Fellowship Description:
The Psychology Post-doctoral Fellowship is in the Section of Pain Medicine with primary responsibilities to the comprehensive Chronic Pain Rehabilitation Program. There are 2 fellowship positions. Fellows carry out research projects, primarily using our IRB approved data registry, but also prospective studies of their own designs. Each fellow participates in the CPRP, doing biofeedback assisted psychotherapy, family therapy (couples sessions and groups), as well as monthly aftercare groups. Psychodynamic group is a responsibility in which one fellow co-leads the group with either a psychiatrist, or psychologist. Fellows are also responsible for preparing and conducting some CBT-based groups. They administer, score, interpret, and report cognitive and personality assessments. Fellows are involved in group supervision twice a week and as needed. Fellows are encouraged to take advantage of the wide variety of educational opportunities at Cleveland Clinic.
Chronic Pain Rehabilitation Program Description:
The Chronic Pain Rehabilitation Program is a comprehensive, interdisciplinary program designed to treat patients with chronic non-malignant chronic pain. It is dedicated to working in collaboration with people who have chronic pain, to help minimize their suffering and restore their ability to take joy from life while contributing to it. The program provides comprehensive specialized care to people experiencing chronic pain utilizing an interdisciplinary team approach. To these ends, the team works in a compassionate way to help people to exceed their perceived limitations, eliminate harmful behaviors and replace them with healthy living.
The CPRP is a comprehensive, interdisciplinary approach to chronic pain rehabilitation. Services include: occupational therapy, physical therapy, group and individual psychotherapy, psychophysiological pain and stress management training, and medication management, including the elimination of habituating substances, when needed, and chemical dependency evaluation and treatment as needed. Treatment is tailored to the individual needs of the patient and administered in group and individual settings. Potential patients receive a comprehensive clinical evaluation and during admission, patients are clinically assessed by each member of the interdisciplinary team. The outcome of their clinical findings is integrated into the patient’s initial treatment plan of care.
Listed below is a detailed description of the program.
- Behavior modification (operant conditioning):
- The CPRP is based on behavior modification principles. During the evaluation and admission process, the program philosophy and behavioral techniques utilized in the daily operations are explained to patients and families. The professional team interacts with patients in a positive manner, encouraging patient’s efforts with individual attention and praise, rewarding patient’s improvement in ambulation, minimal use of assistive devices, decreasing expression of pain behavior and the ongoing performance of an exercise routine. Individual goal accomplishments are acknowledged and treatment goals are realistic and set to a level that guarantees successful completion with appropriate effort.
- In order to avoid reinforcing sick role behavior, patients are encouraged to use the medical status sheet for any minor medical concern they may have. The resident MD and or attending physician will review it daily and will establish an appropriate plan of action.
- Psychotherapy
- Group therapy: Dynamic group and Cognitive Behavioral groups are held under the direction of the clinical psychologist.
- Individual therapy is the responsibility of the psychology section and the case managers following the direction and input of the attending physician and psychologist.
- Family/Couples' therapy is conducted by nursing and psychology staff.
- Sexual dysfunction counseling and social service consultations are provided if needed
- Psychophysiological pain and stress management is performed by trained therapists under the supervision of the licensed clinical psychologist.
- Physical therapy/reconditioning
- A comprehensive physical therapy assessment is completed in all patients within the first two days. Daily exercise sessions are scheduled 5 days a week.
- Patient and family education
- Patients and their families receive ongoing education in various topics such as the physical causes of chronic pain, program philosophy, and behavioral principles utilized in the daily operations. Other educational topics areas include: medication use and abuse, assertiveness training, coping strategies and “enabling” behaviors.
- Substance Abuse and Medication Misuse
- Habituating drugs are tapered and then eliminated when appropriate. The majority of patients have failed reasonable trials of opioid therapy, and opioids are eliminated in these people. Benzodiazepines, carisoprodol, barbiturates are almost invariably eliminated. Weaning is completed by the time of discharge. Some patients remain on low doses of opiates, if there is good evidence that they have helped them to improve their functional status and there is no history of medication abuse.
