Training Experiences & Rotation Descriptions

Selecting Clinical Rotations

Fulton State Hospital offers three fulltime internship positions, two interns who are matched to the General Treatment Track (program code 178311) and one intern who is matched to the Forensic Evaluation Track (program code 178312). Each track has specific requirements and expectations, which are discussed more thoroughly below. Following orientation, the interns will meet with the Training Director to select the major rotation(s) offered in their track and create their yearly schedule. Also at this time, the interns will review their individual evaluations with the Training Director using the Psychology Intern Competency Assessment Form.

At the outset of each rotation, the rotation’s tasks, requirements, and expectations will be reviewed by the rotation supervisor. At that time, the supervisor will develop an individualized training plan with the intern. The training plan includes the goals of the supervisor and rotation as well as the goals of the intern. The training plan may be modified as the rotation progresses to meet each intern’s needs and interests.

Structure of Clinical Rotations

The experiential component of the program is organized into two, six-month major rotations (roughly 4 days per week) and two, six month minor rotations (roughly 1 day per week). Major and minor rotation sequences are conducted concurrently throughout the internship year and are structured around a 40-hour work week

General Treatment Track

For the General Treatment track, interns receive training in innovative, evidenced-based treatment and best practices within nationally recognized treatment programs targeting specific populations. Each rotation has specific requirements and expectations, which are discussed more thoroughly below. The interns in the General Treatment Track select two major treatment rotations based on their interests, needs, and career goals

General Treatment Track Major Rotations

General Treatment Minor Rotations

Forensic Evaluation Track

For the Forensic Evaluation track, the intern begins her or his experience working with our Forensic Evaluation Team, completing court ordered evaluations of criminal defendants. During the second rotation, the intern will select a treatment rotation based on the intern’s interests, needs, and career goals. Specific requirements and expectations are discussed more thoroughly below.

Forensic Evaluation Track Major Rotations

Forensic Evaluation Track Minor Rotations

Other Intern Activities

 

Forensic Evaluation Track Description

Jeffrey S. Kline, PhD

Certified Forensic Examiner

Randy Telander, PhD

Certified Forensic Examiner

The Forensic Track offers the intern the opportunity to work with the Hospital’s two forensic examiners in completing evaluations of criminal defendants as well as participate in the restoration of incompetent to stand trial defendants. The Forensic Examiners are responsible for completing outpatient and inpatient court-ordered mental evaluations. The evaluation process focuses on several legal questions. These questions include the issues of competency to stand trial, mental state at the time of the alleged criminal conduct (or criminal responsibility), risk assessment for sexual and non-sexual violence, sentencing recommendations, and diminished capacity.

Fulton State Hospital (FSH) also has a Competency Restoration Program located in the Biggs Forensic Unit. The majority of defendants committed to FSH as incompetent to proceed to trial are admitted to this program. In this program defendants are provided appropriate psychiatric treatment and education to help restore them to a competent status.

The intern begins the Forensic Evaluation Track with the six-month forensic major rotation. At that time, s/he will also complete the minor Program Evaluation rotation. The intern will select a second six-month major rotation within one of the treatment programs, depending on interests, needs, and/or career goals. The assessment minor rotation will be completed during the second half of the internship year involving forensically focused assessments and reports while under the supervision of a forensic examiner.

During the Forensic Evaluation Track the intern will participate in both the evaluation and competency restoration process. The intern will work with a primary supervisor throughout the rotation, but also have opportunities to experience additional examiner’s work. Interns will receive at least one hour of individual supervision per week and will review hospital records, police reports, and collateral records and then participate in the evaluation interview and testing. As the track progresses, the intern will take on more responsibility for the interview and information gathering process, culminating in the intern performing evaluations from beginning to end. Throughout the training experience the intern will write complete reports of the evaluation results, detailing the psychological and legal issues that are pertinent to the court. Also, the supervisor may co-sign and submit to the Court some of the intern’s completed evaluations. Finally, interns will have the opportunity to witness testimony of the Forensic Examiners in a variety of cases.

