Behavioral Medicine

Astrid Reina, Ph.D., Chief, Psychology Division; Co-Director of Training; Director, Behavioral Medicine Services

The Behavioral Medicine emphasis area provides advanced training and professional development in behavioral medicine for fellows interested in working in the field of Clinical Health Psychology and in large teaching facilities specializing in the provision of services in the public sector and poverty medicine settings. The clinical population served in this emphasis area includes patients ranging from childhood to older adulthood and from diverse socio-cultural backgrounds; the emphasis area offers a rich experience in working within a poverty medicine framework, treating minority populations that historically have been under served and disenfranchised.

Fellows receive experiences in consultation/liaison, psychotherapy, and brief psychological assessment. Over the course of the year, fellows are expected to provide services/treatment to patients, consult with medical providers, participate in case conference, and supervise doctoral students (externs). In their supervision of extern-level trainees fellows are required to participate in the evaluation of their students, including providing them with ongoing feedback on their progress. Fellows are encouraged to discuss their interests and training needs with their supervisor(s) early in the year to design a program suitable to them; ongoing discussion of interests is also encouraged in order to maximize training experiences.

Fellows in the Behavioral Medicine emphasis area are also strongly encouraged to develop advanced clinical management and administrative skills by assuming the role in medical clinics of both the psychology representative and point person for referrals between the medical and mental health care systems on the HUMC campus. They also are taught to manage and coordinate other trainees and staff, as appropriate, and programmatic planning, implementation, and evaluation. In this capacity, the fellows are aided in a stepped progression towards independent practice with attention paid to the nuanced nature of behavioral medicine services.

The Behavioral Medicine emphasis area collaborates with medical colleagues in ongoing research projects; fellows in this emphases area are invited to participate in these projects as well as initiate projects of interest to them. Opportunities also exist for fellows in the Behavioral Medicine emphasis area to learn grants writing skills, and to participate in all levels of the research process.

Fellows in the Behavioral Medicine emphasis area are required to cross train across the opportunities described below.

HIV Mental Health

The fellowship training in Behavioral Medicine/HIV Mental Health  offers experiences in behavioral medicine focused on psychiatric and psychological treatment to HIV/AIDS affected and infected individuals living in Los Angeles County. Provision of integrated care services to the HUMC Immunology Clinics is also required, wherein the fellow serves as the psychology representative on the multidisciplinary team (physicians, nurse practitioners, HIV/Infectious Disease medical fellows, nurses, social workers, case managers). While the fellow interfaces with medical patients and personnel on the HUMC campus, ample opportunities also exist for collaborating and providing integrated care services to patients from the following partnering Immunology clinics in the community:

  •  Long Beach Health Department Early Intervention Program
  • St. Mary Medical Center, CARE Clinic;
  • HIV Mental Health Service Requirements:
  • Provide consultation services to the outpatient Immunology Clinic (N24) on average eight (8) hours per week
  • Provide outpatient psychotherapy on HIV Mental Health Services (D2) on average eight to ten (8-10) hours per week
  • Inpatient HIV/AIDS consultation (per admission census)

Women’s Health

Women’s Health is focused primarily on providing psychological consultation and psychotherapy services to women of various ages and from diverse socio-cultural backgrounds. This area offers a rich experience working in a poverty medicine framework, treating minority populations that historically have been underserved and disenfranchised. Patients seen for medical treatment in the following clinics are serviced by the sub-emphasis area:

  • Continuity Care Gynecology Clinics
  • Gynecology Urgent Care Clinic
  • HUMC Obstetrics (OB) Clinics, including Special Obstetrics (SPOB)
  • Specialty Care Gynecology Clinics:
    • Tumor (Gynecologic Oncology [Gyn-Onc]) Clinic
    • Urogynecology Clinics
    • Reproductive Endocrinology and Infertility Clinic (REI)
    • OB/Gyn Inpatient Floor

Prerequisites

  • Prior advanced/significant experience in Behavioral Medicine and Clinical Health Psychology
  • Previous experience in the assessment and treatment of persons with severe and persistent mental illness and persons from varied diverse backgrounds
  • History of scholarly activity and interest in research; health disparities interests preferred though not required

