Psychology Education and Training Program

Core Training Area II: Consultation

Neonatal Intensive Care Unit

The training goal of this rotation is to provide clinical experience with infants and their families in an inpatient intensive care setting. This rotation involves consultation and collaboration with multiple disciplines, including nursing, developmental therapies (physical, occupational, speech, music, and child life), social work and neonatology. This rotation complements the Neonatal Follow-up Program rotation and provides a foundation for understanding the needs of the population referred to that program. This rotation is generally completed as an 8-hour rotation.

Training objectives

• Learn to conduct infant assessments using parent interviews, nursing interviews, clinical observations, and standardized assessment procedures
• Learn how to provide feedback to parents regarding their infants’ development
• Work with multidisciplinary colleagues and parents to create developmentally appropriate schedules and activity suggestions

Training activities

• Become knowledgeable about preterm and term infant development, including the role of parents in this process
• Learn how the intensive care environment and infant medical complications impact infants’ developmental progress; observe developmental assessments
• Develop consultative working relationships with multidisciplinary colleagues through participation in developmental rounds
• Learn how parent-infant relationships can be affected by the intensive care environment, and develop strategies for intervention
• Assess family needs for additional supports, and use consultation and individualized intervention strategies to promote parent-infant relationships

Paperwork expectations

• Will provide documentation for interactions with patients, and generate reports, developmental programming and other materials as needed

Oncology Survivorship Clinic

Interns completing the Survivorship Clinic rotation will provide outpatient consultation and intervention services for children, adolescents, and young adults and their families who have survived cancer. Interns will respond to outpatient consultation requests, refer patients for outside services and/or provide outpatient therapy. Common referral issues include: adjustment to survivorship, issues of loss and grieving, posttraumatic stress. Interns may also co-lead a bi-monthly parent group for parents of inpatients, and may have the opportunity to co-lead other groups for survivors and their families.

Training objectives

• Develop consultation skills as the psychosocial member of an interdisciplinary team providing care to survivors and their families.
• Gain family-systems and cognitive behavioral psychotherapy skills for a wide range of issues related to childhood cancer and its treatment, with children, adolescents and young adult survivors and their families.
• Become familiar with long-term cognitive, emotional, and medical late effects of childhood cancer treatment, and the effect of these late effects on the development of the survivor and his/her family.

Interns are expected to attend patient care meetings and didactics within the Division of Oncology, including Psychosocial Rounds, Journal Club and Tumor Board. Specific training objectives of the rotation will be tailored to each intern’s training needs, goals and objectives.

Rehabilitation Psychology

The inpatient rehabilitation program is located in Children’s Seashore House and is an 18-bed unit, providing services to children with a variety of neurorehabilitation and musculoskeletal needs. Psychology interns working with this program will develop skills at providing psychological services for neurorehabilitation patients within an interdisciplinary team (including attending physician, resident, clinical nurse manager, PT, OT, SLP, Child life, social worker, and case manager). The rehabilitation psychology service provides initial assessments, case consultation, behavioral management, individual psychotherapy, family therapy, education, cognitive screening, and co-treatment with other members of the team, and overall team support. Interns on this service will be responsible for the initial assessment and provision of indicated psychological services for a limited caseload of patients with traumatic brain injury, brain tumors, encephalitis, and so forth. Trainees may also have the opportunity to participate in the Minimally Responsive Evaluation Program if appropriate patients are entered in this program during the rotation.

Training objectives

• Develop knowledge related to the unique sequelae and biopsychosocial needs of children with neurorehabilitation issues, and their families.
• Develop skills related to the clinical assessment of patients and families with neurorehabilitation issues, which will include diagnostic interviewing and cognitive screening as indicated.
• Develop skills related to the provision of services to patients and families with neurorehabilitation issues, which will include individual and family interventions, education, behavioral interventions, and cognitive remediation as indicated.
• Gain knowledge and skills related to working within a multidisciplinary inpatient treatment team.
• Develop skills as a consultant to members of the treatment team around patient care issues.
• Develop skills related to documentation, including progress notes, discharge summaries, and psychological evaluations.
• Participate in team meetings, family meetings, and school re-entry meetings.
• Participate in monthly Psychosocial Rounds.

Regional Autism Center Rotation

This rotation provides the opportunity to participate in a multidisciplinary evaluation of young children (age 2-6 years) for possible autism spectrum disorders (ASDs). Disciplines include developmental behavioral pediatrics, psychology, speech and language pathology, occupational therapy, and social work. This is a training clinic: most of the providers are clinical trainees under supervision, and there are frequent trainee observers (LEND fellows and pediatric residents).

Training

• Administer the ADOS as part of a multidisciplinary evaluation.
• Provide consultation to the team about observed behaviors, diagnostic impressions, and recommendations.
• Participate and lead the team case discussion.
• Provide written and oral feedback to families individually and on behalf of the team.

