Clinical Training Opportunities
The following training opportunities are available as electives to all interns, regardless of the intern’s track and background experience, based on the feasibility of scheduling, with a few exceptions. There are opportunities for research collaboration in many of these services.
The services have been grouped into six broad categories:
- Adult Psychiatry Inpatient and Outpatient Services
- Behavioral Medicine and Neuropsychology
- Pediatrics and Child/Adolescent Psychiatry
- Community Programs for Children and Families
- Developmental Disabilities
- Adult Psychiatry Inpatient and Outpatient Services, UNC Department of Psychiatry and UNC Department of Emergency Services
There are multiple inpatient and outpatient services for adults in the Departments of Psychiatry and Emergency Services at UNC. Training goals of these services, with modifications based on the treatment context of a specific service, include: 1) to learn diagnostic interviewing and treatment planning; 2) to utilize the range of evidence-based and evidence-supported therapeutic options available in that setting; 3) to function as an integral member of a multidisciplinary assessment and/or treatment team; 4) to express logically and concisely (both verbally and in writing) the relevant history, formulation, recommendations and treatment progress; 5) to utilize the literature and gain familiarity with medical issues relevant to psychiatric disorders, such as pharmacotherapy, ECT, and co-existing medical illnesses; and 6) to gain familiarity with sociolegal issues, such as patient’s rights, commitment laws, and confidentiality.
UNC Center of Excellence for Eating Disorders (CEED). Housed within the UNC Neurosciences Hospital, the CEED provides comprehensive multidisciplinary assessment and treatment to individuals with eating disorders. Interns work with professionals and trainees in psychology, medicine, psychiatry, nursing, social work, nutrition, occupational therapy, and recreational therapy. Interns work within the inpatient eating disorders unit (EDU), a 6-bed inpatient program for the treatment of low-weight adolescents and young adults with anorexia nervosa and other comorbidities. Length of stay is variable, but typically ranges from two weeks to four months. The treatment model within EDU utilizes cognitive-behavioral and dialectical-behavioral approaches and emphasizes the therapeutic milieu. Interns may participate in daily rounds, interdisciplinary treatment team meetings, engage in individual psychotherapy, and co-lead CBT and DBT groups. Interns also have the opportunity to participate in a variety of other treatment services, including family therapy, parent education, nutrition education, and therapeutic community outings within EDU. As an elective rotation, training experiences are structured as four-month rotations, but the time commitment for each rotation is negotiable.
UNC Center for Women’s Mood Disorders. On this service, interns will participate in the assessment and treatment of mood disorders in women within the UNC Perinatal Psychiatry Inpatient Unit and the Women’s Mood Disorders Outpatient Clinic. The Perinatal Psychiatry Inpatient Unit is one of the only facilities in the nation providing multidisciplinary care to women with severe mental illness during pregnancy and the postpartum in a separate, stand-alone setting that minimizes mother/baby/family separation. The inpatient unit is dedicated to treatment of severe mental illness, including treatment for mood disorders, anxiety disorders, substance use disorders, psychosis, trauma, and chronic suicidality, during pregnancy and the immediate postpartum period. Interns will work with both individual and group modalities. In the outpatient clinic, the intern will participate in the provision of evidence–based treatments for women across the lifespan experiencing mood and anxiety disorders such as perinatal depression and anxiety, premenstrual dysphoric disorder, and depression during the menopause transition. Specific aims include: 1) Gain experience in screening, diagnosis, and treatment of mental illness in the context of women’s reproductive events (pregnancy, infertility and assisted reproduction, pregnancy loss, postpartum, menstrual cycle, and menopause) in outpatient and inpatient environments; 2) Develop skills in Interpersonal Psychotherapy (IPT) and Acceptance and Commitment Therapy (ACT); and 3) Obtain experience in case formulation and treatment planning from multiple evidence-based theoretical perspectives.
