IPPP Placements for 2013 - 2014

Child and Family Rotations

* All Child and Family rotations include a primary placement at the Children's Intervention Program (ChIP) at RCMH, which involves work with children ranging in age from 2 to 18 years of age.  Each rotation includes a secondary placement that is in one of our school-based locations.

1. (C&F) Young Child/ASDs - Interns placed in this rotation will have an emphasis on work with young children (ages 2-6 years), as well as a role on a multidisciplinary community-based committee that addresses the early intervention needs of youth.  In addition to providing consultation, interns may participate in the development and implementation of training programs for daycare providers.  Additionally, interns in this position take on a substantial role in our Asperger's Emotional and Social Enrichment Program (AESEP) by conducting evaluations (ADOS/ADI-R) and facilitating social skills groups.
2. (C&F) Adolescent/DBT - Experiences in this rotation involve extensive training and supervision in Dialectical Behavior Therapy (DBT) with adolescents, including co-facilitation of multifamily skills-based groups, individual therapy with DBT participants, and participation on the weekly DBT consultation team.
3. (C&F) General/Trauma/Assessment- This rotation allows interns to focus on work with traumatized children and their families through extensive training and supervision in Trauma-Focused Cognitive Behavior Therapy (TF-CBT), as well as participation on the TF-CBT consultation team.  Additionally, interns placed in this rotation will have a more substantive portion of their time devoted to conducting comprehensive psychological evaluations.

Integrated Primary Care (IPC) Rotations:

* All Integrated Primary Care rotations involve a primary placement in an integrated care setting with Capitol Region Health Care (CRHC), a RCMH affiliate, which includes  work with individuals from across the lifespan.  The Adult or Child and Family emphasis pertains to the secondary placement at RCMH's satellite office in Franklin, NH.

4. (IPC) Adult - This rotation includes training at the Concord Hospital Family Health Center (CHFHC) in a rural satellite branch office in Hillsboro, NH.  Intern experiences will involve the provision of individual and family therapy on an outpatient basis to a generalist population through a primarily family systems orientation.  Additionally, work in the IPC setting includes consultation with Dartmouth Family Practice Medical Residents.  The secondary setting for this rotation occurs at Twin Rivers Counseling Center (TRCC) in Franklin, NH, which is one of RCMH's rural satellite offices.  At TRCC the intern is a member of the Adult Treatment Team and receives training and supervision from a largely psychodynamic perspective.

5.  (IPC) Child and Family - Interns placed in this rotation receive training at Concord Hospital Family Health Center (CHFHC) located at Concord Hospital.  Intern experiences will involve the provision of individual and family therapy on an outpatient basis to a generalist population through a primarily family systems orientation.  Additionally, work in the IPC setting includes consultation with Dartmouth Family Practice Medical Residents.  The secondary setting for this rotation occurs at Twin Rivers Counseling Center (TRCC) in Franklin, NH, which is one of RCMH's rural satellite offices.  At TRCC the intern is a member of the Child Treatment Team and work involves treatment to Seriously Emotionally Disturbed (SED) children and their families.

Training Program Descriptions

Children's Intervention Program.  The Children's Intervention Program (ChIP) of RCMH provides quality; comprehensive, family centered and community based mental health services to children and families.  We work actively toward the development of an individualized comprehensive system of care for children and families.  We believe that collaboration and partnerships with families and with community resources are important methods to attain this goal.  The ChIP program believes that children are best served in their families and in their communities, with access to quality and comprehensive mental health services.  We develop treatment plans that are based on a comprehensive biopsychosocial assessment that delineates the child and families needs, and encourage parent and guardian participation, involvement and investment in the assessment, treatment planning, service delivery and the treatment review process are necessary for successful outcomes.  The resources and services provided by the mental health center are part of the continuum of a larger system of care for children and youth within the community and the State and we operate under the premise that successful treatment requires collaboration and coordination among these resources.  Services need to be flexible and creative. That treatment plans need to be continually evaluated and altered to meet the changing needs of children and families.  At ChIP, interns conduct individual and family therapy with clients age three to eighteen who exhibit a wide range of psychopathology.  They also conduct psychological assessments, participate in multidisciplinary teams, and conduct crisis and case management.

