Child and Adolescent Track
Jennifer West, Ph.D.
Child & Adolescent Psychology Internship Training Track Director
The Child and Adolescent Psychology track of the internship program seeks to provide diverse opportunities for specialized clinical training with children, adolescents, and families. Although we embrace the scientist-practitioner model in Psychology and the Department of Psychiatry, we view the internship year as a pivotal clinical year that is essential to the development of all professional psychologists, even those who will go on to be full-time researchers. Therefore, the majority of the interns' time is spent in clinical training activities, although we do provide opportunities for child interns to meet with researchers in the department to discuss their interests and future career goals.
The goals of the program are to enhance each trainee's knowledge base and clinical skills in relation to developmental psychopathology, assessment, treatment planning, and treatment implementation. These goals are consistent with the six core competencies (diagnosis and assessment, treatment, consultation and administration of clinical programs, ethical understanding and behavior, exemplary professional development and demeanor, supervision and/or teaching and scholarship) that we address during the training year.
The internship is comprised of a sequence of didactic/clinical seminars and a series of supervised clinical experiences with children and adolescents experiencing a broad range of psychological disturbances. The training program emphasizes understanding children, adolescents, and families from a developmental and systems perspective. Diagnostic evaluations are followed by patient-specific treatment planning. A wide range of diagnostic and treatment skills are utilized. For example, treatment may involve one or more of the following modalities: individual, group, family, sibling, and parent consultation. Intensive supervision is provided to facilitate each trainee's professional growth. Six child and adolescent internship positions will be offered for the 2014-2015 training year.
Outpatient Rotation, 12 months
Rotation Coordinator: Kenya Malcolm , Ph.D.
Faculty Supervisors: Wendi Cross, Ph.D., Sarah Jonovich, Ph.D., Kenya Malcolm, Ph.D., Deanna Sams, Ph.D., and Jennifer West, Ph.D.
Interns participate in an outpatient rotation through their internship year in the Strong Behavioral Health: Child and Adolescent Outpatient Services. Patients at Outpatient Services include children from infancy through age 18 with a wide range of psychopathology and from diverse socioeconomic and ethnic backgrounds. Interns have approximately 10-12 hours of direct outpatient contacts per week involving both assessment and treatment. All therapy rooms are equipped with audio-visual equipment to allow trainees to videotape their patient contacts for supervision.
Assessment – While on the outpatient rotation, interns will regularly conduct diagnostic evaluations that involve the use of empirically validated assessment tools and collateral contacts with parents/families, schools and medical professionals. Interns use their findings from these assessments to develop family-centered treatment plans.
Treatment – Interns deliver a variety of treatment modalities including individual, family, and group therapies as well as and parent and school consultation. While interns are expected to see patients across the developmental spectrum with a variety of presenting problems, there is the opportunity for interns to tailor their caseload to meet their particular clinical interests and professional goals. The use of evidence-based approaches is emphasized.
Crisis Intervention - Interns spend 2 months providing service as a member of the Crisis Intervention Team. The Crisis Intervention Service is a unique service of Strong Behavioral Health: Child and Adolescent Outpatient Services. Each appointment provides both evaluation and intervention components to families in crisis. We utilize a team approach in order to accomplish this goal. Families meet with the Crisis Intervention Team for one, two, or three appointments based on each family’s needs. The intern and a crisis case manager work together with each family to identify the immediate emotional, behavioral, social, and educational needs of the child or adolescent and provide brief evidence-based interventions to the family. The intern, as part of the Crisis Intervention Team, may also help facilitate referrals to community resources and provide consultation to primary care physicians and/or schools.
Inpatient Rotation, 6 months
Supervisor: Deanna Sams, Ph.D.
Each intern participates in a 6-month inpatient rotation on the Child and Adolescent Inpatient Service. The inpatient units provide assessment and crisis stabilization for approximately 22 children and adolescents with an average length of stay of 10 days. Patients are admitted to the inpatient unit for a variety of reasons, including risk of harm to themselves or others, behavioral instability, deterioration in functioning and psychosis. Throughout this rotation, the intern works closely with the inpatient psychologist to provide psychological assessment, consultation, and treatment to patients on the unit. He/she is a part of the interdisciplinary treatment team, and participates in treatment team meetings on the unit several times per week.
