Training Experiences

The Integrated Care Family fellowship teaches trainees the needed skills to practice family-oriented health psychology in a primary care setting. The focus is on using the biopsychosocial model, and providing collaborative clinical care with medical professionals. Fellows participate in seminars that highlight the generalist nature of working in primary care and help hone their clinical, collaborative, academic, and administrative skills. There are five major emphases on the Integrated Care Family track, each with specific clinical care settings and supervision: (1) Family Medicine/Geriatric Internal Medicine, (2) Functional Neurology, (3) Primary Care Internal Medicine, (4) Pediatrics, and (5) Obstetrics and Gynecology (formerly Women’s Health).

Not all emphasis areas are recruited for each year. Visit our How to Apply page for more specifics.

Family Medicine/Geriatric Internal Medicine

This focus includes intensive clinical training in integrated care, primary care behavioral health, and medical family therapy. There are many opportunities for collaborative care with physicians and other health professionals, inter-professional education, family therapy training, teaching, and scholarship in urban primary care settings. Time is equally divided between two settings: an urban, primary care family medicine clinic and a community based hospital (Highland Hospital) affiliated with URMC. The fellow provides behavioral health consultation and brief therapy to family medicine patients and families, many of whom are economically disadvantaged and/or from historically underserved populations. There is daily opportunity for collaboration and consultation with medical professionals, as the fellow serves a critical role in interdisciplinary team-based care. At Highland Hospital & the Highlands at Brighton (a skilled nursing facility), the fellow serves as an educator to internal medicine residents and medical students, providing: one-to-one coaching focused on general communication skills and with focused attention to older adults facing life transitions (from Hospital to Rehab); group-based didactics focused on best practices in communication and wellness and management of ethical dilemmas; assessment, consultation, and brief treatment of depression and other mood disorders and cognitive decline in primary care settings.

Highland Family Medicine

This large, urban family medicine practice, with a diverse patient population, offers a full range of services, including mental health care. Trainees are part of a coordinated, collaborative family care team.

Functional Neurology

This focus includes intensive clinical training in integrated care in a Level 4 Comprehensive Epilepsy Center, housed in a large academic medical center Neurology Department. The fellow serves as a valuable team-member in the departments of Psychiatry and Neurology, where they engage in collaborative care with physicians and other health professionals, inter-professional consultations, education and teaching. Time is equally divided between an off-site outpatient clinic and a long-term Video-EEG monitoring inpatient unit at URMC's Strong Memorial Hospital. The fellow is trained to provide psychological diagnostic evaluations and psychotherapy to patients with functional neurologic disorders (e.g., nonepileptic seizures, conversion hemiparesis), neurological disorders (i.e., epilepsy, brain injury, TBI), and other stress-sensitive disorders (e.g., chronic pain, migraine). The fellow will receive training in intensive short-term dynamic psychotherapy (ISTDP), and gain experience utilizing interventions that are often utilized in the treatment of FND (CBT, DBT, ACT, and family/couples therapy). The fellow is also involved in providing communication coaching to neurology residents focused on optimizing physician-patient-family relationship skills.

Primary Care Internal Medicine

This focus is in primary care (assessment and brief treatment using behavioral health interventions in a primary care setting). Specific training in this fellowship includes working with a diverse patient population at Strong Internal Medicine, a safety-net integrated primary care clinic that has been an accredited Level 3 Patient Centered Medical Home since 2011.  The fellow will spend 50% time treating a broad range of patient care issues that present in primary care (depression, anxiety, grief, caregiver burden, adjustment to chronic disease, adherence issues, insomnia, family/relationship problems).  A portion of this clinical time will be devoted to same-day behavioral health consultation, brief assessment, and intervention with patients who present for their primary care visits. The fellow will also spend approximately 50% time devoted to Internal Medicine resident education via novel application of skills through clinical communication coaching and traditional didactic teaching. Coursework and professional seminars are dedicated to expanding knowledge base and skill development toward the application of integrated care psychology and medical family therapy principles.

Pediatrics

Specific training in this area includes pediatric psychology, integrated primary care psychology, family and broader systems, and family psychology. Coursework and professional seminars are dedicated to expanding knowledge and skills in primary care psychology and medical family therapy principles. The primary placement for the pediatric fellow is in an urban family medicine clinic. The fellow provides therapy to children and their families, collaborates and consults with medical professionals as part of an interdisciplinary team, works with multiple systems such as schools and community agencies, and provides consultation and teaching to pediatric residents and primary care teams. The clinical service at the academic health center offers variety in clinical caseload and skill development, including families who are coping with comorbid medical problems as well as those with relationship difficulties. The fellow also serves as an educator to pediatric and family medicine residents, providing one-to-one coaching focused on general communication skills. The fellow will also have the opportunity to contribute to interprofessional education via traditional didactic teaching, as well as partnership with fellowship faculty working on ongoing scholarly projects, clinical quality improvement, and research in the areas of pediatric primary care and integrated healthcare.

Obstetrics and Gynecology (Formerly Women's Health)

Specialized training in this area includes providing consultation, assessment, and treatment to obstetrics and gynecology (OB/GYN) patients and their families. Close collaboration with a team of clinicians, including medical clinicians, social workers, and nutritionists, is an essential component of the role. The fellow provides individual, couples, and family therapy to a largely underserved population in a clinic that provides general OB/GYN, high-risk pregnancy, and chronic pelvic pain care, among other services. The fellow provides brief consultation and supportive counseling for patients and couples attending a specialty care Fertility Clinic. The fellow also serves as educator to OB/GYN residents, providing one-to-one coaching focused on patient-and family-centered communication skills. The fellow may choose to participate in additional content-specific teaching, supervision and research.

Scholarship Opportunities

All Integrated Care Family fellows have the opportunity to participate in scholarship activities. Past projects have included exploration of smoking cessation and fertility, population health approaches to improve women’s health behaviors, examination of the qualitative use of cognitive screening, evaluation of training programs (including preparing master’s students to conduct clinical work, and medical residents to conduct a biopsychosocial interview). Fellows are able to collaborate with faculty on existing projects and to develop their own lines of scholarly inquiry in individual settings.

Drs. Magdalene Lim, Lauren DeCaporale-Ryan, Ellen Poleshuck, & Tziporah Rosenberg presented, Integrated primary care in family medicine, geriatrics, and women’s health: Leadership Opportunities Symposium at the American Psychological Association Annual Convention, Toronto, Canada.