The Crisis Stabilization Unit is a 15-bed psychiatric inpatient program, serving patients primarily between the ages of 18-60 years of age, from all socioeconomic groups. This is a regional hospital that accepts patients with a wide variety of psychiatric disorders, which offers the opportunity for interns to be exposed to patients with a broad range of psychopathology. The average length of hospitalization is 4-6 days. Interns on this unit participate in daily interdisciplinary treatment team meetings and may develop a cognitive-behavioral psychoeducational group to offer to patients on a topic of the intern’s choosing. Topics for work either in a group or individual format can include depression, anxiety, stress management, anger management, trauma, grief, and substance abuse/dependence. Group therapy sessions for substance abuse issues, starting in 2019, will provide an opportunity for co-leading groups. Interns also have the opportunity to provide brief supportive therapy to patients.
Psychiatric Emergency Service The Psychiatric Emergency Service, a program of the Emergency Department, uses a crisis intervention model, which includes assessment, intervention, and disposition of patients who present to the ED with emergent mental health and substance abuse problems. The philosophy of PES advocates maximizing the use of community resources and avoiding unnecessary hospitalizations. The Service is staffed 24 hours a day, seven days a week. Interns will typically participate for one day a week, for one rotation, as a member of the multidisciplinary team, learning to provide clinical assessment, intervention, and disposition of individuals presenting to the ED on a voluntary or involuntary basis while experiencing a psychiatric/substance abuse emergency. Interns will also provide follow up/supportive and problem-solving therapy to clients following an emergency visit, on a temporary basis until long-term treatment can be arranged; and answer incoming calls regarding psychiatric emergencies and referrals. Case consultation reports will include biopsychosocial history, differential diagnosis, risk assessment and treatment recommendations. This Service may not be available in 2022-2023. Additionally, it is only offered as an in-person elective.
2. Behavioral Medicine and Neuropsychology
Lung and Heart Transplant Teams and Ventricular Assist Device (VAD) team. Interns with an interest in the psychological issues surrounding organ transplantation and VAD surgery may work with the clinical psychologist of the UNC lung and heart transplant teams and the VAD team. Interns will have the opportunity to complete comprehensive psychological evaluations of adult candidates for lung and heart transplantation and VAD surgery. Interns will consult with members of the interdisciplinary transplant and VAD teams (physicians, nurse coordinators, physical therapists and social workers) to help maximize patient functioning and outcomes. Interns will be able to provide individual and couples therapy before and after transplantation and VAD surgery, and group therapy with patients and their caregivers who are pre- and post-transplant and VAD surgery. Interns have the chance to follow patients from pre- to post-transplant which is a very powerful experience. On this rotation, interns gain an in-depth understanding of heart transplant, lung transplant and VAD placement. Interns also learn the disorders associated with heart disease (congestive heart failure, post-partum cardiomyopathy, etc.) and lung disease (cystic fibrosis, COPD, sarcoidosis, etc.) and they learn to assist patients in coping with the myriad comorbid conditions (pain, insomnia, substance abuse, psychological distress) that patients may experience pre- and post-transplant and VAD. Interns have the opportunity to supervise master’s students in mental health counseling. Interns are welcome to participate in ongoing research on psychosocial issues surrounding transplantation and quality of life before and after heart and/or lung transplant and VAD surgery.
