Serious and Persistent Mental Illness - Area of Emphasis

Focuses on working with individuals with serious mental illness across acute and chronic care settings. This emphasis also provides opportunities to collaborate with medical providers and interdisciplinary teams serving these populations, fostering skills in consultation and integrated care.

Primary clinical training sites: Inpatient Psychiatry, INTERCEPT Program Treatment and assessment of serious mental illness across the lifespan, course of illness, and levels of care with an emphasis on psychotic disorders, severe mood disorders, and chronic suicidality.

Program Description

The Serious and Persistent Mental Illness (SPMI) Area of Emphasis offers unique training working with individuals experiencing psychosis and severe mood disorders across the lifespan, course of illness, and levels of care. It aims to prepare interns for careers in clinical practice and/or research with an emphasis on serving individuals who experience severe mental illness. Training emphasizes both evidence-based interventions and specialized assessments for this population, alongside exposure to cutting-edge research focused on intervention and program development.

Core Clinical Training Experiences

Intervention

Diverse rotations prepare trainees to provide evidence-based psychotherapy to patients identified to be at clinical high risk for psychosis (CHR-P), experiencing a first psychotic episode or an acute exacerbation of their psychiatric symptoms, and managing chronic conditions. Rotating within both inpatient and outpatient settings will equip trainees to tailor evidence-based interventions to match individual patient needs, developmental stage, and symptom severity. This specificity is supported by intensive training in Cognitive Behavioral Therapy for Psychosis (CBT-P), with additional exposure to third-wave cognitive behavioral approaches, including Acceptance and Commitment Therapy for Psychosis and Dialectical Behavior Therapy Skills for Psychosis Resilience. Trainees will also learn how to flexibly adapt a range of evidence-based treatments to the often brief, dynamic, and fastpaced nature of inpatient settings.

 Assessment

Interns will develop proficiency with unique assessments for psychotic disorders: Structured Interview for Psychosis Risk Syndromes (SIPS): At the beginning of the year, interns will complete a two-day training in the Structured Interview for Psychosis Risk States (SIPS) assessment, an evidence based structured interview for identifying prodromal and attenuated psychotic symptoms. Interns will then utilize this assessment to evaluate referrals to the INTERCEPT Clinic.

MATRICS Cognitive Consensus Battery (MCCB): Interns will gain familiarity with the MATRICS Cognitive Consensus Battery, a repeatable neuropsychological battery used to evaluate key cognitive domains relevant to psychotic disorders.

SAFESIDE Suicide Prevention Framework: Interns will gain specialized training and supervision in implementing the SAFESIDE Framework to develop multifactorial suicide risk assessments and safety plans. Training will emphasize the use of risk assessment as a meaningful clinical intervention and adjusting assessment based on changes in patient presentation and treatment progress. Training in the SAFESIDE model is supported by Annamarie Defayette, Ph.D., a member of the University of Rochester’s Center for the Study and Prevention of Suicide.

Interns will also develop skills in conducting brief, focused assessments across adult inpatient psychiatric units, with an emphasis on differential diagnosis and case conceptualization.

Clinical Rotations

Adult Inpatient Psychiatry: Interns work with adults and older adults in an acute psychiatric inpatient setting that spans across multiple units. Patients are admitted for acute psychiatric crises, including but not limited to suicidality and psychosis. Interns conduct psychodiagnostic testing, actively participate in multiple interdisciplinary teams, and work with patients by providing individual and group therapy. Interns develop skills working in a fast-paced setting and responding to a variety of patient and staff needs. Additional opportunities for interprofessional education and program development are available pending trainee interest.

Interventions for Changes in Emotions, Perception, and Thinking (INTERCEPT) Program: An outpatient clinic for people ages 15-28 who are considered to be at clinical high-risk (CHR) for the development of a psychotic disorder in the next 1-2 years. As with other CHR programs, the goal of treatment is to prevent the onset of a psychotic disorder. Interns will obtain an in-depth experience in the field of risk factors for psychosis, and preventive treatment. Core responsibilities include completing comprehensive intake batteries, seeing patients for individual treatment sessions, participating in groups, providing tiered supervision to extern trainees, and conducting additional (i.e., non-intake) assessments as needed.

Specialized Didactics

In addition to core didactics within the internship program, the SPMI Intern will complete additional didactics to further specify their clinical knowledge.

Case Consultation Seminar: The SPMI Intern will attend a monthly case consultation seminar with an emphasis on clinical roleplay and skills training. This seminar steps beyond the theoretical to provide feedback on treatment planning and intervention delivery. The primary emphasis on this seminar is Cognitive Behavioral Therapy for Psychosis, with additional sessions focused on suicide risk assessment, motivational intervention, and safety planning.

CHR Research Interest Group: Additionally, the SPMI Intern will attend a monthly meeting intended to share novel research developments in the fields of psychosis risk, early identification, and prevention. Speakers are recruited from CHR programs across the nation, offering exposure and connection within the wider CHR field. Recent speakers include researchers from McLean Hospital, Universitätsmedizin Berlin, and Northwestern