- Training Components & Tracks
- Evaluation Experiences
- Intervention Rotation Experiences
- Consultation Experiences
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.
Eight interns comprise our 2016-17 class. We will be adding an additional three positions for the 2017-2018 training year. There are postdoctoral fellows and externs training with us as well. While we are known as a "hard working" training site, we are also known for the warm and friendly relationships between our trainees and faculty. Formal supervision is abundant and faculty have an open door policy for informal consultation.
Integrated Behavioral Health Track (Five 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.
- 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.
- Major, year-long rotation in pediatric primary care psychology across at least two primary care satellite clinics.
- Minor rotation in telehealth (1/2 day per week for 12 months).
- Major rotation in inpatient consultation/liaison psychology. Interns will participate in a year long intensive 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.
A Sample Year at a Glance
Integrated Behavioral Health Track:
- 12-month Primary Care Experience
- 12-month Clinical Child Psychology Outpatient Therapy Experience
- 12-month Telehealth Intervention Experience
- Diagnostic Evaluation Rotations
- 6-month Behavior Consultation Clinic Experience
- 12-month Specialty Experience: Adolescent Health, Cardiology, Diabetes, GI, Neurology, Pain Management, Sleep, Sickle Cell, Transition to Adult Care and Weight Management
- Group Therapy Experience
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: Cardiology, Chronic Pain, Diabetes, Feeding, GI or Sickle Cell Disease
- Parent/Child Disruptive Behaviors Group
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 and ADHD: Includes the assessment of multiple domains of functioning of children and adolescents presenting with a broad range of attentional, developmental, medical, behavioral and emotional concerns. Diagnoses to be considered often include ADHD, anxiety disorders, depressive or mood disorders, disruptive behavior disorders, intellectual disability and language disorders. 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. This experience typically does not provide sufficient neuropsychological assessment experience for interns who wish to apply to postdoctoral fellowships in clinical neuropsychology.
Includes testing for diagnostic determination of autism spectrum disorder and its common comorbidities. “Gold standard” assessment tools are utilized, such as the ADOS-2, ADI-R, ASRS, SRS-2 and other related diagnostic measures.
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.
Includes testing for diagnostic clarity of complex presentations, with a focus on assessing domains such as thinking, mood, behavior and personality dynamics. Both objective and projective measures are typically administered, such as the MACI, Million, Rorschach (Exner Scoring), MMPI-A and Roberts Apperception Test, which are administered and interpreted in the context of a comprehensive battery of other measures of intellectual, memory, executive, attentional and social-emotional-behavioral functioning.
Intervention Rotation Experiences
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.
Interns on both tracks will rotate through one of our Behavior Consultation Clinics. All of our clinics provide live supervision during the entire clinic via a one-way mirror or video feed. Interns routinely consult with pediatrician, teachers and child care providers in order to implement recommendations. Interns also have teaching opportunities as medical residents frequently observe behind the mirror. Our original Behavior Consultation Clinic (BCC) on Friday morning was designed to provide short term services for parents and children ages birth to 6 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. Appointments are 45 minutes in length.
Our Autism Behavior Consultation Clinic (ABC) is designed to provide brief, targeted behavioral services for children with Autism Spectrum Disorder (ASD) or other developmental disorders and their caregivers. Intervention focuses on empirically-based approaches to behavior management and addresses a wide range of behavioral and developmental concerns, including aggression, tantrums, compliance, self-help skills and toileting concerns. Appointments are 45 minutes and therapy focuses on evidence-based, short-term, goal-oriented techniques.
The Early Childhood Clinic (ECC) provides evidence-based psychotherapy services to young children (typically aged 2 to 6 years) and their families. Common reasons for referral include disruptive behaviors, anxiety, parent-child conflict, attention concerns and emotion regulation difficulties. Treatments provided may include Parent-Child Interaction Therapy (PCIT), exposure-based cognitive behavioral therapy for anxiety and parent management training using a family-systems approach.
Interns gain experience in group therapy at several points throughout the year. Opportunities include co-leading hospital-based or primary care-based parent groups to address common disruptive behaviors associated with ADHD, such as noncompliance and aggression. Other group opportunities may include group treatment for internalizing conditions.
In an effort to improve access to quality psychological services for patients, IBH interns will provide evidence-based intervention services via video communication technology to primary care patients and families in southern Delaware who would otherwise be unable to receive services at the hospital. Telehealth represents a rapidly expanding mode of service delivery with the potential to help address shortages in mental health services in many communities. Interns will receive supervision focused on issues and special considerations in implementing telehealth interventions safely and effectively.
Pediatric Psychology interns provide intervention services to hospitalized children/adolescents, often following patients over multiple hospitalizations. Work with Bone Marrow Transplant (BMT)/Oncology patients comprises a major focus of this experience, although patients with other medical conditions are also followed. Interns typically carry 1-3 inpatient intervention cases on their caseloads. As part of their inpatient work, interns collaborate and consult with nurses, child life specialists, creative arts therapists, physicians and other medical team members. Early on in the training year, Pediatric Psychology track interns receive training in the Surviving Cancer Competently Intervention Program — New Diagnosis (SCCIP-ND), a manualized intervention for caregivers of children with a cancer diagnosis. SCCIP-ND was developed by Anne Kazak, PhD and her colleagues and is designed to promote healthy family adjustment to pediatric cancer and treatment and to prevent cancer-related posttraumatic stress symptoms in family members.