Paperwork expectation

The intern will take an active role in helping create a team documentation summary, because the current format will not be compatible with EPIC in the future. Documentation of consultation is currently in the form of a brief summary of ADOS testing, impressions, and recommendations, but will move toward a more integrated team summary. Completed documentation must be posted in EPIC within one week, so as to be available to families when they return for their feedback appointment.

Thoracic Organ Transplant Program

This rotation provides interns with exposure and direct practice opportunities in providing psychological services as a member of an interdisciplinary cardiothoracic transplant team. This team serves children and adolescents who are experiencing heart failure, pulmonary hypertension, and/or who are candidates for or have previously received a heart, lung, or heart/lung transplant. Psychology services provided include:

• Inpatient intervention services for children and adolescents awaiting heart transplant and their families
• Consultation with the transplant medical team around patient and parent coping and family-staff interaction
• As-needed follow-up of patients through the interdisciplinary outpatient clinic

Common referral issues include adjustment to illness, prolonged hospitalization, and transplant; grief and loss; family/team communications; and adherence to medical regimen pre-and post-transplant.

Training objectives

• To develop an understanding of child and family coping with severe cardiac illness, heart and lung transplant, and prolonged hospitalization, as impacted by individual, situational, and systemic factors.
• To develop skills in intervening to support children, parents, and siblings coping with illness and hospitalization across inpatient and outpatient contexts.
• To develop skills in consultation with medical and nursing staff to support patient and family coping and positive family-staff interactions.
• To gain exposure to the types of cardiothoracic illnesses seen in children awaiting transplant, as a means of gaining an understanding of potential illness-specific psychological, cognitive, and social sequelae.

Pediatric Feeding and Swallowing Center

The Pediatric Feeding and Swallowing Center assesses and treats children typically between 2 months to 5 years with a variety of complex feeding and swallowing problems. These children may present with limited intake of food and/or fluid, limited variety of foods accepted, dependence on tube feedings, and failure to advance from smooth to textured foods. Comprehensive services are provided by an interdisciplinary team, comprised of a pediatrician, nurse practitioner, psychologist, dietitian, speech and language pathologist, and occupational therapist. Services offered include evaluation of feeding problems, outpatient consultation and feeding therapy in a day hospital setting. Limited inpatient consultations and feeding therapy in outpatient setting may also be available.

Training objectives

• To increase knowledge about assessment of complex feeding disorders
• To develop behavioral techniques to treat feeding difficulties in both outpatient and day hospital settings
• To understand the role of the pediatric psychologist on an interdisciplinary team

Pediatric Sleep Center

Psychology trainees will join the multidisciplinary team, including pulmonary, neurology, and psychology, of the Sleep Disorders Center in the Division of Pulmonary. Approximately 500 new patients are seen each year. The focus of this rotation includes both assessment and treatment of sleep disorders in children and adolescents, with follow-up of individual patients. As part of this rotation you will participate in a weekly didactic series.

Training objectives

• To understand normal sleep patterns in children and adolescents and the symptoms and treatment of common pediatric sleep disorders, including sleep apnea, narcolepsy, parasomnias (e.g., sleepwalking, sleep terrors), rhythmic movement disorder, bedtime problems, and night waking.
• To gain training in assessment of pediatric sleep problems, including subjective (e.g., history taking, sleep diaries) and objective (e.g., overnight polysomnography) measures of sleep and sleep disorders.
• To develop treatment programs for behaviorally based sleep problems and consult with team members on medically-based sleep issues.
• To expand skills in working within a multidisciplinary team.

Pediatric Stroke Program Internship Rotation

The Pediatric Stroke Program is a multidisciplinary clinic that provides comprehensive treatment and assessment of children who have suffered from strokes or other vascular conditions. The team consists of individuals from nursing, neurology, physical therapy, occupational therapy, speech-language therapy, social work, school intervention and neuropsychology.

Interns in the pediatric stroke clinic will see patients in the multi-disciplinary clinic who are referred for various emotional, behavioral and cognitive concerns. Interns work closely with the other team members and provide integrated assessment, consultation, or brief intervention services within the clinic setting. Supervision involves shadowing and individual supervision.
Interns are expected to attend weekly Stroke Conferences, pre-clinic rounds and stroke clinics

Activities

• Review the literature on pediatric stroke and related disorders.
• Observe clinic visits conducted across all disciplines.
• Identify patients in need of comprehensive neuropsychological assessment through interview and brief neuropsychological screening.
• Provide consultation and education for parents/patients on issues related to behavioral, learning/cognitive, and psychological concerns secondary to history of stroke.
• Collaborate with neurologist and other team members in adapting appropriate recommendations/interventions for clinic patients.

Training objectives

• Increase understanding of pediatric stroke and related medical conditions
• Develop consultation and assessment skills as a member of an interdisciplinary team providing care to stroke patients and their families.
• Develop skills working within an interdisciplinary treatment team, including providing feedback and consultation to the team.

Specific training objectives of the rotation will be tailored to each intern’s training needs, goals and objectives.