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  • 1. Miami Children's Hospital Internship in Pediatric Health Psychology, Child and Adolescent Clinical Psychology and Clinical Neuropsychology Outline I. Introduction II. Description of the Hospital A. Training Resources III. Overall Description of the Psychology Program A. Training Philosophy B. Training Resources C. Administrative and Teaching Faculty D. Interdisciplinary Function E. Cultural Function IV. Clinical Psychology Internship Training Program A. Eligibility B. Funding and Benefits C. Internship Duration D. Application Procedure i. Application Materials ii. Mailing Address iii. E-Mail Contact E. Intern Selection Timeline V. Overview of Training A. Goals and Objectives B. Core Training Components C. Specialized Training Tracks i. Pediatric Health Track 1. The Developmental Disabilities Rotation 2. The Developmental Evaluation and Intervention Program Rotation ii. Child, Adolescent and Family Therapy Track 1
  • 2. iii. Neuropsychology Track D. Elective Multidisciplinary Training Experiences E. Didactic Training i. Yearlong Assessment/Intervention Seminars 1. Consultation Liaison Seminar 2. Family Therapy Seminar ii. Yearlong Topic Specific Assessment/Intervention Seminar iii. Professional Development Seminar F. Supervision Miami Children’s Hospital Psychology Internship Program I Introduction The Miami Children’s Hospital Psychology Internship Program (PIP) offers a pre- doctoral clinical psychology internship program with an emphasis in the areas of pediatric health psychology, child and adolescence clinical psychology, and clinical neuropsychology. MCH’s PIP was created by the merger of two previous internship programs, the Department of Neurology’s Pediatric Behavioral Medicine Internship Program and the Department of Psychiatry’s Internship Program. Both were designed to meet the American Psychological Association criteria for accredited internship programs and held independent membership in the Association of Psychology and Post-Doctoral Internship Centers (APPIC). The Department of Psychiatry 2
  • 3. Internship Program was granted APPIC membership in 1982 and the Pediatric Behavioral Medicine Program in 1996. The two programs allied in 1999 and joint APPIC membership was obtained in 2001. Program unification was effected to improve psychological service delivery throughout the hospital and enhance the quality of training provided to interns while at the same time preserving the unique nature of the individual training areas and specialized clinical services. The integration of the two programs has allowed for enhanced breath of training through increased exposure to a variety of service delivery options. Trainee’s exposure to a range of theoretical and professional orientations has also been expanded. A. Training Philosophy The Psychology Internship Program’s philosophy and mission are grounded in the belief that the psychologist’s role is paramount to meeting the psychological, behavioral, and developmental needs of children who are seen through pediatric tertiary care facilities. The development of our training components has paralleled the increasing demands of clinical service delivery, with an ever- expanding appreciation for children’s unique needs as well as the manner in which behavioral and psychological factors interface with medical conditions to determine health outcomes. The mission of our training program is to contribute to and formalize our commitment to the fields of pediatric health psychology, child and adolescent clinical psychology and clinical neuropsychology. The following goals have been established to guide our training program and to facilitate ongoing assessment of how our training curriculum is fulfilling our mission. 1. To prepare doctoral level students, who are enrolled in an accredited graduate program of psychology, for the independent practice of professional psychology; 3
  • 4. 2. To provide a graduated program of training spanning the full range of psychological assessments (developmental, psycho-educational, neuropsychological, personality) necessary to evaluate children’s developmental, intellectual, academic, emotional, and behavioral needs; 3. To provide a graduated program of training in the application of psychotherapeutic techniques (e.g., individual therapy, family therapy and group psychotherapy); 4. To provide training in developing respect for and sensitivity to cultural and individual diversity in carrying out the roles of the professional psychologist; 5. To provide training in the ethics of clinical service delivery in the field of professional psychology; II Description of the Hospital Miami Children’s Hospital is a private, non-profit hospital specializing in neonatal, pediatric and adolescent medicine. All subspecialties are represented. The geographic regions served include the southeastern portion of the United States, the Caribbean Islands as well as the Central and South American Countries. The Hospital is accredited by the Joint Commission on Accreditation of Hospitals and the Liaison Committee on Graduate Medical Education. It is also a recognized member of the American Hospital Association, the Florida Hospital Association, the South Florida Hospital Association, and the National Association of Children’s Hospitals and Related Institutions, Inc. 4