Required Experiences

  • Maintain sub-emphasis training requirements as well as the overall training program requirements
  • Provide outpatient psychotherapy at the Family Medicine Clinic (Adult Primary Care) at Lomita (i.e., FHC) on average four (4) hours per week
  • Provide outpatient psychotherapy at the Gardena High School Medical Clinic (GHS; Adolescent Medicine) on average four (4) hours per week
  • Participate in the Behavioral Medicine Consult Clinic approximately four (4) hours per month. Fellows consult and provide short-term treatment to patients referred for Health Psychology/Behavioral Medicine consultations from various medical departments and clinics at HUMC. An interdisciplinary model is used (Psychology and Psychiatry); patients are followed by the Psychology Fellows and PGY 3 Psychiatry Residents on the Psychiatry C/L Service. A co-precepting model (Psychology and Psychiatry attendings) is used
  • Provide weekly (approximately [4] four hours per week) of consultation services to the Department of Pediatrics focused on reducing diabetes and overweight and obesity disparities in pediatric populations. Services are focused on the following two pediatric subspecialties and are primarily outpatient based though inpatient consultations do arise: Pediatric Endocrine (diabetes clinics); Be Forever Fit (overweight and obesity clinic).
  • Participation in supervision of clinical cases, administrative issues, professional development, and supervision of externs (in addition to other needs that arise)
  • Routine and regular contact with supervisor(s) (weekly supervision, including weekly log of hours). Ongoing communication of patient progress, with particular attention to those seen on a consultation/liaison basis in clinics and inpatient
  • Provide at minimum two (2) audio-recorded sessions per month for review. In vivo or videotaped supervision may also be instituted. All outpatient therapy cases should be recorded on a weekly basis
  • Meet with assigned supervisors; assigned supervisors to discuss their expectations of supervision
  • Supervision of assigned extern(s); provide one (1) audio-recorded supervision session per month for review
  • Teaching Behavioral Medicine Foundations to Department of Mental Health psychologists; teaching appropriate psychological and health behavior change theories, models, applications, topics, etc., to medical staff
  • Attendance and participation in Behavioral Medicine Service meeting

Required Supervision

• One (1) hour individual supervision with emphasis area supervisor
• One (1) hour group supervision for supervision of supervision
• One (1) hour of group supervision with psychiatrist
• One (1) hour of group supervision with psychiatrist or psychologist
• Attend Service Staff Meeting/Case Conference

Required Courses
• Behavioral Medicine Seminar
• Psychiatry Grand Rounds
• Three day DBT training (24 hours)
• One day CBASP training (8 hours)
• One day ACT training (8 hours)
• Psychology Case Conference (1.5 hours/week)

Elective Courses/Clinical Experiences
• Medical ER rotation Half-day per week for six (6) months
• Rotate for one (1) month full-time or six (6) months part-time as primary evaluator in the Psychiatry ER
Evaluation of Satisfactory Progress and Outcome
Fellows in the Behavioral Medicine emphasis area will be assessed using a competencies-based evaluation tool both at mid-year and end-year; fellows are expected to obtain a rating of satisfactory (score=3) or above across the following competencies (especially by the end of the fellowship):
• Interpersonal Skills
• Psychological Assessment
• Research/Scholarly Activity/Program Evaluation
• Teaching/Training
• Consultation/Interdisciplinary Collaborations
• Diversity
• Ethics
• Self-Management/Metacompetencies
• Leadership Skills
• Supervisory Skills
Additionally, fellows’ progress and outcomes will be assessed on an ongoing basis utilizing:
• Supervision (individual and group), including review of charting/documentation practices, review of session recordings, observation of clinical care/consultation of patients, etc.
• Participation and contributions to case conferences, meetings, rounds, etc.
• Consultation to medical and other treatment teams
• Feedback from other attending and supervisory faculty
• Review of mid- and year-end evaluations by supervised psychology externs.

Goals and Objectives
The target goal in the Behavioral Medicine emphasis is for fellows to successfully complete the program with a minimal level of satisfactory ratings in the following areas:

  • Interpersonal Skills
    o Ability to take respectful, compassionate and professional approach with diverse others and all levels of contact (patients, supervisors/attendings, staff, students)
    o Competence in functioning as the psychology representative on inter-and multi-disciplinary teams
  • Psychological Assessment.
    o Accurate complex diagnosis of patients
    o Assessing and utilizing patient outcomes to direct behavioral medicine interventions and treatment linkage
    o Formal, hypothesis driven psychological testing of behavioral medicine patients
    o Writing concise, tailored consultation reports
  • Research/Scholarly Activity/Program Evaluation
    o Research project development and collaboration
    o Prepare and submit manuscripts for presentation/publication
    o Presentation of findings at conferences
    o Oversee research assistants
  • Teaching/Training
    o Teach foundations of Behavioral Medicine and other psychological models, theories, applications, etc., to county psychologist and medical staff
  • Consultation/Inter- and Multi-disciplinary Collaboration
    • Outpatient consultation services to medical clinics
    • Inpatient consultation services to hospitalized patients
    • Competence in functioning as the psychology member of inter- and multi-disciplinary teams
  •  Diversity
    • Awareness, integration, monitoring of stimulus value including areas related to diversity
    • Application of culturally competent practice of Behavioral Medicine
  • Ethics
    • Ethical practice of psychology across consultation, psychotherapy, assessment, supervision, teaching, research, etc.
  • Self-Management/Metacompetencies
    • Knowledge of one’s scope of practice and professional limits
    • Development and refinement of metacompetency skills
    • Practice of timely and thorough charting, adherence to work hours and workplace regulations/policies, etc.
    • Implementation of self-care practices
  • Leadership Skills
    • Effective participation and contribution to inter- and multi-disciplinary teams
    • Competence in the managing the daily activities associated with the practice of Behavioral Medicine
  • Supervisory Skills
    • Knowledge of supervision theory and supervisory skills limit
    • Development of evaluating supervisees and providing formative and constructive feedback