Behavioral Medicine Track (155214)

The Behavioral Medicine Track offers a variety of training experiences that address the relationship between psychological functioning and physical health. These rotations involve multi-disciplinary training in a variety of in- and outpatient settings with both civilian and veteran populations in specialty and primary care settings. The patient populations seen in these rotations are heterogeneous, as are the service settings.

• Behavioral Medicine Clinic (BM-IOP)
• Department of Family Medicine - Behavioral Health Consultation Clinic (BHCC)
• Hollings Cancer Center (HCC)
• Sickle Cell Disease Adult and Pediatric Clinics (SCD)
• Telehealth Resilience and Recovery Program (TRRP)
• Tobacco Treatment Program (TTP)
• Weight Management Clinic (WMC)
• Women’s Health and High Risk OB Clinic

Behavioral Medicine Clinic (BM-IOP)

On this rotation, interns receive a wide array of clinical experiences geared toward the delivery of psychological services to adult patients with a variety of general medical issues and chronic illnesses. Interns will gain some experience in working with AYA (adolescent and young adult) populations as well. Interns will gain fluency in a range of psychological/behavioral medicine services including but not limited to interviewing, assessment, psychological testing, individual psychotherapy, consultation, treatment-planning, and oral & written communication with a variety of medical specialties and interprofessional health care teams.

Behavioral Medicine Individual Psychotherapy

Interns see patients in the Behavioral Medicine Clinic for individual psychotherapy geared toward helping them manage chronic medical conditions and associated psycho-social complications. The Behavioral Medicine Clinic has relationships with several medical specialties and departments at MUSC and we provide comprehensive psychosocial services for patients preparing to undergo transplant or bariatric surgery. Interns may follow candidates for bariatric or transplant surgery for “pre-hab” (pre-surgical psychological and behavioral services focused on improving candidacy and surgical outcomes) and throughout recovery. For this population, interns may provide clinical services focused on improving health behaviors, cognitive therapy for treating psychiatric symptoms, and relapse prevention skills to assist in maintaining abstinence from substances. Additionally, interns may see patients with any number of medical conditions such as: chronic pain, irritable bowel syndrome, pancreatitis, headache, sleep problems, hypertension, Crohn's disease, fibromyalgia, conversion disorder, diabetes, and many others. Interns will get hands-on experience in multidisciplinary treatment, providing cognitive psychotherapy, biofeedback, behavioral therapy, integrative psychotherapeutic approaches, and are expected to communicate relevant treatment-planning information to a variety of medical disciplines including physicians, APPs, nurses, and social workers.

By the end of the rotation, the intern will be able to:

• Use science-informed approach to evaluation and evidence-based assessment to identify psychosocial risk and resilience factors for patients that are being considered for bariatric, transplant, or other surgery; and formulate pre- and/or post-surgical recommendations.
• Prepare and apply empirically supported and evidence-based psychotherapeutic interventions, including surgical preparedness, to patients with comorbid medical conditions (e.g., obesity, end stage organ disease, chronic pain, epilepsy) and their families engaged in medical care; and to accurately track and monitor patient’s progress in treatment via clinical observation and psychological testing.
• Identify and respond to the unique psychosocial challenges associated with a full range of patients that are engaged in psychiatric and medical care.
• Integrate psychological evaluation, treatment, and recommendations through verbal and written interactions with the medical teams and as an effective provider in interprofessional health care teams.
• Apply appropriate ethical and legal standards when working with patients with comorbid medical and psychological illnesses across the lifespan. This includes discussing with patient (and as relevant, medical providers) limits of confidentiality, reporting safety concerns, and maintaining appropriate privacy of patient while communicating case conceptualizations and treatment recommendations to the inter-professional team and family/caregivers.
• Use the research literature to guide the appropriate selection, implementation, and adaptation of treatment and assessment approaches for patient care, incorporating various factors such as sociodemographics, medical diagnoses and/or presenting symptoms, and presenting concerns. Reviews research to obtain additional education when providing services outside of clinical competency or seeing a unique presentation.