  • 5. Miami Children’s Hospital is South Florida’s only independent, freestanding specialty hospital exclusively for children. For half a century, Miami Children’s Hospital has provided state-of-the art pediatric care for South Florida’s children, ranging in age from birth to 21. The Variety Club International, a group dedicated to helping indigent children, obtained the necessary funds and founded Variety Children’s Hospital in 1950. The medical institution was renamed Miami Children’s Hospital in 1983. The 268 bed pediatric complex offers more than 40 distinct medical specialties to treat childhood diseases and disorders. With a medical staff of more than 600 doctors, MCH supports over 40 pediatric specialties and subspecialties (Adolescence Medicine, Allergy, Anesthesiology, Asthma Center, Bone Marrow Transplant, Brachial Plexus Surgery, Cardiology [Congenital Heart Institute], Cardiovascular Surgery [Congenital Heart Institute], Center for Brain Behavior, Clinical Immunology, Craniofacial Center, Critical Care Medicine, Cystic Fibrosis Center, Dentistry, Dermatology, Emergency Medicine, Endocrinology, Enuresis Center, Epilepsy Center, Gastroenterology, General Pediatrics, Genetics, Hematology-Oncology [Cancer Center], Infectious Diseases, Neonatology, Nephrology, Neurology, Neuropharmacology, Neuroscience [Brain Institute], Neurological Surgery, Nutrition, Ophthalmology, Orthopedics-Orthopedics Surgery, Otolaryngology, Pathology, Pediatric Surgery, Pediatric Trauma Center, Plastic Surgery, Preventive Medicine, Psychiatry, Pulmonology, Radiology , Rheumatology, Scoliosis Surgery, Sleep Disorder Center, Thoracic Surgery, Urology-Urologic Surgery). Accredited by the Joint Commission on Accreditation of Hospitals and the Liaison Committee on Graduate Medical Education, it is also a recognized member of the American Hospital Association, the Florida Hospital Association, the South Florida Hospital Association, and the National Association of Children’s Hospitals. MCH’s founding vision was the creation of a full service pediatric center to provide South Florida with state of the art clinical services, medical research, and a comprehensive teaching program for doctors, nurses and medical specialists. 5
  • 6. Toward this goal, MCH has developed and maintained graduate training programs of the highest academic quality for pediatric residents and fellows as well as psychology interns and fellows. Affiliated with the hospital Neurology and Psychiatry Departments, the MCH Psychology Internship Program (PIP) offers a pre-doctoral clinical psychology internship program with a focus in the areas of pediatric health psychology, child and adolescence clinical psychology, and clinical neuropsychology. MCH promotes equal employment opportunity for all current and prospective employees and is committed to providing a work environment free of discrimination and harassment. It also engages in actions that indicate respect for and understanding of cultural and individual diversity. Interns are protected by Hospital and Psychology Internship Program due process and grievance procedures. A. Training Resources. Miami Children’s Hospital’s main campus is located in the heart of the city. In addition, a number of programs function outside the actual Hospital, including the Early Intervention Program and the Dan Marino Center for developmental disorders. Interns are provided office space at Miami Children’s Hospital and at their primary rotation site. Psychological assessment materials and computer assisted scoring programs are available. Interns have access to computers, audiovisual and library facilities within the Hospital. A number of areas are devoted to special functions that serve the training programs. Evaluation and therapy rooms are designed for patient evaluations, treatment, clinical interviews and counseling. Some evaluation and treatment rooms contain one-way vision mirrors and sound monitoring systems. Videotape equipment is available for recording testing and therapy sessions, or live observation of clinical activities. 6
  • 7. III. Description of the Clinical Psychology Program. The Department of Psychology Internship Program provides a comprehensive training program which is designed to make a significant contribution to the understanding, diagnosis and treatment of developmental disabilities, emotional disturbances, and behavioral problems associated with genetic, environmental, and medical conditions of children and their families. Clinical training is provided to interns and post-doctoral fellows, doctoral practicum students and master level clinicians. Training experiences are offered in psychological assessment, individual and group treatment techniques, family therapy, consultation-liaison services with medically involved patients, assessment and secondary prevention in at-risk populations, parent counseling, and community outreach activities. Training is also provided through specialty training seminars, participation in a variety of multidisciplinary teams and clinics, attendance at multidisciplinary teaching rounds and applied clinical research. Trainees participate in supervised experiences in diagnostic, therapeutic, and clinical research settings. Interns gain experience with a broad range of problems. Patients present with moderate to severe developmental, emotional and behavioral problems. They range in age from infancy to early adulthood (i.e., 21 years of age) and come from diverse cultural backgrounds and socioeconomic levels. Due to the hospital’s unique geographic location, patients from Central and South America and the Caribbean Islands are routinely served, in addition to the large Hispanic and Afro-American population geographically located in Miami. Many patients present with problems related to difficulties in adjustment to a chronic/acute medical condition (e.g., Cystic Fibrosis, Diabetes, Epilepsy, and Asthma), neurodevelopmental disorder, multigenerational psychiatric family disturbance, co-morbid substance abuse, psychological, physical and/or sexual trauma, as well as distress related to medical or surgical procedures. Presenting 7
