The acute inpatient Units (three at NCB and four at Jacobi) are locked, short term units providing treatment for acute psychiatric disorders. The average length of stay on the inpatient units is two weeks which means that much of the focus of training will be on assessment and short-term therapeutic interventions. One of the units at NCB is for geriatric patients while one unit at Jacobi is a bicultural (Hispanic) unit. Patients are typically involuntarily committed to the hospital and their stay averages approximately two weeks. The units are structured to provide a milieu treatment setting in which both staff and patients participate in the recovery process.
The intern functions in the role of psychotherapist on a team which includes psychology, social work, psychiatry, creative arts therapy and nursing. The major goals of the inpatient service are to provide rapid and thorough assessment, treatment of the presenting mental illness and discharge planning.
The Psychiatric Outpatient Services provide treatment for an ethnically diverse, though primarily lower to middle class African American and Hispanic, population. The multidisciplinary staff is comprised of a medical director, psychiatrists, psychologists and social workers. Presenting problems range from acute individual or family crises to chronic mental illnesses.
At Jacobi, there are outpatient clinics for adult and geriatric populations. Other available sites for outpatient work at Jacobi include the Adult and Pediatric HIV Primary Care Services, the Pediatric Service and the Family Advocacy Program (for children newly identified as physically or sexually abused).
At NCB, all outpatient work is done at the Adult Behavioral Health Outpatient Service.
The Psychiatric Emergency Room
Those who wish an extended ER experience may opt for the Consultation Liaison elective rotation (see below) C/L service is an offshoot of the Psychiatric Emergency Room. Located near the medical emergency room, the PER is a separate, locked, secure unit. It is comprised of a patient waiting area, nurses’ station, four small observation rooms with beds and three interviewing rooms. The functioning of the unit is overseen by a nurse and several clerks, aides and hospital police.
Acute Geriatric Inpatient Unit
This unit operates similarly to the adult inpatient units. The patient population includes older adults from ages 55 and up who often present with a myriad of psychiatric and medical problems and, very commonly, dementia.
The Partial Hospitalization Program
The Partial Hospitalization Program (PHP) at NCB provides short-term, intensive outpatient evaluation and treatment to adults with acute psychiatric symptoms who would otherwise require inpatient treatment. The purpose of PHP treatment is to prevent or reduce psychiatric inpatient stays and to help patients with acute symptoms improve to the point that they can transition back into the community. The PHP has a multi-disciplinary team (psychology, psychiatry, social work, activity therapy) that offers services such as individual psychotherapy, crisis management, case management, group therapy and psychiatric assessment (among others).
Consultation Liaison Service
The Consultation-Liaison intern is paired with the C/L psychologist who provides psychiatric consults to the adult medical/surgical units and the pediatric units. Problems resulting in consult requests may include assessing a patient’s ability to make health care decisions, medical management of patients who are also psychiatrically ill, making a differential diagnosis between psychosis and delirium, determining the existence of conversion symptoms as well as more routine assessment of depression/suicidality and/or agitated behavior. Unlike other rotations, interns gain extensive experience understanding the interaction between psychiatry and medicine. Additionally, interns gain experience assessing high risk cases (e.g., suicide attempts) and determining the appropriate discharge plans accordingly.
Inpatient Detox Unit
The Inpatient Detox Unit is a 16-bed unit treating a variety of people with chemical dependence who present with acute medical, psychiatric and psychosocial concerns. Many patients arrive in a state of crisis and often have histories of multiple addictions, trauma and poor social support. The goals are to medically detox each individual, assess and address their treatment needs and offer appropriate referrals upon discharge. An interdisciplinary team is assigned to each patient. The patient needs to be medically and psychiatrically stable upon completion of a 3-5 day detox.
Comprehensive Addiction Treatment Center Intensive Outpatient Program
The CATC Intensive Outpatient Program offers comprehensive addiction treatment to patients at various stages of recovery. The program utilizes a combination of individual, group, and pharmacological treatment to help patients achieve and maintain recovery. Our patients present with a range of substance use disorders and complex psychological presentations that require intensive services. Our multidisciplinary treatment team consists of psychiatrists, nurses, psychologists, social workers, addiction counselors, activity therapists and a vocational counselor. During this rotation, the psychologists-in-training have the opportunity to follow patients from their first day of admission through the inpatient detox into outpatient treatment. In this way, interns are thoroughly immersed in the challenging process of working with patients as they progress through the different phases of treatment. Interns carry a caseload of up to 3 patients in the Outpatient Program in addition to running psychoeducational and psychotherapeutic groups.
