D. Specialized Tracks
i. Pediatric Health Track
The goal of this track is to provide interns with knowledge in evaluation and intervention with medically involved infants, children and adolescents. The intern will participate in a variety of multidisciplinary clinics and teams addressing medical conditions, such as diabetes, migraines, neurodevelopmental disorders, craniofacial anomalies, and juvenile rheumatoid arthritis. Children with major behavioral/developmental disorders (e.g., autism, mental retardation, failure to thrive, insomnia, attention deficit/hyperactivity, learning disorder, chronic pain) as well as children medically compromised (chronic and acute medical conditions and pain) are assessed and treated. The format on this track is a developmental process that involves observation of evaluations/interventions under direct supervision and subsequently completing the evaluations/interventions without direct supervision. Training in psychoeducational and developmental assessment is provided in the areas of clinical interview, assessment, and direct observation of the supervisor working with patients and their families. Beyond the core training experiences and specialized training tracks, interns gain additional experience through participation in several multidisciplinary clinics and training teams including Craniofacial Clinic, Neurodevelopmental Clinic, Diabetes Clinic, Juvenile Arthritis Program, and Neuro-oncology clinic. Other subspecialty clinics are held and may be pursued given the intern’s individual interest and attendance at several hospital multidisciplinary teaching rounds across services (e.g., Pulmonology, Oncology, Gastroenterology, etc.) are also available and encouraged for interns to attend.
Assessment training includes the developmental (i.e. Battelle, ADOS) and psychoeducational assessment of toddlers 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. Children are referred from other departments in the hospital as well as from schools, community agencies, and private referral sources. 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. Cases are varied in terms of ethnic background, socioeconomic status and age (i.e., infancy through adolescence). Evaluations include a clinical interview, administration and interpretations of test batteries, behavioral observations, and consultation with other professionals. Findings are communicated verbally and in writing to parents, the referring physician or allied professional as well as to other professionals involved in the care of the patient. Follow-up on treatment recommendations is also provided. Interns are required to complete a minimum of 12 comprehensive evaluations a year.
This service focuses on children and adolescents who are presenting with or are a risk for emotional and behavioral problems. Children from preschool age through adolescence and their families are seen in consultation. Families vary in terms of ethnic background and socioeconomic status. 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, feeding and elimination disorders, 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, developmental and family systems perspectives are emphasized in understanding patients’ needs and developing intervention strategies.
a. Individual Therapy – Interns will have a minimum of 5 outpatient therapy cases per week. Presenting problems includes anxiety, depression, aggressive behavior, autism, ADHD, and psychosocial factors related to medical conditions.
b. Groups- Interns participate as leaders for a variety of clinical groups, such as groups for Social Skills, Diabetes, and Oncology.
C. Consultation Liaison
The Consultation-Liaison Service focuses 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 inpatients/outpatients units: Neurology, Hematology/Oncology, Bone Marrow Transplant, Diabetes/Endocrinology, Gastroenterology, among others. The training experience focuses on the behavioral aspects of chronic illness (e.g., diabetes, sickle cell disease, asthma, Crohn’s disease, etc.), adherence with treatment regimens and problems with disease management (e.g., stress management during medical procedures), and supportive interventions for children and adolescents with chronic diseases. Cases range from pain management to complex family dysfunction and provide training experiences in behavioral interventions and prevention of psychological adjustment problems. Training opportunities include individual and 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, child life specialists, 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.
D. Multidisciplinary Clinics
Interns participate in a variety of multidisciplinary clinics as consultants, such as Juvenile Rheumatoid Arthritis (JRA), Headache, Diabetes, Neuro-Oncology, Neurodevelopmental Disorders, and Craniofacial clinic.
Interns regularly participate in the training of medical students as well as pediatric residents in the area of early development, assessment and intervention (the third Monday of each month in our Pediatric Care Clinic). In addition, they are an integral part of the overall educational/professional program hospital wide, presenting in a variety of forums (nursing, medical students, community outreach) and covering a diversity of topics relevant to our pediatric/adolescent population. There are also opportunities for supervision of practicum students.
ii. 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.
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 his/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 neuropsychological 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.