Acquired Autonomic Dysfunction Program (AADP)

Interns will provide specialized consultation and clinical care to patients in the Acquired Autonomic Dysfunction Program (AADP) at CHOP. Within this program, they will be responsible primarily for conducting consultative intakes and occasional follow up sessions with other members of the multidisciplinary care team in clinic. Patients in AADP typically are characterized of adolescents with a combination of functional somatic symptoms, chronic pain, fatigue, cardiovascular symptoms, gastrointestinal complaints, neurological burden, sleep disturbance, and comorbid anxiety or depression. Interns will participate in multidisciplinary clinic on Fridays including specialty providers (Behavioral Health General Pediatrics Diagnostic Pediatrician and Nurse Practitioners, Gl, Cardiology, Neurology, Physical Therapy, and Education Coordinators).

Interns will have the opportunity to spend a full day in the multidisciplinary AADP clinic. Typically, each psychologist sees three patients a day (a mix between new intakes and follow up clinic patients) and presents case conceptualizations and treatment recommendations at post clinic conference to the entire team. The primary mode of supervision is individual. Interns will have the opportunity to conduct intake evaluations and consult with the team on best practice recommendations. Interns may have the opportunity to consult with follow-up patients and coordinate care with community mental health providers.

Behavioral health treatment in AADP focuses on utilizing Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) to understand the biopsychosocial model of managing somatic complaints which builds capacity-based coping skills for re-engaging in school and daily activities using a functional rehab treatment approach. Psychologists additionally coordinate care with other CHOP psychologists, the patients' medical care team, school educators, and community providers to provide comprehensive care for AADP patients.

Training Objectives:

• To learn about the Autonomic Nervous System and understand the biopsychosocial model of managing somatic complaints which builds capacity-based coping skills for re-engaging in school and daily activities using a functional rehab treatment approach.
• To increase understanding of the mind-body connection, support a functional rehabilitative model of treatment, and be able to share with patients and team members how aspects of CBT and ACT can help patients increase their repertoire of coping strategies for managing physical symptoms, stress, and mood.
• To learn how to efficiently evaluate the presenting somatic and psychological concerns and relevant background and history.

Audiology/Center for Childhood Communication

This rotation will allow trainees to gain specialized training in supporting children who are deaf/hard of hearing (DHH) on a multidisciplinary team. Trainees will have the opportunity to complete multidisciplinary cochlear implant team evaluations, post-implant follow-up, and consultation/brief intervention for all DHH children and their families. Common targets for intervention include supporting families following initial diagnosis of hearing loss, decision-making regarding cochlear implants and hearing aids, increasing adherence to medical recommendations, integrating deaf identity, and support for co-occurring mental health diagnoses (e.g., ADHD, anxiety, and/or depression). Training will emphasize supporting patients/families with a "whole child" philosophy, including an appreciation of broader deaf/disability community perspectives and respect for the intersectionality of patient identities when engaging with the healthcare system. 

Training objectives

• Gain competency in specific considerations for how deafness and hearing loss impacts overall child development.
• Learn how to implement cochlear implant evaluations with a respect for development, medical needs, and deaf culture
• Develop brief assessment and consultation skills to evaluate for co-occurring mental health conditions in DHH children.
• Identify common psychological and behavioral factors that impact urological concerns/condition
• Develop competency in explaining the biopsychosocial model within the context of urology
• Gain experience adapting evidenced-based treatments (e.g. CBT, ACT, MI) to target urological concerns (i.e. coping with chronic illnesses and medical complexities, toilet training, social and emotional development and problem solving)
• Consult with multidisciplinary team members (e.g., surgeons, advanced practice provides, nurses, child life specialists, social work, physical therapists, and occupational therapists)
• Coordinate with outside providers as needed (e.g. school, outpatient therapists)
• Application of empirically-supported therapy with patients and bedside caregivers to support coping and adjustment to hospitalization.
• Develop and enhance consultation/liaison skills with interdisciplinary inpatient team.
• Ongoing implementation of token economy (standard of care) to improve medical adherence.
• Culturally-responsive clinical care and supervision.

