Virginia Treatment Center for Children
Pre-doctoral Internship
in Clinical Psychology
Director of Training: William E. Fahey, Ph.D.
804-828-3266 wfahey@mcvh-vcu.edu
Intern Coordinator: Natikki Velez
804.828.4393, nvelez@vcu.edu
Virginia Treatment Center for Children (VTCC) is well known within the field for its ability to successfully treat complex emotional and behavioral disorders. A multidisciplinary team administers all of the clinical programs and works with the child/adolescent and his or her family to develop and implement an individualized treatment plan.
With a wide range of clinical services offered by a highly diverse, professional staff of psychiatrists, psychologists, social workers, educators, and occupational, recreational, art and music therapists, VTCC provides acute and residential inpatient programs, a day treatment program, and outpatient counseling services for children, adolescents, and their families. VTCC also offers consultation services to local mental health clinics, juvenile justice centers, and pediatric clinics. In addition to clinical services, the center reaches out to provide information to Virginia’s mental health system and policy makers through training, technical assistance and consultation services, as well as research and program evaluation activities.
The population served at VTCC includes children, adolescents and their families from all regions of the state of Virginia. The children represent a diversity of cultural backgrounds, ethnicities, ages, diagnostic categories and severity of presenting problems. At VTCC, we believe that each child deserves the best treatment possible. We believe that families deserve respect and compassion. We also believe that parents and guardians deserve to have an active role in their child’s care — from the initial evaluation to a participating role in treatment and aftercare planning.
VTCC is part of Virginia Commonwealth University Medical Center (VCUMC), Virginia’s pre-eminent academic medical center. A vital component of Virginia’s community-based mental health system, VTCC continually works to improve the mental health of all Virginians through clinical services, research, training and professional development.
VTCC makes available to the families a breadth and depth of clinical experience that is unique among Virginia’s community of mental health care providers. The clinical services offered at VTCC are widely known for their excellence. As part of a university-based medical center, VTCC also provides advanced training and professional development for mental health clinicians. In addition, through the Commonwealth Institute for Child and Family Studies, VTCC conducts research and provides technical assistance for Virginia’s community-based mental health care system.
VTCC was one of the first psychiatric hospitals in the nation to commit to establishing an “aggression-free environment.” In 1990, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) rated VTCC in the top 10 percent of all the hospitals they accredit nationally. In 1992, VTCC won a national achievement award from the American Psychiatric Association for its innovative programming. In 2003, VTCC received a JCAHO rating of 98 out of a possible 100 points, the highest in the medical center.
VTCC officially became part of Virginia Commonwealth University (VCU) Medical Center on July 1, 1991. Prior to this affiliation, VTCC existed for almost 30 years as a freestanding public psychiatric facility and was operated by the Department of Mental Health, Mental Retardation and Substance Abuse Services, treating children and adolescents with serious emotional problems from across the state.
As one of the VCU Medical Center Hospitals, VTCC belongs to a network of hospitals located in downtown Richmond that is operated by the VCU Health System. This network of hospitals is licensed for 1100 beds and provides training facilities for VCU Medical Center’s programs in allied health professions, basic health sciences, dentistry, medicine, nursing and pharmacy. Located in the capital of Virginia and only 100 miles from Washington, D.C., the medical center is in the advantageous position of being conveniently located to policy makers at both the state and national levels.
The Psychology Internship Program at VTCC is guided by the principle that professional growth and learning occur as a result of participation in a wide range of clinical and didactic experiences within a supportive environment. The program is dedicated to enhancing each intern’s existing clinical strengths, as well as identifying clinical skills that require additional development. To ensure ready accessibility of faculty to interns, each intern is assigned a preceptor at the onset of the training year. The preceptor serves as the intern’s yearlong primary supervisor and liaison to the psychology internship faculty.
Through exposure to a wide range of presenting problems in a diverse client population, the training program provides each intern with the opportunity to develop professional skills and awareness of cultural and familial influences on children’s development. In addition, interns will gain a working knowledge of the varied service systems designed to address the needs of children, adolescents, and their families and will develop the skills required to influence these systems on the child’s behalf. Finally, in order to facilitate the development of a professional identity, interns are encouraged to experiment by exploring new ways of conceptualizing problems, new treatment techniques and clinical interventions, and alternate personal styles in psychotherapy.
