Behavioral Medicine Service

APPIC #118323

Overview

The Behavioral Medicine Service is a psychological consultation and intervention program integrated within specialized medical services of Yale-New Haven Hospital (YNHH) and the Yale Cancer Center/Smilow Cancer Hospital. Fellows train within multidisciplinary teams of physicians, surgeons, nurses, and social workers and gain valuable experience in the provision of behavioral health consultation, psychological assessment, and behavioral health intervention with a broad range of medically ill patients. Emphasis is placed on understanding the biopsychosocial factors influencing adjustment and adaptation to chronic medical illness, and on developing skills for behavioral health consultation and intervention in an academic medical setting.

Placement Options

This track consists of a single, full-time, twelve-month placement within YNHH's Psychological Medicine Service.

Number of Fellows

Two doctoral fellows will be selected into the Behavioral Medicine track for the 2017-2018 academic year.

The Setting

The Behavioral Medicine Service is part of the Psychiatric Services of Yale-New Haven Hospital. Developed in 2008, the Behavioral Medicine Service has become a valued and integrated component of the medical center. The service continues to grow in regard to its integration and value among the many components of the medical center with which we are involved including the Yale Cancer Center/Smilow Cancer Hospital, Yale-New Haven Transplantation Center, and the Psychiatric Consultation Liaison Service of Yale-New Haven Hospital.

The Yale Cancer Center and Smilow Cancer Hospital combine a tradition of innovative cancer treatment and quality care for patients. A National Cancer Institute (NCI) designated comprehensive cancer center for over 40 years, the Yale Cancer Center is one of only 45 Centers in the nation. Comprehensive cancer centers play a vital role in the advancement of the NCI’s goal of reducing morbidity and mortality from cancer through scientific research, cancer prevention, and innovative cancer treatment. The Yale Cancer Center and Smilow Cancer Hospital aim to prevent and cure cancer through groundbreaking research, scientific discovery, and compassionate patient care.

The Yale-New Haven Transplantation Center (YNHTC) provides expert, comprehensive and compassionate care for adult and pediatric patients throughout the world who are candidates for organ transplantation. The YNHTC specializes in liver, kidney, pancreas, and heart transplantation; and is the region's leader in the evaluation and treatment of advanced liver disease.

The Psychiatric Consultation Liaison Service of YNHH assists with the evaluation and treatment of psychiatric conditions related to medical illness, whether these are physiological, such as delirium related to infection, or psychological, such as emotional reactions to illness. The service also assists in medical conditions related to psychiatric illness, such as anorexia nervosa, or to psychiatric treatment, such as side effects of psychotropic medications.

Clinical training occurs within the inpatient units and outpatient care clinics of these major hospital centers.

The Internship

The goal of the Behavioral Medicine Service is to provide support and assistance to medical care providers and their patients so that the patient’s emotional and mental health needs can be addressed within the context of their overall medical care. The service operates under the premise that integrated behavioral medicine has the potential to benefit both patient and physician by improving access to behavioral health care for medically compromised individuals. Primary goals of this service are to improve adherence to medical treatments, target lifestyle and psychosocial issues effecting wellness, address issues of pain management, stress tolerance, addictions, coping, and to help prevent the development of more serious mental health disorders through early recognition and intervention.

Fellows divide their time between the Yale Cancer Center/Smilow Cancer Hospital, Yale-New Haven Transplantation Center's Liver Transplant Program, and YNHH's inpatient Psychiatric Consultation Liaison Service.

Within each of these placements, Behavioral Medicine fellows consult with medical providers and provide evidence-based assessment and intervention services to medically ill patients using a combination of brief and longer-term supportive, cognitive-behavioral, and mindfulness-based therapeutic approaches.

Fellows also attend and participate in a number of weekly multidisciplinary meetings and case conferences such disease specific tumor board meetings, Palliative Care Interdisciplinary Team Meeting, Liver Transplant Recipient Review Committee, Liver Donor Advocacy Meeting, as well as a host of interdisciplinary seminars and workshops with advanced fellows in psychiatry, oncology, and internal medicine, depending on their current rotation.

Major Placements:

Fellows receive training within three major placements over the course of the year: Yale Cancer Center/Smilow Cancer Hospital/ (6 months), Liver Transplant (3 months) and Consultation Liaison Psychiatry (3 months).

Yale Cancer Center/Smilow Cancer Hospital

Within the Yale Cancer Center/Smilow Cancer Hospital, fellows receive training within the Cancer Center’s inpatient palliative care service, and within the center’s outpatient oncology clinics. Fellows have a three month placement within the inpatient Palliative Care Service. During this rotation, fellows function as full-time members of the multidisciplinary team, attend daily rounds, and work closely with Palliative Care physicians, advanced practice nurses, social workers and chaplains. Fellows provide bedside consultation and brief evidence-based interventions to address issues related to pain, emotional distress and end-of-life concerns.

