(APPIC/NMS program code = 161915)
The Rehabilitation Neuropsychology track was created to provide residents with an opportunity to receive more focused training in neuropsychological assessment and neurorehabilitation. Importantly, this track does not consist solely of neuropsychological testing and interpretation. Rather, residents in this track will receive specific education and training in neuropsychological aspects of typical rehabilitation populations, diagnostic interviewing skills, test selection, test interpretation, report writing, conducting testing feedback sessions, and using neuropsychological test results and knowledge about brain-behavior relationships to inform multidisciplinary rehabilitation programming. Residents in the Rehabilitation Neuropsychology track will also receive general training in rehabilitation psychology analogous to those in the Behavioral Medicine Track. The training experiences in this track are designed to be consistent with the Division 40 Houston Guidelines, and to prepare trainees for further postdoctoral study in Clinical Neuropsychology. Prior experience in a medical rehabilitation setting is helpful but not necessary to have a rewarding training experience. Prior experience in neuropsychology is expected for the resident in the Rehabilitation Neuropsychology track. We plan to accept one Rehabilitation Neuropsychology resident per training year.
Training Experiences & Treatment Modalities (Model)
All psychology residents at the University of Washington complete a total of three, 4-month rotations during the residency year. For the Rehabilitation Neuropsychology resident, two of these rotations will include more focus on neuropsychology and neurorehabilitation within the medical setting. These will include experiences at Harborview Medical Center, or affiliated clinics, and at the University of Washington Medical Center. All of these sites afford the resident ample training experiences in evaluating adults with a range of cognitive, central nervous system, and medical disorders, including traumatic brain injury, stroke, brain tumor and systemic forms cancer, multiple sclerosis, neurodegenerative disease, and organ transplant.
The third rotation will not have a neuropsychology focus. This rotation may include training in consult/liaison psychology, in the HMC Burns or Pediatric Clinic, at the Madison Clinic, or in another hospital affiliated clinical service. This rotation structure is designed to give the Rehabilitation Neuropsychology resident a training experience that includes both in-depth work in neuropsychology and exposure to more general behavioral medicine content.
The training model emphasizes empirically supported scientist-practitioner approach to assessment and treatment. The Rehabilitation Neuropsychology resident will function as an integral member of an interdisciplinary rehabilitation team, which includes psychology, medicine, speech-language therapy, physical therapy, occupational therapy, nursing, and vocational rehabilitation. For inpatient services, the Rehabilitation Neuropsychology resident will cover 1-2 teams on an acute inpatient rehabilitation unit, which will include psychological and neuropsychological assessment and utilization of the assessment findings for rehabilitation treatment planning and development of behavioral programs. Rehabilitation Neuropsychology residents will also be involved in intensive outpatient evaluation experiences, including comprehensive interview, integrative report writing, and feedback. Psychotherapy training is an important component of the Rehabilitation Neuropsychology track and all residents in this track will follow outpatients to aid in psychological adjustment. Participation in weekly rounds and team/family conferences will also be important part of the neuropsychology residents’ experience.
During their Neuropsychology focused rotations, the Rehabilitation Neuropsychology resident is expected to complete one comprehensive outpatient neuropsychological evaluation per week, and on as needed basis, brief inpatient neuropsychological screens (typically 1-3 per month). Outpatient neuropsychological testing is completed by psychometry but the resident will be required to administer the inpatient battery. The resident will be involved extensively in the interview, integrative report writing, providing feedback to patients and family, and communicating evaluation results to and coordinating care with care providers, including those in our multidisciplinary inpatient and outpatient rehabilitation care teams.
In regard to psychotherapy, expectations of case load of first rotation will vary slightly depending on site (UWMC or HMC) but will typically include 5-6 outpatients per week. Inpatient psychotherapy and consultation expectations typically include 8-12 patients per week. The Rehabilitation Neuropsychology resident will provide the initial inpatient comprehensive psychological evaluation on each of their rehabilitation patients, with the clinical responsibilities being to see the patients once a week and combine their input with those of a multidisciplinary team during weekly rounds. Throughout the internship year, the Rehabilitation Neuropsychology resident will also participate in regularly held neuropsychological journal club and fact-finding exercises. The resident will also join the Behavioral Medicine residents in a weekly neuropsychology seminar and the monthly rehabilitation psychology journal club.
The faculty neuropsychologists will provide at least two hours per week of individual supervision for each assessment case, but the resident will also be involved in weekly group supervision that can be utilized to discuss neuropsychological cases. Outpatient neuropsychological assessment and report writing is supervised by ABPP board certified clinical neuropsychologists.