Bio-Behavioral Medicine Seminar

Interns meet with faculty to discuss issues relevant to clinical service provision for patients with chronic illnesses. Clinicians from a variety of disciplines present lectures on a variety of topics relevant to behavioral medicine.

Location of Rotation

MUSC Institute of Psychiatry, Division of Bio-Behavioral Medicine. The BM-IOP rotation is a hybrid in-person and virtual (telemedicine) clinic with modality of services delivered based on patient preference and provider availability.

Clinic Hours

Monday through Friday, 8am to 5pm.

Faculty

Wendy Balliet, Ph.D.
Professor

Jeff Borckardt, Ph.D.
Professor

Rebeca Castellanos Gonzalez, Ph.D.
Assistant Professor

Lillian Christon, Ph.D.
Associate Professor

Brian Haver, Psy.D., MPH
Assistant Professor

Rebecca Kilpatrick, Ph.D.
Associate Professor

Stacey Maurer, Ph.D.
Associate Professor

Sharlene Wedin, PsyD, ABPP
Associate Professor

Department of Family Medicine - Behavioral Health Consultation Clinic (BHCC)

Family Medicine is unique among medical specialties in that it integrates care for people of all ages, genders, and states of health. Family Medicine encompasses prevention activities as well as the treatment of a broad range of acute and chronic illnesses. The approach of family physicians is evidence-based and incorporates biological, psychological, and social/cultural, and spiritual aspects. Family physicians serve as guides and advocates for their patients within the broader health care system. Family doctors are also specifically trained and skilled with regard to interdisciplinary practice and particularly place a high degree of value on the contributions of clinical and counseling psychologists towards their patient's well-being and overall health.

The Behavioral Health Consultation Clinic (BHCC) provides participating psychology interns with opportunities to work primarily within two outpatient Family Medicine clinics (Ellis Oaks faculty practice and Trident Family Health residency practice). Patients are referred by their treating physician for assistance with diagnostic assessment as well as time-limited evidence-based psychological interventions (generally 6 sessions or less). Typical presenting problems include: ADHD, depressive disorders, anxiety disorders, insomnia, pain management, tobacco abuse, alcohol abuse, and adjustment issues. Psychology interns will have ample opportunity to collaborate with referring physicians (both faculty and resident physicians) with regard to patient care.

Psychology interns will learn to effectively utilize both clinical interview as well as brief self-report measures to succinctly and accurately assess the mental health/behavioral needs of their patients (at baseline and across time). Interns will also learn to effectively and succinctly communicate their clinical findings and treatment plans to patients as well as referring physicians (both verbally and in writing). Given the central nature of the doctor-patient relationship in primary care practice, emphasis will be placed on developing knowledge and skill for managing the doctor-patient relationship to support optimal patient health and well-being. The psychology intern will become familiar with a variety of evidence-based psychological treatments (generally behavioral and cognitive behavioral) for the effective management of specific presenting conditions.

Of note, many patients being referred to the BHCC will be taking psychotropic medication. Some patients may have mediation changes (including starting a new psychotropic medication) occur while participating in BHCC services. Other patients will prefer to address their presenting issues without the use of psychotropic medication. So, in addition to developing knowledge and skill regarding brief evidence-based psychological assessment and treatment approaches, the psychology intern will also become familiar with evidence-based biological approaches for addressing patient complaints. In all cases, consideration of patient preferences, evidence-based practice, and collaboration amongst treatment professionals will be combined to determine the optimal clinical approach for each patient.

After completing the BHCC rotation, interns will be able to:

• Accurately diagnose and assess mental health/behavioral symptoms within a civilian Family Medicine (primary care) setting.
• Effectively communicate clinical findings both verbally and in writing to the referring physician, other professionals, as well as to the patient.
• Develop evidence-based treatment plans.
• Deliver brief versions of evidence-based psychotherapy and other behavioral interventions appropriate to specific presenting problems.
• Assess treatment progress via evidence-based assessment practices.
• Effectively manager the doctor-patient relationship to promote the health and well-being of patients.
• Understand the evidence-base for both biological and psychosocial approaches to mental health/behavioral health issues as presented within the unique context of a civilian Family Medicine (primary care) settings.
• Document their findings appropriately within the Electronic Health Record.

