Clinical Psychology Training Consortium

The Providence VA Medical Center offers a number of internship/training opportunities in patient-centered medical homes, referred to in the Department of Veterans Affairs as Patient-Aligned Care Teams (PACT), through its Clinical Psychology Training Consortium.  The predoctoral rotation in primary care, part of the behavioral medicine/health psychology track of the Brown clinical psychology predoctoral training program, is designed to introduce clinical psychology residents to behavioral health consultation within the primary care setting using the PACT model of care.  The clinical psychology resident serves as a member of an interdisciplinary treatment team comprised of primary care providers, nursing staff, psychiatrists, social workers, nutritionists, clinical pharmacists, and health technicians. The clinical psychology resident is trained in the role of a behavioral health consultant for the PACT, with attention to distinguishing differences between the specialty/traditional mental health model and the behavioral consultant model.  In addition, the program trains on the biopsychosocial aspects of stress, illness, and coping as it relates to physical functioning.

Through this program, the clinical psychology resident develops disease-specific knowledge to assess the interplay between physical and mental health, evaluate mental and cognitive status, deliver brief evidence-based interventions for a variety of presenting problems, and provide the PACT team with succinct same-day feedback. Common clinical and sub-clinical presentations of the following disorders in primary care include depression and other mood disorders, anxiety, post-traumatic stress disorder (PTSD), substance abuse, dementia, adjustment disorders, chronic pain, and sleep disorders.  The clinical psychology resident also co-leads shared medical appointments for obesity management, chronic pain, and diabetes self-management.  Additionally, the predoctoral clinical psychology resident on the VA primary care rotation spends one day per week in home-based primary care, where he/she serves on a PACT team that provides integrated home care services to veterans with complex chronic disease not managed effectively by routine clinic-based care. Consultation questions are diverse and include managing chronic illness (e.g., congestive heart failure, coronary artery disease, chronic obstructive pulmonary disease, diabetes mellitus, neurological disorders, end-stage liver disease), enhancing medical regimen adherence, reducing care-giver burden, managing behavioral disturbances in dementia, and evaluating decision-making capacity.