Behavioral Health Integrated Program (BHIP) - inpatient consultation liaison 

Interns will have the opportunity to provide consultation and intervention services to a variety of patients through the Behavioral Health Integrated Program (BHIP).  BHIP is devoted to addressing the behavioral health care concerns of hospitalized children/adolescents and their families.  Interns who participate in BHIP will provide behavioral assessment, consultation, and brief interventions for a wide-range of pediatric subspecialty services including but not limited to adolescent medicine, gastroenterology, hematology, and neurology.  Presenting concerns include problems in patient or family coping and adaptation to illness or injury, psychosomatic presentations, eating disorders, and other mental health disorders (e.g., depression, anxiety).  Opportunities for collaboration will occur with other behavioral health care providers (psychiatry, social work, child life) and nursing and medical providers.  Specific training goals of the intern will be discussed at the start of the rotation. 

Training objectives

• Develop inpatient consultation skills related to the clinical assessment of patients and families with a range of medical diagnoses and behavioral health concerns.
• Develop skills related to the provision of inpatient behavioral health intervention for patients and families, which may include education, individual and family interventions, behavioral interventions, and brief psychotherapy.
• Develop skills as a consultant to members of the treatment team to plan for patient care issues.
• Gain knowledge and skills related to working as a consultant to interdisciplinary inpatient treatment teams.
• Develop skills related to documentation, including inpatient consultation and progress notes, and medical chart review.

Behavioral Health Integrated Program (BHIP)- Eating Disorders focus

Primary duties:

• Complete initial inpatient consultation and progress notes
• Attend consultation-liaison (Behavioral Health Integrated Program) and Adolescent Medicine rounds
• Prepare for and participate in weekly group as well as individual supervision
• Observe and provide psychoeducational group to caregivers
• Participate in multidisciplinary family meetings
• Assist with quality improvement projects for the eating disorder program

Training Objectives:

• Learn how to assess and accurately diagnose patients admitted to the hospital with disordered eating
• Build insight into factors that contribute to diagnosis and treatment recommendations
• Build competence in understanding how to collaborate with multidisciplinary teams in a primary medical setting

Cancer Survivorship

Survivors on those who are at least 2 years off tx, 5 yrs from diagnosis. They meet with a new multidisciplinary team to address managing future cancer risk and late effects of treatment. Psychology is part of that team and sees patients (most often, adolescents and young adults) for health worries, PTSS, depression, adjustment, cognitive/learning difficulties, relationship issues, sub use, transition to adulthood/adult care, etc. Often the presenting problem is typical issues of emerging adulthood. We do a consult with recommendations, and sometimes pick up the patient for therapy.

Training Objectives

• Understand psychosocial issues faced by long-term survivors of childhood cancer.
• Assess psychosocial issues faced by long-term survivors of childhood cancer.
• Develop developmentally and culturally informed recommendations for childhood cancer survivors.

Center for Epilepsy and Neurodevelopmental Disabilities (ENDD)

This training rotation focuses on outpatient consultation with patients and families seen within the Center for Epilepsy and Neurodevelopmental Disabilities (ENDD). Patients include individuals ranging in age from infancy to adulthood with one of two rare genetic conditions: STXBPI and SYNGAPI related disorders. Common symptoms of these conditions include seizures, global delays and/or intellectual disability, autism spectrum disorder, speech and communication differences, movement disorders, behavioral issues, and other complex medical conditions.

This rotation offers the opportunity to be part of an outpatient interdisciplinary team comprised of neurology, genetic counseling, dev peds, physical therapy, occupational therapy, speech therapy, and psychology. Patients and families come for a full day clinical and research visit and return every 6 months for follow up and continued research participation. Trainees will help provide behavioral consultation to patients and families with opportunities to practice developmental testing (i.e., Bayley) and autism diagnostic testing (i.e., CARS2).

Training Objectives:

• Develop/increase ability to translate longer term intervention strategies to brief intervention strategies in a consultation setting.
• Develop/increase ability to independently provide in the moment recommendations and strategies for families.
• Develop/increase competence in administering the Bayley and CARS2 in a medically complex population.

