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Rotation Options
Interns rotate through two major six-month and two minor six-month rotations throughout the training year, with interns spending about three days (about 24 hours) per week in a major rotation and about one day (about 8 hours) per week in a minor rotation, with the remaining time spent in other training activities. OSH-PIP offers the following rotation options.
Major Rotations
- Competency Restoration
- Forensic Evaluation Service
- Neuropsychological Assessment
- Sexual Offending Treatment Program (SOTP)
- Psychiatric Intensive Care under Competency Restoration
- Psychiatric Security Review Board (PSRB)
Competency Restoration
*Available as a major or minor
**Unit-based treatment/Mixed population
In this rotation, interns will primarily work with individuals committed to the hospital by a circuit court judge pursuant to Oregon Revised Statute 161.370 as unfit to proceed to court (also referred to as unable to aid and assist). Services provided are focused on identifying clients’ barriers to fitness/competency and aiding in their restoration. Upon admission, many of these clients present with acute symptoms of mental illness and/or cognitive impairments that interfere with their factual and rational understanding of the legal proceedings against them. Challenging personality disorders, substance use disorders, and response style issues (e.g., overreporting, underreporting) are also common. Once recommended fit to proceed (by a certified forensic evaluator from OSH’s Forensic Evaluation Service), clients typically return to their committing county jail to proceed with their legal case.
Interns who choose the competency restoration rotation are provided with a strong focus on clinical interviewing and psychological assessment (e.g., testing for psychopathology, personality, cognition, response style). Additionally, interns attend daily nursing report meetings as well as regular Interdisciplinary Treatment Team meetings, develop and implement behavioral management plans, and carry out group and individual interventions with a focus on addressing barriers to competency. Opportunities include screening patients to assess their evaluation readiness and documenting and communicating related information to the Forensic Evaluation Service. Opportunities may also include attending court hearings and observing competency evaluations.
Competency Restoration
*Available as a major or minor
*Unit-based treatment/Mixed population
OSH has six units in the Harbors program that receive many direct admissions to the hospital and are considered the highest and most acute level of care at OSH. Many individuals admitting to these units are admitting directly from jail and are experiencing significant symptoms of psychosis, mania, and other behavioral disturbances. Harbors is a fast-paced environment with a high-needs and still stabilizing population. Turn over as individuals move to less acute units can be high at times and interventions are often shorter-term and more focused, though opportunities for longer-term interventions may be available. This rotation is designed to provide an exposure to the role of a unit psychologist on such a unit. Experiences are likely to include regular participation in treatment care plan meetings, participation in unit leadership meetings, completion of structured suicide risk screenings, and providing individual and/or group interventions for legal skills, emotion regulation, coping skills, hypothetical reasoning, supportive interventions, and more. Interns will likely also have opportunities to consult with various disciplines on the treatment team, forensic evaluators regarding cases, and Behavioral Psychology Services (BPS) for the development, implementation, and management of behavioral plans. Lastly, there may also be opportunities for completing STARTs (Short Term Assessment of Risk and Treatability) for civil and GEI patients and for testing (e.g., cognitive, personality, response style), as available.
Forensic Evaluation Service
*Available as a major or minor
*Not a unit-based rotation
The Forensic Evaluation Service (FES) completes outpatient and inpatient court-ordered evaluations for counties across Oregon pursuant to Chapter 161 of the Oregon Revised Statute. Orders primarily involve initial competency to stand trial (CST) evaluations pursuant to ORS 161.365 for defendants residing in county custody for one-day evaluations at the hospital or evaluations pursuant to ORS 161.370 for defendants residing at the hospital and already determined not fit to proceed by the court. Additional orders (ORS 161.315) involve criminal responsibility and diminished capacity evaluations.
Interns who choose a rotation within FES will have the opportunity to participate in the evaluation process including and not necessarily limited to record review (hospital records, police reports, collateral records), contacting collateral sources, interviewing, administering and interpreting psychological tests, and report writing, as well as the possibility of witnessing and/or offering testimony. Interns will also provide as-needed consultation with treatment teams and attorneys to guide case conceptualization and provide appropriate competency restoration services. Interns work with a primary supervisor but will also observe and work with other evaluators in the department including an adjunct supervisor with whom the intern will regularly work. Specifically, interns are asked to observe other evaluators on a weekly basis to gain exposure to various evaluation and report writing styles. Interns also complete psychological testing to gather supplemental information for evaluators’ opinions and reports, and an end-of-rotation mock trial using a report the intern authored (in a hospital courtroom setting with other evaluators or attorneys role-playing courtroom personnel). Additional rotation experiences include department meetings twice per month and a didactic series covering foundational forensic concepts and case law (following the ABPP recommended readings, e.g., response style, report writing, testimony, forensic assessment, and forensic relevant instruments). Interns will complete a related FES didactic evaluation form and submit to the Training Director(s), which will then be submitted to the FES supervisors anonymously on an ongoing basis, throughout the training year.
