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Child and Adolescent Track

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Jennifer West, Ph.D.

Child & Adolescent Psychology Internship Training Track Director

Overview

The Child and Adolescent Psychology track of the internship program seeks to provide diverse opportunities for specialized clinical training with children, adolescents, and families. Our training model supports practitioner-scholar careers.  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 that involve exposure to and experiences with a wide range of health and mental health problems as part of team-based, collaborative care.  We also believe that psychologists are well suited to conduct empirical research and to translate the results of research into effective practice and programs in an array of settings and we provide a variety of opportunities for child interns to meet with researchers in the Department and Medical Center community to discuss their interests and future career goals.

The goals of the program are to enhance each intern's knowledge base and clinical skills in relation to developmental psychopathology, assessment, treatment planning, and treatment implementation. These goals are consistent with the five overarching long-term goals for all interns across tracks.  In the area of Professional Skills and Competencies, we aim to develop psychologists who have skills in:  1) diagnosis and assessment, and 2) treatment and consultation.  In the area of Professional Standards and Behavior, we aim to develop psychologists who demonstrate: 3) ethical understanding and behavior, and 4) professional development and demeanor.  In the area of Academic Competencies, we aim to develop psychologists who have skills in: 5) teaching and scholarship.

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. Four child and adolescent internship positions will be offered for the 2017-2018 training year.

Clinical Rotations

Outpatient Rotation, 12 months

Rotation Coordinator: Linda Alpert-Gillis, Ph.D.

Faculty Supervisors: Linda Alpert-Gillis, Ph.D., Fabienne Bain, Ph.D., Wendi Cross, Ph.D., Kenya Malcolm, Ph.D., Deanna Sams, Ph.D., Katelyn Taylor, 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. The Clinic also has a large inventory of therapy supplies (art materials, toys, games) and a library of therapy manuals and worksheets.

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 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. Interns are also expected to participate in the group therapy component of this service, which includes participation in group supervision and serving as a group co-leader.

Crisis Intervention - Interns spend 2 months providing service as a member of the Crisis Intervention Team. The Crisis Intervention Service (CIS) is a unique service of Pediatric Behavioral Health & Wellness. Each crisis appointment provides both evaluation and intervention components to families in urgent need of psychological services. We utilize a team approach in order to accomplish this goal. Families meet with the Crisis Intervention Team for 1-3 appointments based on each family’s needs. The CIS team work 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 to make recommendations and facilitate referrals to community resources and provide consultation to primary care physicians and/or schools. The intern receives live supervision from Dr. Katelyn Taylor.

Inpatient Rotation, 6 months

Supervisor: Deanna Sams, Ph.D.

Each intern participates in a 6-month inpatient rotation on the Child and Adolescent Inpatient Unit. The inpatient unit provides 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.

Throughout the rotation, interns will provide group, family, and individual treatments, psychological testing, and multidisciplinary consultation as described below:

Group Therapy: Interns facilitate group therapy sessions for both child and adolescent inpatients. Groups are both structured / skill based (e.g. Mindfulness) and process-oriented (Teen Expressions Group). Interns facilitate approximately three - five groups per week.

Individual, Narrative, & Family Therapy: Interns will be assigned patients for individual therapy work. While these sessions are sometimes cognitive-behaviorally based, interns will also work with patients on Narrative Therapy exercises, in which the goal is to elicit from the patient a strength-based recovery narrative. Interns guide the teen as they share their life story, and then present him/her with a written narrative to review.  This process is therapeutic for the patient as well as the family, with whom the narrative is shared in a family therapy session.

Consultation: Interns function as consultants to the multi-disciplinary treatment team, including psychiatrists, nurses, and social workers.  This important role includes participating in treatment team meetings and providing consultation regarding diagnosis, treatment, and milieu management.  Such consultation may include formal psychological testing, as described below. Once familiar with the Narrative Therapy process, interns have the opportunity to mentor a third year medical student as they develop the skills needed to conduct a successful narrative interview, write-up, and feedback.  Interns, under the supervision of Dr. Sams, also provide written feedback for each medical student based on their performance and skill.

Supervision throughout this rotation includes live supervision of group therapy, weekly group supervision with all inpatient interns, and testing or individual therapy supervision as cases are assigned.

Other Inpatient Opportunities: Throughout the inpatient rotation (and through a seminar series), 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.

Interns also 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.  Recent initiatives included integration of Acceptance and Commitment Therapy (ACT) into unit programming and evaluating the impact of Narrative Therapy exercises, and the evaluation of a Movie Therapy group.

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 Service, 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 or to help non-psychologist clinicians better understand and utilize evaluations from other sources.

Test batteries are constructed based on the individual referral questions. Commonly used instruments include: objective measures (e.g., MMPI-ARF, 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-V (administered via iPads), WASI-2, and WAIS. Occasionally, evaluations include full assessment of cognitive ability and academic functioning; these referrals typically originate from Outpatient Services. Interns are assigned a maximum of two psychological evaluations at one time.

