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Miami Children s Hospital Internship in Pediatric Health Psychology Child and Adolescent Clinical Psychology and Clinical Neuropsychology

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Miami Children s Hospital Internship in Pediatric Health Psychology Child and Adolescent Clinical Psychology and Clinical Neuropsychology Powered By Docstoc
					                          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



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                 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
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




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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;

   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




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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.

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.
Toward this goal, MCH has developed and maintained graduate training



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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.

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.


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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
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


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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. 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

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;


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                                                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

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


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of child and adolescent clinical psychology, pediatric health psychology, and/or
clinical neuropsychology.

B. Funding and Benefits

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)
   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.


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     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 15th. Applications are
reviewed by members of the Psychology Internship Selection Committee and
invitations to attend an Open House are extended by December 15th. 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
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




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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,
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 therapy, family therapy, group therapy) modalities, taking into
consideration the intern’s prior training and experience.

2. Goals and Objectives


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    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




                           Core Training Components




Consultation Liaison         Outpatient Psychological      Outpatient Treatment
Services                     Assessment Services           Services




                           Specialized Training Tracks




  Pediatric Health Track       Child, Adolescent &          Neuropsychology Track
                               Family Therapy Track
                                                                                       12
   Craniofacial Clinic                       Eating Disorder Team
   Diabetes Clinic                           Juvenile Arthritis
   Neurodevelopmental Clinic                 Inpatient Multidisciplinary Rounds



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



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interaction. Interns complete a 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
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


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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

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


                                                                                 15
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 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 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


                                                                                  16
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.

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.

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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
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
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.


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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
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


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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 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


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and group supervision on a weekly basis as part of the yearlong
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.




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