Neuropsychological Assessment
*Available as a major or minor
The Neuropsychology Assessment rotation offers neuropsychological consultative services to units and Interdisciplinary Treatment Teams across the hospital, including those serving clients of various commitment types. Interns who select a Neuropsychological Assessment rotation gain experience in the practice of clinical neuropsychology in a forensic inpatient psychiatric setting. In addition to developing the intern’s understanding of the practice standards in clinical neuropsychology, this rotation focuses on increasing the intern’s familiarity with brain-behavior relationships and the methods and measurements utilized to assess brain functioning, from the initial neurobehavioral exam to more advanced assessment instruments. Additional attention is given to the role of the neuropsychological consultant within the hospital setting, appreciation for the complex utilization of the literature to advance knowledge and analysis of assessment and behavioral data, the development of skills in the communication of results and recommendations through the report and providing feedback to staff and clients. This rotation can be adapted for interns with only beginning experience in neuropsychological assessment who are interested in obtaining preliminary training to augment a more generalist orientation or tailored to more advanced students who may be pursuing future training and practice in neuropsychology.
*Neuropsychological Assessment is a non-unit-based rotation.
Sexual Offending Treatment Program (SOTP)
*Available as a major or minor (with limitations)
*Not a unit-based rotation
The Sexual Offending Treatment Program (SOTP) offers evaluation and treatment services to patients across the hospital, while collaborating with multiple treatment teams. Interns assigned to any SOTP rotation will work with individuals under the jurisdiction of the Psychiatric Security Review Board (PSRB) who have sexual offense histories and/or ongoing sexually problematic behaviors. Interns interested in any SOTP rotation will gain an understanding of the sexual offense evaluation and treatment literature, the Association for the Treatment and Prevention of Sexual Abuse (ATSA) practice and ethical guidelines, and the Risk-Need-Responsivity (RNR) principles. This rotation is best suited for those with foundational clinical skills relevant to risk assessment and/or group and individual interventions, and an interest in sexual offense-specific services in a forensic, inpatient setting.
There are 3 options for the SOTP rotation:
- Evaluation and Treatment (major only)
- Evaluation only (minor)
- Treatment only (minor)
For SOTP rotations involving Evaluation, interns will conduct Psychosexual Evaluation and/or Consultation reports under supervision. They will be formally trained in evidence-based sexual risk tools (Static-99R, STABLE-2007). Their ability to complete the certification training for a protective factor tool (SAPROF-SO) will depend on availability. Of note, this rotation may require travel to the Junction City campus for evaluation interviews. For the Evaluation only minor rotation, interns may attend other SOTP activities of interest and as available (e.g., consult group, administrative meetings, treatment term and/or program planning days). For those who are primarily interested in general risk assessment (e.g., violence, stalking, fire-setting), please refer to the Risk Assessment minor rotation; there may be opportunities for cross-rotation collaboration depending on supervisor availability and with training director approval.
For SOTP rotations involving Treatment, interns provide evidence-based treatment modalities informed by ATSA, including sexual offense-specific individual therapy and groups under the SOTP-sponsored Sexual Health And Relationship Planning (SHARP) jurisdictional treatment track. SHARP groups are aimed at reducing sexual-specific Dynamic Risk Factors (DRFs; e.g., sexual self-regulation, intimate relationships) and enhancing Protective Factors (PFs; adaptive sexuality) identified at the time of evaluation; most non-sexual DRFs and PFs are addressed in other PSRB jurisdictional treatment tracks. Additionally, interns may complete Treatment Progress reports and Feedback reports for OSH’s Risk Review panel and the Psychiatric Security Review Board, with an opportunity to provide informal Risk Review testimony about their treatment patients. Interns collaborate with a patient’s Interdisciplinary Treatment team to inform them of concerns, progress, and ongoing treatment planning. Interns work closely with all SOTP clinicians by attending our weekly staff meeting and consult group, as well as treatment term and program planning days. Interns may also have an opportunity to visit a community group home (e.g., the Pendleton Cottages, Telecare – Woodburn) and assist with patient community placement.
