Geropsychology | veterans affairs

GEROPSYCHOLOGY Dr. Lisa Bloom-Charette | [email protected] Dr. Kristen Dillon | [email protected] Dr. Lisa Taylor | [email protected] Dr. Matt Wachen | [email protected]

The Geropsychology Fellowship at VA Bedford utilizes the PIKES PEAK MODEL for training in Professional Geropsychology and emphasizes training that prepares future clinicians to become BOARD

CERTIFIED GEROPSYCHOLOGISTS.  The overall goals of the residency are to: 1) PROVIDE EVIDENCED-BASED TREATMENTS and interventions for older veterans and their families; 2) recognize the

INTERSECTION OF COGNITIVE, EMOTIONAL, MEDICAL, AND FUNCTIONAL CHANGES that accompany aging; 3) understand the DIVERSE EXPERIENCE OF OLDER ADULTS NAVIGATING HEALTHCARE and the involvement of

various stakeholders; 4) hone skills necessary to function on an INTERDISCIPLINARY TEAM in various settings. We invite you to watch the following video about our program: VA Bedford

Geropsychology Training. The resident will work concurrently in three to four clinical settings depending on interest and training goals.  Training settings in the program included in this

training experience: * Dementia Specialty Care Unit * Inpatient Hospice and Palliative Care Consult Team * Community Living Center * Home-Based Primary Care (HBPC) * Geriatric Evaluation and

Management Unit (GEM) * Outpatient Geropsychology Clinic Each of these settings prepares trainees for board certification and the opportunity to hone their clinical skills in the seven

major core competencies identified in the Pike’s Peak Model for Geropsychology Training (Theoretical/Conceptualization Skills, Psychological Assessment, Psychological Intervention,

Consultation, Program Development and Evaluation, Clinical Supervision, and Teaching). Residents are trained in the use of evidenced-based treatments with particular focus on how to adapt

treatments for older adults. In all settings, residents will have an opportunity to work on various interdisciplinary teams that share decision-making, treatment planning, and implementation

responsibilities.  Opportunities for research, program development, administration, and teaching are available.  The resident will provide supervision to interns and practicum students and

will receive training in supervision., Residents will also participate in a variety of teaching, educational and professional development activities aimed to prepare clinicians to function

as a staff psychologist by the end of their postdoctoral training.  CLINICAL ROTATIONS: COMMUNITY LIVING CENTER (CLC/GERIATRIC EVALUATION AND MANAGEMENT (GEM): Community Living Center

psychology services are offered on nine inpatient units: four general CLC units, three dementia specialty care CLC units, one geriatric evaluation and management GEM/ shorter-term

rehabilitation unit, and the hospice unit. The resident will be assigned specifically to one to two of those units and may also work with Veterans on other units in instances of transfers,

continuity of care, or special circumstances. The psychological services include, but are not limited to, evaluation, psychotherapy, and consultation. Evaluations consist of personality,

basic cognitive assessment, safety/suicide evaluations and planning. Consultation with Neuropsychology services is available for in-depth evaluations. Therapy referral questions include

general mental health concerns with an understanding of health and geriatric needs and often include anxiety, PTSD, depression, pain, sleep, adjustment, grief, couples/family, emotional

regulation, health management, etc. Individual therapy treatment options available to Veterans include, but are not limited to: multiple subsets of cognitive behavioral treatment, acceptance

and commitment therapy, cognitive processing therapy, later-adulthood trauma reengagement, meaning centered psychotherapy, complicated grief treatment, validation, hospice approach, seeking

safety, motivational interviewing, life review, and more. The resident will also have the opportunity to facilitate a group in the CLC, and ongoing groups include for caregivers, positive

psychology, and reminiscence. Residents will also be trained in use of the STAR-VA model of consulting with Veterans and staff in dealing with dementia-related behaviors. DEMENTIA SPECIALTY

CARE UNITS (DSCU): DSCUs offer a valuable training opportunity for students interested in working with veterans with dementia and providing caregivers support to veteran’s families. On our

three specialty care units, interdisciplinary teams provide individualized, compassionate care to promote quality of life for veterans coping with neurocognitive disorders. As a student, you

will participate in assessments, care planning, and evidence-based interventions including STAR VA for veterans' behavioral and psychological symptoms. You will consult with the team

to develop holistic, patient-centered care plans informed by the veterans' abilities, needs and interests. You will have the chance to learn and educate others on behavioral

modification techniques to address challenging behaviors. An important part of your role will be providing support and education to families and caregivers of veterans with dementia. During

your placement, you will gain experience in geriatric mental health care including differential diagnosis, therapy approaches and program development. You will also attend and conduct staff

trainings on best practices in dementia care, managing behaviors, and delivering compassionate end-of-life care. Our specialty units provide an impactful opportunity to build skills in

working with veterans with dementia and making a difference for them and their families. HOME-BASED PRIMARY CARE (HBPC): In Home-Based Primary Care, an interdisciplinary primary care service

for homebound Veterans, psychology trainees truly “meet Veterans where they are.”  On this rotation, you will join HBPC psychology staff in traveling to Veterans’ homes to provide clinical

assessment and psychotherapy.  You will learn to utilize cognitive screening techniques to assess for presence of dementia or other cognitive deficits and establish a baseline track of

decline.  You will also use psychological assessment techniques to screen for mental health issues such as depression, anxiety disorders, and PTSD. HBPC trainees also learn to collaborate

with fellow team members in truly interdisciplinary care, exchanging pertinent information, learning sensitivity to maintaining Veterans’ dignity and privacy while collaborating

inter-disciplinarily, and developing expertise in health psychology through teamwork. You will have opportunities to conduct individual and couples’ psychotherapy in Veterans’ homes for

