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Adult Neuropsychological Testing Service 

Alison Thomas, Ph.D.

- 4 month commitment
- Available as a major or a minor
- Can accommodate both a major and minor intern at the same time
- Required day: services in person - Mon or Thu morning; telehealth – Mon morning

Population Served: The Neuropsychological Testing service provides assessment service to four of the five inpatient psychiatry units. The units served are: Geriatric Psychiatry, Adult Psychiatry, Serious Mental Illness – Adult Psychiatry (acute behavioral), and long-term Adult Psychiatry. There may also be opportunities on the Adolescent inpatient psychiatry unit. The most frequent referrals are dementia/memory loss evaluations, evaluation of first episode psychosis, and differential diagnosis with medically, psychiatrically, and neuropsychologically complex cases (e.g., unusual presentations that could be a rare or uncommon neuropsychological disorder). As all referrals are from inpatient psychiatry, clinical presentations are usually more complex than the average outpatient neuropsychological evaluation.

*For a limited time (mid-August to end of October/mid-November) this rotation will also include some ambulatory assessment focused on transplant evals and a few general adult referrals (e.g., college students with a question of ADHD, mild memory difficulties). Outpatient assessments will follow the same model as inpatient, such that interviewing will be done via telehealth and testing administered in- person by our psychometrist. For interested interns, as long as this service is available, you may choose to spend your time per your preferences between inpatient and outpatient (depending on how many interns are rotating). However, once that clinic closes, you will be expected to use your time on the inpatient service until the conclusion of the rotation.

Clinical Duties: Assessment includes some combination of clinical interview, cognitive testing, and personality testing depending on the referral question. We are supported by trained psychometricians, some of whom are clinical psychology graduate students, many of whom have a focus in neuropsychology. There is a wide range of tests available for administration and interns are expected to order testing that is specifically appropriate to the diagnostic question. Occasionally I also have a graduate student rotating with me, in which case the intern will be expected to engage in a tiered supervision model.

*This rotation is being offered only as a telehealth option for the moment. Interns are interviewing the patients by phone. There may eventually include true telehealth (video and audio).

Expected Learning: Interns are expected to challenge and hone diagnostic skills. There is a particular emphasis on differential diagnosis that accounts for medical, psychiatric, and neuropsychological contributors to the clinical presentation. In addition, interns can expect exposure to a range of diagnoses and clinical presentations that is expected to support a broader understanding of the intersection of medical, psychiatric, and neuropsychological factors. Interns are expected to gain proficiency in developing concise, targeted assessment batteries that are specifically related to the pertinent diagnostic question. As this is an inpatient service, interns are expected with work with increasing efficiency in all aspects of the assessment.

Adult Outpatient Therapy in Community Mental Health (SMI and non-SMI) and First Episode Psychosis (FEP) 

Alison Thomas, Ph.D.

- 1 year commitment
- Available as a minor or an element of major rotation
- Can accommodate 1-2 interns at the same time, depending on the combination of interests
Required day: Tue morning for FEP work; Strong preference for Friday afternoon

Population Served: The Community Psychiatry Program (CPP), UAB’s Community Mental Health Center, primarily serves individuals with serious mental illness diagnoses at a range of levels of functioning. CPP also serves individuals with Medicaid or no insurance, including individuals with non-SMI diagnoses. The First Episode psychosis Clinic (FEC) runs Tuesday mornings from 8-11 am. This clinic solely serves individuals experiencing early phases psychosis and their families.

Clinical Duties: The primary duty on this rotation is intervention. There is also an opportunity for some consultation within the FEC as the intern will, at times, sit with the attending psychiatrists. As the population served varies greatly in age and level of functioning, interventions also vary greatly. For the most part, treatment includes behavioral interventions, psychoeducation, and CBT-based techniques. There are also often clients who are interested in more introspective therapy.

*This rotation is being offered as a telehealth rotation only. Therapy is being provided via telehealth. Although both video and audio platforms are possible, there is a strong preference for video based session, phone only is an option.

Expected Learning: This rotation will challenge intervention skills on several levels. The SMI population often requires clinicians to work at a slower pace with highly individualized markers of progress. Interns can also expect to work closely with families. One of the most rewarding (and at times challenging) aspects of this work is the personal growth many clinicians experience around working with clients with a wide range of unchangeable barriers. Interns can also expect to develop an explicit focus on both common factors (e.g., the importance of the therapeutic alliance) and a large dose of principles of Acceptance and Commitment Therapy.

