Veteran's Affairs Medical Center Rotations
The Mental Health Services of the Veteran's affairs Medical
Center offers a full range of evaluation and treatment services. These
services are based in eleven units, all of which are available for intern
rotations. The VA Psychology Service is composed of approximately 25 Ph.D.
and 9 Psy.D. clinical and counseling psychologists, as well as a number of psychological
technicians and other support staff.
The five VA funded interns spend a minimum of 1,500 hours at
the VA. They will serve their three
major rotations at the VA and will also have a VA psychologist as their primary
supervisor. Interns also have elective
minor rotations away from the VA, allowing the intern the opportunity to sample
other settings in the larger Health Sciences Center.
The VA Psychology Service Staff is committed to providing high
quality of training to interns. Caseloads are reasonable, leaving time
for the intern to prepare for his/her cases by reading relevant material,
conducting literature reviews, and viewing tapes. VA interns can expect to
spend time viewing videos of their work (and at times their supervisor's work)
with their supervisor. Interns have the
opportunity to see their supervisors at work.
VA interns can often serve as co-leaders with their supervisors in group
and family/marital psychotherapy and work with supervisors to create innovative
treatment plans, approaches, and projects.
VA interns will also have the opportunity to work and see
their supervisors functioning in multi-disciplinary settings. In VA Mental Health Services, psychologists
serve as administrative directors in four units working closely with the
psychiatrist medical director. In four
other units, the psychologist serves as the director of the unit. Interns will have role models who are an
active and effective part of the management of the services.
The Psychology Service is also committed to the overall well
being of our interns. Interns will find themselves working with other
staff that enjoy their work and find this challenging profession fun and
exciting. Interns have access to an onsite professional library where
computer literature search services are readily available. Interns can
also take part in the Wellness Program and have access to an excellent facility
featuring a walking track, basketball court, weight machines, and after work
programs including aerobics, volley ball, etc. Interns will also receive
training and work in the VA Computerized Patient Record System.
The following rotations are available at the Oklahoma City VA
Medical Center:
Substance Treatment And Recovery (STAR)
Health Psychology Clinic
Ambulatory Mental Health Clinic (AMHC)
Neuropsychology – Veteran’s Administration
Trauma & Deployment Recovery Center (TDRS)
Family Mental Health Program (FMHP)
Psychiatry Inpatient Unit
Geropsychology (Community Living Center and Palliative Care)
Primary Care Mental Health
Psychosocial Rehabilitation and Recovery Center
1. Substance
Treatment and Recovery (STAR)
The VAMC Substance Treatment and Recover (STAR) provides a
continuum of specialized substance abuse treatment services within a
comprehensive treatment program for veterans with active substance use
disorders. Services provided by interns may include intake assessment;
inpatient and outpatient consultation; case management, treatment planning, and
participation on a multidisciplinary treatment team; patient education,
individual, and group therapies; and outreach.
The intern follows selected cases from initial contact,
engagement in treatment, continuing care, and discharge. The intern has the
opportunity for a variety of clinical experiences in the Substance Abuse Clinic
Intensive Outpatient (SAC IOP) program, which is targeted for the veteran at a
high risk for relapse and in need of a structured and supportive therapeutic
milieu to provide ongoing stabilization and psychosocial rehabilitation. The
intern will also provide continuing care in the SAC regular outpatient
treatment program, which is targeted for maintenance of a drug-free lifestyle.
SAC provides several special treatment tracks and/or groups, including extended
opioid substitution therapy in addition to groups for women, PTSD, CMI, affect
management, Seniors in Recovery, 12-step facilitation, and Native American
veterans. Attention is given toward utilizing social and community support systems
to bridge patients from formal treatment into extended recovery within the
community. By the end of the STAR rotation, the intern will sharpen
assessment, individual, and group therapy skills in the area of specialized
substance abuse treatment.