Veterans coping with psychological, psychosocial, medical problems and issues of aging, such as loss of independence and end of life, and you will refine skills in Veteran and family

education and treatment planning. Caregiver education and family support is also a component of this service. Close staff supervision will support your training in complex ethical

situations, as well as assist you in delivering psychological services in unconventional settings. HOSPICE AND PALLIATIVE CARE: The hospice and palliative care rotation provides trainees

comprehensive training in end-of-life psychological care. Trainees develop competency in assessing and addressing psychological, sociocultural, spiritual, and interpersonal factors impacting

patients with advanced terminal illness and their loved ones. Core training components include: understanding the dying process; managing complicated grief and bereavement; addressing

specific assessment and psychotherapy needs of Veterans with chronic life-limiting illness focused on symptom management and end-of-life issues; providing anticipatory grief services for

family members; delivering bereavement care for families/loved ones of deceased Veterans; and supporting professional caregivers experiencing compassion fatigue.  Trainees will also gain

experience with ethical and legal considerations in hospice and palliative care provision in varied contexts. Our interdisciplinary team was a recipient of the National Compassionate

Caregiver Award in 2022, offering trainees an opportunity to train and become a member of an award winning team. Overall, the rotation prepares future geropsychologists to provide

compassionate, evidence-based end-of-life care. GEROPSYCHOLOGY OUTPATIENT CLINIC: Psychology trainees in our Geropsychology Outpatient Clinic conduct individual and group psychotherapy in a

more traditional mental health care setting, engage in program development, and provide clinical consultation to other mental health programs throughout the hospital where older Veterans

receive care.  You will hone your skills in sharing your expertise in Geropsychology in settings such as our general Mental Health Clinic (MHC) and with our Primary Care Behavioral Health

providers.  You will attend team meetings in the MHC to provide consultation with diagnostic and treatment planning recommendations for team members working with older adults.  Trainees in

our Geropsychology residency will also train in the administration of a clinic, responding to consults, managing the caseloads of fellow clinicians, and developing clinic policy.  The

rotation in the Geropsychology Outpatient Clinic is one more setting in which our Team Gero staff and trainees meet the increasing demand for Geropsychology services here at VA Bedford!

DIDACTIC ACTIVITIES: Clinical experiences are supported by didactic seminars that include monthly  Geropsychology didactics, Geriatric Grand Rounds, Capacity evaluation didactics, bimonthly

Psychology Grand Rounds, Psychology Training Day as well as numerous inter-professional trainings within the Hospital. Residents will also attend trainings designated to the larger

postdoctoral cohort such as Diversity, Ethics, and Supervision of Supervision. SUPERVISION: The resident will receive a minimum of two hours of individual supervision and one hour of group

supervision per week. The resident will also be expected to provide one hour of supervision to at least one practicum student. LEARNING OBJECTIVES 1. To understand the biological,

psychological, and social aspects of normal aging 2. To understand common medical and/or neurological problems, their interplay, and how those issues affect psychological treatments 3. To

facilitate a psychotherapy group with older adults 4. To effectively implement general as well as age-specific evidenced based treatments 5. To verbalize understanding of end-of-life issues

and utilize associated interventions 6. To identify the complex ethical issues that arise in the care of the older adult 7. To recognize the importance of inter-professional teams to address

the complex treatment needs of the older individual 8. To understand the continuity of care for the older Veteran 9. To be skilled in the psychological assessment of the older adult 10. To

learn to assess various risk factors and provide appropriate interventions 11. To be able to provide consultation to team members to incorporate Geropsychology information into treatment

planning and implementation TARGET PROFESSIONAL EXPERIENCES 1. Carry a total caseload of approximately 12-15 psychotherapy clients, providing a minimum of ten hours per week of individual

treatment across three to four of the Geropsychology rotations (CLC, outpatient, HBPC, and Hospice/Palliative Care) 2. Co-facilitate a minimum of two psychotherapy groups related to one’s

particular area of clinical interest and needs of the veterans. 3. Collaborate with inter-professional trainees and faculty on at least one inter-professional team. 4. Provide consultation

and outreach to staff and families in the CLC and/or Palliative Care unit. 5. Provide supervision to earlier-in-training psychology students 6. Determine specific clinic/program needs and

modifications and to institute at least one innovative geriatric based program.