Traumatic Stress Track (155212)

The Traumatic Stress track offers unique opportunities to work with both military and civilian populations. Treatment settings are varied 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.

The Community Outreach Program — Esperanza (COPE) is a specialty clinic within the National Crime Victims Research & Treatment Center (NCVC) created nearly 20 years ago by Dr. Michael de Arellano. COPE provides community-based assessment, treatment, and case management 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) and in response to the COVID-19 pandemic, via telehealth. COPE attempts to reach victim populations that have traditionally been poorly served by office-based mental health care programs. Although open to all children, a significant proportion of referrals involve children of Hispanic (~30%) 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. More recently, trainees will receive specialized training in telehealth as a service-delivery modality. Special emphasis is placed on adapting evidence-based trauma-focused interventions for use in community settings with heterogeneous populations. Interns develop expertise in the assessment and treatment of post traumatic stress disorder and other trauma-related symptoms including anxiety, depression, and disruptive behaviors.

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

In order to minimize barriers in access to care, interns are expected to be available to see their patients from 8am to 7pm (last appointment scheduled at 6pm to finish at 7pm). Please consult with your supervisor if you have questions about this expectation.

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.).

The Telemental Health Outreach Program for Traumatic Stress (TOP-TS) 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-TS 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 poorly served populations, especially rural populations. Interns function as an integral part of the treatment team and have the opportunity to be involved with all aspects of TOP-TS 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.

Dee Norton Child Advocacy Center (DNCAC)

Dee Norton 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. Dee Norton 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, Dee Norton provides direct services to over 1,200 child maltreatment victims, including both forensic and clinical (i.e., assessment and/or treatment) services. Children served at our program are  quite heterogeneous, over half have experienced child maltreatment, including physical abuse (43%), exposure to domestic violence (27%), and sexual abuse (25%).

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 Dee Norton include Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), Parent-Child Interaction Therapy (PCIT), Risk Reduction through Family Therapy (RRFT) and Sexual Behavior Problem–Cognitive Behavioral Therapy (SBP-CBT). Psychology interns predominantly conduct mental health assessments and provide TF-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, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Parent-Child Interaction Therapy (PCIT)].
• Document the delivery of services and patient response to services appropriately in each patient's electronic medical record.
• Effectively provide evidence-based treatments to poorly served populations, including those families at economic disadvantage, and overcome barriers to the implementation of evidence-based treatments in community settings.

Location of Rotation

Dee Norton Child Advocacy Center
677 Long Point Road
Mount Pleasant, SC

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.

The Pediatric Primary Care (PPC) Program involves a partnership between the National Crime Victims Research and Treatment Center (NCVC) and Division of General Pediatrics, both within the College of Medicine at the Medical University of South Carolina. PPC houses two programs, the Collaborative Care for Children and Caregivers (4C) and the Pediatric Primary Care Psychology Internship rotation, which work closely together to meet the needs of youth and families within the pediatric primary care clinics. The 4C program was initiated in 2016 with grant funding from the South Carolina Office of the Attorney General, Department of Crime Victim Assistance Grants (Victims of Crime Act grant). 4C aims to expand access, availability and utilization of services for child and adult victims of crime by providing intensive case management, care coordination and direct mental health treatment services in the community, on-site in pediatric primary care clinics serving the Charleston tri-county area. Due to the COVID-19 pandemic services have been provided via telehealth.

The PPC psychology internship rotation was initiated to expand the reach of services for youth and families, since many children with behavioral health needs are not identified, nor do they seek specialty mental health services. The rotation operates within an integrated health care model, to address the mental health, behavioral and physical health needs of patients seen in Pediatric Primary Care. This also includes the Foster Care Support Clinic, which serves children who are currently in foster care placements in the tri-county Charleston area. On the PPC rotation, interns are actively involved in consultation, brief mental/behavioral health assessments, and behavioral health interventions to reduce the time burden of the medical providers, as well as address the needs of youth experiencing behavioral health concerns. An important aim of this rotation is to provide the intern with rich and varied experiences that meet individual needs, as well as training and career goals. Thus, Dr. Hanson will work closely with the intern at the onset of the rotation to establish rotation goals and discuss the schedule and rotation opportunities. Over the course of the rotation, intern progress will be tracked, with ongoing discussions to ensure that these goals are being met.