Location of Rotation

The BHCC at Ellis Oaks (Faculty) Clinic (James Island)
The BHCC at 30 Bee St Clinic (Downtown)

Personal transportation required to complete this rotation.

Clinic Hours

Hours are currently Monday and Friday from 8:20 a.m. to 5 p.m.

Faculty

John Freedy, M.D., Ph.D.
Professor of Family Medicine

Brandon Sanford, Ph.D.
Assistant Professor of Family Medicine

Hollings Cancer Center (HCC)

Interns provide psychological services for patients (and families of patients) who are being treated through the MUSC Hollings Cancer Center, the only NCI Designated Cancer in South Carolina. The intern provides consultation services for the various oncological treatment teams and sees individual patients for psychotherapeutic management of cancer-related psychosocial issues (including disease management, pain management, and end-of-life issues) and co-morbid psychiatric disorders. Interns also provide psychological assessment services to assist in the multi-disciplinary determination of eligibility for bone marrow or stem cell transplantation.

By the end of the rotation, the intern will be able to:

• Effectively evaluate patients who are being considered for bone marrow or stem cell transplantation, identify resilience and risk factors related to surgical intervention, and formulate pre- and/or post-transplant recommendations.
• Prepare, competently apply, and effectively monitor empirically supported psychotherapeutic interventions to patients with cancer and their families.
• Integrate psychological treatment and recommendations through verbal and written consultations with medical teams and as an effective provider in multidisciplinary teams.
• Identify and respond to the unique psychosocial challenges associated with patients during cancer diagnosis, treatment, and recovery.

Location of Rotation

The HCC rotation is a hybrid in-person and virtual (telemedicine) clinic with modality of services delivered based on patient preference and provider availability.

Clinic Hours

Hollings Cancer Center operating hours are 8 a.m. to 5 p.m.

Faculty

Wendy Balliet, Ph.D.
Professor

Rebeca Castellanos Gonzalez, Ph.D.
Assistant Professor

Stacey Maurer, Ph.D.
Associate Professor

Sickle Cell Disease Adult and Pediatric Clinics (SCD)

On this rotation, interns receive training in the delivery of psychological services to both pediatric and adult patients with sickle cell disease. Interns will gain fluency in a range of psychological/behavioral medicine services including diagnostic interviewing, brief assessment/screening, individual psychotherapy, consultation, interdisciplinary team services, and group therapy. Interns will participate in in-clinic screening of patients and will assist in developing treatment plans for a variety of mental health conditions as well as chronic pain and disease adjustment. Interns will also gain experience working with patients with opioid use disorder and/or maladaptive pain coping. After initial screenings, interns will participate in delivery of brief, in-clinic follow-ups and more traditional individual and/or group psychotherapy sessions. A large part of this rotation involves working with medical colleagues in the clinic to collaborate on optimizing the overall healthcare and wellness of patients with SCD.

After completing the SCD rotation, interns will be able to:

• Screen pediatric and adult patients with sickle cell disease for a wide array of emotional, behavioral, and substance-related conditions
• Conduct pain-focused psychosocial assessments and provide evidence-based behavioral pain management
• Accurately assess, diagnose, and create treatment plans for patients with opioid use disorder
• Effectively communicate with sickle cell disease providers and clinic staff to identify psychosocial needs and treat/refer as appropriate
• Effectively communicate screening/assessment findings to referring providers
• Understand and effectively integrate considerations of human variability into the assessment and treatment of patients with sickle cell disease
• Apply appropriate ethical/legal standards to working with this specialized population (e.g., confidentiality, mandated reporting, safety assessments, managing patient-parent/guardian consent)

Location of Rotation:

The rotation will have both in-person and virtual/telemedicine components.
Pediatric SCD Clinic: MUSC Downtown, Shawn Jenkins Children’s Hospital, 1st floor
Adult SCD Clinic: MUSC Downtown, Rutledge Tower, 2nd floor

Clinic Hours:

Monday-Friday, 8:00 a.m.- 5:00 p.m.