  • 8. problems for which a psychological evaluation are indicated include academic/learning difficulty, emotional maladjustment as well as developmental delay and regression. Evaluations are also conducted to monitor overall development and guide intervention for children with chronic/acute medical conditions. Patients in this group include at risk premature infants, oncology and cardiovascular surgery patients and epilepsy surgery candidates. Presenting problems for which psychotherapy are indicated include depression and anxiety, conduct disorder, psychosis, developmental delay and trauma, eating disorder, pain/impaired body function and substance abuse. A number of theoretical orientations are represented, most prominently cognitive-behavioral, psychodynamic, object relations, developmental and family systems. A. Interdisciplinary Function The Psychology Internship Program provides training experiences in the various roles of the psychologist as a member of an interdisciplinary team. Interdisciplinary assessment and intervention is emphasized in all training experiences. Psychological assessment of and intervention with developmentally and medically complex children is coordinated with professionals from other disciplines resulting in comprehensive service delivery. B. Cultural/Linguistic Function The Psychology Internship Program provides a unique opportunity for interns to be trained to work with ethnic minority populations in general, and to specialize in working with Hispanics from different socioeconomic levels in particular. The trend in ethnic minority growth suggests a large and increasing discrepancy between Hispanics in need of services and availability of culturally competent and relevant treatment. Sensitivity to cultural diversity is an essential component of training. In addition to didactic seminars, clinical experiences with the Hispanic population are supervised by trained, bicultural/bilingual psychologists. 8
  • 9. Interns are trained to consider cultural variables in work with culturally and linguistically diverse children and families. Sensitivity to multicultural issues for mental or medical illness, development, family, education, grief/loss and service delivery is foster. C. Administrative and Teaching Faculty Faculty Member Training Responsibility Marisa Azaret, Psy.D. Co-Director of Training; Clinical Director, Behavioral Medicine Program; Supervisor, Pediatric Health & Neuropsychology Tracks, Treatment; Neurodevelopmental and Juvenile Rheumatoid Arthritis Clinics; Training Committee Vivian M. Umbel, Ph.D. Co-Director of Training; Supervisor, Pediatric Health and Neuropsychology Tracks, Psychological Assessment; Training Committee Gilda Moreno, Psy.D. Chief Psychologist; Supervisor, Child, Adolescent & Family Therapy Track; Training Committee David Coe, Ph.D. Supervisor, Pediatric Health Track; Autism Clinic, Feeding & Swallowing Team; Didactic Training Seminar Presenter; Training Committee 9
  • 10. Gustavo Rey, Ph.D. Supervisor, Neuropsychology Track; Neuro-Oncology Clinic, Multisdisciplinary Neurosurgery Team; Didactic Seminar Presenter; Training Committee Rose Alvarez-Salvat, Ph.D. Supervisor, Pediatric Health Track, Consultation Liaison Service, Early Intervention Program; Training Committee Michael Puhn, Ph.D. Supervisor, Child, Adolescent & Family Therapy Track; Family Therapy Seminar; Training Committee Janet P. Rosen, Psy.D. Supervisor, Child, Adolescent & Family Therapy Track, Psychological Assessment; Training Committee Laura Moreno-Chavez, Psy.D. Supervisor, Craniofacial Clinic; Training Committee Graciela B. Nearing, Psy.D. Supervisor, Neonatal Intensive Care Unit; Training Committee Charles Dickson, Psy.D. Supervisor, Department of Psychiatry, Group Therapy Silvia Sommers, Psy.D. Supervisor, Department of Psychiatry Elizabeth Palenzuela, M.S., L.M.F.T. Supervisor, Department of Psychiatry, Family Therapy Seminar 10
  • 11. Trevor Resnick, M.D. Medical Director, Department of Neurology; Supervisor, Neurodevelopmental Clinic Americo Padilla, M.D. Medical Director, Department of Psychiatry; Supervisor, Consultation Liaison Service IV. Clinical Psychology Internship Training Program A. Eligibility Consistent with MCH’s employment practices, our program demonstrates a commitment to diversity and ethnic minority recruitment and retention. Staff and internship applicants from all cultural and ethnic minorities are considered based on their training and experience and its relevance to our training site The internship candidate must be enrolled as an advanced graduate student in a clinical or counseling psychology program approved by the American Psychological Association. Individuals in Ph.D. and Psy.D. programs will be considered. Candidates should have their coursework completed by the beginning of the internship year. Applicants should have a substantial amount of prior practicum supervision and clinical experience relevant to work in the areas of child and adolescent clinical psychology, pediatric health psychology, and/or clinical neuropsychology. B. Funding and Benefits 11
  • 12. Seven internship positions are available, contingent upon availability of funding, with current support set at $19,032 for a 12-month period. In addition, a hospital- funded health care insurance plan is provided to the interns. Paid vacation and sick leave is included as part of the benefit package. Attendance at Hospital sponsored conferences and seminars are available to the intern at no charge. Post-doctoral positions are funded through grants. C. Internship Duration The duration of the internship is one year, or the equivalent of 2,000 hours of supervised clinical experience, beginning the first week of September. The internship year runs consecutively from September through August the following year. D. Application Procedure The Psychology Internship Program application process and allocation of funded internship positions is track specific. Each intern candidate must indicate on the application form or in the cover letter, which one of the three training tracks they wish to apply for. The tracks are as follows: 1) the Pediatric Health Track (two funded positions available), 2) the Child, Adolescent and Family Therapy Track (four funded positions available) and 3) the Neuropsychology Track (one funded position available). Applicants may apply for two of the three tracks and indicate their primary and secondary preferences. Applicants are requested to submit the following materials: 1. Miami Children's Hospital Psychology Internship Program Internship Training Track Selection Form and Materials Checklist. (download) 12