2. Health
Psychology Clinic
The Health Psychology Clinic is a multidisciplinary treatment
setting established to provide a psychological treatment interface to Medicine
and Surgery Services. Four psychologists and one post-doctoral fellow comprise
the Health Psychology Clinic faculty.
Five interrelated components can identify the activities of the Health
Psychology Clinic: patient diagnosis, patient treatment, patient education,
staff education, and research. Consultation/liaison and Primary Care Mental
Health is not a specific component of this Clinic. Rather, we place emphasis on
effective and timely intervention following the diagnosis. Typically, we
provide this on an outpatient basis.
Brief, goal-oriented therapy is the intervention mode most
often employed in this setting. Knowledge of general psychology is important,
as applied behavioral techniques across a variety of settings and circumstances
require creativity, initiative, and understanding of developmental and
interpersonal, as well as medical, contributors to the clinical picture.
Major and minor rotations of the psychology intern reflect an
interface of the intern's interests and the clinic's opportunities. The intern
can arrange emphasis with special populations or procedures. However, the
intern should expect a general introduction to the wide arena of behavioral
medicine. Participation in applied research activities is also an opportunity
for a psychology intern on this rotation.

3. Ambulatory
Mental Health Clinic (AMHC)
The Ambulatory Mental Health Clinic (AMHC) is a comprehensive
outpatient mental health triage and care delivery unit with 18,000 plus visits
per year. It is a busy, productive, active setting in which to hone
psychotherapy and diagnostic skills.
A staff composed of four full-time psychologists, five
full-time psychiatrists; a psychiatric social worker, an advanced practice
psychiatric nurse specialist, a full-time and a half-time RN, and a psychology
technician specializing in biofeedback are all available in the main clinic for
supervision. The AMHC-Extended has a number of units which are attached, some
of which have their own rotation available to interns. The Primary Care Mental
Health Team is attached to the AMHC and consists of a psychiatrist, a
psychologist, and a post-doctoral fellow. The Family Therapy Program is
attached to the AMHC and is staffed by four psychologists. The AMHC also has a
tele-psychiatrist and two tele-psychologist attached who specialize in
providing mental health services to our smaller VA community based outpatient
clinics (CBOC's). The Mental Health
operations at the larger CBOC's are attached to the AMHC. Theoretical
orientations are varied and include but are not limited to: cognitive behavioral, psychodynamic,
humanistic, self-psychology, interpersonal process, transactional analysis,
problem solving RET, and experiential.
Evidence-based therapies (e.g., CPT, ACT, prolonged exposure, etc.) are
practiced and taught to trainees.
Our setting is a topnotch, highly affiliated VA Medical Center
with approximately 600,000 outpatient visits and 75 specialty clinics, which
allows us access to an extremely diverse population. The AMHC provides
consultation on patients referred from the other outpatient specialty clinics
as well as from the admissions area and provides support to the Emergency Room.
Experiences available for the intern selecting this rotation
include several options from which to choose:
a. Providing outpatient mental health consultation
services for patients referred from other clinics, the admissions area, and the
emergency room. These patients' diagnoses range the spectrum of DSM-IV and
allow the intern an opportunity to hone their skills of interviewing,
diagnosing, and making appropriate case disposition with feedback to the referring
physician in a relatively brief period.
b. Intensive psychotherapy with a variety of cases
including individual, groups, couples, and family treatment. In-depth
psychotherapy supervision is a hallmark of this rotation, providing interns an
opportunity to polish existing psychotherapy skills and acquire new approaches
to understand and treat a multiplicity of patients.
c. Psychodiagnostic assessment experiences are
available which utilize the extensive VAMC computer capabilities for objective
testing and structured interviews as well as supervision of projective testing.
d. Experience with our psychoeducational
classes providing a wide range of services for patients with different
disorders. The primary care initiative developed by AMHC which includes a
number of psychoeducational classes, is an award-winning program used as a
model for other VA medical centers.
e. Biofeedback/Relaxation Training/Stress Management
program experiences. Patients referred to this program include not only the
more usual anxiety-based disorders but also many patients with physical
disorders exacerbated by stress (headaches, GI disorders, etc.).
f. Group psychotherapy experience is available in the
main clinic as well as our Crisis Intervention Program. Daily, weekly, and monthly
groups are available.
g. Intensive treatment experience with the
PTSD-diagnosed patient is available on the unit with PTSD being the most common
diagnosis in our AMHC population. The
MHC treats combat-related PTSD, sexual trauma-related PTSD as well as PTSD from
a variety of other experiences.
h. A monthly
group for WWII Prisoners of War and their spouses is run by AMHC staff and
available for participation. This is a good setting to better understand the
long-term effects of PTSD as well as geriatric issues, including mortality.
i. One of the AMHC's RN's runs the weekly
anti-psychotic injection program for patients managed on injectable
anti-psychotic medication. Exposure to this model of management of psychotic
patients is available.
j. Additional information in the theories and practice
of the use of psychotropic medication is available from AMHC psychiatrists
and/or our doctoral level clinical pharmacist.
k. The opportunity for training and supervision in
Mental Health Administration is also available to interns in the AMHC.
Training is a priority in the AMHC. The AMHC psychologists
enjoy supervising psychology interns and the intern's caseload with
approximately two hours per week of supervision with a psychologist. Video
recording of cases is encouraged and video recording equipment is available in
each trainee room for this purpose. We keep caseloads at a level to allow
interns time to investigate further the diagnoses and conceptualizing of the
cases with which they will be involved. Training needs and interests figure
prominently in the establishment of goals for the rotation.
The case mix of the AMHC is quite diverse, sometimes referred
to as a "living DSM-IV.” Consultation will expose the interns to this
diversity. We only refer the more functional patients with the skills to engage
in a therapeutic relationship to the psychotherapy list. Interns are encouraged
to select patients from the list who meet the training needs of that particular
intern. There is normally a good range of diagnoses, types of patients, ages,
and ethnic backgrounds represented on the waiting list. While most of the
patients are male, there are typically some female patients available for
treatment. Since most mental health clinics have a higher representation of female
patients, many interns look forward to this opportunity to broaden their
experience working with male patients. For the intern interested in broadening
his/her group therapy skills there are a large number of groups from which to
choose. The atmosphere of the clinic is supportive. Due to the high caliber of
interns who have rotated through the clinic, there is always a positive
anticipation by clinic staff when a new intern comes to the AMHC. The AMHC is a
rotation where interns are encouraged to extend themselves to learn new skills
while the clinic staff provides a supportive base out of which to function.