Young Child Focus.  In 1999 a county-wide, formal Zero through Six Mental Health Steering Committee was formed. This committee identified the following priorities: to develop in the community, competence and expertise in addressing the mental health needs of children and families; address multi-level training need in the community (i.e. for child care providers and medical service providers; develop an interagency community based consultation and evaluation team; develop an understanding of related financial issues and resources; and further prevention efforts in our region.  Our Young Child rotation involves participation on the Zero to Six Mental Health Steering Committee, which is part of the NH Association for Infant Mental Health, that  now represents collaboration between many agencies and programs, which share as their mission, supporting the development of healthy children and families in greater Merrimack County.  As a member of this committee, interns provide direct services to children ages two to six years at ChIP, provide daycare and preschool consultations to address the emotional and behavioral needs of identified youth, and offer training to childcare providers across the community.

Asperger's Emotional and Social Enrichment Program (AESEP). Due to the burgeoning need for services to children on the Autism Spectrum, AESEP was designed to provide an array of services for individuals with ASDs that may benefit from a comprehensive treatment program.  The AESEP program begins with a thorough evaluation of an individual's strengths and needs conducted by psychologists who specialize in the treatment of AS.  Results from the evaluative process are used to develop goals and objectives that inform the approaches and practices of providers on the treatment team.  Based on the information gleaned from the evaluation process particular services will be prescribed and implemented by a team of professionals that may include psychologists, mental health therapists, family therapists, outreach workers, and psychiatrists.  Skill development for each participant of the program is routinely assessed to assure that progress is being made and that treatment is effective.  Treatment team members meet on a regular basis to order to make certain that services are being implemented in a coordinated fashion.  They participate in ongoing training which is informed by evidenced based practices from the literature and consultation by experts in the field so that each participant in the program can be assured that treatment is provided by knowledgeable and skilled practitioners.  Interns placed in this rotation provide individual therapy to ASD children, and participate in the development and co-facilitation of psychotherapy groups.  They develop the capacity to conduct comprehensive evaluations with this population through extensive training on the ADOS and ADI-R and are members of our Asperger's consultation team.

School-Based Services.  Our school-based services are premised our commitment to provide quality, accessible services to the community.  We have long-standing interagency collaborative relationships with area rural schools.  All interns placed in the Child and Family rotations are assigned to school-based clinics as the secondary portion of their rotation.  School staff or parents can refer clients to Riverbend and the Admissions department and clinician collaborate to determine if it is appropriate for them to be seen in the school setting.  The co-location of academic and mental health services fosters ongoing consultation with parents, school staff, and other agencies involved with RCMH clients. Often interns present to teachers and/or parents about mental health issues.  The clinics at schools represent successful efforts to integrate health care services.

Dialectical Behavior Therapy.  This rotation involves working with adolescents participating in a Dialectical Behavior Therapy (DBT) program.  ChIP's DBT program is based on the work of Marsha Linehan, Ph.D., Alec Miller, Psy.D., and Jill Rathus, Ph.D.  Clients who participate in this treatment modality demonstrate severe difficulties in the areas of emotional regulation, distress tolerance, adolescent-family relationships, and interpersonal effectiveness.  These adolescents typically display suicidal and self-harming behaviors.  Interns learn theories and framework of DBT, how to provide the individual therapy component to DBT, and serve as co-facilitators in a 16 week multi-family skills group, and are members of ChIP's weekly DBT consultation team which provides ongoing consultation and support for therapists working in this model.

Integrate Primary Care. The integrated primary care (IPC) pre-doctoral psychology internships are a joint venture between Riverbend Community Mental Health Center and Concord Hospital.  Both organizations are part of Capital Region Health Care and have a long standing history of working collaboratively.  The internships are both located in primary care centers. The Family Health Center (FHC) is in Concord NH and Hillsboro Family Health (HFH) in Hillsboro NH, a rural community about thirty minutes away.  These health centers partner with the NH Dartmouth Family Medicine Residency which is a three year program with a mission to train medical school graduates to practice comprehensive family medicine.  This residency, with its educational mission, provides an excellent opportunity for psychology interns to learn how to partner and collaborate with medical professionals.

Two theoretical models provide orienting an orienting philosophy to the internships, one older, the other more recent.  The first is the biopsychosocial model first described by George Engel in 1969.  The basic premise of this model is that health care is best provided within a broad systems view where biological/genetic factors as well as psychological, social and spiritual variables are all considered in the care of an individual patient.  Further the relationships between these variables and their mutual influence on each other is seen as critical.  The second model is the patient and family centered medical home which includes concepts about health care delivery including comprehensiveness of care and access to all services needed by a patient and family to improve health.  The clinical application of both these models requires partnerships between medical and psychosocial professionals.  The psychology interns practice for a year in these practices.