On this rotation, interns perform a variety of duties, including:

• Consultation with pediatricians on behavioral health issues.
• Brief, targeted psychological assessments that include semi-structured interviews with youth and caregivers, along with objective data using clinically indicated assessment measures.
• Real-time, behavioral consultations (i.e., warm hand-offs), and scheduled behavioral consultations when requested by primary care providers.
• Short-term crisis stabilization counseling (e.g., Psychological First Aid; Skills for Psychological Recovery).
• Short-term/brief interventions (2-3 sessions) to target specific behavioral needs (e.g., sleep problems; minor behavioral problems) that do not warrant a longer-term therapeutic intervention.
• Longer term therapy (4-16 sessions) when indicated, using evidence-based interventions to address common behavioral health problems (e.g., trauma-related mental health problems, depression, anxiety, behavior problems).
• Weekly participation in case staffings with the full PPC team (pediatrician, nurse-practitioner, social worker, case manager, and psychologist), which collaboratively determines the service plan for each child.
• Intensive case management and collaboration with community and public agencies, such as community mental health, schools, child protection and foster care service systems.

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

• Effectively screen and assess for mental health and disruptive behavior problems, parenting concerns, and trauma-related symptoms among a low resource population of youth and families.
• Deliver, with fidelity, evidence-based and best practice interventions to facilitate improvements in an array of behavioral and mental health problems including behavioral adjustment, anxiety, 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.

Location of Rotation

• Services are delivered in clinic or via telehealth.
• For telehealth, if services are delivered from home, interns will need a laptop/desktop, camera, reliable internet, a headset, and a private location in their homes. Telehealth can also be provided in clinic.

Clinic Hours

Official hours for the rotation are between 8:30 a.m. to 5 p.m. However, the rotation does involve flexibility in scheduling to address patient barriers to accessing care. Thus, interns may be asked to see patients outside of these standard hours (e.g., 8 a.m. to 7 pm., with the last appointment scheduled at 6pm to finish at 7pm). Dr. Hanson will work closely with interns around patient scheduling.

The population served by the NCVC includes victims of a variety of crimes and traumatic events (sexual/physical assault, robbery, burglary), intimate partner violence, witnesses to violence, work-related accidents, car accidents, 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 Tuesdays) until approximately 8 p.m. Our Center has a specialty clinic for Latinx victims of crime, therefore a number of referrals are Spanish speaking allowing opportunities for English speaking interns to provide trauma treatment utilizing interpreters and for Spanish speaking interns to provide trauma treatment in Spanish.

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. During the COVID Pandemic, work is being conducted remotely from home with patients being seen virtually through telehealth platforms. Once it is safe to return to the office, there will be continued opportunities for telehealth delivery.

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.Accurately track and interpret ongoing progress in treatment over the course of therapy with frequent self-report measures combined with a synthesis of all other clinically relevant information (e.g. participation in assigned work at home, affect during trauma treatment, etc).
• Use the research literature to guide the appropriate selection, implementation, and/or adaptation of trauma treatment strategies for patients depending on their demographics (e.g., age, cultural factors) and/or trauma symptom presentation.
• 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.
• The intern will apply appropriate ethical standards to working with trauma-exposed populations and recognize limits and exceptions to patient confidentiality (e.g., mandated reports), including ethical standards related to a telehealth delivery modality (when applicable).
• Integrate appropriate modifications to assessment of and interventions for trauma-related difficulties based upon unique needs of trauma patients with varied cultural backgrounds.
• Function effectively within an outpatient psychiatric trauma clinic coordinating care with other health care professionals including psychiatrists, psychiatric residents, and case mangers as well as with outside community professionals to include child protection agency, child advocacy center, domestic violence shelter, rape crisis center, and law enforcement victims

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.

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. In accordance with COVID guidance, at this time, trainees will provide all patient care via telehealth – subject to change in line with changes in COVID guidance.

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 (*modified due to COVID guidance).
• 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

Alyssa Jones, Ph.D.
Assistant Professor

Ursula Myers, Ph.D.
Assistant Professor

Stephanie Keller, Ph.D.
Assistant Professor

Katherine Knies, Ph.D.
Staff Psychologist