  • 13. 2. A cover letter describing the applicant’s background, the type of clinical experiences desired and the applicant’s expectations for competency at the end of the internship year. 3. APPIC Internship Application and documentation for participation in the APPIC matching process. 4. APPIC Academic Program’s Verification of Internship Eligibility and Readiness form. 5. A current vita. 6. Two comprehensive psychological evaluations reports. 7. Two psychological treatment summary reports. 8. Graduate transcript. 9. Three letters of reference, two of which must be from clinical supervisors. Application materials should be mailed to: Miami Children’s Hospital Psychology Internship Program Attn: Dr. Vivian M. Umbel 3100 S.W. 62 Avenue Miami, FL 33155 E-mail contact: Marisa.azaret@mch.com Application materials must be received by November 15 th . Applications are reviewed by members of the Psychology Internship Selection Committee and invitations to attend an Open House are extended by December 15 th . Applicants who have clinical training and experience relevant to work in the areas of child and adolescent clinical psychology, pediatric health psychology, and /or clinical neuropsychology will be invited to attend the Open House. Open House attendance is encouraged. The Open House is held in early January. Telephone 13
  • 14. interviews may be conducted in lieu of Open House interviews when necessary. During the Open House candidates have the opportunity for a general orientation to the program, as well as personal interviews with internship faculty and current interns. Applicants are ranked and preliminary decisions concerning selection are made following the interviews. Applicants no longer under consideration are notified in writing or by phone at least one week prior to selection day. Interns are selected according to the procedures set forth by APPIC. Written confirmation of acceptance is provided. E. Intern Selection Timeline November 15 , 2007 All application materials due December 15 , 2007 Invitations to attend open house issued January 14, 22, 2008 Open House dates February, 2008 Rank order list submitted V. Description of the Psychology Internship Program A. Program Description 1. Overview of Training The focus of our program is to train psychology interns in the areas of pediatric health psychology, child and adolescent clinical psychology and clinical neuropsychology. A graduated program of training experiences is provided for predoctoral level psychology trainees. Our program is based on a Practitioner Scholar model, an integration of scholarship with experiential learning. The program includes exposure to knowledge and skills necessary for the completion of doctoral level training in professional psychology. From didactic seminars to shadowing experiences, interns are trained in a manner that is sequential, 14
  • 15. cumulative and graded in complexity. The intern’s progression toward independent practice informed by science is closely monitored through supervision provided across all aspects of training, the importance of psychological research and the application of that research to practice emphasized. The internship year begins with an orientation week during which time training supervisors present a description of the activities and requirements of each training setting. All interns are required to participate in training experiences involving psychological assessment, treatment and consultation-liaison service. In addition to these core-training requirements, interns are selected to participate in one of the three following yearlong specialized multidisciplinary training tracks: the Pediatric Health Track, the Child Adolescent and Family Therapy Track or the Neuropsychology Track. The Pediatric Health Track consists of two six months training rotations; the Developmental Disabilities Rotation and the Developmental Evaluation and Intervention Program Rotation. Beyond the core training experiences and specialized training tracks, interns are able to pursue their individual training interests through participation in elective multidisciplinary clinics and training teams. Training in this third area is available through the following subspecialty clinics and services: Craniofacial Clinic, Neurodevelopmental Clinic, Diabetes Clinic, the Bone Marrow Transplant Team and the Pain Management Team. Attendance at hospital multidisciplinary teaching rounds across services (e.g., Pulmonology, Oncology, Gastroenterology, etc.) is also encouraged. Efforts are made to accommodate interns’ individual training interests and needs as long as the core and specialized training requirements are met. Throughout the year, patients are assigned based on the presenting problem in order to expose interns to a full range of assessment (developmental, intellectual, processing, achievement, emotional, behavioral) and treatment (individual 15
