Interns provide treatment and testing services throughout the year in the Ambulatory Behavioral Health Services and Child/Adolescent Outpatient Clinics. Child track interns may rotate in medical clinics and treat patients with integrated behavioral healthcare. In addition, throughout the year, interns select and rotate through four 3-month major rotations, described below.
YEAR-LONG OUTPATIENT TREATMENT SERVICE AREAS
Ambulatory Behavioral Health Services
The Ambulatory Behavioral Health Services (ABHS) provides an array of outpatient psychiatric services and is comprised of several specialized clinics for the treatment of adults experiencing a wide range of mental health problems. The clinic also houses the Methadone Treatment and Chemical Dependency Program. Psychology interns work in ABHS on a part time basis for the entire training year. Their primary responsibilities include providing individual, group, and family therapy. They also conduct psychological testing cases in the outpatient clinic. They will be conducting therapy sessions in-person and/or via telehealth (video platforms or telephonically).
Staffing: ABHS is staffed by multi-disciplinary teams of mental health professionals including psychiatrists, psychologists, social workers, community liaison workers, caseworkers, activity therapists, nurses and nurse practitioners.
Chemical Dependency and Methadone Program in ABHS
Description of service: The Chemical Dependency and Methadone Program provide outpatient psychiatric services for individuals and families to help with recovery from opioid use disorders and other substance use disorders (OUD/SUD). Based on our federal grant’s funding, interns on the OUD/SUD track will provide treatment by co-facilitating DBT-informed substance use groups.
Staffing: The clinic is staffed with a psychiatrist, social workers, nurses, nurse practitioners, and Credentialed Alcoholism and Substance Abuse Counselors (CASACs).
Child/Adolescent Outpatient Clinic
The Child/Adolescent Outpatient Behavioral Health Clinic provides outpatient services to children and adolescents. Psychology Interns’ primary responsibilities include providing individual psychotherapy to patients ranging in age from 3-21. Some interns will have the opportunity to conduct family therapy and/or group therapy for appropriately referred patients. There are also opportunities to conduct psychological testing to help clarify diagnosis. Therapy sessions are conducted both on an in-person basis and virtually, depending on the needs and situation of the patient. Finally, interns may have the opportunity to take part in the Child and Adolescent Rapid Evaluation Services (CARES) program, which helps ensure that appropriate initial evaluations (intakes) are done for patients recently referred from the community, our CPEP, or inpatient units.
Staffing: The clinic is staffed with psychiatrists, social workers, and a psychologist along with a caseworker.
Child and Adolescent Safety Assessment Clinic (CASA)
The Child and Adolescent Safety Assessment Clinic serves to evaluate and treat at-risk youth who are at significant risk of, or have been the victim of, abuse or neglect. Assigned interns will have the opportunity to provide intake assessments and psychotherapy to children and/or adolescents up to 18 years old who suffer from a variety of psychiatric symptoms that are generally caused by exposure to trauma. Interns will have the opportunity to collaborate with an attending physician specifically trained in identifying signs and symptoms of abuse as well as a social worker who is a child protection specialist and helps to liaison with area services to provide comprehensive treatment for such at-risk youth.
Staffing: The clinic is staffed with a pediatrician, psychologist and social worker.
PEDIATRICS MEDICAL CLINIC
The Pediatrics Medical Clinic provides medical care to patients aged newborn to 21. Children, adolescents and transitional-aged youth are seen by nurses, pediatricians, nurse practitioners, social workers as well as caseworkers. Assigned interns will have the opportunity to provide psychotherapy to children and/or adolescents who are deemed to be at risk of psychiatric illness. Interns will have the opportunity to collaborate with pediatricians and social workers in providing such care to patients and to make referrals to behavioral health clinics, if necessary.
Staffing: The clinic is staffed with pediatricians, social workers, nurses and caseworkers.
