Core Treatment Rotations

(Child interns: full year, correctional/forensic interns: 6 months, adult intern: full year)

Interns are responsible for the treatment of their clients, as well as case management and maintenance of appropriate documentation, including intake assessments, treatment plans, progress notes, and discharge plans, all of which are tailored to each client’s needs. By the end of the training year, interns are expected to prepare treatment plans that require minimal correction. In addition to training in therapeutic interventions, interns gain experience advocating for clients. Interns also gain experience consulting with professionals, agencies, and systems that impact on clients, e.g., child or adult protective services, school systems, the legal system, medical professionals. Interns may complete their age distribution requirement in this rotation (geriatric or early childhood) by carrying at least one outpatient case in the designated age group.

As part of this experience, interns participate in a weekly, interdisciplinary team meeting. In all settings for this experience, interns work under the supervision of licensed psychologists, with whom the decisions about treatment interventions are made, and receive one hour of individual supervision per week. Psychiatric evaluation and management is commonly available, and interns work collaboratively with psychiatrists and other treatment team members.

Child track interns complete this rotation in the Child and Adolescent Outpatient Service (ages 3-17). This unit provides treatment for children with varying levels of disturbance. Clients present with a wide range of problems including family dysfunction, histories of trauma, depression, anxiety, conduct disorder, attention deficit hyperactivity disorder, psychotic disorders, learning difficulties, acculturation problems, and substance abuse. After an initial biopsychosocial evaluation, clients are assigned to an intern who develops, implements, and coordinates the treatment. Depending upon the age of the client and his/her needs, treatment may be more individually focused or more family focused. Decisions about treatment interventions are made by the intern and supervisor, in collaboration with the client and his/her family. Psychiatric evaluation and management is available as needed, and interns learn about the role that psychotropic medication plays in treatment. Interns are expected to engage in outreach activities as demonstrated by at least two home visits and at least two school visits during the year. Child track interns also participate for one semester in the intensive outpatient group, in which children are either “stepping up” or “stepping down” to partial care.

Adult track interns complete this rotation in the Adult Outpatient Services unit of UBHC in Newark. At this program, they will see a range of clients representing the full adult age spectrum, with a variety of presenting problems including histories of trauma, depression, anxiety, bipolar disorder, psychotic disorders, acculturation problems, personality disorders, and substance abuse. This rotation may include both individual treatment and a wide range of group therapies. Decisions about treatment interventions are made by the intern and supervisor, in collaboration with the client, and sometimes his/her family. Psychiatric evaluation and management is common, and interns learn about the role that psychotropic medication plays in treatment.

Correctional/Forensic interns complete this rotation at the outpatient units of UCHC, typically for one semester, although limited cases may be carried more consistently throughout the year. Within Northern State Prison (NSP) and Edna Mahan Correctional Facility for Women (EMCFW), clients present with a wide range of difficulties and diagnoses, including the full array of diagnoses seen in community settings, and notably with a high rate of personality disorders, schizophrenia, mood disorders, and trauma-related diagnoses. Interns in these settings assess clients, and develop and implement site-specific treatment plans. Interns are generally expected to carry 8-10 individual cases and co-lead 1-2 groups, typically in an area familiar to them, such as anger management, DBT, CBT, or the New Directions Manualized Treatments. Process groups may also be co-led.

At the Adult Diagnostic and Treatment Center (ADTC), interns learn a more specialized approach to this particular clinical population of repetitive and compulsive sex offenders. Approximately 20% of sexually-offending inmates are identified as being in need of mental health services. Thus, in addition to their history of sexually offending behavior, these clients also bring a range of other difficulties which are generally addressed in group settings. These groups include Orientation, Process, Psychoeducational, and Mental Health treatments. In the Outpatient Division, the intern principally participates in presentence evaluation of offenders, determining whether they meet legal criteria for repetitive and compulsive sex offending, according to New Jersey Law.

(For child interns: equivalent of 1.5-2 days, 6 months; correctional/forensic interns: 6 months in Inpatient Units; for adult interns: equivalent of 1.0-1.5 days, full year)

Partial hospital - milieu treatment programs provide a very different kind of experience than do outpatient services. Within these units, interns learn to work as part of a multi-disciplinary team, all of whose members are responsible for carrying out at least some elements of the treatment plan. In addition, milieu treatment programs typically have complex structures that interns must learn to manage and work within.