Center for Fetal Diagnosis and Treatment/Special Delivery Unit

Working with expectant parents with babies with congenital anomalies; offering intake evaluations to determine adult psychopathology and providing short-term individual and couples therapy in anticipation of birth and ICU parenting

Training objectives

• To understand risks and symptoms of perinatal mood and anxiety disorders
• To learn EBT to address symptoms in expectant and postpartum parents of critically ill fetuses and newborns
• To build language and skills to support grieving parents post-pregnancy and neonatal loss
• Recognize the role of perinatal psychology within a multidisciplinary maternal-fetal medicinal team

Health and Well-being Program (Pediatric Weight Management and Adolescent Bariatric Surgery)

The Health and Well-being Clinic is an outpatient interdisciplinary team comprised of physicians, nurse practitioners, registered dieticians, physical activity specialists and social workers. Our patient population includes children and adolescents who have a body mass index greater than the 85th percentile. In addition, patients may present with comorbidities associated with elevated BMI, such as, obstructive sleep apnea, dyslipidemia, and Type 2 diabetes. The goal of the clinic is to provide assessment of weight-related medical issues and weight management through a family-based approach that is uniquely tailored for the child and family.

The training goal of this rotation is to provide the intern with direct practice opportunities in providing psychosocial consultation and brief intervention to children with overweight/obesity and their families in the context of a multidisciplinary family-based weight management program.

Training objectives

• To understand the impact of obesity and weight related concerns on child and family caregiver functioning.
• To develop expertise in clinical consultation and brief intervention with children presenting with concerns related to being overweight or obese.
• To acquire skills in motivational interviewing and family systems conceptualization and intervention of cases; specifically addressing health behavior change in the family system.
• To develop collaborative relationships with a multidisciplinary team through conjoint conceptualization and management of cases.

Inpatient Rehabilitation

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 rehabilitation patients within an inpatient interdisciplinary team (including attending physician, resident, clinical nurse manager, PT, OT, SLP, Child life, social worker, and case manager), and will serve as a leader on the treatment team.

The rehabilitation psychology service provides initial assessments, case consultation, behavioral management, patient and family psychotherapy, psychoeducation, 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 diagnosis that could include traumatic brain injury, brain tumor, stroke, encephalitis, orthopedic injury, and Conversion Disorder. Typical interventions include behavioral and cognitive-behavioral interventions for adapting to new injury and hospitalization, improving motivation for or compliance with medical treatment, improving symptoms of depression or anxiety, and decreasing symptoms of post-traumatic stress.

Training objectives

• Develop knowledge related to the unique sequelae and biopsychosocial needs of children with neurorehabilitation issues, and their families.
• Develop inpatient consultation skills related to the clinical assessment of patients and families with rehabilitation issues.
• Develop skills related to the provision of services to patients and families with inpatient rehabilitation issues, which will include individual and family interventions, education, behavioral interventions, and psychotherapy as indicated.
• Gain knowledge and skills related to working within a interdisciplinary inpatient treatment team.
• Develop skills as a consultant to members of the treatment team to plan for patient care issues.
• Develop skills related to documentation, including inpatient consultation and progress notes, and medical chart review.
• Participate in team meetings, family meetings, and school re-entry meetings.
• Participate in monthly Psychosocial Rounds.

Neuropsychology Concussion Clinic

This rotation provides neuropsychological consultation, brief evaluation, and psychoeducation intervention services to children through young adults (ages 3 through 25 years) who have sustained mild traumatic brain injuries. The intern will have the opportunity to conduct brief neuropsychological screening evaluations and to provide consultation and psychoeducation services within a clinic model of care (2-hour visits). The intern will also communicate with medical, psychology, and therapy providers to coordinate care within the multidisciplinary Concussion Program, and will communicate with schools when indicated through written school letters. Primary documentation requirements include EPIC clinic notes, brief screening evaluation reports when indicated, and school letters when indicated. Interns will have the opportunity to complete one comprehensive neuropsychological evaluation per 6-month rotation with a patient of their choosing.

