Traumatic Stress Track (155212)

The Traumatic Stress track offers unique opportunities to work with both military and civilian populations. Treatment settings are diverse and include a Veterans Administration Medical Center, a hospital-based outpatient clinic, a community child advocacy center, and variety of community-based outreach settings. Applicants with interests in either adult or child traumatic stress are welcome.

Community Outreach Program — Esperanza (COPE)

The Community Outreach Program — Esperanza (COPE) is a specialty clinic within the National Crime Victims Research & Treatment Center. COPE provides community-based assessment, referral, and treatment services to children who have been victimized by crime (e.g., sexual and physical abuse, domestic violence) or have experienced other traumatic events (such as a natural disaster or a serious accident). Services are provided in the child's community (e.g., home, school). COPE attempts to reach victim populations that have traditionally been underserved by office-based mental health care programs, especially rural populations and racial/ethnic minorities. Although open to children from all racial/ethnic minority groups, a significant proportion of referrals involve children of Hispanic descent (~40%) and African American descent (~40%), most from low-income backgrounds.

The overarching goal of COPE is to treat trauma-exposed youth “in context” by minimizing barriers in access to evidence-based mental health services (e.g., lack of transportation, distance from clinic) utilizing a community-based service model. Clinically, interns are trained in: (1) Trauma-Focused Cognitive Behavioral Therapy; (2) intensive case management; (3) evidence-based engagement strategies to enhance treatment completion; and (4) appropriate use of Interpreter Services to provide linguistically appropriate treatment. Special emphasis is placed on adapting evidence-based interventions for use in community settings with diverse populations. Interns develop expertise in the assessment and treatment of posttraumatic stress disorder and other trauma-related symptoms including anxiety, depression, and disruptive behaviors. Finally, interns are encouraged to become involved in ongoing research and/or to participate in related research endeavors.

After completing the rotation, interns will be able to:

  • Accurately identify trauma-related symptoms and diagnose trauma-related disorders among child trauma victims in community-based settings.
  • Develop evidence-based treatment plans for addressing trauma-related problems among child trauma victims within community-based settings.
  • Deliver evidence-based treatments for PTSD and other trauma-related problems (specifically, TF-CBT), with fidelity, within community-based settings.
  • Effectively coordinate with physicians who are providing medication evaluation and management and other medical and/or mental health professionals as necessary.
  • Apply appropriate ethical standards to working with trauma-exposed populations and recognize limits and exceptions to patient confidentiality (e.g., mandated reports).
  • Tailor evidence-based trauma-focused interventions to meet the needs of each patient utilizing a culturally competent and linguistically appropriate approach.
  • Identify relevant social service systems that serve child trauma victims and advice patients effectively about those services.

Location of Rotation

This rotation takes place in Charleston Tri-County area schools and homes (community-based). COPE interns are provided an office at the National Crime Victims Research and Treatment Center (for note writing, session prep).

This rotation requires transportation. (Note: Interns are welcome to use our clinic vehicles, if they do not have a vehicle or prefer not to use it).

Clinic Hours

In order to minimize barriers in access to care, interns are expected to be able to see their patients from 8 a.m. to 7 p.m. (last appointment scheduled at 6 p.m. to finish at 7 p.m.).

Faculty

COPE-Telehealth Outreach Program (TOP)

The Telemental Health Outreach Program (TOP) provides telehealth-based assessment and treatment services for children and adolescents who have experienced traumatic events (e.g. sexual abuse, physical abuse, witnessing domestic violence, natural disaster, etc.). Services are provided via HIPAA compliant videoconferencing software in the child’s community, including home, school, and primary care locations. The intern providing telehealth services will be located at the Institute of Psychiatry on the MUSC campus and the child will be located in his/her community location. TOP provides evidence-based trauma-focused therapy for children and adolescents across South Carolina. The program is dedicated to improving access to trauma-focused treatment using telehealth for traditionally underserved populations, especially rural populations and racial/ethnic minorities. Interns function as an integral part of the treatment team and have the opportunity to be involved with all aspects of TOP services. Specifically, interns provide evidence-based, trauma-focused assessment and treatment, including assessment and treatment PTSD and co-occurring disorders such as anxiety disorders, depression, and disruptive behavior disorders. In addition, interns will be involved in evaluation of services and expansion of services throughout South Carolina. Finally, interns are encouraged to become involved in ongoing telehealth research and program development.