4. Neuropsychology
– Veteran’s Administration
The Clinical Neuropsychology Service is comprised of a neuropsychologist, a postdoctoral neuropsychology fellow, and two psychology technicians/psychometrists. Referrals for evaluation, including both outpatient and inpatient requests for services, are generated by providers throughout the hospital, with the most frequent requests coming from ambulatory mental health care (both psychology and psychiatry), neurology, primary care, the Polyatrauma Clinic associated with Operation Enduring Freedom/Operation Iraqi Freedom, medicine, inpatient psychiatry, and neurosurgery. The clinic completes assessments on patients with brain injuries, suspected dementia, and a number of other CNS pahtologies affecting neurocognitive functioning.
The Clinical Neuropsychology Service is well equipped with a
broad assortment of assessment instruments.
The
most commonly used instruments include the WAIS-IV,
WASI-II, WMS-III/IV, portions of the Halstead-Reitan Battery, Wisconsin Card
Sorting Test, RBANS, Dementia Rating Scale, MMPI-2, and an assortment of
measures assessing effort/motivation. A
personal computer is available in the laboratory for use in administering
and/or scoring some assessment instruments as well as for writing reports.
Interns can expect to be involved in completing the clinical
and collateral interviews, test administration and scoring, integrative report
writing, consultation, patient feedback, treatment planning, and brief supporitve therapy involving adjustment to disability and/or cognitive rehabilitation. Interns on this rotation are encouraged to attend the weekly
Neuropsychology Case Conference and Neurology Grand Rounds at OUHSC. Interns with only limited exposure to neuropsychology are invited to select this rotation, which will be individually tailored to meet their needs.

