Interns rotate through two major six-month and two minor six-month rotations throughout the training year, with interns spending approximately three and half days (about 24 hours) per week in a major rotation and approximately one day (about 8 hours) per week in a minor rotation, with the remaining time spent in supervision and other training exercises. OSH-PIP offers the following rotation options.
OSH-PIP offers the following rotation options (with the above noted specifications/exceptions).
*Available as a major or minor
The competency restoration program serves clients (male and female) who have been committed to the hospital by a circuit court judge pursuant to Oregon Revised Statute 161.370 as incompetent to proceed to court (also referred to as unable to aid and assist). Services provided are focused on identifying clients’ barriers to competency and aiding in their restoration to competency. Once deemed competent to proceed (by a certified forensic evaluator from OSH’s Forensic Evaluation Service), clients typically return to their committing county jail in order to proceed with their legal case. 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.
Interns who choose a rotation within the competency restoration program 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.
*Available as a Major or Minor
The Forensic Admissions Program units serve all clients upon admission to OSH (e.g. civil commitment, incompetent to proceed, guilty except insanity, etc.) on co-ed units. Due to COVID-19 and the need to quarantine, the clients are currently admitted in “cohorts” with each cohort being admitted over about one week and then staying on the unit for a minimum of an additional two weeks before they are transferred to other units in the hospital. Services are focused on conducting brief suicide assessments upon admission, engagement in treatment, identifying barriers to competency or discharge (for clients not in the hospital for incompetent to proceed), and starting specified referrals as needed (e.g. neuropsychological testing, early referral for a competency evaluation interview). Many of these clients present with acute symptoms of mental illness and/or cognitive impairments and have varying experiences with psychiatric hospitalization and the legal system.
Interns who choose a rotation on an Admission unit are provided with a strong focus on clinical interviewing, triage, and providing initial treatment/assessment for clients. Treatment can be delivered on an individual and group basis. Additionally, interns attend daily nursing report meetings, Interdisciplinary Treatment Team meetings, leadership meetings, and have frequent communication with members of the treatment team and staff to quickly identify psychological needs of the clients and provide recommendations on future treatment needs. As this is a relatively new program at OSH, there are also opportunities for program development and evaluation.
*Available as a major or minor
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 clients residing in county custody for one-day evaluations at the hospital or evaluations pursuant to ORS 161.370 for clients residing at the hospital and already determined incompetent to proceed by the court. Additional orders 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. As the rotation progresses, the interns’ responsibility for aspects of the evaluation process will increase based on experience and skill. At the outset of the rotation, interns will receive their supervisor’s interview and report templates. Throughout the rotation, the interns are highly encouraged to adapt these templates as they develop their own evaluation style. By the end of the rotation, the supervisor may submit some (or all) of the intern’s completed work to the Court with a co-signed report. In this rotation, the intern will work with a primary supervisor, but will also observe and work with the other evaluators in the department. Specifically, interns are asked to observe other evaluators in the department on a weekly basis to gain exposure to various evaluation and report writing styles. On average, a typical intern completing a major rotation will author and submit to the Court between 12 and 22 competency reports. Interns will also complete at least one criminal responsibility (Guilty Except for Insanity and/or Diminished Capacity) evaluation.
Additional rotation experiences include a weekly department meeting, a weekly didactic 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), two oral case presentations (covering one competency evaluation and one criminal responsibility evaluation), psychological testing to gather supplemental information for other 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 role playing courtroom personnel).
*Available as a major or minor
Clients within this program 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, increase in difficult to manage symptoms). Most individuals are admitted to one of the two acute stabilization units, where the focus is on 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, who refrain from verbal and physical aggression, and who engage in treatment may transfer to one of several step-down units focused on preparing individuals to request and use privileges and eventually move forward to community placement. Some individuals who have shown psychiatric and behavioral stability in the community or in a jail setting may be admitted directly to one of these lower-acuity units. The goal of these units is to help clients 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 a rotation within the GEI program 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 and functional assessments of behavior. Opportunities may be available to attend court hearings and other meetings regarding client privileges as well as readiness for conditional release planning.
