- Training Components
- Evaluation Experiences
- Intervention Rotation Experiences
- Consultation Experiences
Within the Department of Pediatrics, the Division of Behavioral Health serves infants, children, and adolescents in need of psychological evaluation and treatment.
Services are provided to hospital inpatients and outpatients referred from other ambulatory services of the hospital and the community. As previously stated, interns are exposed to a wide range of patients, encompassing both child clinical and pediatric experiences.
In general, diagnostic evaluations include assessment of intellectual functioning and current academic levels; attentional functioning; personality and behavior that contribute to school, family, social, and developmental difficulties; neuropsychological functioning to assist in understanding the relationship between brain physiology and behavior; and early childhood (birth to age five) development.
Interns work closely with parents and schools to ensure that children receive a comprehensive evaluation that not only focuses on accurate diagnosis, but that also provides relevant, timely recommendations on an individual basis.
Consultation and treatment opportunities include experiences such as inpatient and outpatient consultation; individual, family, and group therapies; behavioral medicine, including medical adherence, pain management, adjustment to chronic illness or acquired injury and transplant pre-evaluations and treatment; school consultation; and daycare consultation.
The faculty is primarily behavioral, cognitive-behavioral, and family-systems oriented but appreciate different theoretical approaches with empirical bases. Keeping in step with the times, we strive to offer evidence-based, empirically supported interventions. The wide range of experiences offered to the intern is a strength of the program.
Psychology interns participate in evaluation, treatment, and consultation simultaneously throughout the year.
A Sample Year at a Glance
- Year-long Pediatric/Child Psychology Outpatient Therapy Experience
- Year-long Consultation-Liaison Experience
- Three, 4-month Diagnostic Evaluation Rotations
- 6-month Behavior Consultation Clinic Experience
- 6-month Primary Care Experience
- Year-long Family Centered Consultation Clinic Experience
- Year-long Specialty Experience: Cerebral Palsy, Cardiology, GI, Diabetes, Weight Management, Autism
Psychology interns rotate through three evaluation experiences with different faculty supervisors for four months each.
Evaluation experiences emphasize the need to go beyond accurate diagnosis and provide recommendations tailored to each unique patient to enhance their quality of life. Examples of evaluations include the following:
Includes outpatient diagnostic assessment such as comprehensive cognitive, educational, and emotional evaluations of children and adolescents presenting with a broad range of developmental, medical, behavioral, and emotional concerns. Emphasis is placed on providing multidisciplinary recommendations to address individual patient needs in the home and school settings.
Includes neuropsychological assessment and consultation of children/adolescents with known or suspected CNS compromise such as cancer, sickle cell disease, genetic syndromes, seizures, head injury, CP, cerebral vascular malformations, and infectious processes. Interns work with school systems and other professionals so that recommendations can be feasible to implement for each particular patient.
To address the most common referrals, an integrated diagnostic assessment, treatment, and consultation service for children presenting with attentional and behavioral concerns. Diagnostic assessment involves combining input from teachers and parents with neuropsychological screening for common comorbidities.
Differential diagnoses include learning disorders, mental retardation, conduct disorders, adjustment disorders, anxiety disorders and mood disorders. Emphasis is placed on providing treatments that are indicated by evaluation.
Includes evaluations focusing on children, ages infant to five years. Families present with a variety of concerns that may focus on development (social, cognitive, self-help) and/or behavioral issues (feeding disorders, disruptive behavior, anxiety).
Evaluations may include formal testing, but also emphasize behavioral observations, developmental play and consultation with daycare/preschool caregivers. Frequently, evaluations involve coordinating care with other disciplines (e.g., physical therapy, occupational therapy, speech and language, developmental medicine) to ensure a comprehensive evaluation including an individualized treatment plan, ready to implement across settings.
Adolescents can present to an evaluation experience with a unique set of questions. Sometimes clinical presentations are wrapped in personality dynamics that result in individual and family stress but may not fit neatly into a DSM-based diagnosis.
Adolescents with complex issues are referred to this service so that they can receive a comprehensive assessment of their development, cognition, information processing abilities and their personality structure.
