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VA Southeastern Blind Rehabilitation Center
Preceptor: Chebon A. Porter, Ph.D.
Rotation Site:
The BVAMC Southeastern Blind Rehabilitation Center (SBRC) is 32-bed residential treatment facility for visually impaired veterans. It is one of only five such facilities in the U.S. The patient population is derived nationally, with the majority of referrals coming from states southeast of the Ohio River Valley. The SBRC maintains a staff of over 40 individuals, including master’s level blind rehabilitation specialists, a full nursing staff, physician, optometrist, and other support personnel. The SBRC has a longstanding tradition of providing holistic rehabilitation, as well as tailoring the program to meet individual patient needs, in the areas of low vision training, orientation and mobility, living skills, communications, manual skills, and computer access technology.

Rotation Offered: Major/Minor

Patient Characteristics:
The patient population is representative of veterans from WWII-era to the current conflicts in Iraq and Afghanistan. Although there are high rates of medical comorbidity (e.g., traumatic brain injury, war-related injuries, diabetes, heart disease, stroke, pulmonary disease), blind rehabilitation is a physically and mentally challenging environment, requiring veteran’s to participate in individual training sessions with blind rehabilitation specialists for seven hours a day. Given the degree of medical comorbidity, psychological/behavioral processes involved in pain management, dietary and medication compliance, and arousal reduction are commonly encountered. Moreover, a wide array of psychiatric issues are present in this patient population. The most frequently observed diagnostic entities include PTSD, adjustment disorders, sleep disorders, major depression, dementia, substance use disorders, and characterological issues.

Clinical Activities:
Psychology Service maintains an active presence, per assessment, intervention, and consultation. Therefore the service involves a number of opportunities for assessment and intervention. A comprehensive psychological evaluation is conducted within one-week of admission. Additional assessment may also be warranted and include standardized measures of verbal fluency, verbal learning/memory, and verbal intelligence. Standardized measures of anxiety, depression, and trauma-related distress are also often used. Finally, objective personality assessment is also conducted when needed. Interventions are based in a cognitive-behavioral framework. Staff consultations occur with all members of the SBRC, including nursing/medical, optometry, and blind rehabilitation specialists.

Distribution of Clinical Activities:
Assessment and report writing – 30%, individual intervention – 40%, staff consultations – 20%, supervision received – 10%.
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VA Outpatient Substance Abuse Clinic Rotation
Preceptor: Gloria Roque, Ph.D.- Staff Psychologist
Rotation Site:
OSAC is a multidisciplinary team that works together to provide assessment and treatment to veterans with substance use disorders.

Rotation Offered: OSAC is available as a minor rotation (12-15 hours). The site can only handle one intern per rotation.

Population:
Adult substance abusers (95% male) whose primary substances of abuse are generally cocaine and alcohol. Many of our patients have co-existing psychiatric conditions and numerous psychosocial stressors they need to address in order to initiate and maintain recovery. Many patients are also enrolled in the Homeless Veteran Program (HVP) to address their housing and psychosocial needs. Although many of our patients participate in 12 step programs (Alcoholics Anonymous, Narcotics Anon etc), OSAC focuses more on developing coping skills and operates out of a cognitive-behavioral and social learning model.

Expectations:
By the end of the rotation the intern will be familiar with substance abuse diagnoses, identification and assessment of substance abuse disorders, and basic issues involved in treatment of substance abusers. Most of the intern’s interactions with patients will involve clinical assessment. Interns will have opportunities to co-lead OSAC educational groups.

Clinical Duties:
*Interns generally perform 1-2 psychological assessments per week (interview/MSE).
*Co-lead 1-2 educational groups per week. Groups are scheduled between 8-11:30am.
*Interns may be asked to help with substance abuse consults to inpatient wards.