The internship program at the Virginia Treatment Center for Children, fully accredited by the American Psychological Association since 1975, is designed to provide training in the full continuum of care required to treat children, adolescents, and families with serious emotional disturbances. Four funded positions are available beginning July 1 and ending June 30.
The Internship Program at VTCC includes three tracks: the Hospital Track, the Community Track, and the Public Track. Each track exposes the intern to the full continuum of child mental health care, with differing emphases. The Community Track places an emphasis on outpatient services in a community mental health care setting, including placement on a day treatment program, while also offering experience with inpatient populations. The Hospital Track emphasizes the more severe end of the mental health continuum, offering opportunities to work with seriously emotionally disturbed children and adolescents in acute inpatient and residential treatment settings. The Hospital track also offers rotations in pediatric consultation and liaison. Both tracks offer considerable diversity in the level of severity of presenting problems.
Public Track interns receive intensive training in working with rural and underserved children, adolescents and families. For half of the year, they work two days a week at District 19 CSB, a group of community mental health centers in the city of Petersburg and six nearby counties. Potential experiences include working in the schools and/or juvenile detention center, co-facilitating prevention and treatment groups, and providing outpatient individual and family psychotherapy. The other half of the year, interns work on the acute inpatient unit at VTCC to develop experience working with children with a broad range of acute psychiatric problems from across the state. Throughout the year, public track interns see individuals and families in outpatient psychotherapy at VTCC. Opportunities are available to take other electives, such as child neuropsychological testing and consultation & liaison work. This training track is funded by the state of Virginia. Public track interns must repay the state by working in a community mental health center in an underserved area of Virginia for one year after completing their internship.
Prospective interns are encouraged to select the track that best matches their interests and offers the best opportunities to complement their previous experience and meet their training needs. Internship positions are offered for a specific track, and interns apply for only one of the two tracks — the Community track or the Hospital track.
Each year psychology faculty poll interns to learn how many hours they are putting into their internship experiences. Interns most recently reported an average workweek of 50 hours. Time is generally proportioned as follows: delivering clinical services (55 percent); attending treatment related meetings (15 percent) and seminars (10 percent); receiving clinical supervision (10 percent); and providing case management (10 percent). Interns are involved in a wide range of activities in the programs described on the following pages.
All interns participate on multidisciplinary teams that treat both children and adolescents admitted to the acute, residential and day treatment programs. Interns function as primary therapists on assigned cases. The primary therapist is the executive of a team of mental health professionals, providing intensive individual and family therapy, consulting with psychiatrists regarding medication, and developing and implementing an effective treatment program and discharge plan. The primary therapist also is responsible for behavior management consultations, community liaison work, case management and case advocacy.
The Acute Care Program offers the greatest degree of structure and intensity for children and adolescents in need of short-term intensive inpatient treatment. The interdisciplinary team at VTCC provides superior diagnostic and psychopharmacologic evaluations and seeks to quickly stabilize acute patients.
Upon the child’s admission to the hospital, an interdisciplinary treatment team joins with the family to evaluate him/her and develop an individualized treatment plan. A primary therapist is assigned to monitor the child’s progress during hospitalization. The treatment team works with the family to stabilize the child and provide a smooth transition back to the family, school and community environment. Active case management is a priority, and the program’s emphasis is on stabilization and linking the child and family to community services. The average length of an acute hospitalization is three to seven days.
Residential services are longer-term structured programs designed to serve school-aged children and adolescents, through age 17, who have long-standing emotional, behavioral, and psychiatric problems. A primary focus of the Residential Care program is family and community reintegration. Treatment strongly emphasizes the development of coping and life skills to help the child make a successful transition back into the community. The Residential Care Program provides a 24-hour inpatient level of care in a therapeutic setting.