Fellows also receive training within the Cancer Center’s outpatient oncology clinics. Within the oncology clinics, fellows provide co-located evidence-based individual therapy to referred patients from nearly every cancer-specific disease team (i.e., breast, gynecology, lung, gastrointestinal, melanoma, neuro-oncology, renal, medical-oncology, and palliative care) and at any stage of illness. Fellows have the chance to work closely with members of the patient’s oncology team (oncologists, advance practice nurses, and nurses), while attending and participating in weekly disease specific tumor board meetings and Palliative Care Interdisciplinary Team Meetings.

A unique feature of the Yale Cancer Center rotation is that fellows may spend one-half day per week within each of four innovative integrated oncology clinics:

  • Adolescent and Young Adult (AYA) Clinic: Fellows participate in a developmentally-sensitive multidisciplinary program within the Department of Pediatric Hematology and provide individual and family consultation to AYA patients diagnosed with a range of hematologic and cancer-related diagnoses.
  • Head and Neck Clinic: Fellows receive specialized training in the assessment of high-risk patients and the use of brief Motivational Interviewing techniques to engage patients in smoking cessation and alcohol reduction services.
  • Menopause, Intimacy and Sexuality (SIMS) Clinic: Within the Department of Gynecology-Oncology, fellows participate in a monthly clinic and work closely with a faculty gynecologist and gynecology-oncology surgeon and perform brief behavioral health consultations with women who have a history of cancer and whose primary concern relates to sexuality, sexual functioning, body image, or menopause.
  • Tobacco Treatment Services: Fellows receive specialized training in the provision of smoking cessation to patients diagnosed with a range of cancer diagnoses. The program helps patients quit smoking by combining evidenced-based psychotherapy with drug treatments delivered by advanced practice nurses.

Liver Transplant Program

Within the Liver Transplant program, fellows gain valuable firsthand experience in issues related to organ allocation, patient selection, transplant ethics, and the psychological and neurocognitive functioning of patients with acute liver failure and end stage liver disease. Fellows play a number of important roles in the evaluation and on-going support of liver transplant candidates. Specifically, fellows provide co-located individual behavioral weight loss, drug and alcohol relapse prevention counseling, smoking cessation, and stress management and relaxation training to pre and post- adult liver transplant recipients. Fellows also spend one-half day per week within a multidisciplinary Pediatric Hepatology Clinic and provide consultation along with physicians and nutritionists to patients and families coping with fatty liver disease. Finally, fellows also receive specialized training in the evaluation of living donors, and participate in the program's Donor Advocacy Team. Within the transplant program, fellows attend and participate in weekly multidisciplinary meetings and case conferences such as the Liver Transplant Recipient Review Committee and the Donor Advocacy Meeting.

Consultation Liaison Psychiatry

Within the Consultation Liaison Service fellows function as full members of the Consult Liaison team. Fellows participate in daily rounds, perform individual consultations, and provide bedside psychotherapy and brief evidence-based interventions to medically ill patients throughout the hospital’s inpatient medical units. Fellows have the opportunity to train closely with attending psychiatrists, advanced psychiatry residents and medical students to learn about the intersection between psychiatry and medical illness. Fellows are exposed to a diverse and complex patient population, and provide valuable care and consultation to critically ill patients.

Long Term Care Clinic

All doctoral fellows at YNHH have the option of receiving weekly supervised individual psychotherapy training within the Long Term Care Clinic. The Long Term Care Clinic is an outpatient psychotherapy training clinic operated by the Department of Psychiatry and YNHH. Individual patients are referred to this clinic by the Yale University Health Services, and as such, are typically members of the University community who are seeking insight-oriented psychotherapy for a variety of identified issues, most commonly related to developmental, relationship, mood, and/or anxiety concerns.

Within the LTCC, individual weekly supervision from a psychodynamic perspective is provided to guide the fellow in conceptualizing and implementing treatment from an insight-oriented therapeutic modality most appropriate to the assigned cases. Typically, doctoral fellows see one individual therapy patient in once-a-week psychotherapy for the full duration of their training year.

Evidence-Based Practices

The following evidence-based practices (EBPs) are used in this placement setting. Fellows generally have exposure to most of these EBPs though do not necessarily receive training or supervised experience in all of them. The EBPs include: Acceptance and Commitment Therapy, Cancer to Health Program, Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Meaning Centered Psychotherapy, Mindfulness-Based Cognitive Therapy, Motivational Interviewing, and Stress Management and Relaxation Training.

Psychological Assessment

Doctoral fellows at YNHH conduct a variety of brief and comprehensive psychological and neurocognitive diagnostic testing protocols during the year. Most diagnostic assessments include evaluations of newly admitted patients on the psychiatric inpatient units, patients who have been participating in treatment for longer periods in the intensive outpatient ambulatory services programs, and patients who are receiving care within the hospital acute inpatient and outpatient specialty medical services.

Each assessment involves administering and interpreting a variety of instruments, participating in individual testing supervision, consulting with the treatment team about the implications of test results for the patient's treatment, providing feedback to the patient in consultation with the treatment team, and writing a final report. Doctoral fellows conduct structured diagnostic interviews, a minimum of two traditional full battery assessments, as well as brief forms of personality assessment and neuropsychological screening.

