Interns are provided clinical activities that support the development of a “generalist.” The majority of the Interns’ clinical time is spent developing and enhancing basic psychology practice skill, including conducting diagnostic interviews, psychological evaluations, therapy and consultation. These activities are similarly provided at both the Moorhead and Detroit Lakes locations. Interns will have some opportunity to be on-call in Moorhead, with the Mobile Crisis team, which provides services to the Fargo-Moorhead area.
Psychological Evaluation and Assessment
Psychological Evaluations: (24 required in the year). Interns complete a variety of psychological assessments. Interns may have the opportunity to perform intelligence testing, ADHD testing, adaptive behavior assessments, suicide risk assessments, autism evaluations and personality assessments. Interns administer, score and interpret psychological tests and develop recommendations based on the assessment results. Interns also collaborate with members involved in treatment planning to incorporate those recommendations to services provided. An “evaluation” is defined as an assessment which includes a diagnostic interview and at least two testing methods, along with a discussion regarding integrated findings and recommendations. It is considered an Integrated Report. 24 evaluations are required to be completed during the year. Referrals for psychological evaluations generally come from Solutions’ Outpatient Clinic staff and are for diagnostic clarification. Frequent reasons for referral are for ADHD, autism, intellectual testing, questions about memory impairment, measurement of adaptive skills, neuropsychological screening, and assessment of parental capacity. Drs. Kao and Blake will supervise psychological evaluations, depending upon the location.
Diagnostic Assessments: (24 required in the year) Interns receive early training in Diagnostic Assessments, (i.e., how to conduct clinical interviews for the purpose of determining a diagnosis and eligible/needed follow up care, along with giving feedback to clients). Diagnostic Assessments are generally conducted for clients new to Solutions, and client referrals come from a variety of sources, including self-referral. State requirements also require annual updating of clients’ Diagnostic Assessments. Drs. Kao and Blake supervise Diagnostic Assessments, depending upon the location. Interns will learn to use the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood for children ages 0-5, and have the opportunity to perform at least one of these assessments.
Behavioral Assessment: (2 required in the year). Interns receive training in performing behavioral assessment, including defining particular maladaptive behavior, identification of its function and development of strategies to impact this function. Completion of the behavioral assessment is followed by consultation with appropriate parties for follow up implementation of the recommendations. Referrals for these types of assessments generally come from county case managers and are for individuals with an identified disability who are on a Medicaid waiver and are working with multi-disciplinary teams. Some assessments come from Solutions’ autism clinic. Dr. Witte supervises Interns’ experience with behavioral assessment.
Psychotherapy: (10-12 sessions per week). Interns conduct individual, group and/or family therapy to children, adolescents and adult clients. They assess, treatment plan, and provide evidence-based services to clients. Interns also monitor the client’s progress. Interns are trained in the Managing and Adapting Practice (MAP) model early on in the training year. This gives them tools to provide evidence-based strategies for children, identify outcome measures, and track and graph objective outcomes. Dr. Blake oversees Interns’ therapy experience in Detroit Lakes and Dr. Kao supervises their provision of therapy in Moorhead.
Dialectical Behavior Therapy: The Intern on the DBT rotation co-leads a DBT group. The Intern shadows in the beginning, and then begins to take on more and more of the psychoeducation components and overall group management. Andrew Hoerauf, MSW, LICSW supervises Interns’ experience providing DBT group, during that rotation.
Applied Behavior Analysis (ABA): Interns receive training in behavior analytic interventions within their experience at the autism clinic while on the ABA rotation. They learn to provide ABA interventions such as discrete trial training, shaping, chaining, and the timing of prompts and reinforcement. Over time they will provide supervision and direction to direct care staff implementing these interventions. They learn to conduct reinforcer preference analyses and Functional Behavior Assessments, along with language and adaptive behavior assessments. Interns also provide consultation to the autism staff. Dr. Witte supervises Interns’ experience on the ABA rotation.