- Patients receive education in the areas of addiction and addictive substances. Whenever a diagnosis of chemical dependency is entertained, the Chemical Dependency Counselor completes a substance abuse assessment and provides treatment recommendations. Treatment initiated during this program includes individual sessions with the substance abuse counselor, attendance at 12 step meetings and recovery work assignments. Patients requiring a more intensive level of care may be transferred to a Chemical Dependency Program for further treatment.
- Vocational Rehabilitation Counseling
- Patients of working age (18-65) receive a Vocational Rehabilitation Consultation when indicated. Referrals to local community agencies (e.g. Bureau of Vocational Rehabilitation, Bureau of Worker's Compensation - Rehabilitation Division) are initiated with consistent follow-up to ensure patient has received the services. Services offered within the program may include Vocational Counseling, interest and/or aptitude testing, job seeking skills training), and liaison/intervention with employers to facilitate smooth transition to work.
- Family therapy
- Family members or significant others are required to attend weekly education and family group meetings. Individualized family therapy is provided by the treatment team whenever indicated.
- Occupational therapy
- Occupational therapy is provided three times a week. The primary objective is to help patients to perform daily living tasks independently with appropriate body mechanics.
- Specific services (e.g. desensitization treatments) are provided for patients with complex regional pain syndrome (RSD), neuropathic hand conditions, etc.
- ADL training is provided for patients who need assistance in dressing and bathing to function independently outside of the hospital, at home or in the community.
- Leisure and Activity Groups focus on the value and need for leisure, time management, task management, self-esteem and social interaction. Patients learn through activity that they can function and normalize and enjoy life.
- Work Reconditioning
- This is provided to selected patients who need specific work to improve strength and endurance, to enable them to return to work.
- Medication management
- The attending physician prescribes non-habituating agents for pain control and monitors patients on a daily basis for response.
- The medication program includes medication education/ knowledge assessment, and self administration.
- Medical/surgical consultations
- Extensive medical evaluations are incompatible with the program goal of assisting patients to relinquish the sick role. Therefore, all necessary evaluations should be accomplished prior to admission whenever possible. Problems that arise or are identified during treatment will be evaluated by appropriate specialists, especially when they threaten the goal of maximal possible rehabilitation.
- Anesthesia Pain Therapy
- Patients who have not received a trial of treatment by regional blockade or patients who may benefit with the use of temporary analgesia may be referred to anesthesia prior to initiating the CPRP. Services available include: diagnostic nerve blocks, therapeutic nerve blocks, trigger point infections, TENS, spinal cord stimulation and intrathecal pumps.
- Psychological testing
- Patients receive a cognitive screen and computer scored Minnesota Multiphasic Personality Inventory-2. Additional testing may include projective testing, cognitive assessments, and tests for specific learning disabilities.
- Primary RN Case Manager Functions
- The primary RN case manager coordinates the delivery of care provided to each patient throughout their stay in the program. The case manager ensures that all other disciplines have provided the appropriate services in a timely manner. In addition, the case manager obtains feedback from the team regarding patient’s progress and areas of learning.
- The primary case manager consults with patient and family to determine whether further clinical consultations are needed. At the time of discharge, the primary case manager will ensure that pertinent information is sent to referral sources (with patient permission) including discharge diagnoses, current medication regime and global indicators of patient’s progress.
- Nutritional counseling/dietary support
- All patients are assessed for nutritional deficits. Special consultations are arranged for obese and , underweight patients Follow-up
- The CPRP Aftercare groups are offered once a month at no cost to all former patients. The purpose is to provide a support system that continues to reinforce the principles learned while helping each other achieve stability in their lives.
- Medication management is available at this time for a fee.
Research:
As part of its mission to treat patients in the most efficacious manner, and to be in compliance the CARF regulatory agency, the Chronic Pain Rehabilitation Program maintains an IRB approved data registry that includes information on all patients evaluated and treated in the program, as well as it’s related clinics such as the Failed Back Clinic; Complex Patello-femoral Clinic and Chronic Pancreatitis Clinic. The database includes basic demographic information as well as an assessment of mood, pain, medication, medical and developmental history. Data are gleaned from the initial patient evaluation and patient completed questionnaires, as well as follow-up interviews.