Training Objectives:

• Learn the neuropsychology of concussion, including the biochemical pathophysiology of concussion, expected recovery outcomes, and developmental, psychological, and psychosocial factors that impact recovery.
• Develop consultation and psychoeducation skills within a specialized and psychosocially complex patient population.
• Develop consultation and psychoeducation skills within a specialized and psychosocially complex patient population.

Newborn/Infant Intensive Care Unit (NICU)

The training goal of this consultation 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/week rotation.

Training objectives

• Become knowledgeable about preterm and term infant development, including the role parents in this process
• Learn how the intensive care environment and infant medical complications impacts infants’ developmental progress
• Observe/assist with standardized developmental assessments
• Develop consultative working relationships with multidisciplinary colleagues through participation in developmental rounds
• Work in conjunction with other developmental disciplines to provide developmental intervention for infants
• Learn how parent-infant relationships can be affected by birth complications and 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

Pediatric Feeding and Swallowing Center

The Pediatric Feeding and Swallowing Center assesses and treats children typically between 2 months to school age 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 within outpatient consultation.

Training objectives

• To increase knowledge about assessment of complex feeding disorders
• To become familiar with behavioral strategies as these relate to feeding difficulties
• To understand the role of the pediatric psychologist as consultant to a multidisciplinary team

Pediatric Primary Care

Integrated Behavioral Health Track (2026-2027 year) 

The Primary Care rotation fulfills partial requirements in the core areas of intervention and consultation and includes individual and family therapy, parent training in behavior management, clinical assessment, and consultation with families, primary care pediatricians, school personnel, child psychiatry fellows and pediatric residents.

This rotation is based at the South Philadelphia, Karabots, Norristown, CHOP Campus or Cobbs Creek Primary Care locations.

In conjunction with their psychologist supervisor, psychology interns participate in a brief initial clinical consultation, which focuses on the presenting concern and need for follow-up behavioral health concerns. Clinical consultation results are shared with the referring pediatrician, as well as parent(s). Based on the level of the concerns, short-term, evidenced-based treatment plans are developed. The child and parent(s) are seen for follow-up mental health intervention by the psychology intern at the primary care office location. If necessary, children and families are referred for longer-term community-based care. For these cases, psychology interns work in conjunction with the practice-based social workers to encourage engagement in longer-term care.

Training objectives

• To learn about strategies for providing integrated mental health services in pediatric primary care.
• To learn strategies for conducting brief consultations to develop evidence-informed treatment plans.
• To provide individual and family EBPs to children and families in a primary care setting.
• To learn effective techniques for interviewing parents and children.
• To learn how to conduct behavioral consultation with other primary care providers.
• To become an effective consultant on empirically supported interventions to primary care providers.
• To collaborate with trainees from other disciplines in a primary care setting.

Pediatric Stroke Program

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

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.

Plastic & Reconstructive Surgery (Cleft/Craniofacial)

Interns will predominantly work with our Cleft Palate and Craniofacial Team patients, all of whom have congenital conditions affecting the structure and function of the face. There may be opportunities to work with patients with additional conditions affecting appearance (e.g., acquired differences resulting from medical intervention, injury or trauma; breast anomalies). The patient population includes children (age 0-21) with a variety of medical conditions. Interns work 4-8 hours on Thursdays. Cleft Palate Clinic is held three times a month; Craniofacial Clinic is held on the third Thursday of each month. Each clinic day concludes with a one hour multidisciplinary team meeting. 

Training objectives

• Conduct brief health and behavior assessments for patients with craniofacial conditions and their families presenting for their annual multidisciplinary team evaluation.
• Provide consultation to multidisciplinary craniofacial and cleft palate teams, which include specialists from plastic surgery, ophthalmology, speech pathology, audiology, nursing, neurosurgery, psychology, social work, orthodontics, pediatrics, genetics, growth and otolaryngology.
• Provide follow-up care (e.g., therapy, brief interventions, care coordination) for children/families with acquired and congenital conditions.