Minor Rotations
*In additional to the above rotations available as a major or minor, the following rotations are available as minors only.
- Behavioral Psychology Services
- Dialectical Behavior Therapy (DBT)
- Psychotherapy
- Risk Assessment
- Psychological Assessment
- Sexual Offending Treatment SOTP, Treatment only
Behavioral Psychology Services (BPS)
Behavioral Psychology Services (BPS) is a centralized service within the Psychology Department that offers consultation, recommendations, and interventions with patients at the hospital who are exhibiting challenging behavior. These can include aggression and violence, self-injury and suicidal behavior, lack of engagement in treatment, and other challenging behaviors. Consultation requests come from all units of the hospital, including GEI, admissions, civil commitment, geriatric, and incompetent to stand trial. BPS staff review and sign off on a variety of behavioral interventions within the hospital, including Patient Engagement Plans and individualized incentive plans. BPS also oversees unit-based reinforcement programs such as the Community Building Project.
The intern participates in assessment of patient behavior, including interviewing patients and staff, observation, and record review, as well as development and implementation of behavioral interventions. The intern also participates in presenting the intervention to the patient and seeking further input, as well as assessment of the outcome of the intervention. There are also opportunities for participating in staff training, both on individual intervention plans as well as broader topics such as reinforcement theory. The intern also assists with gathering data and assessing the effectiveness of any unit-based reinforcement plans. Opportunities exist to provide consultation and feedback to treatment teams. There is a weekly BPS team meeting that the intern should attend, as well as weekly supervision with the rotation supervisor.
Dialectical Behavior Therapy (DBT)
The focus of this rotation is on assessment and provision of treatment for individuals diagnosed with Borderline Personality Disorder or have trouble with emotion regulation, interpersonal effectiveness, non-suicidal self-injurious behavior, or suicidal ideation and attempts. Members of the Interdisciplinary Treatment Team have typically been intensively trained by clinicians from Behavioral Tech (founded by Dr. Linehan) or by Portland DBT (directed by Dr. Dimeff). Direct-service aide-level staff receive four hours of formal didactic training monthly, and interns can lead some parts of this training. In addition, interns participate in co-leading skills groups, individual therapy, and treatment team meetings focused on individual clinical issues.
Clinical experiences will occur across OSH and will primarily involve co-leading groups at OSH, participating in consultation team at OSH, didactic training, and supervision including live supervision. Supervision will involve providing education (e.g., assigned readings), training (e.g., role playing teaching a skill in preparation to provide group treatment under supervision, direct client contact), and typical supervision components (including standard and live supervision through co-leading a clinic group including preparation for the group and check-ins following the group (as is already a mechanism of OSH’s DBT); providing feedback about intern progress). Individual skills training may also be a component of the minor rotation as the opportunity, time, supervisor availability, interns’ skills and abilities, and the acuity of the patient allows. *DBT is a non-unit-based rotation.
Psychiatric Security Review Board (PSRB)
*Unit-based treatment; Mixed population
Individuals on this rotation have varying commitment types. Some clients have been adjudicated GEI and committed to the hospital due to the ongoing risk they pose to themselves or others. In addition to those who have recently been found GEI, this population includes those who have had their conditional release revoked (e.g., due to their level of dangerousness in the community or an increase in difficulty to manage symptoms). Other individuals have been committed pursuant to ORS Chapter 426.701 regarding risk of future dangerousness. Interventions include initial assessment, treatment care plan development, psychiatric and behavioral stabilization, and treatment engagement in preparation to move forward within the hospital setting. Individuals who demonstrate stable behavior may work toward community release and meet with the Risk Review Panel, an interdisciplinary panel who consults with treatment teams and helps address any continued risk factors and oversees increases in privileges including access to the community. The goal of these units is to help individuals achieve their highest level of health, safety, and independence as they prepare for discharge or conditional release to a community setting. Often at this point in treatment, mental illness is stable and the focus is on personality and substance use problems and relapse prevention planning.