Rehabilitation Neuropsychology Rotations
As described above, Rehabilitation Neuropsychology residents will complete a total of three rotations during their training year. Two of these rotations will include a focus in Neuropsychology and Neurorehabilitation, while the third will not.
We list these rotation sites separately below.
Rotations With A Specific Neuropsychology Focus
- Jeanne Hoffman, PhD, ABPP-RP (inpatient consultations and outpatient rehabilitation)
- Ivan Molton, PhD, (inpatient rehabilitation, outpatient rehabilitation Clinic)
- Lauren Schwartz, PhD, (outpatient rehabilitation clinic)
- Myron (Moe) Goldberg, PhD, ABPP-CN, (Director, Neuro Rehabilitation Program & Neuropsychology Service)
- Nickolas Dasher, PhD, (outpatient Neuropsychology Service)
The UWMC Rehabilitation Neuropsychology rotation provides an array of clinical experiences to train clinical psychologists within a multidisciplinary team framework in a medical setting. Residents will have opportunities to work collaboratively with physicians, nurses, speech pathologists, physical therapists, occupational therapists, vocational counselors, therapeutic recreation therapists, and social workers, from within the medical center as well as from the community in developing and implementing treatment plans. Psychology is an integral part of the medical team. Our patients are diverse in terms of medical conditions and problems, ethnic and socioeconomic backgrounds, and ages.
Rehabilitation Neuropsychology residents will have an opportunity to evaluate and treat patients with a variety of presenting medical conditions, including spinal cord injury; brain injury due to trauma stroke, tumor, aneurysm, hemorrhage, hypoxia, etc.; multiple sclerosis; muscular dystrophy; post-polio syndrome; amyotrophic lateral sclerosis; cancer; and large organ transplant (heart, lung, and liver). The rotation provides a mix of inpatient and outpatient assessment and treatment opportunities.
Like their counterparts in the Behavioral Medicine track, Rehabilitation Neuropsychology residents learn to function as an integral member of an interdisciplinary rehabilitation team. Rehabilitation Neuropsychology residents cover 2 teams on the acute inpatient rehabilitation unit and follow outpatients weekly in the rehabilitation clinic. Typical patients present with need for assessment of psychological and/or neuropsychological functioning, identification of patient and family concerns, development and implementation of appropriate treatment programs, and mobilization of resources to integrate the patient into the community. Rehabilitation Neuropsychology residents will also participate in both brief inpatient neurocognitive screens and more intensive outpatient neuropsychological evaluation experiences, including interviewing, test selection, administration, scoring, and interpretation, results integration, differential diagnosis, and report writing, as well as feedback to patients, family, and referral sources.
There is also the opportunity to observe or participation in outpatient treatment groups focused on neurorehabilitation. Participation in weekly rounds and team/family conferences is an important part of the psychology residents’ experience.
Psychology residents in this track participate in a monthly rehabilitation psychology journal club. All Rehabilitation Neuropsychology residents attend a weekly neuropsychology seminar that involves relevant topic presentations and case reviews. Residents also have opportunities to attend the Department of Rehabilitation Medicine’s Grand Rounds which occurs twice per month and covers various rehabilitation topics, many of which are of interest to residents.
Expectations of Psychology Residents
Rehabilitation Neuropsychology residents participate in all aspects of the training experiences listed above. Residents in this track can typically expect to follow 4 to 8 inpatient cases, and 5-6 outpatient cases. Rehabilitation Neuropsychology residents will also be expected to be involved in at least one outpatient neuropsychology evaluation case per week.
By the end of the rotation, Rehabilitation Neuropsychology residents are expected to:
- have an understanding of a psychologist’s role on an interdisciplinary rehabilitation team
- demonstrate an increased awareness of and ability to assess the emotional, behavioral, and cognitive sequelae of various traumatic and chronic medical conditions
- have a strong understanding of the functional implications of neuropsychological test results in rehabilitation
- develop the knowledge and skills necessary for basic competence in the neuropsychological evaluation of patients with known or suspected organic brain dysfunction
- recommend and implement basic therapeutic interventions with patients and their families
- apply ethical and legal principles to practice
- have an awareness of personal strengths and limitations as they relate to providing psychological services to this population.