Interns are provided with initial orientation to the Child & Adolescent 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, with a booster meeting in January. Interns also participate in a monthly Psychological Testing Seminar jointly with the adult-track interns, which focuses on assessment of specific disorders throughout the lifespan. 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 testing cases per month. For interns with experience with the ADOS-II, there is often opportunity to provide consultation and testing related to Autism Spectrum Disorder through Outpatient Services.

Testing 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

Supervisor: Kenya Malcolm, Ph.D.
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 led 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, Sleep Medicine and/or the Psychiatric Emergency Department.

Research Elective:

Suicide Prevention Training for Primary Care

(Faculty Mentors: Wendi Cross, Ph.D., & Jennifer West, Ph.D.)
One intern may complete a 12-month rotation (1 day/week) on the research team involving:

  • Training/experience in testing simulation (standardized patient) methods as part of an RCT
  • Extensive training and supervision in reliable observational coding
  • Exposure to suicide prevention research
  • Exposure to a variety of residency and nursing training programs
  • Exposure/experience with online and remote education and clinical methods
     

Applicants must be interested in observational methods and coding, educational research and suicide prevention; interest in primary care is also helpful.  Training will occur in the UR Observational Research and Behavioral Information Technology Lab (ORBIT).

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 (2.5 hours/wk)– 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 (1.5 hours/week, Aug-June) – 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 90 minutes 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, and Acceptance and Commitment Therapy. 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.

Professional Development Seminar (1hr, 2x/month) – Each month the Internship Training Director and Chief Fellow 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.

Department of Psychiatry Grand Rounds (1 hour, 3x/mo) – 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, and Public Health Sciences).

Psychology Testing Seminar (1 hour, monthly); This is a seminar for interns on the child/adolescent and adult tracks to become familiar with evidence-based practices across the domains of diagnosis and assessment, professional/ethical conduct in psychological assessment services, and cultural competence.  Adult and Child/Adolescent interns will work in pairs to research and present information regarding best practices for one topic in psychological testing/assessment across the lifespan.  Topics include mood disorders, psychotic disorders, OCD, and trauma.

Multicultural Experiential Learning Seminar (monthly, 1 hour). The overall goal of this seminar is to increase cultural awareness and sensitivity of psychology interns and fellows through experiential learning activities.  This seminar helps trainees become more aware of their own cultural identities, recognize their own personal biases, better meet the needs of a diverse patient population, and increase awareness of how culture impacts clinical work, research and teaching.

Ethical Dilemmas in Psychology (5 monthly meetings); The overall goal of this seminar is to assist psychology interns and fellows in the development of advanced practice competencies in critical thinking about ethical issues that psychologists encounter as clinicians, educator/teachers, researchers, and in professional relationships.  Specific competencies addressed in the seminar are: Ethical Knowledge and Ethical Behavior.  The seminar is conducted as a case presentation, consultation and discussion series.

Commitment to Living (Suicide Prevention) Seminar (3 hours) and Standardized Patient Practice Session (1 hour). - The overall goal is to prepare trainees with the knowledge and skills needed to conduct person-centered, standard-of-care interviews, risk assessments, safety planning, documentation, and decisions with suicidal patients.  Each trainee practices these skills in a 1:1 behavioral rehearsal experience with trained standardized patients.

Assessment and Treatment of Eating Disorders (4 meetings, 12 hours), This interdisciplinary didactic series focuses on evaluation and evidence=based treatment of eating disorders, with a particular emphasis on interdisciplinary treatment team functioning and planning.

Intimate Partner Violence Workshop (6 hours). This interdisciplinary workshop focuses on the identification, assessment, and treatment of Intimate Partner Violence (IPV). Teaching/learning methods include PowerPoint presentations, film clips, experiential exercises, discussion, and distribution of resource cards and reference materials.

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, but are invited to arrange additional meetings as needed.

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 two to three scheduled individual meetings with the Training Director, but are invited to arrange additional meetings as needed.

Leadership Projects

Because psychologists will continue to be leaders in health care systems, we encourage psychologists-in-training to take advantage of opportunities to develop administrative and leadership skills.  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, Pediatrics), 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

The interns have 2 protected hours each week to work on the project (or 4 hours over a 6-month period) and 1 hour 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  poster of their project at the Psychology Education 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 with in the past include:

Development and Evaluation of Mindfulness Group (Inpatient; Mentor: Deanna Sams, PhD)

Family Advisory Board (Outpatient; Mentor: Linda Alpert-Gillis, PhD)

Development of a Manual for Common Pediatric Referrals (Pediatrics; Mentor: Sarah Jonovich, PhD)

ACT Therapy Program Development and Implementation (Inpatient; Mentor: Deanna Sams, Ph.D.)

Skip Generations Kinship Care Grandmothers Training Program - Development and Implementation Project (Community; Mentor: Deborah King, Ph.D.)