The inpatient experience consists of two sub-rotations: 2-months as a primary clinician and 4 months as a group therapist, consultant (including formal psychological testing), and facilitator of family movie sessions (described below). The sub-rotations provide interns the opportunity to experience first-hand the numerous roles psychologists may have on an acute inpatient unit.
Primary Clinician Sub-Rotation: While on this rotation, the intern is the primary therapist for two patients. The intern works closely with the attending psychiatrist, psychologist, social worker, and other members of the interdisciplinary team to assess and treat children and adolescents in need of acute psychiatric stabilization. Family work is also a vital part of providing inpatient care to patients. During the Primary Clinician rotation, the intern rounds on his/her patients daily, presents their patient’s history and progress in multi-disciplinary treatment team meetings, and works individually with their patients and families to facilitate treatment and appropriate discharge plans. Throughout this rotation, interns receive daily live supervision with attending psychiatrist and psychologist, weekly group supervision with all inpatient interns and the psychologist (60 minutes), individual supervision with the attending psychiatrist (30 minutes), and individual supervision with the psychologist (30 minutes).
Group & Testing/Consultation Sub-Rotation: During this 4-month experience, interns facilitate group therapy sessions for both child and adolescent inpatients. Groups are both structured / skill based (e.g., Mindfulness) and process-oriented (Teen Issues Group). Interns facilitate approximately five groups per week.
Interns also facilitate family therapy sessions as part of the “Family Movie Night” program. This innovative program aims to improve family communication using entertaining and inspiring movies as a catalyst for discussion and a mechanism for families to practice their communication skills. Interns facilitate up to three family movie sessions weekly.
Finally, on this sub-rotation interns function as consultants to the multi-disciplinary treatment team. This includes participating in treatment team meetings and providing consultation regarding diagnosis and treatment. Such consultation may include formal psychological testing, as described below. Interns on this sub-rotation are assigned a maximum of two psychological evaluations at one time.
Supervision throughout this sub-rotation includes live supervision in group therapy, weekly group supervision with all inpatient interns, and testing supervision as cases are assigned.
Other Inpatient Opportunities: Throughout the inpatient rotation (and through a 5-session seminar), the interns will gain exposure and experience with the Collaborative Problem Solving approach (developed by Ross Greene, Ph.D.) as it applies to the inpatient milieu. As such, interns spend time interacting with patients and families informally in the milieu, as well as providing consultation to unit staff. Finally, interns have the opportunity to participate in the development of new unit initiatives and programming, depending on their interests and areas of expertise, as well as the needs of the unit. For example, past interns have developed and implemented group programming, skills-based activities for younger children on the unit, facilitated trainings /workshops for unit nursing staff, and developed cognitive-behaviorally based worksheets for adolescents.
Psychological Testing & Consultation – Interns perform psychological evaluations throughout the training year, though often the majority of evaluations take place during the six-month Inpatient Rotation. Other referral sources include the Adolescent Partial Hospital Program (PHP), Child &Adolescent Outpatient Services, and Pediatrics.
Psychological consultation is conducted when there is a need for diagnostic clarification, clarification of levels of social, emotional, intellectual, or behavioral functioning, or development of specialized treatment plans. A consultation may include formal psychological assessment (testing), which is the process of assessing emotional, behavioral, personality, intellectual, and adaptive functioning through a variety of tools, such as standardized tests, rating scales, self-report measures, and observations. However, consultation does not always include the use of standardized tests. Sometimes, consultations (e.g., clinical interview, chart review) are requested to determine whether the use of psychological tests is clinically indicated.
Test batteries are constructed based on the individual referral questions. Commonly used instruments include: objective measures (e.g., Adolescent Psychopathology Scale, MMPI-A, MACI/M-PACI, CDI/BDI, R-CMAS), projective measures (e.g., Rorschach - Exner System, Roberts Apperception Test, Incomplete Sentences) and parent report measures (e.g., BASC, Conners). When cognitive assessments are needed, commonly used instruments include the WISC-IV, WASI-2, and WAIS. Infrequently, evaluations include full assessment of cognitive ability and academic functioning; these referrals typically originate from Outpatient Services.