Education:
Fellows participate in the CPRP Journal Club and Education Seminar both of which meet monthly. They are expected to present regularly. Fellows also attend the Department of Psychiatry and Psychology grand rounds and may attend any grand rounds or journal clubs of interest in the institution. Teaching opportunities in the Medical College are sometimes available in the second year
Responsibilities:
Post-doc hours roughly include:
- Standard psychological testing including WASI and MMPI-2 report summaries (about 2 hours a week)
- Research related activities including maintaining the data registry (6+ hours a week)
- Out-Patient psychotherapy (~2 hours a week)
- 2 – 3 Chronic Pain Rehabilitation Program patients 3 times a week per patient
- Group therapy (6 – 15 hours a week)
- Family work including groups and couples or family (6 hours a week)
- Personality and Cognitive testing (~5 hours a week)
- Miscellaneous duties including writing for posters and publication (5 hours a week)
- Team treatment planning and notes (5 hours)
- Supervision (2+ hours a week)
- Journal club present on a regular basis and attend one time a month
- Education seminar present once a quarter to the CPRP team
- Attendance at regular CPRP team functions including Post-mortem and Steering Committee
Training and Education Contact:
Judith Scheman, PhD
Program Director
Phone: 216.444.1032
Fax: 216.445.7000
Email: bruchh@ccf.org
The goal of this Clinical Health Psychology Fellowship is to provide clinical interventions with adult patients experiencing a wide range of medical and psychological problems. Our fellowship is primarily outpatient-based and includes consultations and diagnostic interviews, short-term psychotherapy, behavioral interventions, and group psychotherapy. This is a one year certificate program in one major rotation area; fellows may apply for second year of fellowship in same or different area of specialty upon goodness of fit/mutual consent. To date, our graduates have been successful at obtaining a position in Clinical Health Psychology.
Three major rotations for 2012-2013 include: Headache, Multiple Sclerosis, and Biofeedback/Cardiac Rehab clinics. Minor rotations in these areas are assigned based on goodness of fit: Primary Care, Sleep Disorders, Biofeedback, Research, and Medical School Teaching. The fellowship is clinical in nature, but the fellow is expected to participate in ongoing research, poster presentations, didactics, and teaching. Our fellowship is not currently APA accredited, but we are listed on the APPIC directory at http://www.appic.org/directory/4_1_directory_online.asp
The fellowship provides an annual stipend of approximately $46,500 with a cost of living increase in second year of training, as determined annually by the Cleveland Clinic Graduate Medical Education Department and the Clinical Health Psychology Fellowship. Generous benefits include: individual supervision for licensure, extensive didactics, three weeks paid vacation per year, generous individual/family medical benefits and dental insurance in second year of training. It is expected that fellows will have completed their doctoral degrees prior to beginning the fellowship, which is typically September 1st of each calendar year.
Application instructions: Interested applicants should e-mail the following materials to pezdirc@ccf.org between October 1, 2011 and January 6, 2012: CV and a letter of interest/intent. Note: Please specify one or more of the three major rotations for which the applicant would like to be considered. Also include a clinical work sample and three letters of recommendation (sent by their authors). Hard copies of applicant's official graduate transcript and a letter from graduate school program director attesting to the applicant's status as a doctoral candidate/expected dissertation defense date/and verification of applicant's anticipated graduation prior to the anticipated September 1, 2012 start date of postdoctoral fellowship are also required prior to interview day. Note: APA graduate program required; APA health psychology internship strongly preferred. Applicants selected for interviews will be contacted via e-mail in late January/early February. Any questions should be directed to: Ms. Anne Pezdirc at pezdirc@ccf.org or (216)445-1319. Note: We adhere to APPIC Uniform Notification Date, with offers extended on Wednesday, March 14, 2012, Noon EST.
Dana Brendza, PsyD, Director,
Clinical/Health Psychology Training Program,
Section of General and Health Psychology,
Department of Psychiatry and Psychology (P57),
Cleveland Clinic Foundation,
9500 Euclid Avenue,
Cleveland, OH 44195
Phone: 216.445.1319
Current Supervisors and Psychology Staff:
Program Description
The postdoctoral positions within the Section of Neuropsychology in the Department of Psychiatry and Psychology at the Cleveland Clinic (CC) are designed for individuals who have met the basic academic and training requisites for the doctorate degree in clinical psychology, and have a strong academic and clinical training background in the fundamentals of neuroscience and neuropsychological assessment.