MAJOR ROTATIONS
Adult Acute Inpatient Unit
Adult Extended Care Inpatient Unit
Women’s Forensic Inpatient Unit including Bronx Court Clinic
Child and Adolescent Inpatient Unit
Consultation Liaison Service (C/L)
Comprehensive Psychiatric Emergency Program (CPEP)
Child/Adolescent Partial Hospitalization Program
Outpatient Integrated Care (Adult Medical Primary Care and Infectious Diseases Clinic)
Adolescent Collaborative Health (Adolescent Medical Primary Care) including Child Abuse/Sexual Abuse (CASA) intakes and Pediatric Consultation Liaison (Peds CL)
At-Risk Youth (including Healthy Steps, School-based Mental Health Clinic and Community outreach)
Riker’s Island Jail (for Adult Correctional/Forensics Track only)
DESCRIPTION OF ROTATIONS
Elmhurst Hospital Center is a training hospital affiliated with the Mount Sinai School of Medicine; as such some of the units serve as a training rotation for psychiatric residents, child psychiatry fellows, clinical psychology interns, and medical students. Interns are provided with a rich learning experience in which teaching and training are an integral part of most units.
Inpatient Units (Adult Inpatient, Dual Diagnosis, Child/Adolescent Inpatient, Women’s Forensic Inpatient):
Inpatient units serve a diverse patient population with respect to race, culture, ethnicity, age, gender and psychiatric diagnosis. Inpatient services provide assessment and treatment to patients on the inpatient psychiatric units with a broad range of psychiatric diagnoses.
The Child/Adolescent Inpatient Service serves up to 26 patients aged 10-17. The units serve a varied patient population, including patients presenting with suicidality and self-injurious behaviors, mood disorders, conduct disorders, personality disorders, psychotic disorders, and developmental disorders. There are a small number of court-remanded adolescents who require psychiatric evaluation before returning to court. This unit places an emphasis on the evaluation and psychotherapeutic treatment of trauma-related and attachment disorders.
The Adult Acute Inpatient Units include multiple general adult psychiatric services with bed availability ranging from 12 to 29 patients; the units serve a broad age range of patients with a great variety diagnoses. Interns collaborate closely with the interdisciplinary team and individual and group psychotherapy are emphasized on this rotation. There is also the opportunity to facilitate family meetings and learn more about the intersection of the medical and legal systems. Nearly every patient is dually diagnosed with a substance use disorder by history or presently.
The Adult Extended Care Inpatient Unit is a service that offers an opportunity for frequent utilizers to be served on a unit in which the admissions are significantly longer than an acute care unit, typically 1-3 months in duration. There is an opportunity to be immersed among the interdisciplinary team and work closely with patients who may remain hospitalized throughout the intern’s entire rotation.
The Women’s Forensic Unit is similar in its mission as the other inpatient units, but is specialized with regard to the patient population who are women and come to EHC either pre-arraignment (in NYPD custody) or from the Rikers Island jail facility. The interaction between mental health issues and the legal system is a constant consideration. Collaboration with attorneys, diversion programs, and Rikers Island staff occur regularly. Malingering assessment tools are utilized to diagnose malingering and factitious disorders. Competency evaluations are also conducted. Monthly multidisciplinary team meetings are held at Rikers Island. This rotation includes a sub-rotation through the Bronx Forensic Psychiatric Evaluation Court Clinic. Interns will observe and conduct court-ordered psychiatric evaluations of adult criminal defendants related to competence to stand trial or pre-sentencing investigation. Interns collaborate with lawyers, psychiatrists and psychologists. There is an opportunity to observe 730 exams and complete mock-reports.
Staffing: All inpatient units have a multi-disciplinary staff and clinical team, including behavioral health associates, nurses, nurse practitioners, creative arts/activity therapists, social workers, psychiatrists, and psychologists. Staffing also often includes psychiatry resident and fellows, clinical psychology interns, social work interns, medical students, and physician assistant students.
Consultation Liaison
The Consultation Liaison service provides psychiatric consultation, assessment and treatment to patients on inpatient medical units. Evaluations conducted include capacity to make medical decisions. Interns evaluate patients with acute and chronic psychiatric disorders, as well as psychological problems secondary to a medical illness or situational stressor. Interns provide bedside psychotherapy to patients who may benefit from this service.