As part of the Forensic Evaluation Track, the intern will work with the staff of the competency restoration program, including facilitating and co-facilitating competency education groups, providing individual therapy or education, and participating in treatment planning. The intern will also perform psychological screenings of new patients admitted to this program, which includes interviewing each patient and gathering information to help in determining treatment objectives.

The Forensic Evaluation Track is collegial in nature.  We work hard to help the intern develop independence and take on the role of an independent practitioner.  We feel strongly that the intern take an active role in their own learning.  We expect the intern to help us develop learning objectives, modify the objectives as the rotation proceeds, and communicate with us when the rotation is not meeting his or her needs. Clear and open communication is the best way to make this a successful rotation.

Learning Objectives

Responsibilities

General Treatment Track Rotation Descriptions

Intellectual / Developmental Disabilities Program

Sharon B. Robbins, PhD

Program Coordinator

Fulton State Hospital serves a number of clients with intellectual and developmental disabilities, including Moderate Mental Retardation to Borderline Intellectual Functioning, and with additional diagnoses of Pervasive Developmental Disorders.  Many clients have received prior services from the Missouri Department of Developmental Disabilities.  Further, the Hearnes Forensic Center, a minimum security unit at Fulton State Hospital, is entirely populated by clients previously served in a forensic habilitation center setting.  Clients on this program present with a wide array of other treatment concerns, including personality psychopathology, symptoms of mood disorder, and impulsive and problematic behaviors.

Treatment for clients with intellectual and developmental disabilities (IDD) is provided throughout various programs, but it is primarily the New Outlook Program that serves such individuals.  The New Outlook Program has three wards in maximum security (Biggs), two wards in intermediate security (Guhleman), and one ward in minimum security (Hearnes). Interns on this rotation would work with identified IDD clients in any of these locations.  This rotation offers a unique opportunity for the intern in the area of mental health treatment for people with intellectual and developmental disabilities. The intern will be supervised in providing group and individual therapy and comprehensive behavioral assessments by the primary rotation supervisor.  The intern will also assist in the development of individualized treatment plans, emphasizing principles of Positive Behavior Support.  Interns will be expected to participate in the treatment milieu as part of a multidisciplinary treatment team, which includes regular team meetings and team reports and ward activities with the clients.   The intern will receive training in Dialectical Behavior Therapy as part of the New Outlook rotation. Additional training, treatment, or assessment opportunities may also be offered to supplement the intern’s learning experience, depending on his or her specific interests or learning objectives. The intern will meet with the rotation supervisor at least one hour per week.

Learning Objectives

Rotation Requirements

New Outlook Program for Behavior and Mood Self-Management

Sharon B. Robbins, PhD

Program Coordinator

Lee Ann McVay, PsyD

Jessica Sergio, PhD

Team Leader

Internship Training Director

Jonathan Rhodes, PsyD

New Outlook Program for Behavior and Mood Self-Management is a program that combines the use of Dialectical Behavior Therapy and Positive Behavior Support. The most common diagnoses for clients in this program are severe personality disorders, diagnoses involving intellectual and developmental delays, and various paraphilias.

Interns who select this rotation will have the opportunity to learn Dialectical Behavior Therapy and its application in a forensic, inpatient setting. The intern will be supervised in providing group and individual therapy, as well as client skills coaching. Interns are expected to participate in the treatment milieu as part of a multidisciplinary treatment team, which includes participation in a Dialectical Behavior Therapy consultation team, regular team meetings and team reports, and ward activities with the clients.   Additional training, treatment, or assessment opportunities may also be offered to supplement the intern’s learning experience, depending on his or her specific interests or learning objectives. The intern will meet with the rotation supervisor at least one hour per week. Depending on level of familiarity with DBT, in vivo supervision may occur.