Intern Schedules:
Interns selecting this rotation should plan to spend the bulk of their time with OSAC on Tuesdays and Thursdays. Dr Roque works at the VA part-time and prefers to have interns on-site during the days when she can provide direct supervision of their activities.
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VA PTSD Outpatient Psychotherapy
Preceptors: Outpatient Post-Traumatic Stress Disorder Clinic
Susan Isbill, Ph.D., Misti Norton, Ph.D., Susan Rathmell, Ph.D., Brian McFarland, Ph.D.
Rotation Site:
Adult veterans seek treatment for Post-Traumatic Stress Disorder (PTSD) and co-morbid disorders such as Major Depression from the PTSD Clinical Team (PCT). This team represents the largest sub-specialty group in the VA’s Mental Health Clinic.  This is a rapidly growing area of clinical career opportunity, and can serve to outfit interns with clinical skills that will prove valuable in both military and civilian treatment.

Rotation Offered: Major/Minor

Distribution of Clinical Activities:
Interns may complete a major or a minor rotation.  Interns spend approximately 70% of their time in assessment and intervention, 20% in supervision and 10% documenting clinical activities. Interns attend the PCT weekly staffing, where cases are reviewed with team input.

Assessment Characteristics:
Evaluation is done through diagnostic interviews, symptom severity scales and objective personality testing.

Intervention Characteristics:
The PCT runs a recovery-oriented program.  Interventions are multi-modal, and include individual psychotherapy and assessment, time-limited skills groups, evidence-based cognitive processing therapy and prolonged exposure.  Minor foci include: couples’ therapy, marital and family therapy, military sexual trauma treatment.

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VA Outpatient Mental Health Clinic
Preceptors: Maura Carter, Ph.D., David Eakin, Ph.D.
Rotation Site:
Veterans are seen in the outpatient mental health clinic for the full range of psychological diagnoses, including mood disorders, anxiety disorders, schizophrenia-spectrum disorders, and personality disorders. Therapeutic services include individual psychotherapy, couples/marital/family therapy, and group therapy. Interns can gain supervised experience in evidence-based treatment practices with a variety of patients while developing and broadening their skills in conducting psychotherapy with individuals, groups, and families.

Rotation Offered: Minor

Distribution of Clinical Activities:
Interns may complete a major or minor rotation. Interns spend approximately 70% of their time providing direct therapeutic services, 20% in supervision, and 10% documenting clinical activities.

Assessment Characteristics:
Diagnostic interviews, symptom severity scales and objective personality testing as warranted.

Intervention Characteristics:
Interventions typically involve evidence-based treatment strategies, including cognitive-behavioral therapy models. Occasionally, integrative therapeutic strategies are utilized according to the specific needs of the veteran.

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VA Primary Care Mental Health Team
Preceptors: Carin Eubanks, Ph.D.
Rotation Site:
The Primary Care Mental Health (PCMH) Team is a multidisciplinary program that serves male and female veterans and their families. PCMH providers (2 Psychologists and 1 Psychiatrist) act as the initial contact point for veterans referred for mental health care by their primary care providers. The PCMH goal is to see Primary Care (PC) referrals on the same day the veteran is seen in Primary Care.  The veterans seen in PCMH range in age from 18 to over 80 years and present with a variety of diagnoses.

Rotation Offered: Major/Minor

Distribution of Clinical Activities:
The PCMH rotation consists of 80% – 90% intake and report writing. Interns may opt to conduct short-term therapy with 1-2 individual patients during the rotation.

Assessment Characteristics:
Clinical Interview is the primary means of assessment on the PCMH rotation. When formal testing is needed, computer administration of the MMPI-2 or MCMI and administration of the Dementia Rating Scale and Beck Depression Inventory II are the most common assessments conducted.

Intervention Characteristics:
Interns may opt to engage in short-term CBT based interventions.

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VA Geropsychology
Preceptor: Paul Blanton, Ph.D.
Rotation Site:
VA Geropsychology is an integral part of the Geriatric Assessment Clinic, which employs an interdisciplinary team approach to the evaluation and treatment of persons age 65 and older and their families who are coping with a wide range of medical and/or mental health issues. VA Geropsychology is an integral part of the Geriatric Assessment Clinic, which employs an interdisciplinary team approach to the evaluation and treatment of persons age 65 and older and their families who are coping with a wide range of medical and/or mental health issues.

Rotation Offered: Minor only

Distribution of Clinical Activities:
Approximately 45% of the interns time is spent in assessment; 20% report writing; 20% intervention, feedback, and case management; 10% supervision and readings; and 5% meetings.