Liver/Kidney/Pancreas Transplant Teams. Interns with interest in psychological issues in transplantation may elect to work with the abdominal transplant team. This service provides excellent training conducting psychological evaluations of potential transplant recipients (liver, kidney, and pancreas) and of living kidney donors. Areas of assessment include adherence, informed consent, motivation for transplant/donation, substance history/relapse risk, psychiatric history, social stressors, and coping skills. Interns will learn about the disorders most commonly associated with liver disease (e.g., Hepatitis A, B, & C; non-alcoholic fatty liver disease; alcoholic cirrhosis; and hepatocellular carcinoma) and kidney disease (e.g., Type I and II diabetes; hypertension; FSGS). Interns will also likely encounter cases of acute liver failure due to medical disease and deliberate/accidental medication overdose. Consultation with outside professionals is common and there are often opportunities to become involved in cases involving complex ethical decision-making processes with both transplant recipients and living donors. There also may be opportunities to perform islet cell transplant evaluations and work with islet cell transplant patients on issues involving chronic pain and severe mental illness. Typical rotation experiences include psychological evaluations of adult candidates being considered for liver and kidney transplantation, psychological evaluations of candidates considering living kidney donation, consultation with physicians, nurses and social workers on the transplant teams, psychotherapy with both pre-transplantation and post-transplantation patients, brief inpatient consultations and psychotherapy interventions, and participation on the multi-disciplinary transplant team. Opportunities to observe a transplant and/or donation surgery, shadow other professionals, supervise students working toward master’s degrees, attend rounds and didactics, and participate in departmental research projects may also be available.
Integrated Liver Disease Program. Interns interested in learning more about chronic liver diseases may work the psychologist on UNC’s multidisciplinary liver center. The UNC Liver program is one of the few in the country to utilize an integrated management approach to optimize care for patients with chronic hepatitis C, hepatitis B and non-alcoholic fatty liver disease (NAFLD). Team members are from various disciplines including hepatology, psychology, nursing, nutrition, and clinical pharmacy. NAFLD is now the primary presenting issue in the Integrated Liver Disease Program. Interns may gain experience in the following: (1) Conducting comprehensive psychological evaluations, including health and behavior assessments, of patients with NAFLD and elements of metabolic syndrome to initiate lifestyle modification/behavioral weight loss. (2) Providing lifestyle modification / behavioral weight loss treatment, informed by evidence-based practices. In addition, we have several NIH, PCORI and industry-sponsored research projects currently being conducted, so abundant opportunities exist for interns to also work ½ day or full day on intervention research projects.
Bariatric Surgery Program. The UNC Bariatric Surgery Program is housed within the Division of Gastrointestinal Surgery at UNC. This multidisciplinary program is headed by three gastrointestinal surgeons and also includes a nurse practitioner, several dieticians, three clinical psychologists, and a nurse coordinator. Patients who are interested in pursuing weight loss surgery are required to have visits with all providers within the program in order to determine candidacy for surgery and then to continue with follow-up visits afterwards. Interns on this service will primarily participate in the evaluation and diagnosis of pre-surgical bariatric candidates and consultation with the multidisciplinary team, under the supervision of the team’s clinical psychologists. The intern will have the opportunity to co-facilitate group therapy session(s) for post-surgical patients during regularly scheduled (monthly) meeting times. Depending on availability, the intern may also have the opportunity to provide brief individual interventions to post-surgical patients who may be struggling with a unique range of psychosocial challenges. Research opportunities in bariatrics may also be available for the interested intern.
Pain Clinic. The UNC Hospitals Pain Management Center has two outpatient, multidisciplinary clinics that serve a diverse patient population. Patients from the entire state of North Carolina present with many different types of chronic pain complaints and mental health comorbidities. Interns are supervised by a clinical health psychologist and interact with attending physicians, pain fellows, residents, nurses and clinic staff, learning to work well in a demanding multidisciplinary health clinic. Interns conduct semi-structured diagnostic interviews, administer psychological tests, co-lead/lead group therapy, provide individual therapy, participate in crisis management as needed, and perform case management. Interns learn how to assess psychosocial risk for medical interventions and develop comprehensive recommendations for short- and long-term treatment plans. Interns may also shadow physicians at times during patient visits and procedures for further training opportunities. Clinical consultation is done with attending physicians, fellows and clinical pharmacists.