5. Trauma and Deployment Recovery Service (TDRS)
The Trauma and Deployment Recovery
Services is a newly integrated interdisciplinary team from the former Post
Traumatic Stress Recovery Program and the OEF/OIF/OND Readjustment Program. The
focus of this program is to provide specialized outpatient services to veterans
who are having difficulty coping with military related trauma. These veterans
are at particularly high risk for PTSD and other anxiety disorders as well as
depression and TBI. Along with helping returning veterans from the conflicts in
Iraq and Afghanistan, veterans from previous conflicts are also served.
Military Sexual Trauma is also an important emphasis.
The
treatment team consists of four Clinical Psychologists, a full and two part
time Psychiatrists, a Physician Assistant, and four Licensed Clinical Social
Workers. The focus is on providing short term, evidenced-based treatment as
part of an interdisciplinary treatment team. The primary treatment modalities
are individual and group psychotherapy, but psychoeducational groups are also
offered. The trainee may have an opportunity to be involved in outreach
activities to OEF/OIF/OND veterans and training to community agencies and other
treatment facilities about the needs of OEF/OIF/OND veterans.
Theoretical
orientations and corresponding interventions are mostly cognitive and
cognitive-behavioral. The rotation places an emphasis on learning evidence
based practices for the treatment of PTSD.

6. Family Mental
Health Program (FMHP)
The OKC VAMC’s
Family Mental Health Program offers a wide variety of services to veterans and
their families/support persons. The major goals for the Family Mental Health
Program rotation are for the intern to: 1) Understand the rationale for
intervention at the family level in addressing an individual’s symptoms, 2)
Become familiar with various evidence-based treatments for couples, 3) Develop
skills in assessing family strengths and problems and conducting family/couples
therapy, 4) Gain experience with family psychoeducational interventions for
veterans with a mental illness/PTSD and their family members.
This rotation offers
the following opportunities:
- Couples/family therapy (offered both independently or as a
co-therapist).
- REACH Program (a psychoeducational program for veterans
living with a serious mental illness/PTSD and their family members).
- SAFE Program (a support and educational program just for
family members of people living with PTSD/mental illness).
- Core
4 Communication (psychoeducational class focused on interactive skills practice
to assist Veterans in improving their interpersonal communication).
- Couples Tune-Up (prerequisite psychoeducational class for
couples who wish to pursue couples therapy; topics covered include individual
wellness, communication, conflict management, and boundary setting).
- Journey through Loss (psychoeducational class for veterans who have experienced the death of a loved
one and adult family members who have experienced the death of their veteran).
- AMHC outpatient mental health consults (walk-in/triage
clinic)
**Opportunities may differ based on major and/or minor
rotation
Theoretical
orientations and corresponding interventions vary and depend on the needs of
the couple/family, though the rotation emphasizes learning evidence based
practices for working with couples and families.

7. Psychiatry
Inpatient Unit
The Psychiatry Inpatient Unit of the Oklahoma City VAMC is the
main inpatient mental health teaching facility for the University of Oklahoma
Health Sciences Center. The primary purpose of the unit is to admit and treat
veterans who have significant psychiatric issues and require brief, inpatient
stabilization. The secondary purpose of the unit is to train students from the
various health sciences disciplines (psychology, medicine, nursing, pharmacy,social work, etc.) in providing appropriate
patient care in an acute, inpatient setting.
With respect to training in psychology, our goal is to
individualize each interns training experience, within the framework of a
supportive and nurturing environment, in order to maximize growth in areas of
weakness and refine areas of strength. The experiences offered on this rotation
are directly applicable to crisis intervention, work with acutely psychotic
patients, the chronically mentally ill, traumatized veterans, geriatric
populations, and patients with personality and substance abuse disorders. For
those interns who are interested, there is also an opportunity to receive
training in the administration of an inpatient psychiatric unit. The
expectation is that by the end of the rotation the intern will be competent and
comfortable in providing state of the art psychological services on any
inpatient psychiatric unit.