Child track interns gain this experience in one of the two sections of the Child and Adolescent Partial Program. The Challenge Program is a comprehensive half-day, after-school, partial hospitalization program for children and adolescents ages 5-18; and the Collaborative Program is a school-integrated partial hospitalization program. Children in these programs have typically been psychiatrically hospitalized or have been in residential placement or are at risk for such inpatient settings. These children have serious emotional disturbances, are usually prescribed psychotropic medication, and many of them have endured histories of trauma and violence. Many are receiving special educational services. All children in this program receive individual and family therapy in addition to group and milieu services. In this setting, the interns are assigned two individual cases and work more intensively with these two families twice a week. In addition, interns participate in the milieu setting one to two afternoons per week. Interns have opportunity to work as members of a milieu team composed of several clinical staff members who work with the same client. Interns also participate in a weekly, interdisciplinary team meeting. Supervision is provided individually by the Clinician Supervisor of the unit.

The general adult track intern completes a 12-month rotation within two different milieu treatment settings, representing distinct levels of care. These settings are: the general Adult Partial Hospital Program, which services clients with a history of severe and persistent mental health issues, and has a length of stay of up to two years; and the Acute Partial Hospital Program, which focuses on stabilizing clients experiencing mental health crises (including psychotic, depressive, or manic episodes), and has a length of stay of up to 6 months. In the acute program, many clients are referred following recent inpatient hospitalizations, and the broader goals are to help them maintain stability, avoid re-hospitalization, and successfully reintegrate into a community environment.

Treatment in both programs occurs within a therapeutic community that establishes a safe, supportive environment in which clients can maintain or improve their functioning. Clients typically attend five days a week from 9:00 a.m. to 3:30 p.m. They participate in a wide range of clinical groups, receive case management and rehabilitation, and sometimes participate in pre-vocational work activities. The program also includes MICA groups for clients presenting with co-morbid substance use disorders; these groups follow a harm-reduction model, but also can include elements of 12-step approaches.

During this rotation, interns can participate in either or both of the two programs, including co-leading a wide range of psychotherapy and psychoeducational groups, conducting individual treatments, and contributing to the multidisciplinary milieu elements of the program. Common groups include relapse prevention, illness management and recovery, process, and various topics of psychoeducation, but interns are welcome to design and implement groups in other areas as well.

The correctional/forensic interns complete this rotation in one of the University Correctional Health Care Residential Treatment Unit/Transitional Care Unit (RTU/TCU), at either NSP or EMCFW, and are separated from the general population of inmates. The RTU and TCUs provide structured psychosocial rehabilitation and psycho-educational programs, with individual and group counseling, supportive therapeutic activities, and psychiatric and medication monitoring. Like the patients in UBHC’s Adult Extended Partial Hospitalization Program, inmates in the RTUs suffer from severe and persistent psychiatric disorders, and typically stay more than a year; in contrast, the TCUs are more akin to briefer Partial Hospitalization Programs, where the focus is more on stabilization and transitioning back to general population. Differential diagnosis for new admissions is carefully investigated. The intern is part of the treatment milieu which includes participation in community meeting, close coordination with custody staff, treatment team meetings, and direct involvement in individual and group treatments. The treatment responsibilities for inpatient, on average are: 6 individual cases, and 1 to 2 groups, as well as a wide range of documentation, including intake assessments, treatment plans, bed utilization reviews, progress notes, and transfer summaries.

All interns are expected to participate in leading or co-leading at least one group therapy program during the course of the internship year. This requirement can be met in most of the core therapy settings and in many of the elective settings.

Interns can co-lead groups in the Adult Outpatient Services, the Child and Adolescent Outpatient Services or in the Child and Adolescent Partial Care Program, in the group therapy programs of the Adult Partial Hospital Program, and in the UCHC outpatient units, or RTU/TCU units, or at Avenel ADTC. Finally, many of the elective experiences provide opportunities to participate in conducting group therapy.

Supervision for the group therapy experience is typically of an apprentice nature, in that the intern is co-leading a group with a more experienced clinician, with whom the issues in the group are discussed before and after the group meetings. However, there are also opportunities for interns to conduct specialized groups with other interns, and then specific supervisors are assigned for this purpose.

All interns participate in a case competency assessment in the spring of their internship year. The purpose is for interns to demonstrate their ability to conceptualize and treat a given case within a chosen primary orientation. This process includes the preparation of a comprehensive formal written report on a treatment case that is reviewed with the primary supervisor of that case. This case should begin treatment in the fall, when theoretical orientation, initial assessment, and case formulation are addressed in writing. The write-up is completed in the spring, when progress is documented and contextual factors are followed-up. Then, the intern is assigned to an oral examination committee of two psychologists, generally one from within the UBHC system who has not supervised the intern’s work, and another who is on the voluntary faculty and not a regular UBHC employee. This assessment is an opportunity for interns to participate in an evaluation process similar to New Jersey’s former licensing examination, as well as to the ABPP exams. Interns receive feedback on both the written report and their responses to the discussion. Through this assessment, interns demonstrate their domains of competency, as they work towards independent clinical practice.