Training Components & Tracks

Predoctoral Internship Training in Clinical Psychology

Training Components & Tracks

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. Our psychologists, fellows and interns also serve primary care satellite clinics in the surrounding area. As previously stated, interns are exposed to a wide range of patients, encompassing both child clinical and pediatric experiences.

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.

For the upcoming 2014-15 training year, we will offer two training tracks to meet the goals of interns interested in clinical child and pediatric psychology.

Integrated Behavioral Health Track (Two Positions)
This track provides interns with intervention, assessment and consultation training in both community-based pediatric primary care settings and hospital-based settings. This track may be of interest to interns who wish to gain experience in the integration of evidence-based, clinical child psychology services within primary care and other clinics that comprise the medical home.

Pediatric Psychology Track (Six Positions)
This track remains largely the same as our previous internship experience, offering diverse training in inpatient and outpatient hospital-based psychological intervention, assessment and consultation for children and adolescents, and their families.

Although these tracks offer different major emphases, interns in both tracks participate in a number of common training experiences. View track-specific and common rotations.

 
Experiences Common to Both Tracks
  • Diagnostic evaluations, which 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 5) development.
  • Intervention experiences, which include rotations in early childhood behavioral therapy (the Behavior Consultation Clinic), general outpatient child/pediatric psychotherapy, and parent-child group therapy for disruptive behaviors and ADHD.
  • Specialty clinic rotation, with available experiences including diabetes, GI, neurology, pain management, sleep, sickle cell and weight management.
 
Experiences Specific to the Integrated Behavioral Health Track
  • Major, year-long rotation in pediatric primary care psychology across at least two primary care satellite clinics.
 
Experiences Specific to the Pediatric Psychology Track
  • Major rotation in inpatient consultation/liaison psychology. All interns on this track participate in both a six-month intensive inpatient rotation and a six-month endocrinology inpatient rotation.
  • Minor rotation in outpatient consultation through the Family-Centered Consultation Clinic program.
  • Minor rotation in pediatric primary care psychology in one primary care satellite clinic.

Rotation Schedule

A Sample Year at a Glance

Integrated Behavioral Health Track:

  • 12-month Primary Care Experience
  • 12-month Clinical Child Psychology Outpatient Therapy Experience
  • Diagnostic Evaluation Rotations
  • 6-month Behavior Consultation Clinic Experience
  • 12-month Specialty Experience: Diabetes, GI, Neurology, Pain Management, Sleep, Sickle Cell and Weight Management
  • Parent/Child Disruptive Behaviors Group

Pediatric Psychology Track:

  • 12-month Inpatient Consultation-Liaison Experience
  • 12-month Pediatric Psychology Outpatient Therapy Experience
  • Diagnostic Evaluation Rotations
  • 6-month Behavior Consultation Clinic Experience
  • Minor Primary Care Experience
  • Minor Family Centered Consultation Clinic Experience
  • 12-month Specialty Experience: Diabetes, GI, Neurology, Pain Management, Sleep, Sickle Cell and Weight Management
  • Parent/Child Disruptive Behaviors Group

Evaluation Experiences

Psychology interns on both tracks rotate through diagnostic evaluation experiences with different faculty supervisors.

Evaluation experiences emphasize the need to go beyond accurate diagnosis and provide timely, relevant recommendations tailored to each unique patient to enhance their quality of life. Examples of evaluations include the following:

 
Clinical Child Evaluations

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.

 
Neurodevelopmental Evaluations

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.

 
Attention Deficit Hyperactivity Disorder Evaluations

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.

 
Early Childhood Evaluations

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.

 
Adolescent Personality Evaluations

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

 
Outpatient Pediatric/Child Therapy Clinic

Interns on both tracks 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 available for both 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.

 
Behavior Consultation Clinic

Interns on both tracks 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 8 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 or video feed.

Appointments are 45 minutes, and therapy focuses on short-term, goal-oriented techniques. Interns frequently consult 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.

 
Parent/Child Disruptive Behaviors Group

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 on both tracks 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 in-service training are also provided. Interns have the opportunities to follow-up with physicians and school to help ensure implementation of recommendations.

