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Neuropsychology Internship Track (NT)

OVERVIEW AND TRAINING SETTINGS

The Division of Neuropsychology and Behavioral Health of the Emory Department of Rehabilitation Medicine has been preparing students for professional practice in neuropsychology for over two decades, beginning with a practicum training program in the mid-1980s and adding a postdoctoral fellowship program in 1997 which is now a full affiliate of the Association of Postdoctoral Programs in Clinical Neuropsychology. The Neuropsychology Track was added to the APA accredited internship program at Emory/Grady in 2001, initially with one internship position in adult neuropsychology. Beginning with the 2006-2007 academic year, the Neuropsychology Track expanded to include adult, child, and geriatric rotations through the addition of faculty based at Wesley Woods Center and Children’s Healthcare of Atlanta. All neuropsychologists are faculty members in the Emory School of Medicine (Departments of Rehabilitation Medicine or Neurology) and are listed in the attached compendium. In addition, various neurologists and other physicians contribute to the internship as conference leaders, presenters or supervisors, and also are listed in the attached compendium.

The neuropsychology track is based on American Psychological Association (APA) guidelines for training at the internship level in clinical psychology and accepts four interns annually. In addition, the neuropsychology track was designed to meet APA Division 40, Houston Conference, and Association of Internship Training Centers in Clinical Neuropsychology (AITCN) guidelines for neuropsychology internships. Therefore, 50 percent of the clinical service time is devoted to neuropsychology training through the Major Rotations in adult, child, and geriatric neuropsychology and approximately 50 percent is devoted to general clinical psychology training through the Minor Rotations.

The adult neuropsychology rotation is based at the Emory University Center for Rehabilitation Medicine (CRM), a 5-story, 56-bed rehabilitation facility with a 16-bed inpatient neurorehabilitation service. The Center provides a comprehensive program of inpatient, day program, and outpatient rehabilitation addressing the medical, physical, cognitive, psychological, community reintegration, and vocational needs of persons with disability. The CRM includes four fully equipped neuropsychology laboratories. Faculty include two full time and two adjunct neuropsychologists. Although based in a rehabilitation hospital on the Emory University campus, the Division serves all departments in the Emory School of Medicine. Hence interns have the opportunity to work with a variety of patient populations including stroke, brain injury, epilepsy, brain tumor, early dementia, degenerative disease, etc. The CRM is also home to The Emory University Department of Rehabilitation Medicine (http://www.rehabmed.emory.edu/). This department has consistently ranked in the top 10 rehabilitation medicine departments in the country in National Institutes of Health research funding. The department has a commitment to brain injury and stroke research having been the site of a federally-funded Traumatic Brain Injury and Stroke Research and Training Center and a federally-funded Model Traumatic Brain Injury System of Care.

The child neuropsychology rotation is at Children’s Healthcare of Atlanta (CHOA). CHOA is dedicated to enhancing the lives of children through excellence in patient care, research and education. With 529 licensed beds in three hospitals (Scottish Rite, Egleston, Hughes-Spalding), satellite locations throughout Atlanta and more than 750,000 annual patient visits, CHOA is one of the largest pediatric healthcare systems in the country. CHOA is recognized for its many pediatric specialties, including the Divisions of Neuroscience and Rehabilitation. The CHOA Department of Neuropsychology includes ten pediatric neuropsychologists, each having extensive experience in the practice of clinical neuropsychology with children, and one pediatric psychologist who provides intervention services in the Rehabilitation program. The CHOA Department of Neuropsychology serves inpatients at the Scottish Rite and Egleston hospitals, and has outpatient offices at Scottish Rite and on the Emory campus. The Emory office is in close proximity to both CRM and the Wesley Woods Center.

Wesley Woods Center (WW) houses the geriatric neuropsychology rotation and is located on a 64-acre wooded campus adjacent to the Emory University campus. Wesley Woods is nationally recognized for its comprehensive care to individuals and families who face age-related health care issues. Wesley Woods encompasses a spectrum of care for older adults including a geriatric hospital, a long-term nursing care facility, an independent living facility for seniors, an outpatient center and a health center. Wesley Woods Geriatric Hospital, established in 1987 as the first comprehensive outpatient and acute care facility of its kind to specialize in aging adults, encompasses a 100-bed acute care hospital and outpatient clinic. More than 2,347 inpatients and 34,320 outpatients come to the Geriatric Hospital each year. Wesley Woods Health Center houses the Wesley Woods Adult Day Hospital and outpatient counseling and Partial Hospitalization programs. It also houses our nationally recognized teaching and research programs and the Emory Center for Health and Aging, a new interdisciplinary training and research center involving the Emory University Schools of Medicine, Nursing and Public Health. Budd Terrace at Wesley Woods is a 250-bed nursing care facility that offers long-term care to older adults with chronic health problems. Wesley Woods Towers offers assisted living to residents who are 62 years or older. Two neuropsychologists at Wesley Woods Center provide primarily diagnostic services to inpatients and outpatients with dementia, mild cognitive impairment, and movement disorders.