The intern placed at the FHC is on site for two and a half days.  This is a "child placement" for the psychology intern because of the secondary component of the rotation.  In the primary care setting the intern caters to all patients regardless of age or problem.  They function most often as a "behavioral health consultant" and a key skill of this role is to be able to triage patients based on the severity of the presenting issue.  On Monday mornings interns participate in a two hour group supervision, multidisciplinary meeting where clinical material is presented and discussed, often using videotapes.  The psychology intern, in collaboration with a pediatrician and nurse clinician, evaluates children referred for behavioral, medical, or emotional problems.  The intern meets with Dr. Gunn for one hour of individual supervision where cases are presented most often using videotape and/or live supervision.  Dr. Gunn is a family psychologist and supervises cases through a broad systemic and family oriented lens.

There are three primary goals of the IPC rotation.  The first is to increase skill in behavioral health consultation in a primary care setting.  The second is to increase skill in providing individual, couple, or family therapy to a wide range of presenting problems, including chronic health conditions.  A third goal is to learn how to function as a psychologist in a primary care setting. To accomplish the last goal, the intern sees patients with family medicine residents and provides them feedback on their ability to incorporate psychosocial skills into their practice.   They also partner with integrated care managers in the practice to learn how to provide brief targeting treatment to patients.

The HFH is located in a rural area of New Hampshire thirty minutes from Concord.  The professionals at HFH provide comprehensive primary car to 5000 patients, many of whom are uninsured or underinsured.  The intern placed at HFH has a secondary placement that involves work with only adults and thus is termed an "adult placement" however the distinction between a child and adult placement loses meaning in primary care since the intern needs to be able to see all patients regardless of age or problem.  On Monday mornings the HFH intern participates in a two hour group supervision, multidisciplinary meeting where clinical material is presented and discussed, often using videotapes.  The psychology intern also provides assessment services to both children and adults who are referred with in the practice for these services.  The intern meets with William Gunn, PhD, their primary supervisor for one hour of individual supervision where cases are presented most often using videotape or live supervision.  The intern also receives an hour of supervision weekly from Chase Levesque, PsyD.  Dr. Levesque was a previous psychology intern in this program who is a member of the IPPP core faculty and now works as an Integrated Care Manager at the Hillsboro site.

Twin Rivers Counseling Associates.  Riverbend - Twin Rivers Counseling Associates (TRCA) is an outpatient community mental health center office.  We provide a number of psychological and psychiatric services for those in need.  Most of our clients are indigent and suffer with more serious disturbances.  Services are provided for clients based on age by either a Child Team or an Adult Team.  These teams consist of individuals from a variety of disciplines who are fully invested in serving our clients with the highest standard of care.  Our staff consists of:  psychotherapists; case managers; a clinical psychologist; a psychiatrist; a nurse; a vocational specialist; and a pre-doctoral psychology intern.  Additionally, we have a psychotherapist practicing out of Health First - a local, community health clinic.

We provide psychotherapy (of various orientations /styles), case management, vocational services, medication services, and "Illness Management and Recovery", an educational program used for some individuals with more severe difficulties.  Our team is deeply dedicated to healing and believes in the possibility of full recovery - from any mental disorder, regardless of severity.  We have a strong regard for privacy and individual choice and feel that personal, customized care is essential for recovery.

Franklin is a small, rural community.  Our center is in a quiet part of town, tucked back from the main drag.  We have a full organic vegetable and flower garden which staff and clients tend to.  This year, we will have enough produce to donate to community food pantries.

TRCA is the secondary placement for the interns on the Integrated Primary Care track.  The interns are in Franklin two days out of the week.  Primarily, interns focus on providing individual psychotherapy.  Interns will typically have one or two couples or family cases.  Group work would be an option for the interested intern.  Formal psychological assessment is also practiced.  Interns are seen once per week in individual supervision and attend both clinical team meetings (clinicians, case managers, vocational specialist) and dispositional meetings (clinicians, case managers, vocational specialist, psychiatrist, nurse).  The intern becomes an integral part of the multi-disciplinary treatment team and helps formulate treatment decisions.