Faculty:

Rebecca Kilpatrick, Ph.D.
Associate Professor

Telehealth Resilience & Recovery Program (TRRP)

The Trauma Resilience and Recovery Program (TRRP) is a multidisciplinary service that addresses the mental health needs of children and adults who experience traumatic injury (e.g., serious car crashes, gunshot wounds). Patients admitted to MUSC’s Level 1 trauma center are offered TRRP at the bedside and are provided ongoing support and treatment as needed. Our service model has four main steps: (1) in-hospital screening for peritraumatic distress and brief bedside mental health intervention to reduce distress and improve downstream engagement; (2) a 30-day, automated SMS-based service to promote self-monitoring of emotional symptoms during recovery; (3) a brief mental health screen 30 days following hospital discharge to assess PTSD and depression; and (4) comprehensive diagnostic assessment and best-practice mental health treatment (via telehealth or in-person according to patient preference) for patients who exceed clinical thresholds for PTSD and/or depression.

The intern functions as an integral part of the treatment team and is involved in the delivery of clinical services for children, adults and families affected by traumatic injury. Specifically, the intern participates in providing in-hospital brief intervention (~30% effort) for patients who screen positive for peritraumatic distress following injury, and diagnostic assessment and treatment of PTSD, depression, and related mental health conditions (~50% effort) using a multi-dimensional assessment approach and individual and family behavioral treatment approaches such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Behavioral Activation for Depression, and stress management techniques, as indicated. Interns will receive both individual and group supervision (~10% effort), will participate in traumatic injury related seminars (~5% effort), and engage interdisciplinary cage management of clinical cases (~5% effort). Additionally, our team is committed to improving healthcare access for vulnerable patients. As part of this effort, interns will have the opportunity to work with violent injury survivors and individuals from various backgrounds. For example, through our partnership with the Turning the Tide Hospital Violence Intervention Program (TTHVIP), interns will provide mental health care to violent injury patients and collaborate with client advocates who simultaneously work to address social risk factors. Also, interns will have the opportunity to work with MUSC Interpreter Services to provide best-practice care to our non-English speaking patients across all stages of our clinical model. Finally, participating interns may be involved in pilot studies and clinical trials, if appropriate, and programmatic development of the telehealth service for trauma patients.

Note: This rotation is considered both a Behavioral Medicine and Traumatic Stress track rotation.

At the end of the rotation, interns will be able to:

• Deliver brief intervention to distressed patients to reduce risk for PTSD and/or depression symptoms
• Accurately diagnose trauma-related disorders among child and adult survivors of serious traumatic injury using psychometrically valid interview-oriented measures.
• Deliver with fidelity best-practice treatments for PTSD and depression, such as Trauma Focused Cognitive Behavioral Therapy (TF-CBT), Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Behavioral Activation (BA).
• Document the delivery of assessment and telehealth treatment services and patient responses to services appropriately in each patient's electronic medical record.
• Acquire in-depth understanding of stepped care models and provision of mental health care embedded within healthcare systems.

Location of Rotation

MUSC College of Nursing, MUSC Main Hospital, MUSC Center for Telehealth, Department of Surgery, Shawn Jenkins Children’s Hospital

Clinic Hours

TRRP operates from 8:30 a.m. to 6 p.m. to accommodate patients' work and school schedules.