Assessment Characteristics:
Assessments include a thorough clinical psychodiagnostic interview with the patient and family; review of medical records and diagnostic reports; administration and scoring different tests of mental status, cognitive functioning, and mood; interpreting test data; and writing brief reports.

Intervention Characteristics:
Opportunities for intervention include learning a 20-session model of Cognitive-Behavioral therapy (CBT) geared towards older adults who are experiencing symptoms of depression; learning strategies to assist older individuals in coping with normal aging, disability, major or chronic illness, and/or situational psychosocial stressors; and learning a protocol consisting of 8, 2-hour group sessions designed to assist older adults in learning skills for memory maintenance and enhancement. This approach takes a holistic view of memory that addresses cognitive, psychological, and educational factors in memory performance and aims to teach a practical outlook towards managing memory challenges. Other activities include patient and family education about diagnosis, prognosis, management strategies, and resources.

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VA Neuropsychology
Preceptor: Paul Blanton, Ph.D., Kristine Lokken, Ph.D.
Rotation Site:
The Neuropsychology Clinic at the VA provides outpatient neuropsychological assessment for adults of various ages who have a wide variety of medical, psychiatric, and neurological conditions associated with different types of neuropsychological dysfunction. The clinic is a consultation service that receives referrals from neurology, psychiatry, geriatrics, primary care, SCI/TBI rehabilitation, and other sources. Because many of our patients have multiple co-morbid medical and psychiatric disorders, often without clear neurological findings, determining the presence, pattern, and severity of cognitive impairment is often complex and challenging. Within this rotation, there is opportunity for interns to receive specialized training in the following areas (along with gaining general neuropsychology experience). [1] Geriatric Neuropsychology – including normal cognitive aging, differential diagnosis of dementia (e.g. Alzheimer’s disease, FTLD, cerebrovascular disease, etc…), and other conditions which may result in decreased cognitive functioning in older adults (e.g. mild cognitive impairment, delirium, other medical disorders, psychiatric conditions such as depression, etc…); and [2] Traumatic Brain Injury – An estimated 20 percent of those injured in Operation Iraqi Freedom (OIF)/ Operation Enduring Freedom (OEF) have received a TBI as a result of blast injuries. Interns will have the opportunity to learn about, assess, and provide treatment recommendations to persons who have experienced blast injuries.

Rotation Offered: Major/Minor

Distribution of Clinical Activities:
Approximately 40% of the interns time is spent providing neuropsychological assessment; 35% report writing; 20% supervision and didactics; and 5% intervention, feedback, and case management. Interns will be expected to evaluate 2-3 Neuropsychology Clinic patients per week if they take this as a major rotation. Optional activities include attendance at: 1) Neuropsychology Case Conference with UAB-affiliated neuropsychologists once a week for 1 hour; 2) Geriatric Noon Conference (every Thursday at noon, lunch provided); 3) weekly UAB neurology rounds (Tuesdays at 7:00 a.m.); 4) and Brain Cuttings (day and time TBA).

Assessment Characteristics:
Most neuropsychological assessments involve administration of the same set of commonly-employed neuropsychological tests, with tests being added or subtracted depending upon the referral question. Combined with the interview, the assessment process takes about 4-5 hours. Typical assessment instruments include: Wechsler Memory Scale-III, Wechsler Adult Intelligence Scale-III, California Verbal Learning Test-II, subtests from the Boston Diagnostic Aphasia Examination, subtests from the Halstead-Reitan Neuropsychological Battery, Repeatable Battery for Neuropsychological and Status (RBANS), subtests from the Delis-Kaplan Executive Functioning System (DKEFS), Beck Depression Inventory or Geriatric Depression Inventory, and others. Interns will also have the opportunity to learn how to utilize newer instruments such as the Neuropsychological Assessment Battery (NAB).

Intervention Characteristics:
Intervention activities include providing feedback to patients and their families regarding results of assessment; educating them about the etiology, diagnosis, and prognosis of their disorders; and making recommendations about practical methods for coping with cognitive deficits.
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VA Rehabilitation Medicine / Chronic Pain
Preceptor: Kristi L. Clements, Ph.D.
Rotation Site:
This rotation provides experience with multidisciplinary patient care activities in Physical Medicine and Rehabilitation at the Birmingham VA Medical Center. The majority of the patients seen on this rotation will be individuals referred to the 4-week Chronic Pain Management Program. These patients present with a range of neurological and musculoskeletal conditions and frequently have significant psychological co-morbidity, including anxiety disorders, depression, and Axis II traits. Patients receiving services in the program are predominantly male and over 50 years of age. Other patients seen on this rotation include patients with spinal cord injuries, amputations, and brain injuries.