Consultation Experiences

Consultation/Liaison Service

Psychology interns on the Pediatric Psychology track participate in inpatient consultation/liaison (C/L) for the entire 12-month training year. This experience is divided into two 6-month rotations with different emphases and levels of intensity. Interns also participate in didactic and group supervision seminars related to C/L.

During one 6-month rotation, pediatric psychology interns provide C/L services to multiple pediatric services and pediatric subspecialties, including general pediatrics, transplant, neurology, oncology, rheumatology and gastroenterology. Interns are exposed to a variety of ages and referral questions, including those regarding medical adherence, pain management, psychogenic symptom presentation, adjustment to diagnosis and/or hospitalization, procedural anxiety, general medical coping, behavioral problems interfering with treatment and post-discharge treatment planning.

During the other six months, pediatric psychology interns participate in a specialized endocrinology C/L rotation. While on this rotation, interns provide C/L services to patients with new-onset type 1 diabetes and their families, as well as patients admitted for diabetic ketoacidosis and hyperglycemia secondary to medical adherence challenges.

Consults often involve a combination of diagnostic assessment and formulation, psychoeducation, intervention (individual and family), and identification of goals and needs for outpatient follow-up after discharge.

By the end of the training year, interns are expected to independently:
  • Interview the child and caregivers to the appropriate extent.
  • Conceptualize the case.
  • Implement recommended interventions in the inpatient setting.
  • Coordinate with other services in the hospital as an interdisciplinary team member.
  • Communicate conceptualization and recommendations succinctly to the medical and nursing team.
  • Provide a written summary of recommendations for the hospital stay and after discharge.

Primary Care Consultation

Interns also provide consultation services in our satellite primary care offices during a 12-month, two-day major rotation (Integrated Behavioral Health track) or a minor rotation (Pediatric Psychology track). 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. Brief psychological testing and follow-up services also may be provided. The hospital's satellite offices are predominantly located in medically underserved 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.


Family-Centered Consultation Program

For interns on the Pediatric Psychology track, 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 4-month experience.


Specialty Consultation Experiences

 
Chronic Pain

The intern in the chronic pain program will participate on a multidisciplinary treatment team focused on outpatient treatment of pediatric chronic pain.  There will be a focus on intake evaluations, individual and family therapy and consultation with medical staff.

 
Diabetes Clinic

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.

 
Gastrointestinal Consultation Program

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.

 
Improving Diabetes Through Education & Lifestyle (IDEAL) Clinic

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).

 
Neurology Collaborative Clinic

The intern will gain exposure to a multidisciplinary experience for patients who have a variety of neurological issues (e.g., headaches, seizure disorder, non-epileptic seizures, tic/Tourette's disorder).

 
Sickle Cell

This clinic provides an intern with an interdisciplinary exposure to the management of types of sickle cell disease. The intern will be involved in consultation and ongoing therapy (pain management and psychosocial adjustment) and will participate in medical rounds.

 
Sleep

The behavioral sleep program focuses on using behavioral therapy principles to address sleep disorders and dysregulated sleep in children and adolescents.  The resident will gain experience with consultation, intervention and collaboration with the pulmonology team.

 
Weight Management

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.

Didactics

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:

 
Pediatric and Child Clinical Psychology Seminar

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.
  • 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).

 
Assessment Seminar

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.

 
Supervision Seminar

The Supervison Seminar series covers content areas applicable to clinical supervision such as ethical and legal issues, diversity issues, models and elements of effective supervision.

 
Therapy Seminar

The therapy seminar series is centered around evidenced-based interventions for the most frequently encountered referral issues that bring families to the clinical pediatric consulting room. Past seminars have included topics such as treatment of enuresis/encopresis, PCIT, suicide assessment and intervention, motivational interviewing, trauma focused CBT, mindfulness therapy and anxiety treatment.

 
Hospital-Sponsored Programs

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).

Contact Us

Rochelle Glidden, PsyD

Director of Clinical Training
(302) 651-4525
rochelle.glidden@nemours.org