Psychology interns on the Pediatric Psychology track participate in inpatient consultation/liaison (C/L) for the entire 12-month training year. This is a year-long experience with different emphases and levels of intensity. Interns also participate in didactic and group supervision seminars related to C/L.
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 postdischarge treatment planning.
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 6-month experience.
Specialty Consultation Experiences
The Adolescent Health Clinic focuses on providing specialized health care for adolescents in an multidisciplinary setting in the hospital as well as an adolescent medicine clinic within the primary care setting. The interns will provide consultative services and help develop screening initiatives in collaboration with the adolescent health team.
The Behavioral Sleep program is a component of the Division of Pulmonology’s Sleep Clinic. The behavioral sleep intern will gain experience in evaluation and treatment of behavioral sleep disorders in children and adolescents, including difficulties such as insomnia/sleep onset problems, frequent night awakenings, bedtime resistance, PAP therapy nonadherence, nighttime fears/anxiety, delayed sleep-wake phase and sleep terrors/confusional arousals. The resident will gain experience with consultation, intervention and collaboration with the Pulmonology team.
This experience consists of a brief psychosocial intervention for families of infants hospitalized for cardiac surgery. It also includes participation in interdisciplinary developmental rounds in the cardiac intensive care and step down units. Opportunities to participate in developmental assessments through the Nemours Cardiac Learning and Early Development (LEAD) Program may also be available.
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.
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. As a smaller part of the diabetes specialty rotation, twice per year, the resident will co-leads the Improving Diabetes through Education and Lifestyle (IDEAL) group, which is an interdisciplinary multifamily group intervention to empower youth and families to meet the challenges associates with Type 1 diabetes.
The Feeding clinic is a multidisciplinary clinic (Rehab Medicine, Nutrition, Speech-Language and Psychology) that serves patients who have medical and/or behavioral complexities that interfere with adequate calorie consumption. The intern will have the opportunity to observer the clinic, evaluate behavioral feeding concerns, plan treatment, and provide feeding therapy either within Behavioral Health or by co-treating with Speech-Language, Nutrition and GI.
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 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.
The Transition of Care Program provides transition planning for adolescents with complex health needs who are transitioning out of the pediatric system. Interns will cross-train with the social work students and med-peds students who rotate through the clinic and provide consultative liaison services to the transition team. They will also be able to translate the clinical process into the primary care settings.
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:
Four hours per month. This seminar features linked presentations by medical, psychology and/or other allied providers that discuss both the medical and psychosocial aspects of various medical conditions or presentations (e.g., weight management from a medical and psychosocial perspective), as well as topics in general and subspecialty pediatric medical care (e.g., genetic disorders, ambiguous genitalia). Other professionals within the hospital also present on their work and role on the interdisciplinary team.
Two hours per month. 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, benefits from group input and supervision, learn about new measures and relevant topics including sensitivity and exposure to issues related to children representing diverse cultural and/or disability backgrounds.
One hour six times per year. The Supervision Seminar series covers content areas applicable to clinical supervision such as ethical and legal issues, diversity issues, models and elements of effective supervision.
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.
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).
Two to four hours per month. Intervention Seminar is centered around evidence-based interventions for the most frequently encountered referral issues. Past seminars have included topics such as motivational interviewing, exposure-based CBT for anxiety and OCD, treatment of tics and trichotillomania, trauma-focused CBT, Parent-Child Interaction Therapy, mindfulness-based interventions for stress management, suicide assessment and intervention, feeding therapy and treatment of elimination disorders.
One hour per month. This seminar addressed topics related to the conduct and dissemination of research in a health care setting.
Each month, all psychologists, social workers, postdoctoral fellows, and interns working in primary care participate in a one-hour meeting in order to discuss processes and issues related to primary care psychology. Three times per year, interns also discuss primary care issues in a group supervision format.
Over the course of the internship year, each intern presents on a “hot topic” in pediatric or clinical child psychology during a one hour seminar. Interns select relevant scholarly readings that are disseminated in advance of the seminar and also lead a discussion with seminar attendees, including psychology faculty, postdoctoral fellows and other interns.
Two hours per year. Interns learn Continuous Improvement/Program Evaluation processes and complete a CI project as a group that is aimed at improving divisionwide processes to decrease waste and ultimately improve patient care delivery.
One hour per month. During this seminar, Pediatric Psychology interns presents and discuss interesting or challenging inpatient cases, increase their familiarity with medical conditions and procedures that other interns have encountered during their inpatient work, and discuss other issues relevant to inpatient work, such as interdisciplinary team collaboration and effective communication.
One hour per month. This seminar focuses on ethical and legal issues, including the APA Code of Ethics, with particular application to the practice of psychology within a child/medical setting. Topics range from child abuse reporting law in Delaware to ethical issues in transplant evaluation and bariatric surgery.
One hour per month. This seminar focuses on issues and topics related to working with children and families representing diverse cultural backgrounds and other diversity categories.
One hour six times per year. This seminar focuses on skills to promote psychologists’ effective functioning in interdisciplinary settings. Topics include documenting for medical providers and multidisciplinary clinic collaboration.