Our Integrated Care Track is housed administratively within our General Internship Program and physically at various Wayne State University Physician Group and Detroit Medical Center locations. We can accept two interns into this track. While interns in our General Track have opportunities for 4-month rotations in medical settings, this new track is designed for interns committed to careers as health psychologists in the exciting and rapidly expanding area of integrated healthcare, with a focus on reaching underserved populations. Interns learn to function as part of an interdisciplinary team and collaborate effectively with other professionals to benefit a patient's total wellness and increase their overall quality of care. There is a strong focus on short term and health psychology interventions, as well as opportunities for longer term interventions. Many didactic and enrichment opportunities are available including funding to travel to one national integrated care conference and participation in a certification in primary care behavioral health course via a live interactive webinar. Interns have opportunities to contribute to the training experiences of other disciplines through informal consultations and formal lectures. To prepare our interns to become leaders in integrated care settings, we also provide training experiences that address program development and evaluation, funding, and political issues.

APA-Accredited Pre-doctoral Internship Program
Integrated Care Track Program Requirements - Core Clinical Placements:

• Primary Care (12 months): At least 1 day per week in Internal Medicine primary care resident training clinic
• HIV/AIDS (12 months): At least 1 day a week in HIV comprehensive multidisciplinary medical care clinic
• OB/GYN (12 months): ½ day a week in faculty-based OB/GYN clinic
• Inpatient Medical Hospital Trauma Service (6 months): 3 half days

Didactics:

• Health Psychology (bi-weekly with interns from General Track program)
• Cognitive Behavior Therapy (bi-weekly with interns from General Track program)
• Psychoanalytic Theory and Technique (weekly with interns from General Track program)
• Professional issues (monthly with interns from all programs/tracks)
• Dept of Psychiatry Grand Rounds (weekly except summer)
• Certification course in Primary Care Behavioral Health (6 six-hour live interactive webinars with interns from General Track program) facilitated locally with webinar faculty fromUniversity of Massachusetts.
• Trauma didactics (2 hours weekly)
• Behavior Medicine Case Conference (monthly with interns from General Track and psychology and internal medicine faculty). Case presentations related to selected topics.
• Friday Morning Report (weekly general medicine case presentation with medical students and internal medicine faculty)
• Motivational Interviewing seminars/supervision as available.

Conference attendance: funding provided to attend one national conference related to integrated care

Supervision: Using the preceptor model of supervision common in medical residency training programs, interns staff patients in the primary care clinics as they are seen. Supervision is provided by a licensed PhD psychologist and an attending primary care physician where psychology interns and medical residents learn side-by-side in the resident staffing room or in exam rooms. Individual supervision, group supervision and case conferences also take place in each clinical setting. While a licensed PhD psychologist reviews each case, supervision/teaching is also provided by individuals from other disciplines including psychiatry, nursing, OB/GYN physicians, infectious disease physicians, primary care physicians, social work, addiction medicine and pain specialists.

Teaching/consultation/supervision: Interns in this track are expected to contribute to the learning experiences of other trainees and staff from other disciplines. This can be done via grand round presentations, case conferences, mini-presentations during residency staffing sessions, case consultations, etc.

Administration: Interns are expected to attend program, institutional, consumer and county-wide meetings where they will be exposed to issues and participate in solutions related to program development, implementation, evaluation, funding, system integration, and political forces.

Research: Interns have optional opportunities to participate in research related to clinical placements (particularly around program evaluation) depending upon interests and time.

Rotations/Electives: Interns spend 1 to 2 days a week in 2 selected rotations/electives, each 6 months in duration. (Options are described in Rotations/Elective link on home page) Rotations/electives currently available to integrated care track interns (subject to change) include:

• More concentrated time in HIV, OB/GYN or Primary Care clinics
• Geriatrics (Detroit Medical Center Nursing and Assisted Living Centers
• Forensic Center
• Wayne County Jai
• Neuropsychology (Adult at University Health Center or Child/Adolescent at Children's Hospital of Michigan)
• Pediatric Psychology (Children's Hospital of Michigan)
• Adolescent Medicine (University Health Center and WSU Psychology Clinic)

Interns are expected to participate in rotation-specific didactics and supervision.

Description of Core Clinical Placement Settings: All of the core clinical settings (as well as many rotation/elective settings) are located on or adjacent to the Wayne State University School of Medicine and the Detroit Medical Center campus and thus are within walking distance of each other. Paid on-campus parking is provided. Interns in this track are also assigned netbook computers that they can carry from site to site. Electronic medical records are used at each core clinical site. The different clinics have varied organizational set-ups giving interns exposure to variations of integrated care models as well as different target populations. This gives interns opportunities to learn how to work within different integrated care models and with different physician practice styles.

Primary Care Interns are placed year-long in a primary care clinic that serves as a residency training site for WSU/DMC Internal Medicine residents. Interns sit in a shared conference room with Internal Medicine attending physicians, a licensed psychologist, residents and medical students. As cases are staffed, interns are expected to offer insights from a psychological viewpoint. Their involvement in patient care is varied and can involve providing consultation to the primary care provider, seeing the patient on their own or having joint sessions in the exam room together with the primary care provider. Patients are most often seen at the time of their medical appointments but can also be scheduled for separate individual or group psychotherapy follow-up sessions. Psychology interns assist in the detection and treatment of mental health problems and other behaviors that impact overall health. Targeted interventions include pain management, smoking cessation, stress management, adjustment to chronic illnesses, vague somatic symptoms and medical adherence as well as addressing more traditional mental health issues such as depression, anxiety, and substance abuse. The internal medicine primary care clinic serves primarily Medicaid and uninsured individuals. As more individuals in Detroit have become uninsured with the current economic downturn and the auto industry crisis, there has been a shift in the clinic population to more and more individuals without even publicly funded insurance. The Detroit Receiving Hospital emergency department refers their resurgence of uninsured individuals to this clinic where they are guaranteed medical care. Patients present with uncontrolled chronic illnesses along with multiple confounding psychosocial problems.