The Postdoctoral Residency Program in Neuropsychology at CC is a founding member of the Association of Postdoctoral Programs in Clinical Neuropsychology (APPCN). The program operates in accordance to the INS-Division 40 guidelines (The Clinical Neuropsychologist, 1987, 1, 29-34) and the goals espoused by the Houston conference (Archives of Clinical Neuropsychology, 1998, 2, 203-240). Our postdoctoral positions are designed to provide residents with the didactic and experiential opportunities necessary to develop clinical interpretative and consultation skills at a professional level while under the supervision of experienced neuropsychologists. In addition, specific training goals include active involvement in clinical research and educational opportunities within the context of a nationally known tertiary medical center.
Our residency begins on September 1. The two-year experience will be divided into time periods that allow for general clinical training, specialization in particular clinical areas (i.e., pediatrics or adult neuropsychology with the opportunity for specialization with a particular population such as epilepsy patients), research, teaching, and participation in didactics. During the first weeks of each rotation, training concentrates on skill building and refinement in the areas of test administration, test interpretation, and report writing. For the first twelve months, two four-month rotations will be completed in the resident’s primary interest area (e.g., adult or pediatric neuropsychology) and one four-month rotation in the resident’s secondary interest area. The second year consists of elective rotations tailored as much as possible to meet the resident’s specific interests and training needs.
First year
- Rotation in Primary Interest Area - 4 months
- Rotation in Secondary Interest Area - 4 months
- Rotation in Primary Interest Area - 4 months
Second year
- Advanced Specialization and Special Projects/Wrap up - 12 months
Clinical Activities:
The evaluations provided by the Section of Neuropsychology employ specialized testing procedures and a nomothetic framework that strives to integrate medical, neurological, and behavioral data with neuropsychological test findings to answer any of a number of referral questions. Referrals for our services typically consist of, but are not limited to, questions concerning:
- Differential diagnoses (e.g., depression versus dementia, dementia of the Alzheimer’s type versus Primary Progressive Aphasia);
- Delineation of spared and impaired cognitive functions secondary to known central nervous system dysfunction;
- Establishment of a neuropsychological baseline against which to monitor recovery or progression of central nervous system dysfunction;
- Comparison of neuropsychological functioning prior to and following a variety of pharmacological, surgical, and behavioral interventions as part of ongoing treatment outcome evaluations and standard clinical care;
- Assessment of cognitive/behavioral functions to assist with rehabilitation, management strategies and/or educational or employment placement; and
- Evaluation of cognitive status for the purpose of disability, compensation, and/or liability determinations in forensic cases.
The Section of Neuropsychology provides inpatient and outpatient consultation and evaluation services for the staff of the Cleveland Clinic and community referral sources. Currently, the Section of Neuropsychology receives the majority of its referrals from Adult and Pediatric Neurology, Epilepsy and Clinical Neurophysiology, the Mellen Center (Multiple Sclerosis), Neurosurgery, the Center for Neurological Restoration (DBS), Adult and Child Psychiatry, Consultation-Liaison Psychiatry, Alcohol and Drug Recovery Unit, Internal and Geriatric Medicine, Cardiology, Anesthesiology, and Pediatric Oncology/Hematology.
A flexible battery approach is adopted by most staff. The Section has tailored a number of specialized test batteries for specific patient populations. For example, a formal pre- and post-surgery protocol is in place for seizure surgery candidates, and standard protocols are in place for evaluating candidates for deep brain stimulation for treatment of psychiatric or movement disorders (e.g., Parkinson’s disease, essential tremor, dystonia) and surgery for coronary artery disease.
The combination of a rich clinical referral base at the Clinic and an innovative service delivery model has created a strong trajectory of growth for the Section of Neuropsychology. More than 2,000 patients are referred for evaluation annually, making the Section of Neuropsychology one of the most clinically active neuropsychological services in the country for its size.