Day Treatment Program
• Comprehensive assessment to determine treatment needs and provide diagnostic formulation
• Psychological evaluation
• Psychiatric evaluation
• Case management to coordinate with community agencies and schools
• Medication evaluation and monitoring
• Individual, family and group therapy
The Evaluation Program is a residential program that provides a set of diagnostic assessments to assist communities in evaluating the child/adolescent’s emotional, cognitive, behavioral and social needs and to develop service approaches to meet those needs. On a rotating basis psychology interns and faculty assist in providing psychological evaluations to children and adolescents participating in these comprehensive evaluations at VTCC. There are two types of evaluations:
a) Brief Evaluation: Brief evaluations take 15 days. During this period, the child/adolescent receives the same services available in the residential program. In addition, the child/adolescent receives a psychiatric evaluation, a medication trial if needed, an occupational therapy screening, focused psychological testing, and a curriculum-based assessment.
b) Standard Evaluation: Standard evaluations take 30 days. In addition to the services available in the residential program, the child/adolescent receives a psychiatric evaluation and history, medication evaluation/re-evaluation, an occupational therapy evaluation, a psychological evaluation, and an educational evaluation.
All therapists, including psychology interns, rotate through a weekend on-call schedule four time per year to be available for crises or inpatient admissions.
VTCC operates a large outpatient clinic serving children, adolescents, and families from the Richmond metropolitan area. Hospital track interns carry a caseload of approximately four outpatient cases, providing individual and family therapy and case management services. Participation in the clinic provides additional opportunity for longer-term treatment and exposure to a broader range of psychopathology.
The Outpatient Services Program offers a wide range of assessment and treatment services for children, adolescents and their families. Outpatient care is based on a family-focused philosophy emphasizing collaboration between the family and clinical staff. Program goals include providing the clinical support and treatment needed for the child and the family while they remain within their communities, and providing support and follow-up for children and adolescents who have been discharged from more intensive treatment programs.
Trainees in the Pediatric Consultation and Liaison Service (C&L) provide clinical service to pediatric medical patients hospitalized at VCU Medical Center who have psychosocial difficulties that interfere with medical treatment. Trainees from both psychiatry and psychology participate in this service. Medical teams refer their patients when the patients are demonstrating emotional, behavioral or psychiatric problems. The trainee’s role is to assess the youth’s needs and to provide any essential immediate intervention. C&L service trainees are on-call one day each week to the hospital’s pediatric emergency department. Trainees also serve as mental health consultants to a pediatric craniofacial deformities clinic and other specialty clinics within the hospital. A multidisciplinary C&L team meeting is held each week. At this meeting, trainees receive clinical supervision and participate in discussion about C&L issues. Hospital track interns participate in the C&L service for a yearlong period.
Chesterfield Mental Health Center is a progressive mental health center offering an array of outpatient services that provide interns with an opportunity to learn about the challenges and rewards of community mental health within a suburban setting located 20 minutes south of VTCC. Clinical experiences consist of working with individuals (children, adolescents, and their families). Interns have opportunities to utilize a variety of therapeutic approaches, from brief, solution-focused interventions to play therapy to supportive therapies. In addition to this direct service, collateral services include case management and consultation with agency colleagues as well as professionals in the community. Interns in the Community Track spend 17 hours a week at Chesterfield, including evening hours to accommodate family work. They typically schedule 9 to 10 outpatient sessions each week.
Assessment Service
Referrals for psychological evaluations and behavior management consultations are directed to the Psychology Assessment Service and assigned to trainees on a rotating basis. As stated previously, interns participate on a rotating basis in VTCC’s Evaluation Program, which provides a set of diagnostic assessments to assist communities in evaluating the child/adolescent’s emotional, cognitive, behavioral and social needs. Interns receive weekly supervision in intellectual and personality assessment according to their level of experience and conduct up to two evaluations each month.
There are many opportunities to learn about and provide group therapy during the internship year at VTCC. A variety of groups are provided to children and adolescents across VTCC’s clinical programs. Interns have the opportunity to participate in two of these groups during the year as process observers and co-leaders. In recent years, the following groups have been offered:
• Adolescent Process Group – Residential/Day Treatment Programs
• Survivor Groups – child and adolescent survivors of abuse
• Social Skills Groups – children
Supervision
The psychology staff and the adjunct clinical psychology faculty at VTCC provide all the clinical supervision. VTCC’s Psychologists serve as preceptors for trainees. Each intern’s preceptor provides supervision and mentoring throughout the year and coordinates clinical activities for the intern.