Intervention Rotation Experiences
Interns participate in the outpatient therapy program for the entire training year. All faculty members supervise this experience. Individual, family, and group therapies are provided for a broad range of psychological problems. Intervention opportunities are balanced between pediatric psychology and traditional child clinical experiences.
Many of the pediatric psychology cases are follow-up appointments resulting from consultation/liaison activities. Examples include medical adherence difficulties (e.g., diabetes), pain management (e.g., headache, recurrent abdominal pain), weight management, adjustment to transplant, encopresis, and enuresis.
Interns also gain exposure to ADHD, anxiety, and mood disorders including obsessive-compulsive disorder and bipolar disorder, family adjustment issues including divorce and sibling issues, as well as early childhood issues such as child behavior management, parent-child interaction, pediatric feeding disorders, and growth deficiency.
If an intern has a special area of interest, cases may be selected to help foster further growth in that area. Interns participate in individual and family based treatment modalities.
Interns participate in the Behavior Consultation Clinic for six months. This clinic is designed to provide short-term services for parents and children ages birth to eight years for a wide range of behavioral and developmental concerns such as parent-child conflict, sleep problems, toileting concerns, daycare difficulties, noncompliance, and sibling rivalry.
This unique clinic was developed to meet the needs of pediatricians in the area. A preventative, developmentally-based treatment model is applied. The clinic is on Friday mornings with live supervision provided during the entire clinic via a one-way mirror.
Appointments are 30 minutes and therapy focuses on short-term, goal-oriented techniques. Interns frequently interact with child care providers in order to implement recommendations for that setting. Interns also have teaching opportunities as medical residents frequently observe behind the mirror.
Ongoing groups are provided throughout the training year to help address common disruptive behaviors associated with ADHD, such as noncompliance and aggression. Child social skills groups provide help with poor peer relationships. Interns gain experience coordinating and leading both the parent and child groups.
Individualized follow-up treatment for child and family is thereafter available on an as needed basis. Ongoing consultation and inservice training are also provided. Interns have the opportunities to follow-up with physicians and school to help ensure implementation of recommendations.
Psychology interns participate in inpatient consultation/liaison throughout the training year. All faculty supervises this experience. Interns participate in consultation to pediatricians and pediatric subspecialists, in particular, endocrinology, gastroenterology, transplant services, and neurology around health related behavioral concerns, such as poor medical adherence, pain, psychogenic symptom presentation, behavioral feeding disorders, and general coping issues.
Consults often involve a combination of psychological assessment, diagnostic formulation, treatment (individual and family), and outpatient follow-up post-discharge.
By the end of the training year, interns are expected to independently:
- Comprehensively interview the child and parent
- Coordinate with necessary services in the hospital, i.e., be an effective part of a multidisciplinary team
- Conceptualize the case
- Provide a written and verbal summary outlining recommendation for the hospital stay and post discharge
Family-Centered Consultation Program
This program provides brief consultative services to families with concerns about their child’s developmental, behavioral, emotional and/or social functioning. At the end of an initial visit, clinical impressions, psychoeducation, and recommendations are shared with the family.
Brief follow-up services are provided for some concerns (e.g., ADHD, specific behavioral issues). When additional clinical follow-up is needed, referrals and detailed recommendations are provided to the family. Live supervision is provided along with group supervision for case conferencing. This is a year-long experience.
Primary Care Consultation
Interns also have the opportunity to consult in our satellite primary care offices during a six-month rotation. Primary Care Consultation is a rapidly growing area for psychologists and offers an opportunity for community outreach in underserved areas.
Interns conduct intakes and learn skills in consulting with primary care staff regarding in office-based behavioral treatment strategies. The hospital’s satellite offices are in underserved, poverty areas of the city. One site serves primarily a Hispanic population; the physicians at this office are Spanish speaking and provide consultation and diversity training.
Opportunities for providing therapy and consultation in Spanish are available. Another primary care site serves a primarily urban, African American population and again, physicians represent diverse ethnic backgrounds and are community role models for providing culturally sensitive treatment.
