Overview of Clinical Rotations
Please note that rotations vary in length, depending on Fellow need and/or interest. Also, Fellows may choose not to do some of the below offerings although all the below are potentially valuable experiences and some are rotations that all Fellows have done. We try to tailor the Fellow’s curriculum to their unique preferences and interests and these can be clarified at the time of interviewing for the Fellowship. Also, please note that the two major sites where Fellows spend most of their time are at the Jesse Brown VA Medical Center (JB) and the University of Illinois Hospital and Clinics (UIC) and UIC-affiliated programs. Finally, please note that the VA and UIC campuses are roughly “across the street” from one another.
VA Addiction Treatment Program (ATP): A general addiction outpatient program, providing outpatient treatment of a variety of intensities in group and individual formats. This includes various treatments for Opioid Use Disorder (OUD), a partial hospital program, an intensive outpatient treatment program, and an intermediate care program. Please note that Methadone treatment is provided at both the Drug Dependence Treatment Center(DDTC) at VA and the Mile Square Health Center (MSHC) described below
VA Women’s clinic: A general women’s medical outpatient clinic which has a specific women’s mental health component. A significant number of patients in this clinic have Substance Use Disorders (SUDs), which are treated with a variety of approaches in group and individual formats. This last includes psychopharmacological approaches.
UIC outpatient clinics: Fellows will spend at least a day and one-half to two days per week over the course of the Fellowship year in various required UIC outpatient addiction-focused clinics. The Fellow will see patients (who are referred from various settings) in an office-based addiction practice, an important part of which will include outpatient individual psychotherapy and medication management with addicted patients. The UIC outpatient experience will also include ongoing work in UIC’s Recovery Clinic, which has an emphasis on pharmacotherapies for various addiction-related disorders and any comorbidities. Some Fellow have worked in the foregoing settings with non-substance related addictive disorders and this is mentioned below.
Thresholds: Fellows can spend a half-day per week for periods of up to 6 months seeing addicted patients with substance use and other addiction-related issues in a community mental health center population. Here, an important emphasis will be on buprenorphine management of opioid addiction although patients with a variety of addictions and related treatment needs will be seen as well. Thresholds also has a mobile mental health component.
Mile Square Health Center: Fellows can spend a half-day per week for periods of up to 6 months or more seeing addicted patients with substance use issues in this UI Health primary care clinic. Here, the emphasis will be on primary care/addiction treatment integration; many patients will need pharmacotherapy for OUD, but Fellows will be addressing other addiction-related issues as well. Mile Square is one of the few Federally Qualified Healthcare Centers which has a SAMHSA—certified Opioid Treatment Program. The reader is reminded that currently, methadone can only be dispensed out of such OTPs.
Addiction Consult Service: This rotation takes place at the VA. Fellows will provide consultation to medical, surgical, and other non-psychiatric inpatient services, as well as inpatient psychiatric services and the VA Emergency Department. The focus of these consultations is the diagnosis, management, and post-discharge referral of patients with substance-related or other addictive disorders. A special, focused Addiction Consult Service will be opening in the near-future at UIC.
VA Drug Dependence Treatment Center (DDTC): This rotation takes place in a specialized, SAMHSA-accredited, Opioid Treatment Program (OTP). The Fellow evaluates and follows patients with OUD and gains experience with OUD therapies—mostly treatment with methadone and buprenorphine coupled with psychosocial treatment. This treatment also includes the treatment of any general psychiatric and addiction comorbidities that these patients have. Contingency Management is available in this clinic. The reader will note that the treatment of OUDs takes place in a number of the above and below rotations in addition to DDTC.
Adolescent Addiction Treatment: This rotation takes place in a special clinic at UIC’s Institute for Juvenile research (IJR)—the Urban Youth Trauma Project. This clinic provides trauma-focused addiction treatment to adolescents. Here, the Fellow will treat at least one or two outpatients and their families over the course of the Fellowship year.
Substance Abuse Residential Rehabilitation Treatment Program at the VA (SARRTP): Fellows work with patients who are participating in a live-in residential program. The Fellow will screen patients for entrance into this program, follow patients who are in the residential program, and gain experience with the various treatment modalities these patients receive in such a unit. Contingency Management is available for select patients and a special CM treatment is in development for tobacco cessation.
Impaired Professionals Treatment at the Positive Sobriety Institute: This is a comprehensive addiction program located a short shuttle ride distance from UIC and the VA. This program has expertise in, and focus on, the treatment of persons with a variety of addictions who have a history of functioning in settings of high accountability---basically impaired professionals. Outpatient, intensive outpatient, day hospital, residential, and outpatient detoxification services are examples of the sorts of treatments that the Fellow will see in this program.
VA Psychiatry Assessment Clinic and Addiction Central Intake: This rotation is set on the premises of the general psychiatric intake and psychiatric urgent/emergent care clinic for the Jesse Brown VAMC. Here, most of the patients presenting for services have either current substance-related disorders or a past history of substance-related disorders. Many of the patients seen in this clinic will present via the ER at the VA. Here, the Fellow will get an opportunity to work with substance-related emergencies and urgent/emergent care situations.
UIC Pain Medicine Service or the Jesse Brown VAMC Pain Clinic: Fellows will learn how to manage patients who may or may not be substance-impaired, particularly with chronic pain, using a variety of modalities. The Fellow will be working in multidisciplinary pain treatment settings where a variety of techniques such as psychoeducation, various other verbal interventions, various physical therapies, various medication therapies, and various interventional procedures are employed.
“Behavioral addictions”: While we don’t offer specific rotations in these areas, we expect at the least that these will be addressed as a patient receives treatment in any of the above settings. And, a behavioral addiction clinic is in development at the VA. We currently have a behavioral addictions group at the VA, these addictions have also been managed at the above UIH experiences, and some of our clinical staff at both sites have an expertise in this area.
Psychotherapy and psychotherapy-related experiences: These are a particular strength of our Fellowship. They occur in a variety of rotational settings and are all supervised by experienced supervisors. For example,
- VA outpatient therapy group (Masters Group) focused on patients with histories of challenges with sustaining recovery but who are now in stable recovery
- Female Fellows have an opportunity to co-facilitate a special Women’s Group at the VA for 6-12 months
- Motivational Interviewing seminar
- Ongoing adolescent psychotherapy case or cases
- Psychodynamic-focused longitudinal cases
- CBT-focused longitudinal cases
- Contingency Management
- Some previous Fellows have elected to do psychoeducational or other psychotherapy groups with addicted patients or with patients at risk for addiction in various psychiatric or non-psychiatric outpatient clinics at UIC.
- Therapy groups with a variety of foci in many of the above and below settings, in addition to the above
Other clinical opportunities: Depending on need and/or interest, the Fellow may have an opportunity to use existing programs at UIC and/or the VA for additional elective rotations. Examples would include rotations focused on women’s mental health as above, PTSD, HIV-impacted patients, the Veterans’ Justice Outreach program (a forensic rotation). Rotations at UIC in High-risk obstetrics and transplant are currently in development at UIC. If an applicant has a particular interest in these last two areas, please mention this during interview with the PD.