After completing the rotation, interns will be able to:

  • Completely provide assessment and psychotherapy via telehealth technology with trauma exposed children and adolescents.
  • Develop evidence-based treatment plans for addressing trauma-related problems among child victims of trauma via telehealth.
  • Develop and implement clinical procedures specific to a telehealth delivery modality (e.g. safety procedures, protocols for working with clinical staff at remote locations).
  • Deliver, with fidelity, evidence-based treatments for PTSD and other trauma-related problems (specifically, TF-CBT) via telehealth.
  • Tailor trauma-focused treatment to a telehealth delivery modality (e.g. utilizing interactive worksheets, PowerPoint games, screen sharing for real-time viewing of the trauma narrative development, etc.)
  • Effectively coordinate with physicians who are providing medication evaluation and management via telehealth.

Location of Rotation

National Crime Victims Research and Treatment Center at the Medical University of South Carolina

Clinic Hours

Time of rotation can vary, but hours are typically 8 a.m. to 5 p.m.

Faculty

Dee Norton Child Advocacy Center (DNCAC)

DNCAC is a freestanding Children’s Advocacy Center, which is a national multidisciplinary model for responding when there is a concern for child abuse or neglect. DNCAC has a multidisciplinary staff, including representatives from psychology, social work, case management, and forensic interviewing. We also have co-located physicians, nurses and fellows from the MUSC Division of Child Abuse Pediatrics. Each year, the DNCAC provides direct services to over 1,500 child maltreatment victims, including both forensic and clinical (i.e., assessment and/or treatment) services. Children served at our program are racially and economically quite diverse, over half have experienced child maltreatment, including physical abuse (31%), exposure to domestic violence (20%), and sexual abuse (16%).

Psychology interns receive didactic and experiential training in evidence-based assessments and treatments for children who have experienced child abuse or trauma. The treatments provided at DNLCC include Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT), Parent-Child Interaction Therapy (PCIT), Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), and Sexual Behavior Problem–Cognitive Behavioral Therapy (SBP-CBT). Psychology interns predominantly conduct mental health assessments and provide AF-CBT and PCIT. Interns have the opportunity to observe forensic interviews. Psychology interns on this rotation collaborate with many multidisciplinary partners, including pediatricians, social workers, child protective services, law enforcement, and prosecutors. There are also shared training activities with interns from social work and clinical counseling programs.

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

  • Accurately distinguish among forensic and clinical assessments of children.
  • Accurately assess clinical symptoms commonly associated with trauma exposure in children and adolescents.
  • Develop evidence-based treatment plans for addressing trauma-related problems among adult and child victims of abuse and trauma.
  • Deliver, with fidelity, evidence-based treatments for PTSD and other trauma-related problems [specifically, Alternatives for Families: A Cognitive Behavioral Therapy (AF-CBT), Parent-Child
  • Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).
  • Document the delivery of services and patient response to services appropriately in each patient's electronic medical record.
  • Effectively provide evidence-based treatments to underserved populations, including racial/ethnic minorities and those families at economic disadvantage, and overcome barriers to the implementation of evidence-based treatments in community settings.

Location of Rotation

Dee Norton Lowcountry Children's Center

Personal transportation required to complete this rotation.

Clinic Hours

Clinic hours are Monday, Tuesday, Thursday, and Friday from 8:30 a.m.-5:00 p.m.; Wednesdays from 8:30 a.m.-6:30 p.m.