Specialty Consultation Experiences
Interns will have opportunities for both family-based and group treatment for children with an Autism Spectrum Disorder. The intern will assist with screening, planning, and leading groups for children with high-functioning ASD.
Additionally, the intern will provide family-based behavior therapy to assist families with understanding and adjusting to the diagnosis of ASD, address comorbid conditions (e.g., anxiety, feeding difficulties, behavior management), and assist with resource identification.
The Cardiology Consultation Program was developed to extend our liaison connection to the Cardiology Program. This is primarily an outpatient consultation program that serves infants, young children, and their families referred by the cardio-surgery and cardiology program and present with behavioral issues compromising medical care.
This program focuses on working with the Division of Orthopedics to enhance their care of families with children who have Cerebral Palsy. Interns will see families in clinic, along with orthopedists, nurses, nutritionists, and social workers to develop multidisciplinary recommendations for school, development, and emotional functioning.
This is an interdisciplinary diabetes serving high risk children and adolescents diagnosed with Type 1 diabetes. Youth and families are seen co-jointly by a Diabetes Advanced Nurse Practitioner or Physician and a psychology resident (supervised by the attending psychologist). The psychology intern also provides health behavior assessment and interventions using empirically based strategies to help families cope with adherence challenges.
This program focuses on providing services to youngsters with functional abdominal pain, inflammatory bowel disease (i.e., Crohn’s Disease, Colitis), encopresis, and other functional GI disorders. The resident is involved in conducting consultation and ongoing therapy, as well as collaborating with a multidisciplinary team.
In addition, the resident participates in GI-Psychology Rounds. While one intern will be primarily associated with this program, psychological involvement for GI disorders is a common part of our referral base.
This is an interdisciplinary family group intervention to empower youth and families to meet the challenges associated with Type I diabetes. Families learn problem solving and communication strategies to overcome challenges in diabetes management. The team includes a diabetes Advanced Nurse Practitioner, nutritionist, psychology fellow and psychology intern (supervised by attending psychologist).
Interns will participate with the multidisciplinary Weight Management team to evaluate and develop treatment recommendations for children and adolescents who are struggling with obesity. As well, interns will participate in our Adolescent Bariatric Surgery Program.
In addition to direct patient care training opportunities, interns participate in a series of seminar and other didactic training events.
The overall goal of the various didactic conferences and seminars is to provide interns with formal instruction on topics important to their practice as pediatric psychologists. Didactics include:
This seminar is held for two hours weekly and is geared to the needs of psychology interns.
Sessions address the following:
- Basic issues in general and subspecialty pediatric medical care. Topics presented reflect the broad range of medical specialties within the hospital, ranging from psychosocial aspects of diabetes management to child abuse, genetics, headaches, and somatoform illnesses. The willingness of pediatric specialists, many of who are nationally and internationally recognized for their work, to present to psychology interns speaks highly of the regard for training in the hospital.
- Child clinical training issues, e.g., individual and family therapy techniques, various assessment measures.
- Psychosocial ramifications of a variety of medical presentations, including acute and chronic illnesses. The overlap between medical and psychological illnesses in children and families.
- Ethical issues, including the APA Code of Ethics, with particular application to the practice of psychology within a child/medical setting.
- Sensitivity and exposure to issues related to working with children and families representing diverse cultural backgrounds.
- Development of skills related to professional practice (e.g., interviewing, writing research grants, preparing vitae, post-doctoral opportunities)
1 hour weekly. Interns meet with faculty members to discuss current assessments and/or review/discuss tests. Interns gain the opportunity to hear the wide range of assessments being conducted, benefit from group input and supervision, and learn about new tests.
1 hour biweekly. Interns meet with faculty member to discuss ongoing family therapy cases. Supervision is provided via videotapes of sessions. Interns benefit from group input and are provided the opportunity to process themes across various family therapy cases.
Interns are encouraged to attend weekly Pediatric Grand Rounds and other training experiences that are sponsored by the duPont Hospital for Children. Interns also are encouraged to attend monthly ethics rounds sponsored by the hospital. In addition, interns are encouraged to attend rounds or journal clubs offered by medical subspecialties (e.g., neurology, endocrinology, or gastroenterology).