Staffing: Two psychiatrists run the service along with psychiatric residents and psychology interns. The interns on this service are supervised by a psychiatrist on the service as well as a psychologist on the faculty.
Comprehensive Psychiatric Emergency Program (CPEP)
The Psychiatric Emergency Room serves a diverse patient population with respect to race, culture, ethnicity, age, gender and psychiatric diagnosis. The Psychiatric Emergency Room provides consultation to patients in need of acute psychiatric evaluation. After initial triage by nursing staff the patient is evaluated by the clinician, as well as by the staff psychiatrist. After a diagnosis is arrived at, a treatment plan and disposition are determined. The patient may be discharged, hospitalized or continue to be observed in the emergency room for a maximum of 72 hours.
Staffing: The Psychiatric Emergency Room is staffed by psychiatrists (adult and child), a psychologist, social workers, nurse practitioners, nursing staff, as well as assistant coordinating managers. Staffing also includes at times psychiatry residents, clinical psychology interns, and medical students.
Child/Adolescent Partial Hospitalization Program
Outpatient Integrated Care (Medical Primary Care and Infectious Diseases Clinics)
Psychiatrists and social workers are located within the primary care setting to improve medical outcomes, reduce admissions to the hospital, and to identify patients in need of therapeutic intervention. Psychology interns will see patients within primary care settings including internal medicine and the Infectious Diseases Clinic for screening, assessment and short term psychotherapy.
Staffing: This rotation is run by an attending psychiatrist. A faculty psychologist in will provide supervision. Primary care physicians, nurses, and social workers will also be providing patient care and collaborative training for interns.
Adolescent Collaborative Health (including CASA Clinic and Peds CL)
This rotation includes three hospital based services including Collaborative Care, CASA Clinic, and Pediatric Consultation-Liaison services: Patients seen for collaborative care are screened in the clinic for depression and anxiety by their primary care physician. Psychology interns on this rotation provide referred patients with brief psychotherapy once a week. Interns meet regularly with a staff of pediatricians, nurses and social workers to review cases in need of treatment. The treatment primarily focuses on short-term interventions to improve coping strategies and interpersonal effectiveness; triage and determination for longer-term outpatient treatment is also made. Psychology interns will also work in the CASA Clinic which serves an advocacy role with legal, child welfare, and law enforcement agencies and includes a parental education component for the prevention of child abuse. Interns are trained in Child Abuse/Sexual Abuse assessment. Interns develop their skills for trauma-specific assessment and conceptualization of cases through a trauma informed lens, as well as psychoeducation for families and caregivers related to prevention of childhood trauma and abuse. Additionally, interns will gain experience with Pediatric Consultation Liaison services. Working alongside a child psychiatry fellow and supervised by an attending, interns gain experience in assessment of pediatric patients in medicine who require psychiatry consults. Interns are also able to provide bed-side therapy services for the length of the patients’ medical stay. Assessments will seek to determine if the patient requires psychiatric inpatient hospitalization.
Staffing: The Collaborative Care rotation is run by pediatricians as well as the supervising social worker and additional social worker. Therapy is done by the psychology intern and a staff social worker. A faculty psychologist will provide supervision. Pediatricians, nurses, and social workers will also be providing patient care and collaborative training for interns. Attending physician and Psychiatrist of the CASA and Peds-C/L services are also involved in supervision for those sub-rotations.
Staffing: This rotation is supervised by the Healthy Steps Psychologist. Psychology interns will work closely with the pediatric providers as part of the treatment team. School-based mental health staff include a psychiatrist and multiple social workers.
Staffing: This rotation will be supervised by offsite faculty psychologists with a forensics background; there will also be psychologists from Riker’s Island Jail for additional support and guidance. Psychology interns will work closely with other mental health staff members of the jail. There also may be interactions with interns and externs from other area hospitals.