Clinical Component
On average, a minimum of 60% of residents’ time will be devoted to direct clinical service. A portion of this commitment can be focused on services directed at specific patient populations (e.g., epilepsy, pediatric, geriatric, or movement disorder patients). In addition, residents are afforded the opportunity to work with culturally diverse populations due to the high number of international patients who come to CC seeking specialized health care. Although the Section is largely a technician-based service, we recognize the importance of direct patient contact in developing a strong clinical understanding of process variables and patient behaviors that underlie test performance. Consequently, the residents will be responsible for testing some patients each week throughout the two-year residency. Residents will have the opportunity to supervise technicians, generally more often in the second year. It is anticipated that this assessment experience will provide the residents with the opportunity to enhance their existing knowledge and experience with a variety of neuropsychological assessment procedures.
Assessment is only one component of the residents’ clinical duties. The primary goal of the residents’ clinical activities is to expand their expertise in clinical interpretation and reporting of neuropsychological data. Report writing and consultation with patients and other health-care professionals are, therefore, central to this postdoctoral experience. The residents will also be expected to participate actively with members of the Section in one or more clinical team meetings (e.g., Epilepsy-Surgery Patient Management, DBS Patient Management etc.) on an ongoing basis.
Formal clinical supervision is provided on an individual basis, typically two to three hours weekly, to review cases. Informal supervision is also available on a daily basis. Group supervision in the form of weekly postdoctoral conference meetings to review topics of interest, deposition transcripts and videotapes, ethical issues, noteworthy cases, research data, etc. generally accounts for approximately one hour weekly. Practice management issues, such as scheduling patients, managing technical support services, and billing and coding practices are often discussed.
Formal written evaluations of the postdoctoral residents’ progress are prepared by the Neuropsychology staff at the conclusion of each rotation. Information is forwarded to the Division of Education in accordance with CC Graduate Medical Education policy. Residents whose performance is not at an expected level of competence will be advised regarding the problem areas in their performance, and a specific plan to remediate those weaknesses will be developed. In the course of these regularly scheduled evaluations, residents are asked to evaluate the program and to recommend changes to suit their individual goals.
Research Activities:
In keeping with the scientific basis of clinical neuropsychology, the CC Section of Neuropsychology is actively involved in ongoing clinical research. The Section has served as a validation site for new assessment procedures (e.g., Wechsler Adult Intelligence Scale-III, Children’s Memory Scale, Wechsler Memory Scale-III, Kaufman Adult Intelligence Test, MicroCog, etc.). It is an integral component in a number of grants involving Alzheimer’s Disease, epilepsy surgery, deep brain stimulation for treatment of movement and psychiatric disorders, multiple sclerosis, and pharmacological drug trials. In addition, the Section has been heavily committed to advancing scientific inquiry via collaborative projects with other institutions, including the neuropsychology services at Ohio State University’s Medical School, Mayo Clinic, University of Wisconsin, the Medical College of Georgia, UT Southwestern Medical Center, Medical College of Ohio and the Bozeman Epilepsy Consortium. These collaborations extend our research activities and enrich our collegial relationships with other professionals in the neuropsychological community.
Research Component:
Research will be an integral component of the postdoctoral experience. The Section maintains a number of IRB-approved patient registries and is involved in a number of ongoing collaborative research projects both within and outside the institution. The Cleveland Clinic is highly supportive of research activities, and provides excellent statistical, computer, graphic art, photography and editorial support services. It is expected that the residents will become involved in one or more of the existing research projects within the Section, with the goal of preparing at least one paper for publication and/or presentation at a national meeting. Independent and/or new collaborative research projects will be encouraged, and grant activity highly supported. Travel time is provided to make presentations at professional meetings, and some financial support for travel is available, especially for first-authored papers based on work accomplished at Cleveland Clinic.
Terms and Conditions:
Residents will have completed all of the formal requirements for the doctorate before beginning postdoctoral training; in most cases, appointments begin in September. Although the CC Clinical Neuropsychology Residency is designed as a two-year program, contracts are made on a year-to-year basis, with renewal for the second year being made by mutual consent.
The residency currently carries a 12-month, first year stipend of $42,357, which typically increases prior to the second year. Fifteen days of vacation and health insurance are among the benefits provided. The grievance process, allotment of vacation and meeting time, and other institutional procedures occur in accordance with the General Policies for Graduate Medical Education.
