Description of Services
I. The Inpatient Experience
There are two acute 24 hour, 70 bed inpatient units, one of which was granted a New York State Office of Mental Health Program and System Award for Inpatient as the most outstanding inpatient unit in the State. Housed within the Center building, its availability to the community prevents disruption of the patient’s social roots and enables sustained family involvement. Treatment occurs through the therapeutic community that encompasses all disciplines. The primary goal of the inpatient unit is to reintegrate patients into the community as rapidly as possible, while maintaining standards consistent with good patient care. A necessary consequence of the attempts to avoid long-term hospitalizations, which has recently been exacerbated by the restrictions of managed care, is a high rate of recidivism. Thus, there is an increasingly significant caseload of patients with severe and chronic pathology, but who are nevertheless able to return to community ties and family.
On this unit, the intern will work with patients in the most acute stages of their disturbances and will gain experience with patients whose problems encompass a wide spectrum of severe pathology. The intern’s confidence as a clinician should blossom rapidly, as he or she takes on management responsibilities for as few as four to as many as six patients. The intern will become directly involved in the establishment and integration of appropriate treatment goals. The intern will maintain continual contact with the assigned patients evaluating their clinical status vis-a-vis treatment goals, as well as arranging for the patient’s after care following discharge. In negotiating patients' discharges and transfers to other units of service, the intern will be expected to engage in on-going communication with the clinical staff of the units. He or she will thereby develop the skills necessary for effective professional collaboration.
Acquisition of group therapy skills with the severely and chronically disturbed will occur in a number of contexts. The intern will act as co-therapist in group therapy with the senior psychologist as well as a leader or participant in other kinds of patient groups. The intern is also the staff member responsible for conducting community meetings within the therapeutic community.
Brief psychodiagnostic assessment techniques are utilized. The intern will learn to compose reports, which directly address the referral problem. Recent changes due to managed care and reduced patient stays have placed an emphasis on quick, pointed and succinct assessment.
The daily interaction of the intern with the intense affective states of deeply disturbed patients facilitates the diminishment of anxieties in the intern regarding exposure to severe mental illness. Care and treatment of hospitalized patients also requires techniques of family intervention. The intern will learn to identify particular family crises or dynamics that may have contributed to patients’ hospitalizations and will assist in preparing families for the return of the hospitalized patient.
II. Wellness Recovery Program
With a highly skilled interdisciplinary staff and an array of clinical services and group programs, this program addresses the needs of the chronically mentally ill. The Program Director is a psychologist, providing the intern with role models of psychologists in leadership positions.
The Wellness Recovery Program focuses on supporting patients in their wellness and recovery goals (ADLs, joining national support networks, making greater use of community resources) and daily maintenance. The clinic serves an adult population 18 years and older with a chronic history of inpatient hospitalization. Patients are often diagnosed with Schizophrenia, Schizoaffective Disorders or Bipolar Disorders. The Wellness Recovery Program also serves a large Latinx population through its “Latino Program,” where a team including a psychologist and two social workers run multiple monolingual Spanish-speaking groups.
The Wellness Recovery clinic adopts a model similar to an Adult Outpatient service and emphasizes patients’ more robust wellness recovery goals such as gainful employment, formal education and volunteering. This is also an adult population with a less extensive history of inpatient hospitalization. Appropriate patients span the full spectrum of adult diagnostic categories and co-morbidities with a more stable symptom profile. Attendance is not greater than 2-3 times a week with attendance in:
1. Specialized Group therapy (i.e. OCD, anger expression, voices) in English and Spanish
2. Individual Psychotherapy
3. Creative Arts Therapy
During the four-month rotation, the intern will acquire supervised experience in case management, intake interviewing, psychodiagnostic assessments, and family involvement. The intern will be expected to both co-lead and lead groups. Treatment planning conferences will offer the intern an active role in professional discussions. Patient-staff discussions within an interdisciplinary team approach, make available a variety of clinical role models and theoretical approaches from the purely dynamic to the psychoeducational. Conducting intakes will bring decision-making encounters with other disciplines and services. Collaborating and negotiating differences of opinion is a powerful growth experience.