  • 16. therapy, family therapy, group therapy) modalities, taking into consideration the intern’s prior training and experience. 2. Goals and Objectives All interns are expected to acquire knowledge and develop skills consistent with the training philosophy of the program. Each intern gains experience in psychological assessment, intervention and consultation liaison service. Each intern will also participate in a specialized interdisciplinary training track and provide services consistent with that track during the internship year. Experience in working with professionals from other disciplines is a critical aspect of training. Sensitivity to cultural and individual diversity is also emphasized. Interns are provided the opportunity to work with individuals from a variety of cultural and socio-economic backgrounds. The internship is also structured so that each intern gains experience with a population diverse in terms of age, gender, and presenting problems. B. Training Components Figure 1 below provides an overview of the program’s training component. Psychology Internship Program 16Core Training Components Consultation Liaison Outpatient Psychological Outpatient Treatment Services Assessment Services Services Specialized Training Tracks Pediatric Health Track Child, Adolescent & Neuropsychology Track Family Therapy TrackElective Multidisciplinary Training Experiences
  • 17. 17 Craniofacial Clinic Eating Disorder Team Diabetes Clinic Juvenile Arthritis Neurodevelopmental Clinic Inpatient Multidisciplinary Rounds
  • 18. 1.Core Training Components The following competencies reflect the program’s training emphasis. These training requirements are not specific to any specialized training track, but rather constitute the internship program’s core training components. Assessment. Interns will acquire the full range of skills necessary to evaluate children’s developmental, intellectual, academic, emotional and behavioral needs. Interns will conduct clinical interviews, administer and interpret test batteries consisting of intellectual, processing, academic, and emotional/behavioral components and produce integrated written reports. Children are referred from other departments in the hospital as well as from schools, community agencies, and private referral sources. Children with neurological (e.g., Tics, Tourette’s) and neurodevelopmental (e.g., PDD, Autism, Epilepsy, Rett’s Disorder) concerns are routinely seen through the Behavior Medicine Program’s affiliation with the Department of Neurology. Evaluations are also conducted to address learning/academic difficulties and emotional adjustment problems and to monitor overall development and specific intellectual functioning due to chronic and acute medical conditions. Evaluations include behavioral observations, and consultation with other professionals in the hospital as well as in the community. Community outreach includes consultation with private and public school personnel in an effort to facilitate social and academic adjustment. Psychological and psycho-educational assessments are also conducted as part of the multidisciplinary assessment of the in-patient in the Psychiatry Department. Assessments are ordered by the attending psychiatrist to facilitate differential diagnosis and treatment. They will also conduct observational assessment of child-parent interaction. Interns complete a 18
  • 19. minimum of 6-10 comprehensive evaluations during the course of the internship year. Treatment. Interns receive training in individual, family and group modalities and be able to apply psychotherapeutic techniques. They acquire experience with children, adolescents and family members utilizing both long term and short- term modalities. They will be able to develop and implement therapeutic interventions for children experiencing emotional psychopathology, behavioral disruption and family systems dysfunction. They will also develop and implement interventions for behavioral/emotional problems associated with chronic and acute medical conditions. Children and adolescents who are presenting with or are at risk for emotional and behavioral problems are seen. Children from preschool age through adolescence and their families are seen in consultation. Emphasis is on the assessment and treatment of common behavior problems including attention deficit hyperactivity disorders, mood and anxiety disorders, oppositional defiant and conduct disorders, eating and elimination disorders, trauma and developmental spectrum disorders. Children and adolescents with difficulties and disorders related to acute and chronic surgical and/or medical conditions are also seen. Collaboration with other disciplines (e.g., medicine, social work, physical therapy, nutrition) and the referral source is a key component of the treatment process. Cognitive- behavioral, psychodynamic, developmental and family systems perspectives are emphasized in understanding psychopathology and developing intervention strategies. Interns typically carry 3-4 therapy cases per week. Consultation Liaison. Interns serve as consultants to physicians, medical residents and nursing personnel involving patients experiencing behavioral and emotional problems associated with a medical condition. They learn rapid assessment and differential diagnosis of psychological factors affecting a wide variety of medical conditions. The focus is on children and adolescents who have 19
  • 20. acute or chronic medical problems and prevention of medical conditions in children and adolescents. Services are provided to patients on the following inpatient/outpatient units: Neurology, Hematology/Oncology, Bone Marrow Transplant, Diabetes/Endocrinology, Pediatric Intensive Care, Neonatal Intensive Care and Cardiovascular Intensive Care, among others. This training experience focuses on the behavioral aspects of chronic illness (e.g., diabetes, sickle cell disease, pediatric HIV, asthma, etc.), adherence with treatment regimes and problems with disease management (e.g., diabetes), behavioral and emotional difficulties associated with recurrent somatic problems, the promotion of child and family coping with pediatric conditions (e.g., stress management during medical procedures), and supportive interventions for adolescents with chronic diseases. Cases range from pain management to complex family dysfunction and provide training experiences in behavioral intervention and prevention of psychological adjustment problems. Training opportunities include individual and family based intervention. Training is provided in consultation, assessment, and treatment before, during and after medical interventions. Interns participate as members of multi-disciplinary teams providing comprehensive health care. Multidisciplinary teams consist of physicians, nurses, social workers, speech/language pathologists, occupational and physical therapists, and patient advocates. Team meetings and case conferences provide a forum for clinical discussions and training across services. Interns typically complete 5-7 consults per month. 