Faculty

Pediatric Primary Care (PPC)

Interns function as part of an integrated behavioral and physical health team that serves children who are currently in foster care placements in Charleston and Dorchester Counties. Interns perform a variety of duties, including consultation with pediatricians on behavioral health issues; brief, targeted psychological assessments; provision of evidence-based interventions (e.g., Trauma Focused-Cognitive-Behavior Therapy, Parent-Child Interaction Therapy); and short-term crisis stabilization counseling (using the Child-Family Traumatic Stress Intervention) with foster children and their families. Interns participate in case staffings with the FCSC team (pediatrician, nurse-practitioner, social worker, and psychologist), which will jointly determine the service plan for each child. Interns round with pediatricians and nurse practitioners to provide some brief interventions “on-the-fly” during clinic and also have scheduled clinics in which they provide more traditional outpatient psychotherapy (based on referrals and case needs from the FCSC team).

The rotation also provides an excellent opportunity to develop skills for effective interaction with community and public agencies, like the child protection and foster care service systems.

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

  • Effectively screen for disruptive behavior problems, parenting concerns, and trauma-related symptoms in underserved, trauma-exposed youth living in out-of-home care.
  • Deliver, with fidelity, evidence-based and best practice interventions to facilitate improvements in behavioral adjustment, depression, and PTSD symptoms.
  • Interact and consult effectively with a multidisciplinary (pediatrician, nurse practitioner, social worker) treatment team within a primary care setting.
  • Educate multidisciplinary health care providers about behavioral health factors that affect health care delivery.
  • Document the delivery of services and patient response to services appropriately in each patient's MUSC electronic medical record.

Location of Rotation

Medical University of South Carolina

Clinic Hours

Official hours are Monday through Friday from 8:30 a.m. to 5 p.m.

Faculty

National Crime Victims Research & Treatment Center (NCVC)

The population served by the NCVC includes victims of a variety of crimes and traumatic events (sexual/physical assault, robbery, burglary), sexual and physical assault, domestic violence, witnesses to violence, and family members of homicide victims. Interns develop expertise in the assessment of traumatic events in the client's history and post-trauma adaptation, including post-traumatic stress disorder, other anxiety disorders, and affective disorders. As a therapist, the intern works with victims (and their families) utilizing evidence-based therapeutic techniques including Trauma-Focused Cognitive Behavior Therapy, Cognitive Processing Therapy, and Prolonged Exposure. Interns see patients in both the adult clinic and family and child clinic, and have separate clinical supervisors for each clinic. Interns may, if their schedule permits, co-lead a support group for surviving family members of homicide victims. Because this rotation serves a cross-section of the community, interns are expected to be available to work in an evening clinic one day per week (currently Wednesday) until approximately 8 p.m. Their remaining work schedules are adjusted to accommodate for this evening clinic requirement.

Research opportunities are available for interns interested in understanding innovative service and training methods for trauma populations; the application of innovative technologies in the treatment of trauma victims and the training of clinical professionals; the epidemiology of trauma and its consequences; and the physiological and genetic determinants of trauma-related psychopathology.

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

  • Accurately identify trauma-related symptoms and diagnose trauma-related disorders among adult and child victims of civilian trauma.
  • Develop evidence-based treatment plans for addressing trauma-related problems among adult and child victims of civilian trauma.
  • Deliver, with fidelity, evidence-based treatments for PTSD and other trauma-related problems.
  • Document the delivery of, and patient response to, services in each patient's medical record.
  • Identify relevant social service systems that serve civilian trauma victims and advise patients effectively about those services.

Location of Rotation

MUSC Institute of Psychiatry outpatient clinic

Clinic Hours

NCVC clinic operates Monday through Friday from 8:30 a.m. to 6 p.m., except on Wednesdays, when clinic hours are from 8:30 a.m. to 8 p.m. to accommodate patients' work and school schedules.