8. Geropsychology
(Community Living Center and Palliative Care)
The purpose of the Geropsychology Rotation is to offer
training and experience in meeting the mental health needs of older adults. The
unit’s emphasis is on meeting those needs with older adults who have physical
problems threatening their level of independent functioning. The majority of
the rotation is on the Community Living Center (CLC), a 23-bed unit that fits
between a nursing home and an intensive rehabilitation program along the
continuum of care. Typically, veterans in the CLC have recently lost some
physical, occupational, or cognitive functioning and are expected to be capable
of significant recovery to avoid placement in a nursing home. The intern
participates in an interdisciplinary team setting designed to assist the
veteran in recovery to as independent a lifestyle as possible.
The rotation also offers training and experience on an 8-bed
Palliative Care Unit (PCU). Outpatient
training and experience is offered through a Home-Based Primary Care Program as
well as a home telemental health program.
- The rotation offers the following activities:
Assessments (neuropsychological bed-side
screenings, MSE's, psychosocial evaluations, some formal testing).
- Individual therapy (brief Cognitive Behavior
Therapy, problem solving, adjustment to illness, change in lifestyle, behavior
modification, pain management, relaxation training, etc.).
- Group psychotherapy (cognitive rehabilitation,
stress management, problem solving, etc.).
- Home visits (Home-Based Primary Care Program).
Home telemental health services.
- Readings in geriatrics (with the psychology
supervisor and the Geriatric Journal Club).

9. Primary
Care Mental Health
In the OKC VA, Primary Care is the patient’s first point of
entry into the health care system and the place patients typically look for
treatment for most of their health care needs. In fact, research indicates that
over half of all visits to primary care settings have a psychosocial component.
The Primary Care Mental Health Clinic is an integrated program consisting of a
psychologist, a psychiatrist, a RN Case Manager and a Post Doctoral Fellow
located on site in the Primary Care Clinics. We provide “front line” triage and
assessment for patients referred by PCPs and/or those who screen positive for
depression, PTSD, anxiety, and alcohol misuse. We provide some short-term
behavioral counseling as well as provide several psychoeducational groups for
patients wanting to learn to manage their anxiety, depression, and sleep
problems. We also work with the Diabetes Education Team in educating patients
about the psychosocial aspects of managing their disease and provide the
behavioral health component for the Quick Assess Medical Appointment Clinic.
Interns who rotate in PCMH will learn how to provide abbreviated clinical
services in an integrated model, consult daily with Primary Care Providers, and
develop basic knowledge necessary for working in a medical setting including
basic medical terminology, common medical disorders, psychological
comorbidities, and frequently prescribed medications.

10. Psychosocial
Rehabilitation and Recovery Center
The VA is continually at the forefront of providing innovative mental health services, and Psychosocial Rehabilitation and Recovery Centers (PRRC) highlight VA’s commitment to quality care. The Veterans Recovery Center (PRRC) is an intensive outpatient treatment program that serves Veterans living with severe mental illness that significantly disrupts their daily functioning. Services at this supportive learning center are based on the core components of psychosocial rehabilitation and recovery-oriented care. The concept of recovery is founded on the understanding that people with significant mental health disabilities can and do overcome the limitations of their illnesses and successfully fill self-chosen, valued roles in the community.
The focus of the VRC includes 1) the client being actively involved in their own care, 2) services being individualized and person-centered, 3) identifying and utilizing personal strengths, 4) treating the whole person, not just symptoms, 5) empowerment through education and support, 6) respect, and 7) creating a sense of hope. At the VRC, Veterans living with significant mental health challenges can build skills that aid in creating and pursuing goals for leading a meaningful, fulfilling life. The VA has determined that all of its mental health services will eventually move to recovery-oriented care, but the VRC was the first to transition to this progressive approach.
The VRC staff is comprised of a psychologist, psychiatrist, two clinical social workers, and a peer support specialist. Other disciplines who participate in providing VRC services are nutrition, therapeutic recreation, and chaplain services. Treatment is provided using a multi-disciplinary approach with a high level of collaboration among staff and with our veterans. The intern experience in the VRC allows for involvement at all levels. Treatment delivery is primarily through the offering of interactive psychoeducational classes, including a number of evidence-based curricula, with learning experiences taking place in the classroom and out in the community. There is also ample opportunity for providing assessment, development of initial and comprehensive recovery plans, and individual therapy. The intern is considered one of the staff and as such is involved in ongoing program development, providing input that shapes the program as it grows. Major and minor rotations are available.