2. Specialized Training Tracks Interns apply for and are selected to participate on one of the following yearlong tracks. Selection is based on the intern’s prior training and experience as well as on the intern’s individual training interests and needs. a. Pediatric Health Track 20
  • 21. The Pediatric Health Track experiences are provided by two concurrent yearlong, the Developmental Disabilities Rotation and Developmental Evaluation Rotation. Interns are prepared for entry level practice in this area, graduates going to postdoctoral fellowships in pediatric psychology programs in medical schools and Psychiatry and Behavioral Medicine programs in children’s hospitals and fellows in Clinical Child Psychology Programs. i.The Developmental Disabilities Rotation The goal of the Developmental Disabilities Rotation is to provide interns with basic knowledge in evaluation and intervention with infants, children and adolescents. Children with major behavioral/developmental disorders (e.g., autism, mental retardation, failure to thrive, obesity, insomnia, attention deficit/hyperactivity, learning disorder, chronic pain) are assessed and treated. Assessment training is provided in the areas of clinical interview, assessment and direct observation of the supervisor working with patients and their families. Training in the area of intervention involves assorted behavior modification and cognitive behavioral protocols including reinforcement and response cost contingencies (e.g., reinforcement, time-out, token economy), in addition to antecedent and setting event manipulations (e.g., sleep hygiene protocol, hypnosis and biofeedback). In the case of children diagnosed with failure to thrive, limited or excessive oral intake, restricted diet, inappropriate feeding schedules and non-compliance and rumination, the intern participates as a member of the Feeding and Swallowing Disorder Team. The team’s goal is to meet the unique needs of infants, children and adolescents with feeding and swallowing disorders by using an interdisciplinary approach to evaluation, treatment and management. Other disciplines involved include: Gastroenterology, Nutrition, Pulmonology, Radiology, and Speech and Language Pathology. The psychologist’s role is to provide evaluation and therapy for children who have feeding or swallowing 21
  • 22. problems with psychological components. Interns typically see 2 therapy cases per week and 4 hours of assessment. ii. The Developmental Evaluation and Intervention Program Rotation Through it association with the hospital’s Early Intervention Program, the Developmental Evaluation and Intervention Program Rotation provides training in the developmental assessment of infants and children exposed to multiple medical and socioeconomic risk factors. Children diagnosed with or at risk for mental retardation, developmental delay, and emotional problems are assessed. Graduates of the Neonatal Intensive Care Unit and other at risk children are screened at planned periodic intervals. A multidisciplinary team assesses developmental progress. The disciplines involved include psychology, speech- language pathology, occupational and physical therapy and education. Interns typically conduct 4 evaluations per month. b. Child, Adolescent and Family Therapy Track The assessment and treatment experiences provided interns participating on the Child, Adolescent and Family Therapy Track are varied, training venues designed to give interns experience with various aspects of psychopathology commonly encountered in children and adolescents hospitalized for psychiatric illness. In association with the Department of Psychiatry, interns are provided the opportunity to enhance their skills in general clinical practice with a pediatric, child and adolescent population. At the end of the internship year the interns will have acquired the basic abilities to provide competent care in a private practice setting under supervision, or function in a more specialized treatment setting such as a hospital, community mental health center or residential treatment facility specializing in child and adolescent psychiatric care. Interns will have the 22
  • 23. opportunity to refine their skills at conducting an initial assessment for history and mental status, in providing individual psychotherapy, group therapy, family therapy and discharge planning. They are also provided training opportunities in crisis stabilization and management of the suicidal patient, and will work with patients who experience physical, sexual and emotional trauma and or neglect. Interns collaborate with other treatment team members including the attending psychiatrist, the clinical coordinator and milieu therapists who supervise the daily flow of patient care activities. Inpatient caseloads vary depending on hospital census but range from 2 to 4 patients daily. Interns are also involved in making recommendations and developing an after care program which may or may not include follow-up aftercare with the treating intern. This model also allows frequent and accessible collaboration with the attending psychiatrist when medication management is also provided