Interns are provided with initial orientation to the Testing Service, as well as participate in in-depth seminars regarding objective and projective components to psychological assessments. These trainings take place in the beginning of the training year. Throughout the course of the training year, interns are provided with ongoing supervision on each psychological evaluation / consultation they are assigned. Supervision takes place at each stage of the process, beginning with test selection based on the referral question.
Though interns receive extensive training and supervision regarding psychological testing over the training year, it is extremely important for incoming interns to have a strong foundation (both academic and practical) in test selection, scoring, interpretation, and report writing. Though it is beneficial for interns to have had experience with the Rorschach prior to internship, this is not a requirement of the program. Interns on the inpatient rotation are assigned testing cases as described above. During the other 6 months of the internship year, interns are assigned approximately 1-2 Outpatient or Partial Hospital testing cases per month. The patients represent a broad spectrum of developmental and psychological disturbances. Intensive supervision is provided for both inpatient and outpatient testing, including supervision of test administration, scoring, report writing, and feedback.
Minor Pediatric Behavioral Health Rotations, 6 months
During the 6-month block opposite the Inpatient Rotation, interns spend 4 hours a week as members of the Pediatric Behavioral Health Service, providing clinical service in the General Pediatrics Clinic of the Golisano Children's Hospital. The General Pediatrics Clinic is one of the largest pediatric practices in Monroe County, serving about 13,000 patients. Interns provide a consultation-focused service, which includes an initial evaluation, treatment recommendations, short-term treatment, crisis management and consultation with medical providers. Typical presenting problems include a wide range of adjustment difficulties, mood disorders, parenting support, anxiety/trauma, behavioral disorders, school problems, and other behavioral/emotional difficulties. Patients range from 2 years to 21 years and come from a diverse background. Weekly supervision is lead by a psychology faculty member and provided in a group format during the 4 hour rotation in Pediatrics.
Interns also participate in shadowing experiences two half-days per month in order to gain additional exposure to specialty clinics in Pediatrics. Interns shadow faculty members and/or fellows providing services in a variety of clinics, including options in Adolescent Medicine, Pulmonary, Craniofacial, Endocrine/Diabetes, Gastroenterology, Pediatric Inpatient Consultation/Liaison Service, and/or Psychiatric Emergency Department.
Each intern participates in a leadership project mentored by a faculty member. The leadership project is designed to:
- enhance the intern’s understanding of complex issues facing a clinical service (Inpatient, Outpatient, Peds), the Department or the Psychology Training Program
- give interns exposure to the scope and depth of the functioning of psychologists within a clinical service or a Psychiatry department and expand their ideas regarding the “value added” of psychologists.
- provide current Service and Department leaders with new perspectives and ideas for addressing long-range issues
- facilitate intern competency development including: Consultation, Professional Development and Demeanor, Administrative Skills, Industry and Initiative in the Training Process, and Teaching Skills.
The interns have 2 protected hours each week to work on the project (or 4 hours over a 6-month period) and 30 to 60 min. to meet with the project mentor once per month or as needed (total of 2.5 to 3 hrs. per week). At the conclusion of the training year, interns present a brief summary of their project at the Leadership Project Capstone Event that is attended by psychology training program faculty and other department faculty and leaders.
Examples of projects that child interns have been involved in include:
Mindfulness Group (Inpatient; Mentor: Deanna Sams, PhD)
- The treatment on the Child & Adolescent Inpatient unit currently includes a bi-weekly mindfulness group for adolescents. This Leadership Project involves adapting the current mindfulness group curriculum / programming for use with younger patients (ages 5-12). Activities could include adapting activities and materials to ensure they are age-appropriate, piloting the adapted activities with children on the unit, and evaluating the feasibility and effectiveness of this type of group with children in an acute inpatient setting. This project will involve significant collaboration with unit leadership and nursing staff.