Geropsychology/Neuropsychology 

Brittney Randolph, PhD (ABPP-CN Eligible)

Patient Characteristics: Patient population includes men and women primarily over the age of 60, though adults over the age of 18 are seen as well. These individuals are primarily seen on outpatient basis, though inpatient is also available. Common diagnostic categories represented include MCI vs normal aging, Dementia (AD, VAD, PD, etc), depression, and functional status/capacity evaluations. This population often has a wide variety of medical problems that may case conceptualization more complex

Distribution of Activities: Neuropsychological assessment of outpatients is typical, as is occasional inpatient assessment, with the intern performing some of the testing if desired or if psychometric support is unavailable. For those less experienced in neuropsychological assessment training is provided. Interviewing patients and family members is an important component of the experience, as well as organizing and interpreting neuropsychological test results. Test selection is also important and should be tailored to the ability of the patient. Interns participate in feedback sessions with patients and family members. Concise and clear report writing is emphasized, ranging from short staffing notes to neuropsychological testing reports of several pages.

Assessment Characteristics: Interns will learn to employ measures of neurocognitive ability at a screening level and in a more comprehensive battery. The latter usually involves a half day of assessment focusing on major neuropsychological instruments. This includes assessment of intellectual and academic skills, as well as memory functioning, reasoning skills and language abilities. Personality assessment, particularly use of projective instruments, is brief in nature. Interns are expected to participate in initial interviews for testing cases and also in feedback sessions, which ideally occur the same day. Psychometric support is available, but the intern may be performing some of the testing, which is considered an important part of the learning experience.

Intervention Characteristics: When intervention is offered it usually consists of individual therapy with an emphasis on behavioral and cognitive orientations and techniques. Interns are not expected to assume a leading role in intervention, unless they request to do so.

Time Commitment: This rotation is offered as either a Major rotation (3 days) or a Minor rotation (1.5 days). Psychiatry Grand Rounds are offered Tuesdays from 11:00 am to noon. Gerontology, Geriatric and Palliative Care Conference occurs Thursdays at noon. Neuropsychology case conference and journal club are Wednesdays at noon.

Goals of Rotation: This rotation can be tailored to each intern’s specific training needs. Training and supervision will follow a graduated approach, increasing responsibilities as appropriate for each intern’s level of competency. Therefore, this rotation is appropriate for those with little to no experience in neuropsychological assessment and for those who have advanced neuropsychological assessment skills. Differential diagnosis is an important skillset to be learned for the more advanced trainee while administration may be more appropriate for the neuropsychology novice.
Note: Collaborative research activities are available for interested interns.

Medical/Surgical Neuropsychology Rotation 

Brittney Randolph, PhD (ABPP-CN Eligible)

Patient Characteristics: The vast majority of patients seen on this rotation are candidates for heart and lung transplantation and are referred by the UAB Department of Surgery’s Cardiothoracic Transplant Service as part of a series of pre-transplant medical evaluations. Very occasionally, referrals for neuropsychological transplant evaluations are made to this service by other medical/surgical services. Roughly 75 percent of patients are seen on an outpatient basis, while the remaining 25 percent are seen on an inpatient basis. Patients range in age from the mid-teens to mid-seventies and present with a wide range of medical, psychiatric, and behavioral diagnoses.

Distribution of Activities: Roughly 40 percent of the intern’s time is devoted to evaluation, which includes conducting clinical interviews and possibly administering and scoring neuropsychological measures. Approximately 30 percent of the intern’s time is devoted to reviewing patient records and information, test interpretation, and report writing. The remaining 30 percent of time is spent in transplant team meetings, didactic meetings, and supervision.

Assessment Characteristics: All assessments include a thorough diagnostic clinical interview that includes an evaluation of patients’ compliance, substance use, exercise, diet, health behavior, psychiatric, social, academic, and vocational histories, social support network and stress-coping skills. The evaluations are geared toward helping the Transplant Service determine the candidate’s suitability for transplantation, identifying areas of concern that may negatively impact upon the individuals transplant candidacy (e.g., limited and inconsistent social support, cognitive deficits), and suggesting ways in which these limitations may be practically addressed. Neuropsychological testing is “light” in
nature. The typical evaluation is less than three hours in length, with intellectual, attentional, memory, expressive language, visuoperceptual, and executive cognitive functions being assessed.

Psychometrician support is typically available for test administration and scoring. While a “standard” battery of tests is routinely used, the battery may be tailored to accommodate the specific needs of patients

Intervention Characteristics: This rotation provides the occasional opportunity for short- and long-term psychotherapy, as well as patient education to improve/enhance compliance and adherence behaviors.

Time Commitment: This is a minor rotation and will require 1.5 days per week. Some flexibility in the intern’s schedule can be accommodated. Lung and Heart transplant team meetings are held from 7:30 to 9:00 am on Wednesday and Thursday mornings, respectively. The multidisciplinary Liver Disease Conference is held Tuesday mornings at 10 am.

Goals of Rotation: Specific goals of this rotation are fairly flexible and can be accommodated to meet the intern’s specific training needs. However, the general goal for the rotation is to familiarize interns with neuro/psychological evaluation of medical/ surgical patients. Supervision over the course of the rotation will typically follow a graduated approach, with increasing responsibility being given to interns as the competency increases. The rotation is appropriate for interns with limited neuropsychological assessment experience, as well as those with advanced pre-internship training in clinical neuropsychology.