in-house. In addition, interns attend inpatient psychiatry rounds, which are held weekly. The purpose of this meeting is for treatment and discharge planning, psychopharmacological management, teaching by the attending psychiatrists regarding patient psychopathology and coordination of care by all treatment team members. At this meeting, interns are expected to present and discuss patient and family dynamics and psychopathology as well as progress towards treatment goals. The Department of Psychiatry accommodates psychology interns, second year doctoral level practicum students, post-doctoral psychology fellows and masters level clinicians completing internship requirements in the areas of marriage and family therapy, mental health counseling and developmental psychology. Interns are also provided the opportunity to supervise doctoral practicum students in assessment with patients that are referred for evaluation by psychiatrist on the unit. They provide training in test selection, administration and scoring as well as case conceptualization. The interns supervise the doctoral students in conjunction with his or her supervisor who has primary responsibility for the assessment. 23
  • 24. c. Neuropsychology Track The Psychology Internship Program Neuropsychology Track, in association with the Departments of Neurology and Neuroscience, provides neuropsychological assessment services for inpatient and outpatient consults. The service offers neuropsychological evaluations focused on children with neurological conditions and/or other medical disorders that affect brain functioning, resulting in behavioral and cognitive alterations. Neuropsychological evaluations provide detailed information regarding cognitive skills including attention, language and communication skills, memory and learning, motor and sensory functions, academic achievement, and “executive” processes. The information obtained from these evaluations provides baseline levels to monitor change over time, serves to determine the presence or absence of brain dysfunction, assists in differential diagnosis and in developing remedial intervention and treatment strategies. The neuropsychology service also collaborates with a wide range of other medical specialties. Services are provided to children with acquired brain disorders including traumatic brain injuries, hypoxic episodes, brain tumors, metabolic encephalopathies, cerebrovascular disease, CNS infections, and other medical conditions that affect the brain. Additionally, the neuropsychology service is part of the hematology-oncology team. Evaluations are frequently requested in order to monitor the impact of treatment on cognitive, intellectual, and academic functioning. The neuropsychology service has an active role in the epilepsy program at MCH. This program is considered among the best in pediatric epilepsy in the nation, specializes in the treatment of complex epileptic disorders and has a world- renowned epilepsy surgery program. Neuropsychological assessments are an integral part of the work-up of surgery candidates and test results are discussed weekly in the multi-disciplinary surgical conferences in conjunction with neurology, neurosurgery, radiology, and neuropathology. As part of this 24
  • 25. program, the neuropsychology service is also involved in clinical research with this patient population and recently began clinical and research activities with functional magnetic resonance imaging in order to “map” the location of cognitive skills pre- and post-surgically. Interns are involved in all aspects of this service, and clinical training is also provided to post-doctoral fellows and practicum students. They are also provided the opportunity to supervise doctoral practicum students on evaluations to determine epilepsy surgery candidacy. Once the intern receives weekly consults from the attending neurologist and/or epilepsy fellow, she assigns cases to practicum students for neuropsychological testing. Supervision is provided with regard to test selection, administration and scoring. The intern also reviews, along with her supervisor, reports written by the practicum student and discusses relevant issues. Intensive supervision, geared to the individual intern’s level of experience, emphasizes both normative and qualitative interpretation of standard neuropsychological tests, with particular focus on integrating results of the neurospcyhological examination with pertinent psychodiagnostic findings. The practicum involves primarily cognitive and psychosocial evaluations that will require clinical interviews, medical chart review, scoring and interpretation of test data. Participation in neuroscience meetings, including a weekly inter- disciplinary epilepsy surgery conference is required. 3. Elective Multidisciplinary Training Experiences This training component allows interns to pursue their individual training interest through participation in a variety of elective multidisciplinary training teams and clinics. Training in this third area is available through the following subspecialty clinics and services: Eating Disorder Team, Craniofacial Clinic, Neurodevelopmental Clinic, Diabetes Clinic, Juvenile Arthritis Clinic, Neonatal Intensive Care Unit, the Bone Marrow Transplant Team and the Pain Management Team and multidisciplinary inpatient teaching rounds. Attendance 25