Psychological Testing (Inpatient; Mentor: Deanna Sams, PhD)
- Conduct literature reviews on commonly used psychological testing instruments to inform the updating of our testing supplies. Focus on cultural norms for various measures, as well as exploring the most current research on currently used and potential instruments. May include a focus on Psychodiagnostic instruments as well as screening measures for executive functioning skills.
Group Therapy Program Development & Evaluation (Outpatient; Mentor:Kenya Malcolm, PhD)
- Projects related to the group therapy program will begin with learning about the kinds of groups that are offered through the CAOS clinic and assessing the specific needs as related to evaluation and development of new components of the program.
- Evaluation: Research current methods of evaluating group therapy programs in an outpatient setting. Explore measures and determine best options for our setting and population. Implement the measures for two rounds of group. Use the data to answer questions related to group therapy effectiveness and patient satisfaction.
- Development: Develop a parenting group that runs parallel to a child group. The aim of the group is to teach parents complimentary skills and facilitate their ability to coach their child’s skill development outside of session.
Family Advisory Board (Outpatient; Mentor: Linda Alpert-Gillis, PhD)
- The Child and Adolescent Outpatient Service in the past had an active Family Advisory Board. Due to a combination of factors the advisory board has not met in approximately two years. The intern would be involved in working with Linda Alpert-Gillis and Caroline Nestro to develop a child component to the Department-wide Advisory Board. The project would include determining how best to integrate child content into the present advisory board, designing recruitment efforts to involve family members of our service in the Advisory Board, developing child-related content for the advisory board for this year, and helping to facilitate discussion of this content at advisory board meetings.
National Children's Mental Health Awareness Day (Outpatient; Mentor: Linda-Alpert-Gillis, PhD)
- Mentor: Linda Alpert-Gillis
- Develop and implement an event that will benefit the community (e.g., families, mental health providers) and the mission of the Child and Adolescent Division in honor of National Children’s Mental Health Awareness Day/Month in May 2014.
Development of a Manual for Common Pediatric Referrals (Pediatrics; Mentor: Sarah Jonovich, PhD)
- This leadership project involves developing a manual or handbook to be used by psychology interns during their Pediatrics rotation for patients referred from General Pediatrics Patagonian Children's Hospital. The project would prepare a list of typical referrals to the psychology service, develop outlines for evidence-based treatments to cover with the families and gather relevant handout materials for parents/patients. Typical referral topics would include (but not be limited to): typical sleep problems, picky eating, enuresis, encopresis, toddler temper tantrums, ADHD, trauma. The project could also involve interviewing/meeting with residents or other pediatric providers to determine what topics are most relevant when they seek a psychology referral.
Develop and Implement a Short-Term Intervention Pilot in the Pediatric Setting (Pediatrics; Mentors: Linda Alpert-Gillis, PhD, Sarah Jonovich, PhD, and Kenya Malcolm, PhD)
- Work with lab group (Lab for Innovation in Child Mental Health Care Delivery) to develop and implement a short-term evidenced based intervention in a pediatric setting. One possible option is to implement the Crisis Intervention Service model as a pilot in Pediatrics. Other options could include short-term parenting interventions. The intern could attend the lab meeting monthly or as needed for an hour – either 10-11 or 11-12 on Thursdays.
Individual Supervision for Outpatient Cases – Interns receive a minimum of 2 hours of individual supervision per week. Supervision is conducted by both full-time and adjunct faculty members with a wide range of theoretical approaches and includes videotape review and live supervision. Giving and receiving feedback, both positive and constructive, is an important focus of supervision in our program. Informal feedback occurs throughout the training year, with more formal, written feedback given every three months.
Inpatient Supervision – Interns on the Inpatient Rotation receive intensive supervision related to all aspects of their responsibilities. Specifically, interns participate in one hour of weekly inpatient group supervision, receive live supervision in groups for the first half of the rotation, and receive individual testing supervision as described above. In addition, as-needed supervision occurs frequently as questions or concerns arise on the unit. While supervision is initially intensive, interns are expected to become increasingly independent as they progress through the rotation.