Interns participating in this rotation will be required to read Cognitive-Behavioral Treatment of Borderline Personality Disorder (Linehan, 1993) and Skills Training Manual for Treating Borderline Personality Disorder (Linehan, 1993). Opportunities are also available for Dialectical Behavior Therapy workshops and trainings provided by Dr. Ronda Reitz.

Learning Objectives

Rotation Requirements

Program for Recovery and Self-Motivation

Jeffrey Nolting, PhD

Program Coordinator

Biggs Forensic Center

John Dubose, PhD

In 2012, the Psychiatric Rehabilitation Program (PRP) was completely re-conceptualized and the name was changed to Program for Recovery and Self-Motivation (PRSM). The program was fully implemented in maximum security in April 2012 and intermediate security in May 2012. The intern rotation includes providing services across both maximum and intermediate security settings. PRSM is intended to help clients with primary psychotic disorders such as schizophrenia or major mood disorders that may also have primary or secondary personality disorders (excluding borderline personality disorder).

Treatment begins with the assumption that each person is capable of returning to an independent and productive life in the outside community. Treatment through this program is intended to help client’s develop and affirm that awareness and to identify and learn skills needed to function independently.

After clients are admitted to the program, through formal and informal assessment of their skills, PRSM staff assists clients in identifying skills they are using effectively, and skills they need to learn to use more effectively in order to attain their personal recovery goals. When people with mental illness are assisted in developing and achieving personal goals, motivation for active participation in the recovery process is enhanced. Toward that end, PRSM incorporates the philosophies, strategies, and methods of a transtheoretical approach that includes three interdependent elements: Illness Management & Recovery (IMR); Motivational Interviewing (MI); and Stages of Change.

‘‘IMR is comprised of a broad set of strategies to help individuals with serious mental illness collaborate with professionals, reduce their susceptibility to their illness, and cope effectively with their symptoms’’ (Mueser, et al, 2002). It is grounded in the philosophy of recovery and wellness. The IMR approach in combination with MI and the transtheoretical model emphasizes the importance of understanding and accepting resistive behavior without intentionally or unintentionally stabilizing it, while providing clients with knowledge and skill needed for personal recovery. IMR is an evidence-based practice and informs many of the treatment methods and influences the treatment strategies in the PRSM.

The stress-vulnerability model of Serious Mental Illness (SMI) posits that the course and outcome of major mental illness is determined by the dynamic interplay of biological vulnerability, stress, and coping. IMR is aimed at interrupting the cycle of stress and vulnerability that leads to relapse and poor functioning.

Learning Objectives

Rotation Requirements

 

Sex Offender Rehabilitation & Treatment Services

Ian Fluger, PhD

Program Coordinator

Edd Bucklew, PhD

LaKesha Davis, PsyD

The Sex Offender Rehabilitation and Treatment Services (SORTS) program at Fulton State Hospital specifically provides treatment services for those individuals civilly committed as Sexually Violent Predators under the SVP Act, RSMo, Chapter 632.480 and the following. The Statutory definition of an SVP is any person who suffers from a mental abnormality which makes the person more likely than not to engage in predatory acts of sexual violence if not confined in a secure facility and who has pled guilty to a sexually violent offense, been found guilty of a sexually violent offense, or has been committed as a criminal sexual psychopath prior to 8/13/1980. A mental abnormality is defined as a congenital or acquired condition affecting the emotional or volitional capacity which predisposes the person to commit sexually violent offenses in a degree constituting such person a menace to the health and safety of others. Predatory is defined as acts directed towards individuals, including family members, for the primary purpose of victimization.

The treatment program offered to the SVP population at Fulton State Hospital is Safe Offender Strategies, which was developed by Drs. Jill Stinson and Judith Becker. This treatment “approach emphasizes the role of self-regulation and self-regulatory deficits in the development of problematic and illegal sexual behavior.” The treatment program is “a skills-based intervention that facilitates self-monitoring and self-management for sex offending clients in longer-term or residential settings.” SOS consists of 10 Modules (addressed in SOS group), 7 long-term Stages, and several additional core treatment groups.