Regional Autism Clinic

Autism Spectrum Disorders Track

This rotation provides the opportunity to participate in an interdisciplinary 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, so most of the providers are clinical trainees under supervision, and there are frequent trainee observers from many disciplines, including physician trainees and allied health professionals. The evaluations, case discussions, and feedbacks are conducted with trainees present, which helps the trainees become comfortable with teaching and facilitating clinical training.

The Regional Autism Clinic rotation fulfills a requirement in the core area of consultation.

Training objectives

• Administer the ADOS as part of an interdisciplinary evaluation.
• Provide consultation to the team about observed behaviors, diagnostic impressions, and recommendations.
• Describe the testing and behavioral observations made to visiting trainee observers.
• Provide written and oral feedback to families with the developmental pediatrician.

Solid Organ Transplant Program

The training goal of this rotation is to provide the intern with exposure and direct practice opportunities in providing psychological services as a member of interdisciplinary heart, lung, heart/lung, liver, and kidney transplant teams. These teams serve children who are experiencing organ failures, and who are at various stages in the pre- and post-transplant process.

Psychology services provided include:

• Pre-transplant psychosocial assessment of children and families;
• Inpatient/outpatient consultation/intervention services for children and adolescents awaiting transplant and their families; and
• Consultation with the transplant medical teams around patient and parent coping and parent-staff interaction.

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

This rotation is generally completed as an eight-hour rotation. However, other arrangements may be made to accommodate needs of a particular intern’s training interests/schedule.

Training objectives

• To develop an understanding of child and family coping with organ failure and the need for transplant and prolonged hospitalization, as impacted by individual, situational and systemic factors.
• To develop skills in the conduct of the pre-transplant psychological evaluation.
• To develop an understanding of factors impacting the pre-transplant evaluation process, including psychological, social, medical and ethical.
• To develop skills in intervening to support child, parent and sibling coping with illness and hospitalization.
• To develop skills in consultation with medical and nursing staff to support patient and family coping.

Urology

This rotation is ideal for interns interested in urology, outpatient pediatric psychology, and multidisciplinary care. Interns will have the opportunity to assess and support biopsychosocial factors impacting urological medical concerns and to coordinate with a multidisciplinary team of medical and psychosocial providers. Patients are referred from medical providers due to emotional or behavioral symptoms that are impacting adherence to medical recommendations or treatment. Patients present with a variety of concerns including incontinence, voiding dysfunction, spina bifida and neurogenic bladder, kidney stones, bladder exstrophy, differences of sex development, and surgical reconstruction. Common presenting developmental and psychological co-morbidities including ADHD, ASD, anxiety, and depression. Interns will provide health and behavior assessments and interventions and consultation. The goals of initial health and behavior assessments are to identify biopsychosocial factors impacting urological concerns, deliver psychoeducation and feedback about these factors to patients and their families, and provide treatment recommendations (e.g., health and behavior intervention with pediatric psychology, referral to community care for primary mental health treatment). Health and behavior intervention with pediatric psychology is designed to be short-term (i.e., 5-7 sessions), using evidence-based strategies, including CBT, ACT, and MI, to directly support urological health by increasing understanding and adherence to health promoting behaviors (e.g., bladder hygiene practices, medication adherence), learning symptom management strategies (e.g., relaxation strategies, cognitive coping), and improving caregiver use of behavioral strategies to improve functioning (e.g., using rewards and reinforcements). 

Training objectives

• Identify common psychological and behavioral factors that impact urological concerns/condition
• Develop competency in explaining the biopsychosocial model within the context of urology
• Gain experience adapting evidenced-based treatments (e.g. CBT, ACT, MI) to target urological concerns (i.e. coping with chronic illnesses and medical complexities, toilet training, social and emotional development and problem solving)
• Consult with multidisciplinary team members (e.g., surgeons, advanced practice provides, nurses, child life specialists, social work, physical therapists, and occupational therapists)
• Coordinate with outside providers as needed (e.g. school, outpatient therapists)