All psychology residents will have an orientation session with tours of the facility. Residents will then have an opportunity to accompany and observe the supervising psychologist(s) performing clinical work. Residents will then have opportunities to see patients with direct observation and supervision provided. The eventual goal is for psychology residents to work fairly independently with patients and to move towards a co-treatment model. Psychology residents are provided with examples of psychological /neuropsychological evaluation reports, progress notes, and other written communications as models. All residents have access to a training manual and numerous articles and books to supplement their learning experiences. Residents participate in weekly scheduled individual supervision as well as weekly group supervision. They have additional opportunities for contact and supervision with the supervisors during weekly rounds and conferences. Residents are encouraged to drop by or page the supervisors with day-to-day questions concerning patients. Supervision is provided by the attending psychologists, and additional supervision may be provided by the post-doctoral fellow.
Evaluation of Psychology Residents
Supervisors provide frequent, ongoing feedback on the psychology resident’s performance throughout the rotation. Residents and supervisors discuss the resident’s progress and training needs at the mid-rotation point. Psychology residents participate in standard evaluation practices that are part of the overall internship which includes self-evaluation, evaluations by their supervisors, resident evaluation of their supervisors and resident evaluation of the rotation site.
- Jeffrey Sherman, PhD, (Consults)
- Dawn Ehde, PhD (CORP neuropsychology)
- Gina Formea, PhD, ABPP-CN (CORP neuropsychology)
- Charles Bombardier, PhD, ABPP-RP (Inpatient rehabilitation)
General Rotation Description & Patient Demographics
HMC provides training in medical psychology and neuropsychology and operates primarily within two areas of the medical center: the Inpatient Rehabilitation unit (Bombardier) and the Comprehensive Outpatient Rehabilitation Program (Formea, Ehde and other faculty).
Patients are commonly admitted to HMC due to trauma or acute illness. Psychology residents typically work with patients who have sustained traumatic brain injury, cerebral vascular accidents, spinal cord injuries, and multiple traumas. Patients come from diverse backgrounds in terms of ethnicity, socioeconomic status, and geographical location. An important aspect of HMC rotations is understanding the role of clinical psychologists within an interdisciplinary team framework and within a health care delivery system. All psychology residents work with multidisciplinary teams that include physicians, nurses, speech pathologists, physical therapists, occupational therapists, social workers, and vocational counselors. This site provides abundant opportunities to apply psychological and neuropsychological principles in a medical setting with patients experiencing a variety of acute medical and surgical conditions.
Training Experiences & Treatment Modalities
The mission of the psychologists at the Harborview Medical Center (HMC) rotation is to provide primary psychological care for inpatients on the Rehabilitation Medicine unit as well as patients followed by the Outpatient Rehabilitation Medicine Service. Rehabilitation Neuropsychology residents completing the HMC rehabilitation psychology rotation gain experience with a wide variety of acute medical and surgical conditions and learn to work on interdisciplinary medical teams in both inpatient and outpatient settings. Harborview Medical Center is a Regional Level I Trauma Center serving five states with a highly diverse patient mix. Psychologists play a prominent role in the care of these patients. This site provides a unique opportunity to work with a multiethnic patient population and to obtain training from psychologists who regularly integrate clinical and research activities. It also gives the experience of providing psychological and neuropsychological services in a fast-paced, intense, but extremely collegial environment.
Like their counterparts in the Behavioral Medicine track, Rehabilitation Neuropsychology residents work closely with a variety of medical and adjunctive medical disciplines such as physical therapy, occupational therapy, speech pathology, nursing, social work, rehabilitation counseling, and therapeutic recreation. HMC rehabilitation psychologists must rely on treatment modalities that fit well into the trauma setting. As such, there is a heavy emphasis on consultation/liaison, brief psychotherapy, and focused assessment. Behavioral and cognitive-behavioral frameworks are used frequently. Training in hypnosis for pain control and motivational enhancement therapy for substance abuse is available. The psychologists often rely on a systems approach in which the patient is evaluated and treated within the context of the interdisciplinary health care team and family. Assessing and treating team behaviors is often essential to assisting the patient.
Psychology residents at HMC rehabilitation first undergo a group orientation session with tours of the facility. Residents then accompany and observe an attending psychologist doing clinical work. Based on the residents’ level of comfort they are then provided with the opportunity to see patients under visual supervision. As the comfort level of residents’ further progresses, supervision increasingly takes the form of CO-treatment or face-to-face review of cases. Residents meet with attending psychologists for individual supervision on a weekly basis. Group supervision meetings are held on a weekly basis as well. All residents are invited to attend the weekly neuropsychology case-based seminar. There is a minimum of two hours of individual supervision a week, although psychology residents are encouraged to page the supervisors with day-to-day questions about the patients.