Interns participating in this rotation will be required to read Treating Sex Offenders: An Evidenced-Based Manual (Stinson & Becker, 2013) and Sex Offenders: Causal Theories to Inform Research, Prevention, and Treatment (Stinson, Sales & Becker, 2012).

Interns who select the SORTS rotation will be expected to learn Safe Offender Strategies, the primary treatment modality used for sex offender treatment services at Fulton State Hospital. Interns will also be expected to learn the theoretical and philosophical principles underlying this approach and apply them in treatment.Interns will additionally gain supervised experience with conducting risk assessments, psychosexual history evaluations, and other forms of structured and unstructured evaluation with sex offending clients.Interns are also expected to participate in the multidisciplinary treatment team and collaborate with other treatment providers to enhance client care. Individual supervision is provided on a weekly basis.

Learning Objectives

Rotation Requirements

 

Social Learning Program

Ciara Christensen, PhD

Lisa Mathews, PhD


The Social Learning Program (SLP) is available as a major rotation for interns within both the maximum security and intermediate security units of Fulton State Hospital (FSH).  Interns on the SLP rotation receive supervised experiences in a state-of-the-art, comprehensive psychiatric rehabilitation setting where they function as an active member of an interdisciplinary treatment team.  In addition to gaining valuable knowledge of milieu-based services, interns also obtain experience with a range of clinical interventions, including individual and group psychotherapy and clinical case management.  Interns also receive training and develop skills in using observational assessment data to assist the treatment team with data driven clinical decision-making processes.  While Social Learning Programs are a recognized evidence-based practice, SLPs can also incorporate additional evidence-based and best or promising practices to meet the individual needs and functioning of program residents.  Interns will also have the opportunity to gain firsthand knowledge of recognized evidence-based practices for people with serious mental illness including but not limited to Social Skills Training (Bellack, Mueser, Gingerich, Agresta, 2004; Liberman, Wallace, Blackwell, Eckman, Vaccaro, Kuehnel, 1993); Illness Management and Recovery (Mueser, Gingerich, 2003), Systematic Problem Solving (D’Zurilla & Goldfried, 1971), and Wellness Recovery and Action Planning (Cook, Copeland, Jonikas, Hamilton, Razzano, Grey, Floyd, Hudson, Macfarlane, Carter, and Boyd, 2011).

Social Learning at Fulton State Hospital

In 1987, a task force was formed within the forensic psychiatric service at Fulton State Hospital.  Its purpose was to address the problem of excessive numbers of individuals with serious mental illness (most with schizophrenia spectrum disorders) who were receiving mainly custodial services, had accumulated extended periods of hospitalization within the Biggs Forensic Center and showed little progress toward being discharged due to being highly symptomatic and aggressive.  The task force contacted national experts, visited other hospitals, and conducted an extensive review of the research literature on treatment approaches for the individuals with severe and persistent mental illness.  Their review revealed the work of Gordon Paul and Robert Lentz (1977).  Paul and Lentz completed a six year randomized control trial comparing traditional hospital care, an equally comprehensive milieu-therapy program (Therapeutic Community) and a Social Learning Program.  The results of the trial indicated that the comprehensive SLP, developed by Dr. Gordon Paul and his colleagues, was the most effective approach for improving the level of functioning of individuals who had a significant history of refractory mental health symptoms and institutionalized behavior to the point of enabling them to successfully return to the community.  These results were so compelling that the administration at FSH adopted as a primary goal the implementation of a comprehensive social-learning continuum of care that extend into the community within both forensic and adult psychiatric services.  Full implementation of the SLP at FSH began in 1988. Subsequent implementation of the SLP has been extended not only to hospitals with the Missouri Department of Mental Health, but also to numerous states across the country as well as internationally.

Program Description

The mission of the Social Learning Programs at Fulton State Hospital is to provide comprehensive psychosocial rehabilitation and recovery-oriented services.  The purpose of the program is to teach and support adults with serious mental illness to overcome difficulties and facilitate the process of recovery. Measurable outcomes of the program’s mission and purpose include the ability to safely live and function in a less restrictive setting, reliable performance of activities of daily living, improved social and occupational functioning, and a higher perceived quality of life while respecting a client’s autonomy and self determination.

