Health Psychology/Consultation Liaison

Goals

The Health Psychology track teaches the medicine-psychology interface so those with career goals involving working with the medically ill have the knowledge and skill base needed to work closely with physicians. The primary emphasis is to help the intern gain a keen sense of the effects of medical disorders and therapies on behavior, behavioral influences on symptoms and compliance, and placebo effects so as to develop strong differential diagnostic skills when working with the medically ill. Learning to communicate effectively with physicians and other health care providers is another major goal.

Although there may be rare occasions in which an intern will have contact with adolescents, the Health Psychology Track is otherwise with an adult population.

Rotations

Interns complete three four-month long rotations spanning a wide variety of services. Possible rotations for the internship year include:

General Consultation-Liaison Service

Supervisors: Lisa Matero, PhD, ABPP; Supervision is also provided by psychiatrists (Gregory Mahr, MD and Tiffany Prout, MD)

The intern on the general Consultation-Liaison (C/L) service will provide consultations for inpatients on both the general medical and specialty floors. Common reasons for consultation include depression, anxiety, suicidal ideation, adjustment to illness, behavioral changes, delirium, cognitive impairment, substance abuse, psychosis, and decisional capacity. Brief follow-ups (i.e., evidence-based bedside interventions) are often conducted while the patient remains in the hospital. The intern will gain substantial knowledge in differentiating between medical and psychiatric illness and how these impact each other. Interns can also expect to learn general medicine, interpreting lab and imaging results, and pharmacology. Team meetings with senior staff and psychiatry residents occur daily and supervision occurs regularly throughout the day as you complete consults as well as twice per week with the supervising psychologist.

Internal Medicine/Primary Care

Supervisors: Erin Tobin, PhD and Michael Evitts, PhD

The Internal Medicine rotation will provide exposure to a number of experiences for psychology interns working from the primary care behavioral health model. The Academic Internal Medicine clinic has a large multidisciplinary team, including physicians, over 90 internal medicine residents, a clinical pharmacist, nurses, medical assistants, social workers, and community health workers, to assist in the care of our patients.

Clinical care:

• The intern will complete initial consultations, ideally via ‘warm handoff’ from providers in clinic, and brief goal-directed therapy where appropriate. Reasons for consultation requests include depression, anxiety, pain management, weight management, ADHD screening, adjustment to life stressors, non-adherence, substance concerns, psychosis and somatoform disorders. Most of these patients also have co-occurring chronic illnesses impacting their presentation and management.
• The intern may have the opportunity to co-leads a 6 week behavioral weight management psychotherapy group.
• Interns will also have the option to learn more about providing biofeedback in appropriate patient populations.

Educational opportunities:

• Interns will gain knowledge in assessment and diagnosis, pharmacology, general medicine, brief evidenced based therapies, and learn to work with the primary care team.
• Interns may get the option to help develop and provide content for the multidisciplinary team and Internal Medicine resident didactics.
• Interns will also have the opportunity to join the Internal Medicine residency didactics to broaden their knowledge base of general internal medicine.
• Supervision occurs regularly throughout the day.

Transplant Surgery

Supervisors: Kelly Bryce, PhD, Antu Segal, PhD, ABPP, and Megan Ramthun, PsyD

TThe Transplant Surgery rotation consists of performing inpatient and outpatient pre-surgical psychological evaluations for transplant listing including candidates for liver, kidney, heart/LVAD, lung, and intestinal, as well as evaluating living kidney and liver donors. Henry Ford Hospital is a high volume provider of such transplants and requires a psychological evaluation to assure adherence with the rigorous self-care and follow-up needed for patients to survive and thrive following transplant. Interns assess cognitive functioning, behavioral processes relevant to adherence including psychiatric status and stability, quality of social support, motivation for transplant and other factors relevant to decision making. They collaborate with the surgery/medical staff to assure optimal outcomes and participate in interdisciplinary team listing meetings. Interns will also conduct consultations on an inpatient basis for transplant recipients who may be struggling with various psychosocial concerns. Supervision occurs regularly throughout the day. Interns may have involvement in the supervision of practicum students.

Bariatric Surgery

Supervisors: Aaron Hamann, PsyD, Maunda Snodgrass, PsyD, & Carly Brescacin, PsyD

The Bariatric Psychology rotation is a part of Henry Ford Health’s comprehensive obesity treatment program. On this service, the intern will serve as member of a multidisciplinary treatment team for bariatric surgery and obesity medicine. Primary responsibilities include conducting pre-surgical evaluations to assess suitability for patients pursuing bariatric surgery, co-facilitating both pre-surgical groups and support groups, and participating in multidisciplinary rounds to optimize patient care. There are also opportunities for the intern to provide brief treatment to pre-operative patients focused on improving psychological symptoms and problematic eating behaviors. Additionally, if interested, the intern may have the chance to supervise practicum students and participate in research and program development. Interns receive direct supervision daily.

Minor Rotations

Interns may also have the opportunity to select a minor rotation. The minor could be in one of the core rotations listed above (if not selected as a 4-month rotation) or could be in another specialty area where a psychologist is present. These additional specialties could include: Oncology, Trauma Surgery, Pain Medicine, Sleep Medicine, and Research. The minor rotation is subject to the Training Director’s approval.

Supervision

Interns will receive daily supervision from their primary supervisor on their current rotation. The intern will discuss each new case with the supervisor as well as any difficult cases the intern is following with. Interns will also meet with supervisors for discussion of other areas such as to receive individualized feedback or professional growth. Interns from all tracks also participate in a one-hour, weekly group supervision with the Director of the Psychology Internship Program. Interns will rotate presenting a case paired with a question or topic for discussion for the group.

Research

Although this year is designed to be clinically focused, we do offer research opportunities for interns who are interested. Most often, interns have joined a faculty member on an ongoing research project, but an intern could also start a new project (a faculty member would oversee and provide mentorship). We have many ongoing projects; examples of areas of ongoing research include integrated primary care, chronic pain, obesity/bariatric surgery, transplant, women’s health, substance use, and integrating interventions into medical settings and/or through technology. Interns involved in research have frequently obtained authorship on conference presentations and publications.

Didactics

A monthly Medicine for Psychologists conference reviews a wide spectrum of medical disorders discussing the nature, etiology, diagnosis, and treatment of those disorders with special emphasis on behavioral aspects.

Friday mornings include “Bagel Rounds” and a Team Meeting. Bagel Rounds is a weekly teaching conference. For the early part of the year, staff members present topics designed to orient trainees to the service and provide a crash course for needed medical information. The weekly Team Meeting occurs after Bagel Rounds in which senior staff, health psychology fellows, and the health psychology interns participate. This meeting includes discussion of patient care, professionalism, and brief teachings.

Outcome/evaluation

Interns in the Health Psychology/Consultation-Liaison track will be evaluated in a number of ways. Informally, the interns are evaluated on clinical progress via individual supervision. Additionally, the intern will be formally evaluated at the end of each rotation by their primary supervisor. Interns will also be formally evaluated through case presentations. On each of the three rotations, the interns are expected to make a formal case presentation at the Friday morning Bagel Rounds. This case presentation includes a presentation by the trainee of the nature of the pathology, a review of the literature regarding the disorder, and an assessment of the specific case in light of that literature.