Interns who choose this rotation participate in a variety of direct care services, including assessment regarding various diagnostic and treatment questions, co-leading group treatment focused on the development of skills to help regulate emotional and cognitive functioning, and individual treatment to help strengthen coping skills and help clients deal with their circumstances. In addition, interns attend daily nursing report meetings as well as regular Interdisciplinary Treatment Team meetings. Opportunities are sometimes available for didactic and practical experience in specific areas such as violence risk assessment, functional assessments of behavior, and completing the Short-term Assessment of Risk and Treatability (START). Opportunities also include observing or participating in Risk Review Panel meetings, attending court hearings, or other meetings regarding client privileges as well as readiness for conditional release planning.
Psychotherapy
The psychotherapy minor rotation will provide the predoctoral intern with the opportunity to specifically focus on the practice of providing individual psychotherapy treatment to individuals with severe mental illness (SPMI) in an inpatient setting. In this rotation, interns function as a consultative treatment provider to treatment teams who specifically have requested individualized treatment through 1-to-1 focused psychotherapy to aid the patient in meeting treatment goals. Interns will carry a caseload of 5-6 clients, write individual psychotherapy notes, provide updates to the treatment team during interdisciplinary team meetings (IDTs), and construct brief case conceptualizations and treatment plans. Students will be supported in developing and implementing their preferred theoretical modality provided there is theoretical and empirical support for use with this population; however, additional clinical and theoretical training will be provided in conceptualizing psychotherapy cases from a multimodal perspective, with particular attention to contemporary psychodynamic, neurodevelopmental, systems, and trauma-informed lenses. Supervision will focus on robust conceptualization, and formulation and implementation of an evidenced-based individual treatment plan, while considering and responding to cultural and ethical factors affecting individual treatment in an inpatient setting. Furthermore, supervision will be process oriented as well as pragmatic in order to explore psychotherapy and parallel dynamics occurring in the course of treatment, and will at times incorporate live and video observation, as well as use of transcription of therapy narratives. *Psychotherapy Program is a non-unit-based rotation.
Risk Assessment
Following GEI adjudication, patients are placed under the jurisdiction of the Psychiatric Security Review Board whose primary mission is protection of the public. As such, assessment of risk (e.g., for violence, sexual offending, stalking, etc.), formulation of risk factors, and development of risk management strategies are important tasks for psychologists. Assessment of risk is ongoing throughout the hospital by various providers; however, several psychologists with advanced education and training in risk assessment conduct comprehensive violence and other risk assessments when clinically indicated or when these assessments are required, either by the Risk Review Panel or the PSRB, prior to an individual being conditionally released or to better inform treatment recommendations. Interns who select the Risk Assessment rotation learn more about risk, risk assessment, and associated issues such as psychopathy. They will gain experience in the practice of risk assessment in a forensic inpatient psychiatric setting, with a focus on record review, clinical interview, appropriate assessment tools, case formulation, and individualized risk management strategies. As alluded to above, possible risk assessments include violence risk assessments, psychosexual evaluations, stalking, suicide risk assessment, and fire setting, and are dependent on referral availability. This experience will also include familiarity with seminal research in the field, interdisciplinary consultation, observation of relevant hearings, and invitations to attend community trainings and workshops.
*The Risk Assessment Program is a non-unit-based rotation and is currently offered at both our Salem & Junction City campuses. Junction City is about an hour away from the main Salem campus; an intern who selects this rotation would need to be willing to commute to the Junction City campus at times.
More specifically about sexual offending risk assessments, in many cases, these patients have a current GEI adjudication for a sexual offense, but patients may also be referred to the Sex Offender Treatment Program (SOTP) for historical sexual offenses or sexually problematic behavior in the absence of a formal sexual offense. A vital component of SOTP is risk assessment, as these assessments determine not only a patient’s projected likelihood of sexual re-offense, but also individualized case formulation and recommendations for treatment and risk management. Interns can focus on one specific type or gain exposure to all types, based on availability of referrals. Interns who choose this rotation will gain experience in the practice of risk assessment in a forensic inpatient psychiatric setting, with a focus on record review, clinical interview, appropriate assessment tools, case formulation, and individualized risk management strategies. This experience will also include familiarity with seminal research in the field, interdisciplinary consultation, observation of relevant hearings, and invitations to attend community trainings and workshops.
Sexual Offending Treatment Program (Treatment only)
Please see the paragraph beginning with For SOTP rotations involving Treatment in the Sexual Offending Treatment Program (SOTP) description in the major rotation section above.