The Social Learning Program is a highly structured, milieu-based, inpatient approach to rehabilitation for individuals with the most severe problem behaviors and skills deficits. It consists of a comprehensive integrated network of skills training techniques and supports based on learning theory, individually tailored to client needs and delivered by all staff within the context of a supportive, rehabilitation-oriented foundation. Individual, group, and unit-wide interventions are based on social-learning theory (Paul, Stuve, & Menditto, 1997; Paul & Menditto, 1992). Together these interventions form an extremely positive teaching environment that assists clients in developing adaptive behaviors and skills relevant to successful return to the community (Menditto, 2002). Data collected within the FSH SLP has demonstrated dramatic reductions in aggressive behavior (Beck, Menditto, Baldwin, Angelone, & Maddox, 1991), reductions in inappropriate behavior (Springer, 2008) and significant increases in adaptive behavior (Newbill, Paul, Menditto, Springer, & Mehta, 2011).

Learning Objectives

Rotation Requirements

 

Forensic and Treatment Track Minor Rotations

Program Evaluation

Niels Beck, PhD

Vice Chair, Department of Psychiatry and Neurology

University of Missouri School of Medicine

The Program Evaluation and Research Service at FSH is charged with assisting the executive leadership teamwith assessing the cost and effectiveness of facility treatment and rehabilitation programs, as well as evaluating and developing new treatment/rehabilitation technologies and related techniques. In this rotation, interns will gain supervised experience in the selection, use, and development of appropriate program evaluation measures and data bases, and in appropriate data collection and analysis techniques.

This is a required, six-month rotation for all interns. Interns will devote approximately one day each week to the completion ofa specific program evaluation project during the course of this rotation, working in collaboration with the Program Evaluation supervision order to base the project on an ongoing institutional treatment program where there is a need for evaluation and further development.

At the close of the rotation, interns will prepare reports of their findings and present them to involved treatment teams as well as the internship staff committee. Co-authorship of resulting manuscripts and conference presentations is available for interested individuals.

Learning Objectives and Rotation Requirements

 

Psychological Assessment

The assessment component of internship training is an opportunity to explore different aspects of psychological assessment. By the end of the internship year, the intern is expected to demonstrate competence in a variety of assessment techniques and report writing. Through a combination of didactics, direct supervision and clinical experience, the intern will explore different aspects of assessment in a diverse environment. The methods we are employing are intended to develop the ability to write independent reports that are ready for placement in the medical record. Referrals will be made from a variety of hospital programs and units in order to provide a diverse training experience.

The assessment rotation is a required, six-month rotation for all interns. Interns will receive approximately 1 day per week during that time in which to complete 10 psychological assessments. These assessments will cover a variety of domains, including the following:

In order to ensure competency in a number of areas, interns are expected to cover at least 4 of these 6 domains across the 10 assessments. Additionally, 2 of the assessments should involve testing in more than 1 domain in order to address more complex and integrative client needs.

Each assessment will be evaluated by the supervisor via the Assessment Rating Form. The intern is expected to complete such reports within a timely manner, and a completed report should be presented to the supervisor within 2 weeks of test administration or data gathering.

The interns should write assessment reports demonstrating competency in a variety of domains. Admission Screening Evaluations cannot be used as one of the 10 assessments. The intern will score cognitive assessments (even if administered by the psychometrician) to insure an adequate understanding of the tests. Objective assessments such as the MMPI-2 and MCMI-III should not be hand scored.

The intern is expected to follow the standards for psychological evaluations established by the Psychology Department via Psychology Department Policies for most reports. When completing Forensic Evaluations, the intern is expected to complete the reports based on the standards in the Forensic Manual, which will be provided to the intern.

Learning Objectives and Rotation Requirements