Doctoral Internship – Fresno

The Kaiser Permanente Fresno Internship Program, its directors, and supervisors are committed to facilitating an enriching atmosphere in which students can grow into competent, well-rounded clinicians. As part of that commitment, we are dedicated to the principles of Equity, Inclusion, and Diversity. Our training program emphasizes dignity for all people, respect for their unique cultures and identities, and inclusion of individuals of all walks of life. We have incorporated discussion of EID issues into our supervision, didactic presentations, and practice. Additionally, all staff undergo regular training to keep up to date with these issues, and interns have didactic presentations that focus on a particular aspect of EID throughout the internship year.

We are committed to nurturing and integrating diversity training into all aspects of our doctoral internship by:

• Providing interns with opportunities to work with diverse patients who represent various aspects of diversity, including age, religion, gender, socioeconomic status, ethnicity, values, and lifestyle
• Placing a high value on interns’ willingness to engage in self-reflection and learning and supporting the exploration of attitudes, beliefs, and therapeutic postures that could have a negative impact on clinical interactions
• Maintaining a consistent focus in clinical supervision on expanding interns’ multicultural awareness and competence in the provision of psychotherapeutic services and by providing guidance, suggestions, and resources on topics related to diversity
• Providing formal in-person or online training on diversity topics such as discovering and mitigating unconscious bias, respecting every voice, and cultivating a sense of inclusion and belonging in the workplace
• Encouraging interns to participate in the Regional Mental Health Training Program Equity, Inclusion, and Diversity Committee’s advanced trainings on topics related to cultural sensitivity and competence alongside a forum to reflect on and discuss their varied experiences in a safe environment

Regularly scheduled weekly didactic seminars are organized and administered at the regional level for all KP Northern California doctoral interns. Interns are required to attend the two-hour weekly seminar, which focuses on aspects of clinical practice that the interns may not regularly encounter. Diversity issues are always integrated into seminar presentations.

Seminar topics include: Frontiers in Trauma Treatment; Advanced Risk Assessment; Updates in Substance Abuse Research & Treatment; Advancements in Psychopharmacology; Cognitive Processing Therapy; Technology and Mental Health; Trans/Nonbinary Mental Health; Building a Better Brain through Exercise, Nutrition, Sleep and Stress Management; and Self-Compassion.

Our Regional Mental Health Training Program also sponsors professional training courses for continuing professional development. These courses and presentations are offered at select times during the year for all KP Northern California mental health trainees and staff at Kaiser Northern California Medical Centers. The Regional Mental Health Training Program brings in national experts and keynote speakers on a variety of cutting-edge topics in mental health treatment and research. Interns are required to attend these monthly regional trainings in addition to the weekly didactic seminars. Course dates and a list of speakers and topics for the regional trainings can be found on the Regional Mental Health Training Programs website. In addition, many of these lectures are recorded and available on the regional website under the continuing education lecture library.

We offer 4.5 to 5.5 hours of scheduled supervision per week and provide additional supervision as needed. This is outlined as follows:

• 1 hour of individual supervision for clinical work (An additional hour of individual clinical supervision may be offered depending on the major rotations to which the intern is assigned.)
• 1 hour of individual supervision for assessment
• 1 hour of group clinical supervision
• 1.5 hours of group assessment supervision (The first 45 minutes of this supervision is for only the interns. During the final 45 minutes, staff psychologists engaged in assessment join to share cases. This serves to broaden the assessment experience.)

We believe in being very accessible to the interns for questions or concerns that may come up outside of scheduled supervision and are available either in person or through encrypted electronic communication channels.

Reflecting Kaiser Permanente’s core commitment to mental health and wellness in our communities, each intern will spend at least 32 hours during their training year on a Community Partnership Project that focuses on improving mental health in the local community beyond Kaiser Permanente patient membership.

The goal of this project is to provide outreach to underserved populations in the community to promote healthy behaviors. Anchors for this project include: developing alliances with individuals and/or systems to improve the lives of those served; providing education and training based on the empirical literature; collecting, analyzing, and presenting relevant outcome data to partnership stakeholders.

As part of Kaiser Permanente’s commitment to supporting our communities, the Fresno Internship Program has partnered with Human Good – a nationwide provider of affordable senior living communities – to offer monthly seminars on mental health issues. Our interns are challenged to bring their creativity and compassion to the development of engaging and supportive psychoeducational presentations for a geriatric population.

All doctoral interns complete psychological testing as part of the internship training program. During the training year, interns further their knowledge about test battery design, administration of various tests and measures, interpretation and integration of test results, and communication of test results. Opportunities exist for interns to develop competencies with neuropsychological assessment, psychodiagnostic evaluations, and specialty evaluations (e.g., ADHD and ASD). Interns receive assessment training support in both individual and group format supervision.

Each intern is required to undertake a program evaluation project during their training year. The project is selected based upon the intern’s interests and skill set and should fall within the regular scope of departmental services.