Training and supervision in CBT, DBT, ACT, Substance Abuse, and Motivational Interviewing techniques are available. Interns will have the chance to attend education didactics from the Departments of Neurology and Anesthesiology, attend journal club, and participate in ongoing research projects. Opportunities to supervise master’s and PhD practicum students also are available. Interns may also participate in ongoing research projects in the areas of acute and chronic pain, PTSD, depression, sexual trauma, thermal burn injury, and automobile related trauma events, among others.
Physical Medicine and Rehabilitation (PM&R) Neuropsychology. This rotation at UNC’s outpatient Center for Rehabilitation Care (CRC) in Chapel Hill offers specialized training in neuropsychological assessment and interventions. Interns gain experience in patient/family interviewing and counseling, test administration, scoring, and formulation, writing reports, and providing feedback to patients, family, and referral sources. The patient population is diverse and includes both adult and pediatric patients referred by community providers and by UNC physicians from Neurology, Neurosurgery, PM & R, Psychiatry, Rheumatology, Oncology, the transplant services, and other departments and programs including the UNC Athletic Department, with diagnoses that include stroke, sports concussion, Parkinson’s disease, autoimmune disease, chemotherapy effects, conversion disorder, symptom exaggeration, and other medical and/or developmental or psychiatric conditions with associated cognitive impairments. This service also sees retired football players for evaluation through a partnership with the NFL Players’ Association and can include involvement with a specific dementia clinic we have called the Aging Brain Clinic. Wada tests are sometimes available to observe/help with. Interns may have the opportunity to work with multiple supervisors and to supervise other interns and doctoral psychology students.
Central Regional Hospitals Neuropsychology. The intern will conduct neuropsychological assessments at Central Regional Hospital, the state psychiatric facility located in Butner, NC, on the acute care and the long-term rehabilitation units. The main goals of this rotation are to: 1) Gain experience conducting neuropsychological testing in a state hospital psychiatric population, 2) Obtain a solid knowledge base of the empirical literature on the neuropsychology of schizophrenia and other mental disorders, applying research to clinical cases, and 3) Learn to integrate neuropsychological testing results into rehabilitation and treatment plans and communicate test results to psychiatrists, nurses, and other mental health professionals.
III. Pediatrics and Child/Adolescent Psychiatry
Pediatric Psychiatry/Psychology Liaison Program: This is a major rotation for the Clinical-Child Pediatric intern and for the TEACCH intern, who will spend 2.5 to 3 days a week for a 4-month rotation with this service. Other interns may elect to spend one to two days a week for 4 months on this service. A major objective of this program is to teach the diagnosis and management of developmental, psychological, and social problems of childhood, particularly those that arise secondary to chronic and acute illnesses. To this end, the faculty has established on-going consultation-liaison relationships within a variety of pediatric settings including: Pediatric and adolescent inpatient hospital wards, the pediatric intensive care unit, and the burn unit.
Examples of experiences include:
- consultation regarding assessment of safety in teens who present after a suicide attempt
- evaluation of mental status changes / delirium
- assessment of trauma symptoms in children with burn injuries or motor vehicle accidents
- evaluation of possible conversion disorder.
Interns are expected to take full responsibility for case management, for synthesizing diagnostic material in the consultation, and collaboration with physicians and interdisciplinary team. Because of the nature of liaison psychology, supervision often occurs at the actual practice site, involving continuing dialogue between the trainee and supervisor. In addition, each trainee is free to establish a regular weekly supervision time when more diverse material can be discussed. The following are key general objectives expected of each trainee:
- To acquire clinical experience in the diagnosis and treatment of children and families presenting with organic and/or functional disorders in the pediatric setting.
- To identify significant psychological factors related to chronic illness in children and to understand the integration of these factors into comprehensive medical care.
- To become familiar with the major modes of consultation-liaison teaching and to operate appropriately within these models in relation to both attending and house staff physicians.
- To become familiar with the basic literature on children’s adaptation to chronic illness, psychosomatic disorders, and to develop an understanding of the principles of pediatric behavioral medicine.