Both the CRM and WW are part of Emory Healthcare, while CHOA is an Emory affiliate institution, and all neuropsychologists are faculty members in the Emory School of Medicine. Hence, we are able to create an integrated training experience that nonetheless offers a uniquely diverse set of training experiences across the life span. Interns are trained in neuropsychological assessment, intervention, consultation, and teaching/supervision. Training in assessment emphasizes comprehensive evaluation of cognitive and affective disorders arising from neurologic injury and disease. Interns learn effective interview techniques with neurologically-impaired clients and become proficient in selection of tests, administration and scoring of tests, interpretation of results, and oral and written communication of findings. Interns examine persons with acute neurologic disorders in inpatient settings, as well as persons presenting with chronic residuals of neurologic disorders in outpatient settings. Supervision emphasizes integrated conceptualization of neuropsychological instruments and data. Additionally, interns are trained in psychotherapeutic intervention with adults and children, as well as rehabilitation psychology, cognitive rehabilitation, and behavioral health interventions.

NT TRAINING OVERVIEW

The training plan for each of the NT interns consists of the two Major Rotations (16-20 hours/week), which includes 6-8 hours per week of neuropsychological testing and scoring, 2-4 hours supervising neuropsychological assessments done by practicum students, and 4-8 hours of report writing and feedback to patients and various referral sources. The Neuropsychology Track interns each complete an adult major rotation through the CRM (6 months), and a major rotation either at CHOA or at WW (6 months).  The training plan for rotations for the Neuropsychology Track is as follows:

Adult/Geriatric Training Concentration:

Major Rotations: 6 month adult rotation at CRM, and 6 month geriatric rotation at WW.

Interns completing these rotations will receive extensive experience working with both adult and geriatric populations. This training concentration will be most appropriate for those applicants with strong experiences working with adult populations, and/or those with a particular interest in geriatric populations.

Adult/Pediatric Training Concentration:

Major Rotations: 6 month adult rotation at CRM, and 6 month pediatric rotation at CHOA.

Interns completing these rotations will receive extensive experience working with both adult and pediatric populations. This training concentration will be most appropriate for those applicants with strong practicum experiences working with both adult and pediatric populations, and/or those with a particular interest in pediatric populations.

Determination of which training concentration each intern will complete will be determined as part of the APPIC matching process. There will be a separate match number for the Adult/Geriatric and Adult/Pediatric training concentrations. However, applicants to the Neuropsychology Track may submit rankings and be considered for both of these Neuropsychology Track training concentrations.

In addition to these two major diagnostic rotations in neuropsychology, interns complete two 6-month minor treatment rotations. Minor treatment rotations allow interns to gain experience in psychotherapeutic and behavioral health interventions with adults and children in neurological rehabilitation and psychiatric settings. The specific adult and child psychiatric setting is chosen in collaboration with the intern, training director and neuropsychology faculty advisor based on the intern’s past clinical experiences, areas of interest, and perceived needs. Each of the neurological rehabilitation settings additionally provide interns with the opportunity to learn cognitive rehabilitation interventions. The minor rotations account for an additional 8-10 hours per week. Finally, neuropsychology interns carry one long-term psychotherapy case throughout the full year.

NT interns have 6-8 hours/week for didactic seminars including the weekly Psychology Intern Seminar and Family Therapy Case Conference (both with the General Training Experience Interns), weekly Neuropsychology Case Seminars at each site, brain dissection in the Emory Neuropathology Department during the adult neuropsychology rotation and in the CHOA Department of Pathology during the child rotation, Pediatric Epilepsy Surgery Conference during the child rotation, and Grand Rounds of topical interest in the Neurology and Psychiatry Departments.

A more detailed description of these training experiences follows.

MAJOR ROTATIONS: ADULT, CHILD AND GERIATRIC NEUROPSYCHOLOGY

Interns gain extensive experience in neuropsychological assessment of adult, child and geriatric patients with acquired brain injury, stroke, epilepsy, neoplasm, and other neurological conditions. The diagnostically diverse patient populations and combination of settings are major strengths of the internship. Supervision in the following areas is offered by the Neuropsychology faculty: (1) diagnostic interview techniques for neurological populations; (2) design of flexible test batteries to address referral questions; (3) neuropsychological test administration, scoring, and interpretation; (4) differential diagnosis of neuropsychological syndromes and disorders; (5) production of oral and written reports for lay persons and health care professionals; and (6) development of rehabilitation plans and recommendations. Supervised experience in conducting Wada Tests and Cortical Language Mapping temporal lobe epilepsy surgery candidates is available primarily in the child rotation, but less frequently in the adult rotation as well. Interns receive assessment supervision from a minimum of two neuropsychologists during the internship year.