On-site supervisors are available for all of the clinical experiences that involve psychology interns. Interns receive four hours of weekly individual supervision and at least one hour of weekly group supervision. Faculty members emphasize the use of videotape and live supervision for training purposes. Observation rooms are equipped with one-way mirrors and video equipment to allow taping of sessions and live supervision.
Psychology training faculty shares a general family and systems perspective about the patients seen at the treatment center; however, they utilize a variety of psychotherapeutic approaches to facilitate changes in the system. These approaches include family therapy, cognitive behavioral therapy, psychodynamic therapy, and play therapy. The intern will be provided with the opportunity to use all of these approaches depending on the needs of their patients.
A variety of didactic and experiential seminars are offered to interns at VTCC. These include:
The Topics in Child Mental Health Seminar addresses a selection of topics related to the current practice of clinical psychology. Seminar sessions include a focus on functioning effectively in a managed care environment and a review of ethical issues that may arise in clinical practice.
This seminar presents a multisystemic model of family therapy and reviews structural, strategic, Bowenian and other therapeutic approaches. Other topics in family therapy are offered depending on the interests and training needs of the interns. The seminar includes didactic and experiential training in the summer months and, for the remainder of the year, is devoted to live group supervision of family therapy cases in a family therapy clinic forum described below.
The Family Therapy Clinic provides an opportunity for trainees and clinical supervisors to learn more about families and how to help families make healthy changes. The clinic utilizes a live-supervision model in which a trainee works with a family in one room and the family therapy team views the session through a one-way mirror and offers live consultation from an adjacent room. Trainees participating in the Family Therapy Clinic include the disciplines of psychology, social work and psychiatry. Licensed psychologists and psychology postdoctoral fellows provide supervision.
For the psychology interns, this twice-monthly seminar has a brief didactic component but is primarily experiential. Faculty members present an overview of models of dynamic psychotherapy and clinical supervision. Each intern presents an individual therapy case via discussion and videotaped sessions three times during the year for peer review. The goals for the seminar are:
• To provide didactic and experiential instruction in dynamic psychotherapy.
• To address a need for training in long-term therapy.
• To learn how to provide constructive supervision.
• To develop a cohesive and supportive peer group to talk about cases.
The design of this seminar provides interns with the opportunity to refine their assessment and diagnostic skills via an in-depth review of assessment materials collected from patients in all diagnostic groups. There is an emphasis on projective assessment, particularly the Rorschach. Although primarily didactic through the summer months, this seminar emphasizes case presentation, protocol analysis, and discussion for the remainder of the training year. Guest lecturers provide training in specialized areas of psychological assessment, including neuropsychological assessment, infant and preschool assessment, child custody evaluations, and empirically validated assessment.
Cultural Diversity Seminar
Through this seminar, interns have the opportunity to increase their levels of comfort and sensitivity in working with a diverse population. Generally, we feel more at ease with the familiar, so working with people from different cultural backgrounds challenges us to address issues of difference. We become more adept with these challenges if we have opportunities to practice talking with one another about how differences might influence interactions and communication. Over time, our heightened awareness and sensitivity will be reflected in our relationships with clients and colleagues. We also can develop our skills by exploring our own cultural heritage and the ways we are influenced by our unique histories. Through this process, we sometimes become aware of long-held biases and stereotypes that we might wish to question.
In this 90-minute seminar, held twice a month, culture is defined broadly. The format is experiential (e.g., exercises, role-plays) and discussion-oriented (e.g. case-specific issues, articles, videos).
The Family of Origin Seminar provides a day-and-a-half long opportunity for psychology interns and psychiatry fellows to explore the family issues they bring to the therapy process. The first day of this training is designed for trainees to share information about their own families; the second half-day focuses on the clinical relevance of family of origin issues. In this confidential seminar facilitated by adjunct faculty, interns are encouraged but not required to explore and share their own family of origin issues with the lens of the family therapist and as they relate to their clinical work.
This daylong seminar is a fun training day with a focus on play therapy with children. The day involves a combination of lectures, viewing videotapes and discussion. Interns are introduced to theories about the curative factors of play therapy, the stages of traditional nondirective play therapy, as well as several structured play therapy interventions.
Treatment of Trauma Seminar