Rotation Offered: Minor only

Distribution of Clinical Activities:
A range of clinical activities are available to the intern with time generally distributed as follows: clinical intake evaluations (30%), group therapy (25%), individual therapy (25%), and ancillary activities such as report writing and staff meetings (20%).

Assessment Characteristics:
Intake evaluations are comprised of structured clinical interviews. Various self-report inventories such as the Beck Depression Inventory and the Brief Pain Inventory are used both pre- and post-treatment.

Intervention Characteristics:
Interns will gain experience with behavioral and cognitive-behavioral treatment strategies that are used with groups and individuals. Groups are both psychoeducational and process in structure. Individual interventions are supportive and focus on gaining coping skills and acceptance of medical condition. Relaxation training is an integral part of treatment. Collaboration with multidisciplinary treatment team plays a vital role in this rotation.

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VA Rehabilitation Neuropsychology
Preceptor: Kristine Lokken, Ph.D.
Rotation Site:
The Rehabilitation Neuropsychology Clinic within the Department of Physical Medicine and Rehabilitation at the VA is an outpatient assessment clinic for veterans who have sustained head injuries in both combat and non-combat related events.  The population consists primarily of OEF/OIF veterans who have sustained blast injuries and/or vehicle accidents during their time in combat. The neuropsychological evaluation is part of a comprehensive assessment conducted by the multi-disciplinary TBI Team. Co-morbid conditions, such as PTSD and depression, are common.

Rotation Offered: Major only

Distribution of Clinical Activities:
Approximately 40% of the interns time is spent providing neuropsychological assessment; 35% report writing; 10% supervision and didactics; and 15% intervention, feedback, and case management. Interns will be expected to evaluate 2-3 Neuropsychology Clinic patients per week if they take this as a major rotation. Interns are strongly encouraged to participate in the VISN Polytrauma Conference Call (4th Thursday of the month, 2-3PM), the TBI Staffing Meeting (4thThursday of the month, 3-4PM), and the Neuropsychology Case Conference at UAB (every Tuesday, 4-5PM).

Assessment Characteristics:
Most neuropsychological assessments involve administration of a brief battery of neuropsychological tests, designed to tap multiple cognitive domains. Interns will be expected to interview the veteran, administer and score the tests, and write the report.  Typical evaluations last approximately 4 hours, including the interview.

Intervention Characteristics:
Intervention activities include providing feedback to patients and their families regarding results of assessment, as well as educating them about the etiology, diagnosis, and prognosis of their disorders.  There are also opportunities for brief psychotherapy, typically focused on adjustment issues, with the veteran and the family.  The intern can also assist with the development of cognitive rehabilitation programs for veterans with TBI.

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VA Compensation and Pension
Preceptor: Karen Clark, Ph.D., Kristi L. Clements, Ph.D., Celia Huston, Ph.D., Mark Phillips, Psy.D.
Rotation Site:
The Compensation and Pension (C&P) clinic is located within the Department of Administrative Medicine at the Birmingham VA Medical Center. The compensation and pension clinic serves all veterans of war and peacetime eras who have submitted claims for service connected benefits. Veterans present with a range of DSM IV diagnoses and are assessed for Axis I and Axis II disorders related to their compensation claims.

Rotation Offered: Minor only

Distribution of Clinical Activities:
Clinical intake evaluations (100%)

Assessment Characteristics:
All assessments are structured clinical interviews.

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Other VA Experiences
Coordinator:William Beidleman, Ph.D., Chief Psychologist and Assistant Chief of Mental Health Service

Description: The following additional clinical experiences are available to interns; Hepatitis C evaluations and treatment; transplant evaluations; inpatient and ER consultation.  These are not major or minor rotations.  Rather, these are available as ancillary training opportunities.  Other training experiences can be made available to meet educational and career goals.