It may involve collecting and analyzing data to improve administrative operations, or a quality improvement project aimed at improving or assessing a treatment program or process. Examples include developing and evaluating a treatment group, intake procedure or other new programming; evaluating factors associated with treatment outcomes; or a needs assessment of a service that may be enriched by psychological consultation. Interns meet with the program evaluation supervisor as a group regularly over the course of the training year to review progress on their projects.

Interns will have the opportunity to complete two major rotations over the course of the training year. The Fresno Internship Program offers rotations in four areas: Adult Mental Health Clinic, Adult Intensive Outpatient Program, Child Intensive Outpatient Program, and Behavioral Health.

Doctoral Interns will gain clinical experience as part of the Adult Mental Health team. Doctoral Interns on the Adult Mental Health team will be assigned cases from the broad and diverse patient population served at the clinic, with referrals addressing mental health needs related to the treatment of mood disorders, personality disorders, trauma, aging, adjustment, crisis, work or life stress, neurodevelopmental disorders, schizophrenia and other psychotic disorder, obsessive-compulsive and related disorders, bipolar spectrum disorders, sexual and gender identity disorders, and dissociative disorders. Interns will evaluate and diagnose mental health disorders based on DSM-5TR and ICD-11 criteria. Interns will also learn how to collaborate with patients for treatment planning purposes and gain proficiency utilizing evidence-based interventions within a feedback informed care framework.

Doctoral interns will utilize individual and group supervision for case formulation and treatment planning. Within this rotation, interns will receive training in both individual psychotherapy and group treatment. Training in evidence-based individual treatment will consist of providing individual therapy. Training in evidence-based group treatment will consist of co-facilitating groups under the supervision of licensed therapists.

The Adult Mental Health team is made up of an interdisciplinary team with multiple psychiatrists on staff. The psychiatrists, psychiatric nurse practitioners, and primary care physicians are all open to collaboration in order to deliver the best possible integrated service to the patient.

Interns will have the opportunity to complete two major rotations over the course of the training year. The Fresno Internship Program offers rotations in four areas: Adult Mental Health Clinic, Adult Intensive Outpatient Program, Child Intensive Outpatient Program, and Behavioral Health.

The Intensive Outpatient Program (IOP) provides treatment to adult patients presenting with chronic and acute conditions in need of a higher level of care. IOP serves as a two-week step-down program for patients who were recently psychiatrically hospitalized or patients who need intensive support due to increased symptom severity and acute risk factors. Patients attend the program multiple times per week and receive group therapy, psychiatric medication consultation, and individual therapy. Interns are assigned cases from a diverse population, with mental health needs relating to depression, personality disorders, trauma, life crises, work stress, schizophrenia and other psychotic disorders, and bipolar spectrum disorders.

Doctoral interns will conduct intakes and provide evidence-based group therapy. Training in evidence-based group treatment will consist of co-facilitating groups under the supervision of licensed Adult Intensive Outpatient therapists. The rotation also involves twice daily meetings and consultation within a small, tight-knit, interdisciplinary treatment team. During this rotation, interns will carry a smaller caseload and focus a considerable part of their clinical time working with patients on short-term, crisis stabilization. This rotation broadens and deepens clinical skills across all diagnoses and with a very diverse group of patients, all while working closely with a supportive group of colleagues.

Interns will have the opportunity to complete two major rotations over the course of the training year. The Fresno Internship Program offers rotations in four areas: Adult Mental Health Clinic, Adult Intensive Outpatient Program, Child Intensive Outpatient Program, and Behavioral Health.

Doctoral interns on the Child Intensive Outpatient Program team will work with adolescent patients aged 13-18 who need crisis stabilization. Patients receive 6-9 hours of treatment a week. IOP treatment is primarily delivered in group therapy format, with some case management services, and provides patients with emotional support and skills training. The IOP team utilizes a cohesive multi-disciplinary approach (psychologists, psychiatrists, MFT, LCSW, and recreational therapists) to help prevent psychiatric hospitalization or provide transitional services from the hospital back to outpatient clinic care.

Interns will have the opportunity to complete two major rotations over the course of the training year. The Fresno Internship Program offers rotations in four areas: Adult Mental Health Clinic, Adult Intensive Outpatient Program, Child Intensive Outpatient Program, and Behavioral Health.

Behavioral Health is a subspecialty of the Adult Mental Health Clinic which focuses on the Mind/Body connection. Doctoral interns on this rotation may focus on Women’s Health as it pertains to mental health, as well as co-lead a group for individuals with chronic health conditions.

Participation in 2-3 minor rotations throughout the training year ensures that doctoral interns have experienced a full breadth of clinical work. These supervised experiences are designed to give interns exposure to evidence-based clinical interventions for specialty populations:

• Addiction Medicine & Recovery Services (AMRS)
• Dialectical Behavioral Therapy (DBT)
• Depression & Anxiety Program
• Cognitive Behavioral Therapy (CBT) for PTSD
• Acceptance & Commitment Therapy (ACT)
• Child ADHD Assessment Team
• and other training opportunities!