Neuropsychology Staff:
The Neuropsychology Section was organized in 1985 and officially established as a formal patient care center within the department of Psychiatry and Psychology at the Cleveland Clinic in 1986. Richard I. Naugle, PhD, a Diplomate of the American Board of Clinical Neuropsychology and the American Board of Professional Psychology, joined the section in 1987 and serves as the Section Head
- Robyn M. Busch, PhD joined the Section in 2005 with 50% of her time devoted to research regarding cognition in surgical epilepsy patients. She has an appointment in the Epilepsy Center and her current funded research projects examine potential genetic and metabolic factors that underlie memory dysfunction in adults with epilepsy. Retrospective research is focused on improving prediction of cognitive outcome after epilepsy surgery and developing better understanding of the factors that contribute to mood and anxiety disorders in patients with epilepsy. The remainder of her time is spent providing clinical services to adults, primarily patients with epilepsy.
- Darlene Floden, PhD joined the Section in 2007 and primarily provides services to adult patients seeking deep brain stimulation for the treatment of movement disorders. Fifty percent of her time is devoted to research related to frontostriatal function and deep brain stimulation in accordance with her appointment in the Center for Neurological Restoration.
- Jennifer S. Haut, PhD joined the Section in 2001 and provides clinical coverage to the pediatric neuropsychology service. Dr. Haut is a Diplomate of the American Board of Clinical Neuropsychology and the American Board of Professional Psychology and has more than fifteen years of experience in pediatric neuropsychology. She is Director of the Clinical Neuropsychology Post-Doctoral Residency Program.
- Patricia Klaas, PhD joined the Section in 2004 with clinical responsibilities in pediatric neuropsychology. Her research interests involve memory, mood and adjustment issues in pediatric epilepsy surgery patients.
- Cynthia S. Kubu, PhD joined the Section in November 2001 to provide clinical services to adult patients. Dr. Kubu is a Diplomate of the American Board of Clinical Neuropsychology and the American Board of Professional Psychology and has more than fifteen years of experience in clinical neuropsychology. Half of her time is devoted to research related to deep brain stimulation in conjunction with the Center for Neurological Restoration.
- Michael W. Parsons, PhD joined the section in 2007 as an adult neuropsychologist. His clinical caseload includes the full range of neuropsychological referral questions and consulting to services throughout the clinic and community. His research involves the use of functional and structural brain imaging techniques to study processes of learning and memory in cognitively intact individuals and patient populations. Dr. Parsons is a Diplomate of the American Board of Clinical Neuropsychology and the American Board of Professional Psychology.
Application Process:
The Clinical Neuropsychology Postdoctoral Residency Program participates in the APPCN Resident Matching Program. The deadline for receipt of all application materials is January 15 (or the next business day if the 15th falls on a weekend or holiday). National Matching Services, Inc. (NMS) signed agreement forms are due in January and must be submitted directly to NMS. Rank order lists must be submitted to NMS in late February or early March and NMS notifies programs and applicants of the match results later in March. Applicants are encouraged to call or write for information or clarification of the program’s description or opportunities. Applicants’ rights to make a free choice among residencies are recognized and no indication of offers or ranking is discussed until the notification day.
Application materials should be directed to:
Jennifer S. Haut, PhD, ABPP-CN
Cleveland Clinic Foundation
9500 Euclid Avenue (P57)
Cleveland, Ohio 44195
Phone: 216.444.2454
Fax: 216.444.4525
Email: hautj@ccf.org
Applications should include:
- A letter of interest describing relevant academic and training experiences, desired postdoctoral training objectives, and future professional goals
- A current curriculum vitae
- Electronic submission of the above items by e-mail in a word or PDF file to hautj@ccf.org is acceptable
- Three (3) letters of reference, including at least two from individuals familiar with the applicant's academic and clinical training in neuropsychology
- A statement from the applicant's graduate school clinical training director indicating the applicant's status in the program and probability of completing the requirements for the doctorate prior to the residency year (waived for those already holding the doctorate). APPCN’s Verification of Doctoral Training Form (PDF) is acceptable for this purpose
- An official copy of the applicant's graduate transcripts
- Two sample reports of neuropsychological examinations