Faculty

Kenneth J. Ruggiero, Ph.D.
Professor and SmartState Chair

Tatiana Davidson, Ph.D.
Associate Professor

Leigh Ridings, Ph.D.
Assistant Professor

Hannah Espeleta, Ph.D.
Assistant Professor

Tobacco Treatment Program (TTP)

Clinical experiences are geared toward the delivery of psychological services to patients who smoke and have a variety of medical issues and chronic illnesses. Interns work in an outpatient clinic at Hollings Cancer Center and in all inpatient hospitals at MUSC (Main Hospital, Ashley River Tower Hospital, Institute of Psychiatry, and Children’s Hospital), providing one-on-one patient care.

Hollings Cancer Center Tobacco Treatment Program Outpatient Clinic

Interns see patients for individual psychotherapy geared toward helping them change their tobacco use and manage chronic medical and psychiatric problems and associated psychosocial complications. Although our primary charge is for cancer patients treated at Hollings, patients from a variety of other clinics are seen (e.g., cardiology, pulmonology, etc.). Patients are seen in our dedicated clinic space and the medical floors and in infusion settings. In addition to tobacco treatment, interns provide services for improving other psychological issues (e.g., depression). Interns will get hands-on experience in multidisciplinary treatment, providing motivational interviewing and cognitive behavioral psychotherapy. Interns are expected to communicate relevant treatment-planning information to a variety of medical disciplines including physicians, physician-assistants, nurses, and nurse-practitioners.

MUSC Health Tobacco Treatment Program Inpatient Care

Interns conduct brief evaluations and psychotherapeutic interventions for admitted inpatients for all patients in our hospitals. Interns administer interventions to both patients and their family members, including the parents of children admitted to our Children’s Hospital.

By the end of the rotation, the intern will be able to:

• Accurately assess nicotine dependence and strength of nicotine dependence, and psychosocial factors and co-morbid mental health diagnoses among patients served by the TTP.
• Develop evidence-based treatment plans for nicotine dependence and other diagnoses.
• Effectively use techniques of motivational interviewing and other motivational enhancement strategies to address health behavior change.
• Effectively deliver Cognitive Behavioral Therapy to patients in the Tobacco Treatment Program.
• Work effectively in consultation with professionals within an interdisciplinary team setting.
• Identify and respond to the unique psychosocial challenges associated with the full range of patients who are engaged in psychiatric and medical care.

Location of Rotation

Hollings Cancer Center, MUSC

Clinic Hours

8 .a.m. to 5 p.m., Monday through Friday

Faculty

Benjamin Toll, Ph.D.
Professor

K. Michael Cummings, Ph.D.
Professor

Alana Rojewski, Ph.D.
Associate Professor

Amanda Palmer, Ph.D.
Research Instructor

Weight Management Clinic (WMC)

The MUSC Weight Management Center is a multidisciplinary center that offers a full range of evidence-based weight management programs to the greater Charleston community and all of South Carolina. We are staffed with a psychologist, physician, clinical social worker, registered dietitians and exercise physiologists. Interns interested in the assessment and treatment of patients with overweight and obesity will have a variety of clinical, research, and patient education opportunities.

Our interns conduct psychological screenings of new/potential patients, deliver evidence-based treatment protocols, and participate in community-based and worksite weight control programs. An important component of the WMC rotation is the opportunity to work with and learn from the multidisciplinary staff. Interns also can participate in reviews of obesity-related journal submissions with Dr. O’Neil.

After completing the Weight Management Center rotation, interns will be able to:

• Effectively deliver evidence-based treatment plans for addressing overweight and obesity, using in-person and virtual formats.
• Deliver protocol-based interventions in an empathic and individualized manner while maintaining treatment fidelity.
• Help patients identify and implement solutions for common cognitive and behavioral obstacles to successful long-term weight management.
• Appropriately document in each patient's record the delivery of services and patient responses.
• Efficiently and comprehensively manage patient cases within a multidisciplinary medical setting.
• Understand the multifactorial causes of and contributors to obesity, and the various multidisciplinary approaches to its treatment.

Location of Rotation

Weight Management Center, MUSC Health and Wellness Institute
1122 Chuck Dawley Boulevard, Building B
Mt. Pleasant, SC 29464
(843) 792 2273

https://muschealth.org/weight

Personal transportation required to complete this rotation.