Crisis On-Call. Interns are part of a team that responds to urgent calls in the area. Every two months Interns are on-call with the Mobile Crisis Team, over a weekend. The Mobile Crisis Team always has two crisis workers on-call, so the Intern is never alone. Additionally, there is a Mental Health Professional who is alerted to the call and oversees the crisis response by phone. The Crisis Team is dispatched by Southeast Human Service Center, so the Intern accompanies the other crisis worker out into the community for the crisis intervention. The goal of the Mobile Crisis Services is to conduct crisis assessment and intervene to provide resources to clients and divert hospitalization. The Crisis Team makes appropriate referrals for the client on Monday morning. Joel Bakken, MS, LP, supervises Interns’ activities while on-call.
Psychological consultation is an important aspect of the role of the psychologists at Solutions, and is a valuable skill. Interns are provided experience in consultation throughout the year. This is intentionally provided in a number of ways and with a number of supervisors, so as to maximize the Interns’ knowledge of the programs in the organization and provide a broad level of learning. Solutions has a number of naturally occurring program and team meetings for which psychological consultation is required.
Outpatient Case Consultation. The Interns attend two different case consultation meetings each week – one in Moorhead and the other in Detroit Lakes. A developmental approach is taken with these meetings in that at first Interns shadow and the clinical supervisor models how to provide psychological consultation. Interns also see how other Mental Health Professionals provide consultation to one another. Over the course of the year through the supervision process Interns are increasingly prepared to provide consultation and feedback to other Mental Health Professionals. Dr. Blake oversees the Interns’ involvement with the Outpatient case consultation meeting in Detroit Lakes, while Dr. Kao will supervises their involvement in Moorhead.
Mobile Crisis Team Case Consultation. The Intern attends the Mobile Crisis team’s case consultation meeting once per month. This is a meeting where cases are reviewed and additional services and referrals are planned for individuals who have had involvement of the Mobile Crisis team. Joel Bakken, MS, LP provides consultation at this meeting. Interns initially observe the modeling of consultation for these crisis cases and then take on greater responsibility over time in providing input regarding these cases. Joel Bakken supervises Interns in providing consultation to the Mobile Crisis team.
Residential Consultation. While on the DBT rotation, Interns attend the weekly Residential Services consultation meeting. Consultation is overseen by Joel Bakken, MS, LP, and the role of the Interns during these meetings is to provide education about various mental health conditions, explain diagnoses, provide recommendations for intervention, and give therapeutic direction to the residential treatment team. It is expected that the Interns take on an increasingly active role over the course of the rotation. Joel Bakken provides supervision for this activity.
Autism Services Consultation. While on the ABA rotation, Interns attend the weekly Autism Services consultation meeting. This meeting includes staff providing direct service, the Program Coordinator, and BCBA. Dr. Witte attends this meeting and provides supervision to Interns. The role of the Interns during these meetings is to make program recommendations in light of the data being shared. It is expected that Interns will take on an increasingly active role over the course of the rotation.
In addition to the supervision provided to Interns, they also receive training in providing supervision to others, under supervision. Supervision training is delivered in a developmental fashion. Supervision training is a topic covered in the didactic sequence. Interns are provided supervision opportunities within their rotations. Supervision is first modeled for them. For the ABA rotation Interns observe and provide feedback to Behavior Intervention staff regarding their technical delivery of ABA services. Following the Interns developing a comfort level in providing direct ABA services, supervision to behavior intervention staff will be modeled for Interns, and then they will start to provide supervision to behavior intervention staff while under supervision. Interns on the DBT rotation attend group supervision meetings twice per month for the Adult Mental Health Rehabilitation Services (ARMHS) Treatment Directors. Clinical supervision will first be modeled. As Interns develop a level of comfort with the ARMHS programming and philosophy, they will begin to provide supervision while under supervision. The second half of the year, assuming readiness, Interns also provide supervision to master’s level trainees.