Pediatric Psychology Elective: Interns who choose to work with the Pediatric Psychology Program as an elective experience 1 or 2 days per week may be involved with the program in a broader way (a Pediatric Psychology experience) with opportunities to participate in:
- Inpatient pediatric psychology consults on the medical floors
- Outpatient consultations or evaluations in the pediatric clinics of children referred for kidney, lung or heart transplant evaluations, concerns about adjustment to chronic illness in patients with chronic kidney disease, lupus, cystic fibrosis, sickle cell disease, and other pediatric illness
- Interns can sometimes become involved with individual outpatient therapy cases.
- Depending on the intern’s interest, there are opportunities to participate in systematic neuropsychological evaluations and/or follow-up of infants, children, and adolescents with chronic medical conditions.
- There are some opportunities to be involved with Children’s Supportive Care team/Palliative Care, which can include consultation work with children with terminal illness and their families.
- Interns are also able to work within the Gender Equality Psychiatry Clinic. Interns can work with faculty to conduct initial assessments and may have the opportunity for short-term individual outpatient therapy cases.
Child Psychiatry Inpatient Unit: Treatment. This is a major rotation for the Clinical-Child Pediatric intern, CIDD intern. and the TEACCH intern, who will spend 2.5 to 3 days a week for a 4-month rotation with this service. The Child Inpatient Unit provides services to children (5 through l2) and adolescents who have severe neuropsychiatric illnesses, and their families. Services include intensive diagnostic evaluation and treatment consisting of individual sessions with the children, treatment planning, ward milieu, medication management, and work with the parents and community agencies. The medical team often asks the psychology intern for additional assistance regarding diagnostic clarification for patients with complex presentations, particularly utilizing the psychology intern’s strengths and conceptual abilities.
Interns are given primary responsibility for the overall coordination of the treatment of the children to whom they are assigned. Because of the rapid nature of acute hospital stays, each intern will be assigned 2 children at a time, thus allowing exposure to a number of varying cases. The interns are responsible for the general case management, individual therapy, working with the nursing staff to plan individual behavior management regimens, participation in the family work, and consultation with the child psychiatry fellow assigned to the case for the medical management of the patient’s disorder initially, with direct case supervision by the psychiatry attending.
The intern has also been involved in implementing evidence-based practices on both an individual level with patients but also informing and educating the medical team about specific treatment models and ideas. The medical team may make requests of the psychology intern to consult regarding specific issues on the milieu based on evidence-based practices. Some interns have chosen to lead weekly group treatment with some of the children using various strategies, as appropriate for that particular group that can include social skills training, relaxation / mindfulness training, or the Coping Power Program.
Interns participate in treatment team conferences, call in appropriate referrals for consultation, and effectively utilize various community resources. Furthermore, the intern works with the medical team to construct treatment plans that can direct longer-term community management.
Psycho-oncology. Within the UNC Comprehensive Cancer Support Program at the North Carolina Cancer Hospital, interns may participate in the provision of inpatient as well as outpatient psychotherapy to pediatric and adult patients with cancer, in the provision of consultation and liaison services with the pediatric and adult oncology teams, and in conducting psycho-educational assessments with children/adolescents with cancer.
- Community Programs for Children and Families
Child and Adolescent Outpatient Program (CAOP), UNC Department of Psychiatry. Located in Raleigh. CAOP is a community-based outpatient program that provides training for mental health professionals to develop the skills necessary for service in the public sector. The CAOP clinic has a multidisciplinary team model which includes child psychiatrists, psychologists, social workers, psychoeducational consultants, psychology interns and trainees, child psychiatry residents, and social work trainees. It serves children and adolescents with a range of presenting issues including attachment, trauma, identity and anxiety/mood. Training in performance/projective measures is provided, as well as in adaptive and some neuropsychological measures.
