trainee can select from a mix of acute care and longer-term recovery-oriented inpatient services, with an emphasis on tailoring the training experience to the specific needs and interests of the trainee. Daily inpatient rounds familiarize the intern with a broad range of patients with schizophrenia and schizoaffective disorders, psychotic mood disorders, delusional disorders, and, in addition, psychoses that are secondary to drug use. The intern serves as the primary clinician for a caseload of three inpatients and works closely with a resident in psychiatry, an attending faculty psychiatrist, and other members of the treatment team. Weekly supervision is provided by a licensed clinical psychologist (Dr. Haas), with additional supervisory sessions, as needed, from the physician faculty member who leads the treatment team, as well as the medical director (Dr. Kahn). Individual supervision with Dr. Haas focuses on the selective application of cognitive, behavioral, psychoeducational, and supportive intervention strategies and techniques for work with the seriously ill psychotic patient. Supervision on the unit with Dr. Kahn focuses on the use of multimodal treatment strategies including pharmacotherapy; group, family and individual therapeutic modalities; and psychoeducation with patient and family members. As a primary clinician, the intern may have the opportunity to work with one of the individuals who is receiving treatment for a first episode of a psychotic disorder; including those who participate in clinical neuroimaging and neurobehavioral research protocols affiliated with the Conte Center for Neuroscience of Mental Disorders (schizophrenia).

Dual Diagnosis Inpatient Services
(Antoine Douaihy, MD)
     The Dual Recovery Unit of Addiction Medicine Services provides a range of opportunities in the areas of assessment, diagnosis, and delivery of evidenced-based psychosocial treatments integrated with pharmacological interventions for patients with substance use disorders (SUDs) and co-occurring psychiatric disorders. These opportunities include: (1) participation in daily rounding (usually Monday – Thursday 8:30am – 12pm) with a multidisciplinary treatment team, including medical students, psychiatry residents, pharmacists, social workers, and addiction psychiatry fellows. During rounds, the intern will receive in-vivo modeling and coaching in Motivational Interviewing (MI), (2) an individual therapy caseload of one to two patients using the MI approach to treatment, integrated with other psychosocial interventions such as Cognitive- Behavioral Therapy (CBT), (i.e., relapse prevention), (3) didactics on a broad range of relevant topics including MI, addiction and psychopharmacology, and (4) teaching and supervision of other trainees, including the medical students and psychiatry residents on MI and integrated therapeutic approaches. By the end of this rotation, interns can expect to gain a rich learning experience in the diagnosis, in the evidence-based treatments of SUDs and co-occurring psychiatric disorders, and in the practice of MI.

Center for Advanced Psychotherapy
(Laura Dietz, PhD; Holly Swartz, MD)
     The Center for Advanced Psychotherapy (CAP) is an outpatient clinic that specializes in delivering evidence-based treatments for patients with unipolar depression, bipolar disorder, anxiety disorders, and mixed depressed and anxious presentations. Supervision will be provided in evidence based therapies including interpersonal psychotherapy (IPT), interpersonal and social rhythm therapy (IPSRT) and Cognitive Behavioral Therapy (CBT) for the treatment of mood and anxiety disorders. Practicum opportunities include training in the theory and implementation of evidence based psychotherapies, in combination with pharmacotherapy as needed. Interns will be expected to participate in individual supervision, group supervision, and carry a small caseload of adult or child outpatients.

Center for Treatment of Obsessive-Compulsive Disorder
(Terri Laterza, LCSW)
     The Obsessive-Compulsive Disorder Intensive Outpatient Program provides intensive treatment sessions. Exposure with Response Prevention (ERP) is the primary treatment. Group therapy is the primary modality, supplemented by individual exposure sessions. Family psychoeducation and medication treatments are standard interventions. Interns may elect three- or six-month, half-time rotations. Involvement for all three days of the program is preferred. Supervision in assessment, treatment formulation, and ERP through weekly meetings is provided. The treatment population is adults with diagnosis of OCD or OC spectrum disorders (e.g., body dysmorphic disorder, trichotillomania, skin picking).

Adult Services Acute Ambulatory Programs
(Tiffany Painter, LCSW)
     The Adult Services Acute Ambulatory Programs provide short term stabilization for adult men and women with acute mood and/or anxiety symptoms. There are several specialty tracks across 12 programs located in Oakland. Each program meets 3 days per week for 3 hours each session with an average length of stay 6-8 weeks. The track for women with self-harm offers exposure to Dialectical Behavior Therapy skills training. The track for Bipolar patients offers exposure to Interpersonal and Social Rhythms therapy as modified for Intensive Outpatient level of care. Interns function as an active part of the treatment team which includes a psychiatrist, group therapist, and individual/family therapist. Interns colead groups, and depending on learning interests, have a small individual caseload, and attend treatment team meetings for collaborative treatment planning. Interns have often worked on a short project during the rotation in an area of interest that also enhances program quality.

Forensic Program
(Stephen Zerby MD; Christine Martone, MD; and various faculty supervisors)
     Various forensic experiences are available through the Department of Forensic Psychiatry. These clinical experiences can include court-ordered assessments for competency at the Allegheny County Behavior Assessment Unit, the court appointed forensic clinic, or shadowing private cases which include pre-sentencing evaluations, disability evaluations, worker's compensation evaluations and a variety of other cases. Additionally observation at Cove Prep, a long term residential treatment unit for adolescent sexual offenders, may be available on request. A series of forensic lectures, which deal with a wide range of topics including assessment for the risk for violence and malingering are offered in the fall. Interns can design a rotation that suits their individual interests and training needs.

Psychotherapy Training Clinic (PTC)
(Various licensed PhD supervisors)
     Each intern is expected to follow a minimum of two outpatients in individual psychotherapy during the year. Interns are provided access to patients through the WPIC Psychotherapy Training Clinic. Weekly supervision is offered by individual faculty members with expertise in a variety of empirically-supported treatments (including, for example, cognitive-behavioral therapy, interpersonal psychotherapy, and dialectical behavior therapy. Careful case conceptualization is encouraged. Interns develop case presentations for group feedback and discussion during Friday morning group supervision meetings.