Diversity

At Yale-New Haven Hospital diversity and inclusion are important components of its organizational values. The hospital is committed to providing an environment of inclusion that supports the diversity of its patients, visitors, employees, business partners and communities. Serving the Greater New Haven area and surrounding Southern New England region, YNHH admits a diverse population of patients, both diagnostically as well as demographically. Racially, approximately 65 percent of patients admitted to the hospital are Caucasian, 15 percent Black, 15 percent Hispanic and 5 percent Asian. Likewise, nearly 60 percent of patient’s hospital costs are paid for through Medicare or Medicaid. The hospital is committed to providing the highest standard of care to all patients regardless of socioeconomic status, race, ethnicity, language, nationality, sex, gender identity, sexual orientation, religion, geography, disability and age.

Scholarly Activity

Four hours per week of protected time is provided to allow fellows with the opportunity to design and conduct a scholarly project of their choice. Individual project objectives are coordinated with the primary advisor, and/or another faculty mentor involved in a program of active research. Fellows may design a project with faculty within their primary training placement, or request to be matched with other faculty in the Yale School of Medicine based on their shared interests and faculty availability. The fellow’s scholarly activity can take many forms. In consultation with the faculty advisor, the fellow may choose to engage in an ongoing research project, evaluate a clinical service or program, or help design and implement a new project that will benefit the individuals receiving services within the YNHH system.

Faculty

Dwain Fehon, Psy.D., Chief Psychologist, Primary Advisor
John Cline, Ph.D., Clinical Supervisor
Kathi Croce, Ph.D., Clinical Supervisor
Kelly DeMartini, Ph.D., Secondary Supervisor
Donna DiCello, Psy.D., Clinical Supervisor
Lisa Fucito, Ph.D., Secondary Advisor
Carrie Lukens, Ph.D., Clinical Supervisor
Amit Oren, Ph.D., Clinical Supervisor
Maya Prahbu, M.D., Clinical Supervisor
Marisa Spann, Ph.D., Assessment Supervisor

Supervision

Fellows have weekly individual supervision with a primary advisor and with secondary clinical supervisors, weekly BMED group supervision meetings, and as-needed individual or group psychological assessment supervision.  Fellows may receive additional individual supervision for optional clinical activities, such as training within the Long Term Care Clinic or the Refugee Clinic. Formal evaluations are completed that serve as opportunities to review progress on training goals and address progress toward mastering core competencies.

Seminars and Specialized Training

Behavioral Medicine fellows attend and participate in weekly core didactic seminars held within the Department of Psychiatry, and weekly general hospital-based seminars for fellows and other psychology trainees based at YNHH. In addition, Behavioral Medicine fellows also attend weekly multidisciplinary seminars and case conferences with advanced psychiatry fellows, residents, and medical students within the Department of Psychiatry’s Psychosomatic Medicine Fellowship program that address topics relevant to behavioral medicine and clinical health psychology.

Numerous additional didactic health and medicine related case conferences, seminars, and grand rounds are offered through the Yale-New Haven Transplantation Center, Yale Cancer Center, and Yale School of Medicine. Participation in these optional activities is at the discretion of the fellow and their primary advisor as their schedule permits.

Behavioral Medicine fellows are also invited to attend the YNHH Dialectical Behavior Therapy Summer Seminar (July and August). This seminar covers theory, formulation and major strategies of Dialectical Behavior Therapy (DBT) as it is applied to treating severe borderline personality disorder in outpatient and day hospital settings. Attendees actively engage the material through discussions of cases and video examples, skills practice, self-monitoring and problem solving exercises, and role play.

Applicant Qualifications

Strong applicants for this placement generally have prior experience working within medical settings and with individuals diagnosed with serious or chronic medical illness. These applicants will also have experience conducting evidence-based therapies (e.g., cognitive behavior therapy) and have some basic experience with neuropsychological assessment. Fellows who match with this placement typically have a strong interest in the provision of clinical care and/or scholarship related to behavioral medicine or clinical health psychology and show promise for developing into leadership roles.

Applicants selected for this placement must successfully pass background checks conducted by Yale University and Yale-New Haven Hospital.

For Further Information

For more information about this placement site, please e-mail dwain.fehon@yale.edu.

Dwain Award

Dr. Dwain Fehon, Director of YNHH's Behavioral Medicine placement, accepts the Society of Behavioral Medicine's, "Excellence in Behavioral Medicine Training Program Award" from SBM president, Dr. James Sallis (left), March 2017.

Abir Presentation

Abir Aldhalimi, PhD (class of 2016) presenting her scholarly project at the Association of Psychologists in Academic Health Centers annual conference in Detroit, Mich, March, 2017.

Rebecca Project

Rebecca Saracino (right) congratulates fellow Behavioral Medicine intern Devika Jutagir (class of 2017) as she presents her scholarly project at the American Psychosocial Oncology Society conference in Orlando, Fla., February, 2017.

David Conference

David Finitsis, PhD (class of 2016) discusses his scholarly project at the American Psychosocial Oncology Society conference in Orlando, Fla., March 2017.