Psychological assessment will be emphasized in this service, using objective tests as well as more traditional intelligence and projective exams. This will fortify skills needed in the currently changing field and provide the expertise required to navigate today’s marketplace. Relative to other CMHC units, assignment to the Wellness and Recovery Unit will bring the intern into a much more informal ambiance of patient-staff interactions.
III. Assessment and Disposition
For four months, each intern will rotate through a variety of outpatient services, conducting intakes, psychological assessments, and initial interviews. Our goal for the intern in the Assessment and Disposition rotation is to offer a broad and varied experience, allowing exposure to the many roles of a psychologist in a medical center
Adult Outpatient Services (AOS)
Interns are supervised by a Senior Psychologist as unit supervisor. Assignment of a diverse caseload of long term psychotherapy and crisis intervention cases enables development of clinical flexibility that is invaluable within the public mental health sector. Interns will also be assigned Psychodiagnostic testing cases and weekly intakes. While on the service, the intern will be asked to join an AOS High Risk Team. At the high risk team meeting, the intern will be exposed to staff case presentations and be able to present high risk cases. Treating the severely ill along with the more neurotic patient will strengthen skills in an area where society is increasingly focusing mental health resources.
As on the inpatient unit, many of the adult patients are medicated. The intern will learn about the varieties of medication, will begin to understand its use and evolve a collaborative relationship with the team psychiatrist.
Child and Adolescent Outpatient Services (CAOS)
Another component of the Assessment and Disposition training is in the child and adolescent service. The priority Psychology and the CMHC gives to the treatment of our young are underscored by the fact that a majority of CMHC psychologists work in this unit.
As a result of being located in South Brooklyn, the CMHC supports a large Orthodox/Hassidic, Latinx and Asian population. Intense efforts are made to recruit psychologists who are sensitive to the specific needs of these communities.
Interns will explore the full range of professional skills utilized for the treatment of the child and adolescent; play therapy, individual psychotherapy, and family therapy. In addition to standard intelligence and projective tests, the intern will learn to administer various achievements and other specialized tests. Intake interviews in this service will more frequently utilize family members. The intern will learn how to organize and formulate clinical findings with respect to many participants including schools and social agencies frequently involved with our children. Testing and intake work-ups are presented by the intern at multidisciplinary clinical staff conferences.
Psychiatric Emergency Room
Interns will spend a day in the Psychiatric Emergency Room performing rapid diagnostic work, as well as addressing hospitalization and treatment issues with acutely mentally ill and substance abusing patients. They have an opportunity to work as a member of an interdisciplinary team, while assisting patients in their initial exposure to the hospital setting.
The interns have the opportunity to complete one neuropsychological test battery on a child ranging in age from 4-18 years old. The children seen are typically experiencing medical issues with cognitive sequelae in addition to psychological difficulties and academic problems. The neuropsychological battery is utilized to inform medical and mental health care as well to determine appropriate school accommodations. The interns meet with the service supervisor weekly for supervision.
While rotating through the different units of service, interns will concurrently be working with up to 10 long-term psychotherapy patients. These patients are maintained for the entire clinical year, with new patients added when initially assigned patients leave treatment. An attempt is made to offer the intern therapeutic experiences in areas that he or she would like to gain additional expertise. Interns are expected to work with both adults and children or adolescents although the number of patients in either group can be skewed to the intern’s particular interests. Individual, couple and family therapy are the most frequent modalities of treatment for long-term patients, although interns can join an on-going long-term therapy group for the year as a co-therapist. Long-term therapy offers interns an opportunity to work in depth with patients and to utilize the therapeutic techniques (under close supervision) that they have been studying in their respective schools. Along with all of the other experiences it is an opportunity for the intern to have experience in areas, which heretofore had only been theoretical.