Clinic Hours

The Weight Management Center's hours are 8:30 a.m. to 5 p.m. Monday through Thursday. 8:30 a.m. to 12:30 p.m., Friday. 

Faculty

Pat O’Neil, Ph.D.
Professor

Robert Malcolm, M.D.
Professor

Sarah B. Hales, Ph.D., LISW-CP, CSOWM
Assistant Professor

Tonya Turner, RDN, MPH
Associate Director for Clinical Services

David Sword, DPT
Exercise Specialist

Shawn Witherspoon
Clinic Coordinator

Women’s Health and High Risk OB Clinic

Patients in the Women’s Health and High Risk OB Clinic are referred for psychiatric and behavioral risk factors related to pregnancy (OB population) as well as outside of pregnancy (GYN population). Patients present with high levels of trauma exposure, co-morbid psychiatric disorders, and substance use problems (including opiate use disorders) or high risk for opiate misuse. The patient population is heterogeneous, with high levels of socioeconomic disadvantage (approximately 80% low income). There is a high need for integrated medical and behavioral health care; until recently, the only services available were brief, supportive counseling and medication management provided by a consulting psychiatrist and psychiatry residents as well as brief psychological intervention to GYN populations by a psychology intern. Beginning in the 2020-2021 internship training year, integrated services provided by clinical psychology trainees will be expanded to serve high risk OB patients, including those seeking MAT and empirically supported intervention/relapse prevention for OUD during pregnancy.

Interns in the Women’s Health and High Risk OB Clinic will work with both obstetric (OB) and gynecological (GYN) populations, screening patients for the presence of psychiatric (depression, anxiety, bipolar disorder, PTSD) symptoms and substance abuse risk behaviors and make a determination about the type of services recommended for the patient. These may include counseling around wellness and general health, prenatal dietary and lifestyle management, psychotherapeutic interventions or emotional disorders, and/or interventions to reduce substance use, including MAT for OUD; services will be delivered both in person and via tele-health. Interns will function as part of a multidisciplinary team of OBGYN physicians, nurses, psychiatry residents and fellows, and clinical psychology professionals. In addition to individual counseling, intern training opportunities may include facilitation of virtual groups for relapse prevention of OUD in OB populations, utilizing telehealth to maximize patient reach.

At the end of the rotation, interns will be able to:

• Effectively screen for mood, anxiety, trauma-related, and substance use problems among low resource, high-risk women.
• Deliver, with fidelity, evidence-based and best practice interventions to reduce mood, anxiety, PTSD, and substance use problems, as well as short-term health-related counseling (e.g., weight management, health maintenance).
• Provide effective behavioral health intervention to support MAT for OUD in appropriate patients.
• Use telehealth service delivery methods effectively to provide all required assessment and intervention activities.
• Interact and consult effectively with a multi-disciplinary (OBGYN physicians, psychiatrists, psychiatry residents and fellows, nurses) treatment team within a primary care setting.
• Educate multi-disciplinary healthcare providers about behavioral health factors that affect the healthcare industry.
• Document the delivery of services and patient response to services appropriately in each patient's MUSC electronic health record.
• Accurately monitor, demonstrate sensitivity, and apply knowledge of others as individuals and cultural beings in assessment, treatment, and consultation.

Location of Rotation

The Women’s Health and High Risk OB Clinic intern operates out of 2 clinical sites - one that is on the MUSC main campus downtown (1 day per week) and another clinical site in North Charleston that is approximately 15 miles (approximately 20 min drive) off the main campus (1 day per week). Interns are required to provide their own transportation to the site.

Clinic Hours

Hours at the downtown location are 8 a.m. to 5 p.m.
Hours at the North Charleston location are 8 a.m. to 4:30 p.m.

Faculty

Amber Jarnecke, Ph.D.
Associate Professor

Constance Guille, M.D.
Professor

Sara Witcraft, Ph.D.
Assistant Professor

Marie Ann Hayes Ph.D.
Assistant Professor