*In additional to the above rotations available as a major or minor, the following rotations are available as minors only.
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.
The focus of this rotation will be on proving individual treatment (CBT for psychosis specifically) for patients on one of our incompetent to proceed units. Time spent on this rotation will also include related documentation and participation in relevant multi-disciplinary treatment team meetings. Interns will learn how to apply and adapt the CBT model in order to provide effective, person-centered treatment to residents at the hospital struggling with psychosis. Interns will learn how to create dynamic case conceptualizations and utilize these conceptualizations to guide treatment (i.e. individual therapy). Interns will be expected to provide individual CBTp to at least two residents in the hospital and co-facilitate a CBTp group (e.g. “coping with voices”, “coping with paranoia”) in the hospital’s “aid and assist” treatment mall. Interns will also learn how to tailor their treatment to specific programs (e.g. addressing barriers to competency in the “aid and assist” program, risk mitigation in the GEI program, etc.). Interns will be expected to share their case conceptualizations and progress of therapy with their residents’ treatment teams and participate in their residents’ interdisciplinary treatment team meetings, when possible. A background in CBT is helpful but not required. Supervision will involve recorded sessions.
The focus in the DBT program is on assessment and provision of treatment for individuals diagnosed with Borderline Personality Disorder. People with other diagnoses may also participate in the program if they experience difficulty 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 and programmatic 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 program); 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.
The Geropsychology program provides care and treatment to older adults with severe and persistent mental illness, traumatic brain injuries, and disease processes known to affect the central nervous system. Clients in this program have been committed for a variety of reasons and demonstrate a wide range of neurocognitive disorders along with chronic medical problems that require substantial nursing care needs and medical monitoring. Due to the complexity of this client population, there is a heavy emphasis on understanding the relationship between physical and mental health. Interns who choose a rotation within this program have the opportunity for individual and group therapy, neuropsychological assessment, and interdisciplinary consultation. Interns also participate in the development of treatment plans that address very specific biopsychosocial needs through an integrative, interdisciplinary approach with a goal of helping patients return to a less restrictive environment.
The Neuropsychology Assessment program 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.
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.
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 provided throughout various programs, but several psychologists with advanced interest and training in risk assessment conduct comprehensive violence and other risk assessments when clinically indicated or when these assessments are required prior to an individual being conditionally released. Interns who select a rotation in Risk Assessment learn more about risk, risk assessment, and associated issues such as psychopathy. As alluded to above, possible risk assessments include violence risk assessments, sexual offending risk assessments, stalking, and fire setting, and are dependent on referral availability. 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. *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.
The Sexual Offending Treatment Program (SOTP) offers evaluation and treatment services to patients across the hospital, while also providing consultation to various treatment teams. Interns in the SOTP rotation will work primarily with GEI patients who have sexual offense histories and/or ongoing issues with sexually inappropriate behaviors that are difficult to manage. Interns interested in this rotation will gain an understanding of evidence-based treatment modalities informed by the Association for the Treatment of Sexual Abusers (ATSA) practice and ethical guidelines, as well as the Risk-Needs-Responsivity (RNR) principles in a forensic, inpatient setting. Interns will have opportunities to provide sexual offense-specific treatment primarily in individual therapy due to COVID-19 restrictions. Should group therapy become available, this will involve co-facilitating or leading “core” sexual offense-specific groups (i.e., the intensive program), as well as Dynamic Risk Factor (DRF) groups based on patient needs (e.g., healthy relationships, sex education, safety planning). Finally, interns will carry a small caseload and will gain experience in a consultation role, collaborating with patient(s) IDTs to inform them of concerns, progress, and ongoing treatment planning. This rotation will be best suited for those with a solid foundation in group and individual interventions and interest in sexual offense-specific treatment. Please note that this minor rotation is heavily focused on sexual offense-specific treatment. Opportunities to observe Psychosexual Evaluations may be available; however, this is not guaranteed. For those who are primarily interested in assessment and evaluation, please refer to the minor sexual/violence risk assessment rotations.