Internship: Placement Settings

Rotation # 1: Young Child/School-Based/PDDs (ChIP, PES, & PMHS) (141811)

This intern rotation has been developed to provide extensive clinical experience in the treatment of young children and their families, but also includes some work with pre-teens and adolescents. This rotation combines: 1) a position on the multidisciplinary children’s team; 2) participation on an infant and toddler mental health committee; and 3) placement in the school-based clinic at Pittsfield Elementary School (PES), serving a small, rural community with a high need for mental health services. The intern’s caseload is comprised largely of children between the ages of two and six years of age; their work involves providing individual and family therapy services, consultation to educators, parents, and other mental health providers, and conducting observational assessments and psychological evaluations.

The Children’s Intervention Program (ChIP) is staffed by a multidisciplinary team that provides psychotherapy, assessment, medication management and a range of other services for children and adolescents with emotional/behavioral disturbances and their families. In additional to outpatient services, Family Support Services are available to families of children with more severe difficulties: these include: therapeutic respite services, home-based family therapy, community-based support to individual children, and intensive case management. Interns at ChIP are a member of a psychologist team that offers individual, group, and family therapy; they perform a limited number of comprehensive psychological evaluations.

The Infant and Toddler Mental Health committee arose from a community need for collaboration of services for children under the age of five. Service providers from various local agencies meet on a monthly basis to learn about available services for this population and to discuss particular cases in order to link them with appropriate providers. As a member of this team, the intern, attends a conference regarding this specialization, monthly meetings, and other associated events. The intern conducts assessments of toddlers and consults with other professionals about recommendations for remediation. In the past, interns have been instrumental in developing and refining this program.

The ChIP program and the Pittsfield School District formed an alliance several years ago in order to provide accessible services to this rural community and to improve collaboration efforts for the large number of families serviced by both organizations. The school placement is provided in order to increase accessibility of services in an area where clients have serious mental health issues, multi-system problems, and limited resources. The school values highly the mental health services offered by Riverbend and offer office space and resources at the school. Interns placed at Pittsfield Elementary School (PES) have an opportunity to consult with teachers, guidance counselors, and special education staff.

Riverbend has a well-established social skills training program and interns serve an integral role in this program. ChIP provides several groups a year for youth of all ages with Autism Spectrum disorders, PDD, and ADHD and the intern co-facilitates these groups. Additionally, interns in this position provide individual and family therapy to children diagnosed with PDDs, namely Asperger’s Syndrome.

Rotations # 2 & 3: Child/Family/School-Based/DBT (ChIP, MVHS, PMHS) (141812) ** 2 Positions

The second rotation offered emphases the treatment of children and families with a focus on adolescents and involves a placement at the ChIP program and at either Merrimack Valley High School (MVHS) or Pittsfield Middle High School (PMHS). At both sites, interns are exposed to children who exhibit a wide range of psychopathology, including primarily those with severe emotional disturbances.

At MVHS and PMHS, interns provide mental health services as part of an integrated health care center or Wellness Center. Family practice residents provide medical treatment, dental services are offered, and interns provide individual, family, and group therapy to students. Interns regularly consult with parents, school staff, and other agencies involved with their clients. Often interns present to teachers and/or parents about mental health issues.

At ChIP, a significant part is working with adolescents participating in a Dialectical Behavior Therapy (DBT) program. ChIP therapists maintain an on-going DBT consultation team that meets weekly to support therapists providing DBT treatment to adolescents with severe difficulties in the area of emotional dysregulation and self-harming behaviors. ChIP’s DBT program, based on the work of Marsha Linehan, Ph.D., and her colleagues, includes both individual therapy and a multi-family skills group to teach self-management skills to clients and their caregivers.

Rotation # 4: Integrated Primary Care/Adult (CRFHC, Hillsboro & TRCA, Adult) (141813)

This rotation includes in-depth training in integrated primary care and the provision of mental health services to adults in rural settings. The intern’s primary placement is at the Hillsboro branch of the Capital Region Family Health Center (CRFHC) and the secondary at the Twin Rivers Counseling Associates (TRCA) adult services. While at CRFHC and TRCA the intern will work primarily with adults, however, may also provide services to some children and families.

Interns at TRCA work with individuals, many of whom suffer with severe psychopathology. Interns gain experience in psychotherapy, formal and informal assessment, and consultation.

CRFHC developed satellite services in Hillsboro, NH in 2004 in order to address a need for health treatment for those unable to travel to the Concord branches of CRFHC and RCMH. As a division of CRFHC, an important aim of the organization is to serve as a training program geared toward family medicine residents from Dartmouth. Riverbend interns and Dartmouth residents collaborate with each other on cases to insure effective treatment of mental and medical health problems and in the process are able to learn from each other through consultation.

Rotation # 5: Integrated Primary Care/Child (CRFHC & TRCA, Child) (141814)

Interns in this rotation gain extensive experience in the treatment of children and families in community-based settings with a focus on brief psychological evaluations and collaboration between medical and mental health providers. This rotation involves a primary placement at Capital Region Family Health Center (CRFHC) and a secondary placement at TRCA child and family services.

CRFHC is located on the grounds of the local hospital, Concord Hospital, and is a primary care facility providing comprehensive health care services to primarily low-income clients. It is also a major training site for the NH Dartmouth Family Practice Residency Program. Interns placed at this facility work as part of an integrated team of medical and mental health providers that conduct evaluations and provide treatment in a collaborative fashion. Interns play a key role in the Behavioral Pediatrics Clinic that provides assessments of ADHD and other behavioral disturbances of childhood.

The Children’s Intervention Program at Twin Rivers Counseling Associates (TRCA) Franklin offers a comprehensive array of services including psychiatric care, psychological evaluations, intensive case management, therapeutic respite services, and community-based intervention for children with more severe disturbances. Interns serve on multidisciplinary teams, provide consultation services to collaborating agencies such as school, and conduct psychological evaluations.