UNC Horizons. Within the UNC Department of Obstetrics & Gynecology, Horizons targets substance-use disordered pregnant and/or parenting women through a prenatal clinic, an outpatient treatment program, and two residential treatment programs for women and their children. Interns will co-facilitate parenting groups and mother-child psychotherapy using evidence-based models such as Child Parent Psychotherapy, Parent Child Interaction Therapy, Trauma Focused Cognitive Behavioral Therapy, and Circle of Security Parenting. Over time, interns will be able to lead parenting groups, follow at least one mother-child dyad in the residential program through child-parent psychotherapy, and learn how the disease of substance abuse impacts infant/child social and emotional development. Interns may also have some experiences conducting perinatal child psychotherapy and working with infants with neonatal abstinence syndrome. Horizons is a primary site for the Clinical Child – Community interns and is offered as an elective for other interested interns.
Developmental Disabilities: A number of the services and clinics offered by TEACCH and by the CIDD, described in the following section, take place in community contexts.
VI. Developmental Disabilities
Carolina Institute on Developmental Disabilities. The CIDD, a University Center for Excellence in Developmental Disabilities (UCEDD), offers interdisciplinary services to infants, children and adults with developmental disabilities. The CIDD provides assessment, intervention and clinical consultation in the areas of intellectual disability, autism, cerebral palsy, learning disability, epilepsy, chronic medical conditions, and other related developmental disabilities. The assessment, consultation, and treatment programs are carried out by multiple disciplines using interdisciplinary and transdisciplinary approaches. The psychological assessment focuses on cognitive skills, adaptive skills, and socio-emotional and socio-behavioral issues. There is also an emphasis on opportunities to observe and learn evaluation and treatment techniques from the other disciplines, including special education, speech and language pathology, social work, occupational and physical therapy, psychiatry, and pediatrics. Community-based and school-based consultations (e.g., behavioral consultation with families, local and regional group homes) are part of the outreach services offered by the CIDD. The following clinics and outreach programs were available for interns in 2019-2020; there are minor changes each year:
TEACCH. The TEACCH Autism Program is a clinical service and professional training program dedicated to serving individuals with autism spectrum disorder (ASD) of all ages and their families. Treatment utilizes multiple evidence-based approaches. TEACCH promotes an integrated approach to the individual’s school or work and home environment. For additional information, see the description of TEACCH on page 11. Opportunities for interns at TEACCH include the following options:
- Chapel Hill TEACCH Center. There are a variety of diagnostic and treatment experiences available for interns interested in working with individuals with ASD of all ages.
- Diagnostic evaluations of children, adolescents and adults who are referred due to suspected ASD; many are diagnostically complex. The intern will utilize assessment instruments specifically designed for determining a diagnosis of ASD, as well as about providing diagnostic information and recommendations to clients and families.
- Group interventions for individuals with ASD and their families, including intervention groups for clients and their parents with ASD of all ages from preschool through adults. The intervention groups focus on teaching a variety of social-communication, independence, and emotional understanding and emotional-control skills.
- Individual interventions for individuals with ASD and their families, including family training sessions for child and adolescent clients and individual therapy for adults with ASD.
- Support groups for parents of children and adults with ASD, as well as support groups for adults with ASD, also provide training opportunities for interns.
- Carolina Living and Learning Center.The CLLC is a model residential and vocational program for adults with ASD, operated by TEACCH in a farm setting in Pittsboro, NC, about 20 minutes from Chapel Hill. The intern will join the consulting psychologist in the development and monitoring of behavior support plans, the assessment of cognitive and adaptive living skills, monthly documentation, and consultation on programs for personal, domestic and vocational skill development. The intern will also participate as a member of the interdisciplinary treatment team in meetings including annual programplanning, and will prepare and present materials to the Clinical Advisory Board/Human Rights Committee. Interns will learn about the application of Structured TEACCHing and other evidence-based intervention procedures for working with adults with ASD.