A psychology resident handbook is provided that contains extensive reading materials pertaining to the patient populations served and resident clinical responsibilities. Model reports, structured evaluation formats and practical clinical care guidelines are also included. Psychology residents typically attend multidisciplinary Rehabilitation and Burn Unit rounds, thereby becoming familiar with the work of other professionals. They continue to attend the regular internship didactics through this rotation as well as specialized seminars on topics of specific importance to residents (e.g., acute pain/stress management techniques, hypnosis for pain and stress, introductions to spinal cord injury, traumatic brain injury, and burn injury as well as sessions on working with interpreters, with multi-ethnic populations, and with medical teams).
HMC Inpatient Rehabilitation
For the inpatient rehabilitation aspect of the rotation residents are the first line consultants to the medical, nursing and therapy team members regarding the assessment and treatment of psychiatric disorders, functional implications of neurocognitive impairment, substance abuse disorders, adherence to treatment issues, and overall adjustment to injury or disease. Residents learn about common cognitive, behavioral, and psychological conditions associated with traumatic injuries such as brain injury and spinal cord injury as well as neurological conditions such as stroke and aneurysms. They learn how to help patients, their loved ones, and rehabilitation team members cope more effectively with the rehabilitation process. Rehabilitation Neuropsychology residents will also select, interpret and report on results from a brief neuropsychological testing battery administered by a dedicated psychometrist and supervised by Dr. Bombardier.
HMC Comprehensive Outpatient Rehabilitation Program (CORP)
The CORP program does not represent a stand-alone rotation. Rather, all residents at HMC treat CORP patients. The resident caseload of CORP patients depends on their other clinical responsibilities. Within CORP, residents will similarly function as an integral member of an interdisciplinary outpatient rehabilitation medical team that serves outpatients with neurological conditions (brain injury, stroke, spinal cord injury), chronic pain, and other medical/surgical conditions such as amputations. Residents provide a range of psychological services including psychological and neuropsychological assessment, consultation, and psychotherapy. Psychotherapy is typically short-term (4-12 sessions) and problem focused. Residents work with the family as well as the patient, consult to team members and community agencies, and utilize neuropsychological test results in treatment planning.
Within CORP, Rehabilitation Neuropsychology residents receive training in comprehensive outpatient neuropsychological assessment. These residents receive specific education and training in neuropsychological aspects of typical rehabilitation populations (see above), diagnostic interviewing skills, test selection, test interpretation, report writing, conducting testing feedback sessions, and using neuropsychological test results and knowledge about brain-behavior relationships to inform multidisciplinary rehabilitation programming.
General Resident Expectations & Supervision
HMC rehabilitation psychologists seek to train residents in a scientist/practitioner model. In addition, psychology residents learn to provide assessments and treatment within a primarily medical/surgical context. Thus, our objective is that residents are comfortable in acute medical settings in general, as well as rehabilitation unit placements specifically. General skills that are taught during these rotations include clinical and neuropsychological assessment of people with acquired physical and cognitive disabilities, integration of neuropsychological findings into multidisciplinary rehabilitation planning, DSM V diagnosis, behavioral management, non-pharmacological approaches to pain control, brief interventions for psychological distress related to medical conditions/grief, brief interventions for substance abuse problems, and working with families of people who have had trauma or disability. Rehabilitation Neuropsychology residents are generally expected to be responsible for eight to 14 inpatients and see about 5-6 outpatients per week. Residents provide an initial comprehensive psychological evaluation on each of their inpatient rehabilitation patients. Clinical responsibilities with such patients include seeing the patients once a week and combining their input with those of a multidisciplinary team during weekly rounds.
Rehabilitation Neuropsychology residents will also complete one comprehensive outpatient neuropsychological evaluation per week under the supervision of a HMC neuropsychologist through the CORP program. All psychology residents at HMC attend outpatient team rounds, collaborate with multidisciplinary team, and participate in groups. Psychology residents participate in standard evaluation practices that are part of the overall internship which includes self-evaluation, evaluations by their supervisors, resident evaluation of their supervisors and resident evaluation of the rotation site. Residents and supervisors exchange verbal feedback at the mid-rotation point. Written and verbal feedback is exchanged at the end of the rotation. In addition, residents are provided with feedback throughout the rotation based on observations of treatment, as well as participation in multidisciplinary team rounds. Training is provided by attending psychologists (faculty within the Department of Rehabilitation Medicine) and, frequently, one or two postdoctoral fellows. At least two hours of individual supervision per week is provided by psychology faculty, with additional supervision offered on an as-needed basis. One hour per week of group supervision is required. Rehabilitation Neuropsychology residents will also attend a weekly neuropsychology/rehab psychology seminar.