Interns are trained in consultation to medical staff members, health care teams, families, administrative systems, and persons with neurological disorders. Consultation emphasizes communication and education. Interns are involved in clinical consultation to physicians and health care teams in formal settings such as medical rounds and team conferences. Interns regularly provide consultative education to patients and families as well as case managers and health care administrators. Finally, interns have opportunities to supervise graduate students completing clinical practicum rotations under the direction of faculty. Supervision in consultation and supervision is provided by a minimum of two neuropsychologists during any training year.

Interns will find that it is a busy training year. Interns are expected to cope with a clinical schedule that is typical for a major academic medical center. A typical workday will run 10 (and occasionally 12) hours. Interns administer, score, and report on at least one neuropsychological examination per week. On the adult major rotation the interns also supervise an additional case done in conjunction with a graduate student who works under the intern’s supervision.

MINOR ROTATIONS: NEUROLOGICAL REHABILITATION AND PSYCHIATRY

Interns are required to complete two minor treatment-oriented rotations. Each minor rotation is six months in length and accounts for approximately half of the intern’s clinical service requirement. Options for the minor rotations include rotations in rehabilitation psychology at the CRM or CHOA, and at several clinical sites that are part of the Grady Health System. These rotations provide supervised experience in psychotherapy, cognitive rehabilitation, team consultation with inpatients and outpatients undergoing neurological rehabilitation and/or crisis intervention and intervention with psychiatric patients.

Pediatric Minor Rehabilitation Psychology Rotation, Children’s Healthcare of Atlanta

On this rotation, interns have the opportunity to engage in psychological intervention with patients in the Comprehensive Inpatient Rehabilitation Unit (CIRU), and on occasion, at the Day Rehabilitation Program (DRP) of CHOA, which are located at the Scottish Rite Hospital. The CIRU is a licensed and accredited 28 bed floor that is dedicated to acute rehabilitation. The CIRU is for acutely ill and injured patients who require intensive medical care, but are able to participate in three hours of rehabilitation per day. The DRP is a transitional day program for patients that do not require 24 hour medical care. Interns have opportunities to assist with diagnostic interviews with caregivers, assess patients' emotional and behavioral functioning, and assist in developing and implementing individual and family interventions. Interns also have the opportunity to learn and assist with providing intervention within the interdisciplinary teams in the CIRU and DRP (PT, OT, SLP, medical team). The patient population (infancy to age 21 years) includes a variety of acute and chronic diagnoses including: traumatic and acquired brain injuries, tumors and cancer, stroke, meningitis/encephalitis, spinal cord and orthopedic injuries, cerebral palsy, developmental and genetic disorders, patients with burns, patients with amputations, chronic pain, conversion disorders, and others. Interns are expected to devote two, half days to this minor rotation, a total of 6 hours (5 hours of intervention and 1 hour of supervision). Dr. Kindell Schoffner provides supervision for this rotation.

Adult Minor Rehabilitation Psychology Rotation, Center for Rehabilitation Medicine

This rotation involves diagnostic interview and psychotherapy with adult neurological rehabilitation inpatients and outpatients. The patients seen have had the recent onset of a neurological condition, mainly stroke or traumatic brain injury, although other diagnoses are possible. Patients are undergoing a program of comprehensive rehabilitation including physical, occupational, and speech therapy, on either an inpatient or outpatient basis. Psychological interventions focus on dealing with depression, anxiety, and other adjustment issues that may be affecting their rehabilitation. Family and a limited degree of sexual counseling may also be needed. The rotation also provides an opportunity to consult and work with the interdisciplinary rehabilitation teams that are treating the patients. This minor rotation involves essentially 1 day per week, similar to the other minor rotations that we offer, and involves 3-5 patients per week, with the number varying based on the complexity of the cases being followed at any given time.  Dr. Suzanne Penna provides supervision for all patients seen as part of this minor rotation.

Grady Health System

There are several options for minor rotations through the psychiatry program at the Grady Health System. These provide the intern with the opportunity to gain experience with diagnosis and treatment of major psychiatric disorder. Examples of psychiatric settings that are available in the Grady Health System for the minor rotations include: the Adult Outpatient Clinic, where the intern is responsible for the initial assessment and case management of outpatients, group therapy, consultation with other staff, psychotherapy follow-up and appropriate disposition planning. Often these patients have recently been discharged from an inpatient service. On the Crisis Intervention Service, interns interview and intervene with individuals in the midst of a psychiatric emergency. All levels and categories of adult psychopathology are represented. The service is the 24-hour psychiatric emergency room for the City of Atlanta and receives over 15,000 patient visits each year. At the Psychosocial Rehabilitation Clinic, interns have opportunities to provide evaluation and intervention with individuals living with severe and persistent mental illness in a day treatment setting.  Finally, in the Infectious Disease Program, interns provide individual and group therapy and case management in an HIV clinic setting for adults or children with a wide range of psychiatric difficulties. Additional minor rotation options at Grady Health System also are possible depending on the interests and training needs of interns, and the availability of faculty supervisors.

