Consultation Experiences

Consultation/Liaison Activities

Consultation/Liaison Activities are both universal and individual.  All interns will participate in the Inpatient Consultation Program, the Behavior Consultation Program and the Primary Care Consultation Program.  We have also developed several specific consultation programs as a result of the increased demand for psychological services to specific medical services.  Not all Interns participate in all of these consultation programs but all Interns will have a specialized consultation focus for the year.

Inpatient Consultation Program

All Psychology Interns will participate in the inpatient consultation/liaison service throughout the training year. Presenting issues vary considerably from anxiety and depression affecting the physical presentation to conversion disorder to parenting issues affecting the child's inpatient stay. All faculty supervise this experience. Interns provide consultation services to general pediatricians and pediatric subspecialists, in particular, Endocrinology, Gastroenterology, Cardiology, Asthma, General Pediatrics and Neurology around health related behavioral concerns, such as poor medical adherence, pain, psychogenic symptom presentation, behavioral feeding disorders, family-system issues, and general coping issues.  Consults often involve a combination of psychological evaluation, diagnostic formulation and treatment (individual and family) planning. Since children often have short stays in hospitals, interns learn to quickly perform bedside evaluations of children and families and communicate results to the consulting medical staff. Outpatient follow-up post discharge is appreciated when patients live within commuting distance to the hospital.

Primary Consultation Care

All interns 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 close contact with pediatricians and nurses working in underserved areas. Interns conduct intakes and learn skills in consulting with primary care staff regarding 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 and physicians at this office are Spanish speaking and provide consultation and diversity training. Opportunities are available for providing therapy and consultation in Spanish. 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. Another primary care site is in a generally rural area of the state.

Community Consultation

All interns will have the opportunity to provide on-site behavioral consultation and in-service training programs to teachers and staff at several early development centers comprised of over 95% minority students. One center serves a primarily African American population and one that primarily serves a Latin population. Opportunities for providing consultation in Spanish exist.

Specialty Consultation Experiences

Impaired Glucose Tolerance Consultation Program

The IGT Program a relatively new, multidisciplinary program that was developed to improve the health of youngsters who are at risk for developing Type 2 diabetes.  One intern will participate in a half-day clinic with the IGT team .  The intern will provide consultation and ongoing therapy within the context of a multidisciplinary team approach.

Diabetes Clinic

One intern will participate in a multidisciplinary diabetes clinic for children and adolescents struggling with adherence to their diabetes management regimens.   Children and adolescents in this clinic see the diabetes educator, nutritionist and the psychology intern all of whom consult to provide comprehensive treatment recommendations to improve diabetes management.  Treatment is short-term and consultative in nature.  While one intern will participate in this particular clinic, psychology is well-integrated into the diabetes team and there are numerous opportunities for interns to be able to work with this team.

Cardiology

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.

Gastrointestinal Consultation Program

This program focuses on providing services to youngsters with recurrent abdominal pain of unknown origin, common GI diseases (like Crohn’s) and encopresis.  While one intern will be primarily associated with this program, psychological involvement for GI disorders is a common part of our referral base.

Cerebral Palsy Program

This new consultation opportunity comes to DBH at the invitation of the Division of Orthopedics to enhance their care of families with children who have Cerebral Palsy (CP). Interns will see families in clinic, along with orthopedists, nurses, nutritionists, and social workers to develop multidisciplinary recommendations for school, development and emotional functioning.

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.

Other Consultations

Other areas for consultation are also available as we try to fill the hospital’s need for behavioral health services. The Sickle Cell, Craniofacial, Bone Marrow Transplant, Oncology and Children’s Advocacy Center (statewide program for child abuse housed in the hospital) are examples of other common consultation partners.

Sample Year at a Glance

• Year-long Pediatric Child Psychology Outpatient Therapy Program
• Year-long Inpatient Consultation-liaison experience
• Year-long Social Venture Community Consultation Program
• Three, four-month Evaluation Service rotations
• Six month rotation in the Behavior Consultation Clinic
• Six month rotation in Primary Care
• Specific Consultation Experience: Cerebral Palsy, Cardiology, GI, IGT, Weight Management
• Year-long Specialty Consultation Experience (IGT, Diabetes, Cardiology, GI, CP, Wt. Mgt)