Clinical Psychology Internship - Postdoctoral Fellowship Programs

The Portland VA Medical Center is pleased to announce the emergence of four postdoctoral fellowship programs at our facility. The fellowships began in the 2008-2009 academic year. Residencies are for 2080 hours to be completed over a 12-month period. The start date is to be determined and may vary from fellowship to fellowship.

The stipend for these positions is $42,763 plus benefits. Residents are granted Annual Leave and Sick Leave, ten federal holidays, and up to six days of authorized absence for educational leave. Funding for select educational activities may also be available.

Most clinical and research activities will take place at the Portland VA Medical Center, but
fellows may also spend time at Oregon Health & Science University, our medical school
affiliate.

Fellowship Descriptions

Elizabeth Goy, Ph.D., lead supervisor. This fellowship is part of the VA Interprofessional Palliative Care Postdoctoral Fellowship. This is a one-year training program in which the psychologist fellow will join an interdisciplinary palliative care team including other fellows in social work, palliative medicine, nursing, and chaplaincy. The psychology fellow will function year round as a palliative care consult team member, attending palliative care rounds, taking psychology referrals for palliative care inpatients (in hospital and nursing skilled care units) and outpatients, and providing expertise to other hospital disciplines caring for palliative and hospice-enrolled inpatients. Additionally, the fellow will complete several 4 or 6-month training site rotations which may include:

• Hematology/Oncology clinics
• VA Home-Based Primary Care
• VA Heart Failure Clinic
• OHSU outpatient psychiatry individual therapy for end-of-life processing and bereavement
• OHSU geropsychiatry clinic

Training will be designed to maximize the fellow's expertise in psychological aspects of end-of life care, including evaluation of mood and quality of life; knowledge and treatment of common end of life psychiatric syndromes (including depression, anxiety, delirium, post
traumatic stress disorder, anticipatory grief, substance abuse, and sleep disorders); caregiver strain and processing of grief; in-depth understanding of disease-specific end-of-life trajectories; working with other disciplines including chaplains, social workers, nurses, pharmacists and physicians to maximize palliative support and identify unmet needs for psychological services; empirical basis of assessment and treatment planning; and in-depth understanding end-of-life pain treatment protocols and symptom management.

Fellows will have one day per week available for development and conduct of faculty/IRBapproved research; this option can be adjusted if more time is desired for clinical activities. Fellows will participate in a specially designed didactic seminar series each week. The series will draw from resources at the VA, at OHSU, and in the community. Didactics will include weekly interprofessional palliative care fellowship didactics, monthly all-city palliative care conference, OHSU department of psychiatry grand rounds, psychology service-sponsored 19 seminars twice monthly, postdoc-specific professional development seminars twice monthly.

The fellow will receive two hours of individual supervision weekly and one hour of group
supervision with VA interns and/or other psychology postdoctoral trainees. If desired, the
fellow may obtain experience in supervised supervision of interns.

Daniel Storzbach, Ph.D.; Amy Wagner, Ph.D., lead supervisors. The trainee in this position will primarily develop skills in the assessment and treatment of Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD). This Fellow will work within the current PTSD Clinical Team (PCT) and the Neuropsychology Service located in the Mental Health Clinic. It is expected that the majority of the Fellow's clinical activities will be with veterans who have recently returned from Iraq and Afghanistan, a population that has been shown to have high rates of TBI and PTSD.

The TBI portion of the fellowship will be managed by the Neuropsychology Service. This
training experience is designed to enhance the skills of Fellows with prior neuropsychology experience through exposure to the unique population of veterans with combat-related TBI and other possible combat-related exposures. The emphasis will be on acquiring specialized expertise in assessment and rehabilitation of the effects of both combat-related TBI and cooccurring adverse psychological effects, particularly post-traumatic stress disorder (PTSD), depression, and adjustment reactions. The assessment approach at PVAMC combines structured and flexible techniques. In addition to clinical training, Fellows would attend seminars that provide theoretical and practical reviews of current issues including formal case presentations, Neuropsychology Case Conferences led by Dr. Muriel Lezak at OHSU, and Neuroscience Grand Rounds. There will also be opportunities to work in collaboration with staff from the VA's Center for Polytrauma Care in Seattle and the Psychology Department at Madigan Army Medical Center.

Fellows will also work directly with the recently funded VA Merit Review study "Multidiscipline Assessment of Blast Victims for Cognitive Rehabilitation." The primary objective of this study is to investigate whether wartime exposure to explosions has long-term neuropsychological and psychiatric effects on OIF/OEF veterans and to clarify the relative extent and severity of these two types of effects.

Within the PCT, fellows will participate in nationally recognized group education and therapy programs developed at the PVAMC. They will also gain experience in evidence-based individual treatment models. The Portland and Vancouver PCT staff have expertise in such treatment models as Dialectical Behavioral Therapy (DBT), Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT). Training emphasizes conceptualization and treatment of acute and chronic posttraumatic sequelae. The Fellow will participate actively in the provision of clinical services, supervise interns, and contribute to ongoing research. The goal of training for the PTSD element is to instill specialized knowledge of and treatment for PTSD and related conditions. Particular emphasis will be on learning and further developing adaptations of PTSD treatments for individuals with TBI.

Linda Gonzales, Ph.D., lead supervisor. The fellow in this position will work in settings that integrate Mental Health and Primary Care services. The fellow will work closely with members of the General Medicine-Psychiatry teams (GM-Psych), groups of mental health professionals embedded in Primary Care clinics. Their placement allows for better coordination of psychiatric and medical care, especially for those patients with multiple co-morbidities. A major benefit of this approach is that many patients can be successfully managed after brief collaborative interventions on an ongoing basis by their Primary Care Providers, with ongoing consultation by mental health providers. Another major benefit is the continued erosion of barriers and silos that often exist between Mental Health and Primary Care Programs.