Rotations Without A Specific Neuropsychology Focus
Harborview Medical Center Department of Rehabilitation Medicine
- Jeffrey Sherman, PhD, (Consults)
- Shelley Wiechman, PhD (Burns, Pediatrics)
- Dawn Ehde, PhD (CORP neuropsychology)
- Gina Formea, PhD, ABPP-CN (CORP neuropsychology)
Harborview Medical Center Burn Unit and Pediatrics Service
Consultation Liaison Residents on this service are actively involved in a thriving psychology consultation service that provides treatment for the majority of the services in a regional, level 1 trauma center. About one third of consultation referrals are to the Burn Unit, which is world famous and provides interdisciplinary care on an inpatient and outpatient basis. Frequent clinical issues include facilitating adjustment to burn injuries, managing acute pain, assessing for reactions to trauma, and behavioral management. One third of the patient population on the Burn Unit is pediatric and residents are given the opportunity to work with children. Training with hypnosis and other acute pain and stress management techniques is available and often emphasized on this service. The other two thirds of consultation referrals are to nearly every unit in the hospital including Neurosurgery, Neurology, Orthopedics, Medicine, Surgery units and every ICU in the hospital. Clinical work with such patients often involves assessment and treatment after multiple traumas. This service differs from Psychiatry Consultation/Liaison in that the emphasis is on adjustment to physical trauma and brief psychotherapy as opposed to Psychiatry’s emphasis on suicide assessment, treatment of psychosis, and pharmacologic treatments.
The Inpatient C&L service and Burn/Pediatric services differ enough so that residents can rotate through both and receive different types of training.
The Madison Clinic
The Madison Clinic is an outpatient clinic located near Harborview Medical Center that provides medical care and social services for persons living with HIV/AIDS regardless of sexual orientation, race, or ability to pay. Each patient has a primary care provider who organizes services required. Care at the Madison Clinic is interdisciplinary. Mental health services are provided by psychologists and psychiatrists. Other providers include nurses, pharmacists, nutritionists, social workers, and other specialists. Psychology residents will function as part of this interdisciplinary team to provide assessment and treatment for a broad range of disorders found in patients living with HIV/AIDS such as depression, anxiety, PTSD and neurocognitive impairments as well as issues related to adjustment to chronic illness and adherence to medical recommendations.
Harborview Medical Center Outpatient Burn Clinic
Patients who are discharged from our inpatient burn unit continue to get care from our outpatient burn clinic often for at least two years after discharge. Much like the inpatient burn unit, it serves the surrounding five state region as the only verified burn center in the region. The clinic also accepts referrals for patients not treated on the inpatient burn unit. The Outpatient burn clinic served 2457 patients (both adults and children) this past fiscal year. Given the multitude of issues that burn survivors face, including ongoing pain, high rates of depression, PTSD and body image concerns, the psychologist is a valued member of the multidisciplinary team. The psychologist screens every patient during their clinic appointment, in conjunction with the medical team. Longer interventions are conducted on those patients who screen positive for psychological issues. Training opportunities include the opportunity to conduct brief screens and consult with the larger medical team, as well as providing evidence-based interventions targeted at managing distress (PTSD, depression, sleep disturbance) and adjustment to injury. Finally, trainees get to see the full spectrum of recovery from a serious injury when they can follow a patient from the ICU to the acute floor and on to the outpatient burn clinic.
Harborview Medical Center Outpatient Pediatrics Clinic
The Pediatric Clinic provides primary care services to children and teenagers, with a mission of serving patients from underserved populations. Approximately 3200 children receive care from this clinic as their medical home. Most patients (>90%) are not Caucasian. Recent immigrants are prevalent: 68% of the parents of children seen in the clinic were born outside the U.S. Fewer than 30% of the families speak English at home. These families rely on the clinic’s accessibility, interpreter services and outreach to specific ethnic and linguistic communities. The clinic is staffed by pediatric residents, attending physicians and mid-level practitioners. A broad range of consultants are housed in this clinic and include psychiatrists, adolescent specialists, social workers, psychologist, lactation consultants, and nutritionists. Psychology residents on this rotation get experience working with medical staff in a pediatric primary care setting. Common referral questions include assessment, treatment, and recommendations for a broad range of childhood internalizing and externalizing disorders such as ADHD/ADD, anxiety, depression, learning problems, eating disorders, eneuresis/encopresis, and disorders along the autism spectrum. Additionally, residents receive training in delivering interventions for behavior change and treatment adherence with common medical problems (obesity, substance abuse, asthma, and diabetes). Treatment planning for children and adolescents with behavior problems such as oppositional defiant disorder and conduct disorder, as well as culturally sensitive parent training strategies, are also common referral questions.