Group Psychotherapy/Group Supervision – Interns receive specialized training in group psychotherapy with children and adolescents. The intern will gain experience in screening and selecting patients for group participation, co-leading groups, and integrating group treatment with individual psychotherapy. Interns receive weekly videotaped group supervision of the groups they lead. Supervision is held for 1 hour weekly for the internship year.
Core Didactic/Experiential Learning
Diagnostic Clinic – Each intern participates in a two and a half hour per week diagnostic clinic in the Child and Adolescent Outpatient Service. This experience is designed to provide live supervision of diagnostic work involving children and parents. The interns participate on a "diagnostic team" and are observed by the supervising faculty and other members of the team through one-way viewing facilities. Each clinical encounter is preceded and followed by group discussion with the supervising faculty member. At the completion of each three-week evaluation, the diagnostic findings and recommendations are made to the family. Interns often continue to provide treatment to patients seen in Diagnostic Clinic if appropriate.
Psychotherapy Seminar – The overall goal of the Child and Adolescent Psychotherapy Seminar is to enhance general therapy skills and build competency in the delivery of select empirically based treatments for children and adolescents. The seminar meets weekly for two hours from August through June and includes both psychology and psychiatry trainees. General therapy skills that are covered include: a) the role of the therapist and therapy, b) core competencies (e.g., reflective listening, autonomy, limit-setting), c) treatment planning; d) therapy tools for children and adolescents (e.g., books, activities, art materials), and e) termination.
Treatments that have been covered in the seminar include: Family Therapy, Behavioral Parenting Treatment, Collaborative Problem Solving, Cognitive Behavioral Therapy for Anxiety, and Depression, Mindfulness Based Interventions, Behavioral Treatment of Encopresis, and Behavioral Treatment of Sleep Disorders. Each section of the seminar includes a didactic component and a supervision component. Trainees are required to bring videotaped recordings of therapy sessions to the supervision focused meetings to share with the group and receive feedback. Cultural factors are discussed throughout the seminar.
Multicultural Training Series – Each year opportunities exist for all psychology trainees and psychiatry residents to participate in interdisciplinary multicultural training focused on increased cultural awareness and skill building.
Multicultural Case Conference Luncheon Series – This monthly series provides an opportunity for trainees to present and discuss cultural formulations from their casework. Participants must present at least one formal cultural formulation from his/her casework during the course of the year
Department of Psychiatry Grand Rounds – This weekly forum brings together faculty, staff and trainees from multiple disciplines to learn together about new developments in education, clinical care, empirical research and other topics of interest. It serves as a way for interns to be exposed to information and people outside of their "silos" of expertise, setting, or daily focus. Presenters may be departmental faculty and trainees, national and international experts, and members of our local community. Grand Rounds also helps to build and promote shared understanding of the mission and values of the Department and the Medical Center. Interns may also choose to attend other Grand Rounds relevant to their training goals (i.e., Pediatrics, OB/GYN, Primary Care, Public Health Sciences).
This forum meets three times a month from September through June; local, nationally or internationally prominent speakers present in an area of their expertise and on current topics in mental health.
Professional Development Seminar – Each month the Internship Training Director hosts a breakfast meeting attended by all interns that includes invited faculty speakers. The meetings are used to promote aspects of professional development such as increasing awareness of various roles that psychologists perform within academic medical centers and community settings and pathways to those roles, refining skills (i.e., job-search strategies, interviewing and negotiating) related to success in obtaining future professional positions, increasing knowledge of requirements for independent practice (licensure), and facilitating group cohesion among interns to promote collaboration/peer support and future networking. Several times a year, the interns also attend the Postdoctoral Fellow Professional Development seminar.
Group Meeting with the Track Director – Interns have a bi-monthly meeting with the Child and Adolescent Psychology Internship Training Director where they can discuss questions or concerns related to their individualized training plan, the training program or their professional development, or provide feedback about the internship. Interns also have bi-monthly individual meetings with the Track Director.
Group Meeting with the Director of Training - Interns meet quarterly with the Director of Training in Clinical Psychology to discuss training-related questions or concerns and their professional development and to provide feedback about the internship. Interns also have three individual meetings with the Training Director.