Faculty

PTSD Clinical Team Service (PCT)

This rotation provides an opportunity to work with veterans who were exposed to military and/or civilian trauma, such as combat or military sexual trauma. The PCT is an outpatient multidisciplinary team consisting of psychologists, social workers, psychiatrists, and trainees. The emphases are on evidence-based evaluation, innovative treatment modalities, and individual evidence-based therapy utilizing exposure therapy and other cognitive-behavioral treatment protocols. Interns will also have the opportunity to provide treatment to veterans in rural locations via tele-mental health. Finally, interns may also lead a weekly group focused on psychoeducation about common reactions to trauma in an acute inpatient setting.

The intern functions as an integral part of the treatment team and is involved in every aspect of patient care. Specifically, the intern participates in the evaluation and diagnosis of PTSD and other psychological conditions using a multi-dimensional assessment approach; implements individual cognitive-behavioral treatment approaches, including prolonged exposure therapy and cognitive processing therapy; gains an understanding of systemic issues related to PTSD in the VA system (such as iatrogenic effects, secondary gain, or malingering); participates in ongoing clinic program evaluation efforts, primarily through collecting and entering data on PCT treatment initiation and primary and secondary outcome measures. Interns will also participate in a multi-day Prolonged Exposure (PE) training, led by PCT faculty.

Opportunities for engagement in productive clinical research are present through on-going studies or the development of new projects. At the end of the rotation, trainees will be able to:

• Accurately identify and diagnose trauma-related disorders among veterans.
• Develop evidence-based treatment plans for trauma-related problems among adult veterans.
• Deliver, with fidelity, evidence-based treatments for PTSD and other trauma-related problems (specifically, prolonged exposure or cognitive processing therapy for PTSD, supplemented with behavioral activation/grief processing/or other anxiety disorder treatments as needed).
• Become familiar with delivering individual, evidence-based therapies to veterans both in-person as well as through telemental health.
• Document the delivery of services and patient response to services appropriately in each patient's electronic medical record.
• Accurately track and interpret ongoing progress in treatment over the course of therapy with weekly self-report measures combined with a synthesis of all other clinically relevant information.
• Participate regularly and deliver clinical feedback effectively during video-based group clinical supervision of prolonged exposure therapy.

Location of Rotation

Ralph H. Johnson VA Medical Center

Clinic Hours

Official VA hours are Monday through Friday, 8 a.m. to 4:30 p.m. You may occasionally be required to come in at 7:30 a.m. to accommodate patient needs/schedules.

Faculty

Telehealth Resilience & Recovery Program (TRRP)

The Telehealth Resilience and Recovery Program is a multidisciplinary experience that provides an opportunity to work with children and adults who experienced traumatic injury. Once enrolled in our service via our level-1 trauma center, these patients are monitored for emotional recovery and offered mental health assessment and treatment as needed. PTSD and depression are prevalent in this population. Interns provide psychoeducation in our acute care setting, assist patients in remote monitoring of emotional recovery, and conduct telehealth-based assessment and treatment for patients who develop PTSD or depression. Exposure-based treatments, behavioral activation, and other best practice interventions are used most often.

The intern functions as an integral part of the treatment team and is involved in every aspect of patient care. Specifically, the intern participates in assessment and diagnosis of PTSD, depression, and other psychological conditions using a multi-dimensional assessment approach, and then implements individual and family behavioral treatment approaches, such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Prolonged Exposure (PE), and stress management techniques, as indicated. Interns also gain an understanding of systemic issues related to continuity of care and interdisciplinary management of clinical cases. 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:

  • Identify trauma-related symptoms and accurately diagnose trauma-related disorders among child and adult survivors of serious traumatic injury using psychometrically valid interview-oriented measures.
  • Track and accurately interpret patient mental health recovery following their discharge using psychometrically validated approaches to determine need for services and monitor progress in telehealth treatment.
  • Deliver with fidelity best-practice treatments for PTSD and depression, such as Trauma Focused Cognitive Behavioral Therapy (TF-CBT), Prolonged Exposure (PE), 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.

Location of Rotation

MUSC Emergency Department and Department of Psychiatry

Clinic Hours

TRRP operates from 9 a.m. to 6 p.m. to accommodate patients' work and school schedules.

Faculty