Inpatient Rehabilitation Medicine Service
A rotation through the Jacobi Rehabilitation Medicine Service provides an opportunity to work with a diverse adult population, most of whom have sustained a recent trauma (e.g. gunshot wound, stroke, head injury, amputation, being struck by a vehicle, burn, spinal cord injury). The 24 bed, inpatient rehab unit receives patients from other Jacobi medical and surgical units as well as from other hospitals in the community. Complicating the individual’s physical rehabilitation may be significant personal/social issues such as substance abuse, personality and/or mood disorders, dementia, anxiety, etc. The psychologist and the psychology intern are part of a multidisciplinary team of medical doctors, nurses, occupational and physical therapists, a speech pathologist and social workers who meet weekly to update and plan strategies and for discharge planning. The psychology intern works with patients individually and in groups and participates in family meetings to provide short-term treatment oriented towards assisting the patient in the recovery process and helping him/her to gain a realistic understanding of his/her situation.
Psychiatric Emergency Room (PER)/Comprehensive Psychiatric Emergency Program (CPEP)
The Comprehensive Psychiatric Emergency Program is a separate, locked, secure unit. It is comprised of a patient waiting area, nurses’ station, observation rooms with beds and interviewing rooms. The functioning of the unit is overseen by a nurse and several clerks, aides and hospital police. It also has six beds for extended observation of patients for up to 72 hours.
Patients who come to the CPEP are most often people with chronic and severe mental illness whose conditions are exacerbated by a current stressor and who present with acute psychotic symptoms. Psychiatric emergency room patients also frequently present with drug and alcohol induced disturbed behavior or mood.
Pediatric Neurodevelopmental Assessment Service
This service provides neuropsychological and developmental assessments to children from birth through age 18. Interns on this service are able to have an intensive learning experience about human development and assessment. Among other, more traditional assessment tools, interns can learn how to administer the Baily on newborns and how to assess children through behavioral observation and play therapy. There may also be opportunity to practice time limited behavioral therapy with parents and children together. Interns may assess for developmental disorders and underlying psychological problems using psychological testing, etc.
Bariatric Surgery Program
The Bariatric Surgery Program at Jacobi is a designated Center of Excellence by the American Society of Metabolic and Bariatric Surgery (ASMBS). Our multidisciplinary team consists of surgeons, dieticians, nurses and physician assistants. The role of the psychologist in training is twofold: to provide individual and group psychotherapy, conduct psychological evaluations, and to function as a consultant to the medical team. Services are provided before and after weight loss surgery. Family and couples’ psychotherapy are also offered on a case by case basis. The trainee will gain experience in understanding the interface between medicine and psychology. The trainee will also develop skills to use evaluations as brief interventions to focalized issues. Supervision in Spanish can be offered to trainees interested in conducting psychotherapy in that language.
Pediatric Medicine Service
The Pediatric Medicine Service offers mental health services to children, adolescents and their families from infancy to age 18. These patients are generally identified for treatment by the Pediatric Neurodevelopmental Assessment Service described above.
Services provided include individual, group and family therapy; individual parent counseling; parenting skills groups; mother/child dyadic therapy and working with schools, teachers, etc. Depending on the patient, modalities of treatment include Behavioral, Psychodynamic Play Therapy, CBT and Family Systems. Unlike other outpatient sites, there are no psychiatrists on the service. Psychologists and interns work with pediatricians, nurses and medical social workers in an ambulatory pediatric medical setting.
Health & Empowerment Center (HIV/AIDS Treatment and Prevention)
Offers primary care to adult and pediatric patients with HIV/AIDS and their families. The multidisciplinary team includes MD’s, nurse practitioners, social workers, nurses, case managers and psychologists. Mental Health Services, including individual, group and family therapy as well as assessments, are provided by psychologists on the team. There is also a part-time psychiatrist to provide psychopharmacological treatment. The setting facilitates the ability of mental health clinicians to coordinate treatment with medical providers. The service uses a “one-stop shopping” model of mental health where multiple members of the same family can be seen on one service. Interns carry several individual cases for the duration of the training year. They also co-lead a group and treat families when available.
The Family Advocacy Program
The Family Advocacy Program (FAP) serves children and adolescents who are victims of physical and/or sexual abuse, domestic violence and/or significant neglect as well as their non-offending caregivers. The majority of the children have histories of sexual abuse. A multi-disciplinary team consisting of a pediatrician, a social worker and, when appropriate, psychologists evaluates all of the children and families. If mental health treatment is recommended, the families are seen in the clinic for long or short-term psychotherapy both individually and as a family. The primary therapy modality used is trauma-focused CBT (Deblinger).
Psychology trainees will have the opportunity to work in a growing psycho-social service and provide both individual and group therapy. In addition, there will be crisis counseling for individuals experiencing symptoms linked to their diagnosis and treatment. The interns will be part of the team there-since it started, they are providing a greatly needed and appreciated resource. Interns will be able to work up to 2 mornings per week during the 4 month rotation seeing 3-4 patients per day. This clinical service will be in collaboration with these other rotations: bariatric medicine, med rehab, CPEP and pediatric neurodevelopmental. Individual, group and family work can be offered depending on the skill set of the trainee.