LONG -TERM PSYCHOTHERAPY CASE

Neuropsychology interns carry one long term psychotherapy case throughout the training year. These are typically patients with a combination of neurological and psychiatric disorders with long term adjustment issues related to their physical, emotional, and cognitive disabilities. Long-term cases may be treated from a variety of therapeutic frameworks, depending upon their clinical presentation, including behavioral, cognitive-behavioral, and insight-oriented psychodynamic approaches.

NT SUPERVISION AND DIDACTIC EXPERIENCES

The extensive supervision provided during the internship year is a major strength of the program. At the beginning of each rotation, interns meet with their supervisor(s) to discuss clinical responsibilities and supervisor/intern expectations. Interns receive feedback on performance during weekly supervision sessions. At the conclusion of each rotation, interns receive written feedback on their performance. If deficiencies are noted, the supervisor and intern jointly develop a plan for remedying these problems. Interns also have the opportunity to complete written evaluations of their supervisors.

Interns are assigned a primary faculty supervisor for each major neuropsychology rotation. Depending upon the rotation, supervisors will be experienced in child, adult, or geriatric neuropsychology. We currently have nine neuropsychologists certified by the American Board of Professional Psychology / American Board of Clinical Neuropsychology across the child, adult, and geriatric rotations. Each week, the intern will receive at least 2 hours of individual assessment supervision in addition to approximately 2 hours of group supervision as part of the weekly Neuropsychology Case Seminars. Individual supervision provides an opportunity for intensive, one-on-one discussion and case conceptualization with a faculty member. Group supervision provides an opportunity to interact with Neuropsychology Residents (Fellows), Practicum Students, and Faculty. Additional informal supervision regularly occurs as the intern manages the demands of clinical services.

The format for supervision during the minor treatment rotations varies with the setting, the supervisor, and the intern’s needs, and may include individual or group supervision, review of process notes, use of audio or videotapes, and live supervision and/or co-therapy. In addition to its focus on clinical skill development, supervision also emphasizes consideration of contextual, cultural, and relational factors as they relate to clinical practice.  Supervision may also include a person of the psychotherapist focus on addressing the trainees’ personal and professional reactions to their patients in order to facilitate an understanding of how these factors may influence clinical encounters with patients. Consistent with the internship program’s developmental training framework, supervision typically progresses over the course of the training year from a more didactic focus on specific clinical skill building processes to an increased focus on supporting the development of professional autonomy and clinical decision-making. The long term psychotherapy cases are supervised on an individual basis, or in a group format (1 hour weekly group supervision).

Training expands the intern’s existing knowledge base in general clinical psychology, psychopathology, neuroanatomy, neuropathology, and the neurosciences and fosters the intern’s development as a psychology scientist-practitioner. Through didactic and experiential training, the intern develops a strong understanding of brain-behavior relationships and furthers his or her knowledge in basic psychological principles, psychometric issues, and general clinical psychology, as well as practice and professional issues. A variety of didactic training opportunities are available to the intern including a weekly Neuropsychology Case Seminar during which interns regularly present cases and discuss relevant neuropsychological literature. Faculty lectures throughout the year provide advanced instruction in areas relevant to the practice of clinical neuropsychology and guest lecturers provide introduction to neurological and neuroradiological examination techniques including Magnetic Resonance Imaging (anatomical and functional) and electroencephalography. Interns also participate in the weekly Psychology Intern Seminar Series and the Family Therapy Case Conference with the general interns on the Grady campus. Interns also may attend Neurology, Rehabilitation Medicine, and Psychiatry Grand Rounds, a Pediatric Epilepsy Surgery Conference (during the child rotation), and clinical brain dissections in the Emory Pathology Department (during the adult rotation) and a multi-disciplinary Dementia Diagnosis Consensus Conference (during the geriatric rotation).

Participation in the Neuropsychology Case Seminars, Psychology Intern Seminar, Family Therapy Case Conference, and brain dissection is mandatory. Interns must also select and attend a minimum of one additional training activity each week.

RESEARCH OPPORTUNITIES

Participation in research is not a requirement of the neuropsychology internship track, however research opportunities do exist for interns interested in pursuing eventual academic careers. Interns are familiarized with ongoing funded and unfunded faculty research and are encouraged to develop a mentor relationship with one or more faculty. Interns may elect to work with faculty on ongoing or new research projects outside of their normal clinical hours. Interns who are interested in applying to the Pediatric Neuropsychology Postdoctoral Fellowship through CHOA are encouraged to develop a research area of interest.