  • 26. at hospital multidisciplinary teaching rounds across services (e.g., Pulmonology, Oncology, Gastroenterology, etc.) is also encouraged. Efforts are made to accommodate interns’ individual training interests and needs as long as the core and specialized training requirements are met. The subspecialty clinics and multidisciplinary teaching rounds occur on a regularly schedule basis. Subspecialty teams also meet on a regular basis. Children and adolescents are referred to the clinics by their primary pediatric resident and by professionals in the community. Psychology interns work alongside subspecialty attending physicians, pediatric residents, medical students, invited foreign faculty, social workers and nurses. Intern participation includes clinical interviews, assessment and diagnosis. Follow-up services are provided, as are referrals to community agencies. 4. Training Seminars Two categories of assessment/intervention training seminars are provided to address the application of psychological concepts and scientific knowledge principles and theories of service delivery. The first group consists of yearlong seminars that provide training in areas consistent with the program’s training emphasis or with knowledge and skills central to participation in a particular specialized training track. The second group focuses on didactic information related to specific presenting problems, professional, ethical and cultural and individual diversity issues. A professional development seminar is also offered. a. Yearlong Assessment/Intervention Seminars i. Consultation Liaison Seminar The Consultation Liaison seminar (theoretical orientation-cognitive behavioral) focuses on the psychological aspects of different medical conditions, behavioral aspects of chronic illnesses, problems with disease management and psychiatric profiles that may result from or be exacerbated by medical conditions. The 26
  • 27. etiology, prognosis and course of treatment for different medical conditions are reviewed. The intern receives training in the evaluation, case management, and short-term treatment of the patient and the family. Interns are trained to address the psychological aspects of different medical conditions, to identify various coping styles and psychiatric profiles that may result from medical problems and to recognize how different comorbid conditions may affect treatment. The didactic component of this seminar is provided on a weekly basis the first three months of the internship year and includes clinical application to specific cases. The intern begins by shadowing the supervising psychologist on consults for different medical conditions and is subsequently shadowed by the supervisor. Supervision is provided on all consults through the end of the internship year. ii. Family Therapy Seminar The Family Therapy Seminar has a didactic portion which includes a review of the major theoretic orientations in family therapy with an emphasis in object relations, attachment and system’s theory. Interventions and techniques utilized are derived from these theories. Transference and countertransference issues are discussed. Emphasis is placed on the role of projective identification in understanding clinical phenomena and in forming intervention strategies. Interns submit cases via live observation, videotaped sessions or case presentation. Live observation cases are viewed by the group via a one-way mirror. A faculty member specializing in this area of treatment then leads a discussion of the family dynamics observed. Interns are also encouraged to participate as co- therapists to enhance treatment outcomes and enrich the training experience. The seminar is presented on a weekly basis for two and one-half hours. b. Yearlong Topic Specific Assessment/Intervention Seminar This seminar focuses on didactic material related to specific presenting problems, professional, ethical and cultural and individual diversity issues. Topics 27
  • 28. covered include attention deficit hyperactivity disorders, pervasive developmental disorders, and obsessive compulsive disorders, among others. In addition to an extensive cultural and individual diversity seminar, a three to eight hour ethics seminar, an eight hour violence seminar is also presented. Interns also contribute to the Topic Specific Assessment/Intervention Seminar by presenting. This group of seminars is presented on a weekly basis beginning the second quarter of the internship year and runs through the end of the year. c. Professional Development Seminar The Professional Development Seminar consists of presentations on professional issues include the preparation of a curriculum vitae, practice strategies in the managed care environment, program evaluation and supervision, benefits of active participation in supervision, discuss mid-year program evaluation form, and how cultural and individual diversity issues impact/are addressed in program evaluation and supervision, ethical dilemmas, adjustment to the new internship site, professional conduct, cultural issues, communication skills, working as a team member, the development of a curriculum vitae, fellowship application and professionalism. 5. Supervision The development of knowledge is also facilitated through supervision, supervisors serving as professional role models. The intern’s primary supervisor is responsible for monitoring progress and insuring that the intern’s training needs are being met. Interns receive a minimum of two hours of individual face- to-face supervision each week. In addition to individual supervision provided for each of the three core training components, Pediatric Health and Neuropsychology Track interns are also provided one hour of individual specialty training track/rotational supervision per week. Interns also receive individual and group supervision on a weekly basis as part of the yearlong 28
  • 29. assessment/intervention seminars they attend, a minimum of four hours of supervision provided each week. A formal written evaluation of the intern is completed midyear and at the end of the training year to determine if internship requirements and individual objectives have been met. A composite written evaluation is prepared and forwarded to the intern’s University Director of Training mid-year and at the conclusion of the internship. 29

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