Psychologists and trainees have been part of GM-Psych from its inception ten years ago. The Fellow in this position will primarily develop skills in the assessment and treatment of patients being seen in Primary Care settings. They would provide various psychological services, including time limited individual treatment, cognitive behavioral therapy, joint brief visits with the PCP and patient as needed, psychological assessment, as well as easily accessible mental health "curbside" consultations. Upon request, fellows may also participate in the Threat Assessment programs within the facility which evaluate and manage disruptive behavior in clinical setting.

Clinical training for the postdoctoral fellowship training will emphasize the following:

1. Appreciation of the culture of the Primary Care Clinic and the way physicians and other PCP's view and treat mental health problems.
   
   
2. How to coordinate care with the other providers in a clinic setting
   
   
3. Understanding of common chronic medical problems and their relationship with
   psychiatric disorders
   
   
4. Basic understanding of commonly used psychotropic medications and how to
   investigate whether there may be drug interactions with other medicines the patient is taking
   
   
5. How to utilize a consultation and brief intervention model within a Primary Care Clinic

David Indest, Psy.D, lead supervisor. As the only VHA facility in the nation housing both a Liver Transplant Program and a Hepatitis C Resource Center (HCRC), the PVAMC offers a unique training experience as a member of an interprofessional care team for a complex specialty medicine condition, hepatitis C virus (HCV) infection. The NW HCRC is a national program charged with developing evidence-based best practices for HCV care with a particular focus on psychiatric and substance use disorders co-morbidity in veterans with hepatitis C.

Patients with HCV commonly present with a complicated set of mental health, substance
abuse, and medical issues. Fellows will be full members of the HCV, Liver Transplant, and
Substance Abuse interprofessional care teams. Through firsthand observation and then direct supervision, they will develop a unique set of skills that can be applied to any complex medical condition requiring interprofessional care:

1. Conducting Pre-Interferon Evaluations to determine patients' suitability to begin interferon treatment, including developing plans to help unsuitable candidates become prepared for treatment and to monitor high-risk patients throughout the course of treatment. These evaluations assess HCV disease knowledge and progression, treatment and side effect knowledge, psychiatric stability, substance use and abuse, psychosocial security, treatment planning and monitoring, and treatment adherence and self-management.
   
   
2. Conducting Pre-Transplant Evaluations to determine patients' suitability to receive and make best use of a rare organ donation. The Fellow will conduct assessments of mental health, substance use, and behavioral issues, including procedure knowledge, psychosocial and material support, and adherence and self-management.
   
   
3. Delivering Motivational Interventions to address entrenched substance abuse and other behaviors that impede health and access to medical services. The NW HCRC has developed a manualized Brief Alcohol Intervention that is being disseminated throughout the VHA system and more recently received VA Merit Grant funding with the Minneapolis HCRC to conduct research using a Brief Alcohol Intervention.
   
   
4. Providing In-Situ Psychological Interventions to Medical Patients. The NWHCRC Fellow will have the unique opportunity to be part of specialty medical clinics and provide psychological services in Liver Clinics, Primary Care Clinics, and the Liver Lodge (residential facility for patients undergoing liver transplant and evaluation for liver transplant). The Fellow will learn cognitivebehavioral treatments for typical symptoms of depression, irritability, anxiety, and panic, as well as behavioral medicine interventions for managing complex conditions such as chronic pain and other somatic symptoms exacerbated by psychological factors.
   
   
5. Developing Best Practices through Clinical Research. The NWHCRC has access to a number of local, regional, and national databases that allow a Fellow to develop a research inquiry to address aspects of care. Past Fellows have analyzed data to provide foundation for successful grant applications for independently funded research studies.
   
   
6. Receiving Research mentorship and training that focuses on the relationship between hepatitis C and the psychiatric and substance use disorders co-morbidity. We have had great success in the last 3 years using the VISN 20 CHIPS electronic record database to delineate issues related to the care and management of veterans with hepatitis C. Fellows can spend up to 50% of their time on research-related activities.

Eligibility: We seek candidates who are US citizens and will have completed an APA-accredited doctoral program in clinical or counseling psychology and an APA-accredited
internship as of August 31, 2008. The dissertation must be verified as completed prior to the fellowship start date. As an equal opportunity training program, the internship welcomes and strongly encourages applications from all qualified candidates, regardless of racial, ethnic, religious, sexual orientation, disability or other minority status.

Deadlines: Applications must be postmarked by January 23, 2009. We will interview all
eligible candidates by February 20, 2009, with a final decision targeted for February 26, 2009.

Application Instructions: To apply, the following materials are required:

1. A letter of intent (identifying the desired fellowship; a brief summary of your interests and qualifications for this specialty training; why you are interested in this position; aspirations for your psychology career)
   
   
2. CV (including a brief description of your internship rotations)
   
   
3. Three letters of recommendation (at least one from an internship supervisor)
   
   
4. Graduate school transcripts (photocopies are OK)
   

Please send all application materials in one envelope. Letters of reference should be signed across the envelope seal. Send application materials to:

David W. Indest, Ph.D., Director of Training
Psychology Internship (P3MHADM)
Portland VAMC
3710 SW US Veterans Hospital Road
Portland, OR 97239
Message Phone: (503) 220-8262, Ext. 54699
FAX:  (503) 721-1053
david.indest@va.gov

Please feel free to contact Dr. David Indest with any questions.

Note: VA interns and fellows are subject to all employment rules applying to federal
employees.

We look forward to hearing from you, and encourage interested candidates to begin application as soon as possible.

Contact the Internship