HIV/AIDS - The Adult HIV/AIDS program operates in a Wayne State University Physician Group clinic run by the WSU Department of Internal Medicine, Division of Infectious Disease. It is the largest provider of medical care to uninsured and underinsured people living with HIV/AIDS in the state of Michigan, serving over 1700 individuals annually, with approximately 250 new persons each year. This multi-disciplinary clinic includes infectious disease physicians, a neurologist, nursing, patient advocates, peer advocates, case managers, social workers, psychologists, substance abuse specialists and a psychiatric nurse practitioner along with trainees from the various represented disciplines. Each half-day clinic begins with a 15 to 30 minute interdisciplinary meeting in which the clinical needs of each individual on the schedule are discussed. Behavioral health staff and psychology interns are assigned to each half-day clinic (nine throughout the week) in which they provide standardized assessment, consultation, and brief interventions in exam rooms alongside the infectious disease medical staff. In addition to addressing obvious mental health diagnoses, interns address a myriad of issues related to HIV/AIDS. This includes coping with and adherence to a medical regime that can have undesirable side effects but requires near perfect adherence. Interns are actively involved in prevention where they work with consumers on how to negotiate safe sex. Addressing stigma and disclosure of HIV status to family and friends as well as sex partners are other important areas of intervention. While interns can schedule follow-up sessions for more traditional ongoing psychotherapy, much of focus is on providing effective interventions at the time of medial visits. This is a particularly important skill for our interns to learn to do as they prepare for careers serving populations who have a variety of cultural and logistical barriers that interfere with their ability or desire to come in for traditionally scheduled weekly psychotherapy sessions. Similarly, group interventions, are an effective and efficient way to provide behavioral health care to medically underserved populations. Interns have the opportunity to lead or co-lead groups such as a Total Wellness group addressing overall healthy behaviors, a Positive/Negative Couples group addressing issues that come up when one partner is HIV+ and the other is not, a Relationship group, a Substance Abuse recovery group, a New to Care group for individuals newly diagnosed or newly entering HIV care, and a Chronic Pain management group.

OB/GYN WSU Physician Group's University Women's Clinic. This faculty-based clinic provides OB/GYN services to a publicly and privately insured population. This clinic has a large need for on-site integrated behavioral health services to meet the needs of at-risk women. It is located in the same building and adjacent to the HIV medical clinic. Integrated care services are relatively new to this clinic. Currently interns see patients as referred by their OB/GYN providers. Interested interns have the opportunity to develop specific protocols targeting women who present with targeted problems. Interns address a variety of women's health issues including chronic pelvic pain, post-partum depression, infertility, and miscarriages.

DRH inpatient psychology trauma service Detroit Receiving Hospital's trauma program is an exciting and unique opportunity for the intern to work with physically injured crime victims and other trauma victims in both the Emergency Department and on the inpatient medical units. Support is also provided to the victims' families when possible or indicated. Patients are often seen within a few to 24 hours after an injury, but in some cases the first intervention occurs several days later. Psycho-educational, normalization, and debriefing interventions are provided in the early stages of encounters. Many patients elect to continue seeing a therapist on an outpatient basis. Some individuals in outpatient psychotherapy may have physical limitations, but most patients difficulties are less overt and are related to psychological adjustment to the trauma. Homicide survivors are often referred here by the Prosecutor's Office. Interns selecting this rotation will have the opportunity to participate in the full range of services. In addition, the student will have the opportunity to work within a major medical/surgical facility and learn to communicate effectively with different (non-mental health) disciplines. Students will become well versed in medical terminology and health psychology issues. A major portion of this program is funded by a grant from the State of Michigan's Crime Services Commission. Supervision for this rotation is provided by three licensed psychologists. In general, the student can expect one hour of supervision per week for outpatient services and daily supervision for inpatient work. Supervisors also have an open door policy for trainees.

Competencies and Outcomes

What type of intern are we looking for?
We are looking for interns who are committed to careers in health psychology with a specific focus on working with underserved populations. This track was developed specifically to address health care disparities and to meet the growing demand for health psychologists to work within outpatient integrated care medical settings. We expect our graduates to become leaders in this growing specialty area. A strong applicant will have experience working within medical settings and also have a solid foundation of general psychological assessment and intervention skills. Simply writing about your interest in health psychology and underserved populations in your application essays is insufficient; you must have proven your interest by the work you have already done in order to receive an interview in the Integrated Care Track. Applicants who are interested in gaining exposure to health psychology but do not have a demonstrated commitment might be better suited to our General track where integrated care rotations can be selected.

For more information, contact:

Lori Lackman-Zeman, Ph.D.
Program Director of Integrated Care Track
Wayne State University
2751 East Jefferson Avenue
Suite 501
Detroit, Michigan 48207
313-577-8172
Program Match Number: 136712