The psychology internship program at CHOC specifically focuses on the development of specialized professional skills in pediatric and child clinical psychology. We expect that interns will enter the program with previous experience in child psychotherapy and child assessment. During the year, interns will receive first-hand experience in applying their knowledge of child development and their skills as a child therapist to children affected by medical illness. Interns have the opportunity to do this through a wide variety of experiences, such as inpatient consultation-liaison services to a variety of medical specialty units, more intensive experiences with specific medical specialty teams, and outpatient psychotherapy. In addition, the internship is committed to providing appropriate and relevant services to culturally diverse families. As an intern, you will be exposed to a multicultural context that challenges the professional practice of even the most seasoned psychologists. Orange County offers a very culturally diverse population. In particular, Orange County has significant Latino, Vietnamese, Indian, and Filipino populations.
Interns at CHOC participate in a variety of training activities. Interns have the opportunity to receive both a breadth of experience with children with medical diagnoses and more traditional child psychopathology along with in-depth experiences with specific specialty medical teams. There are a variety of core training experiences that take place throughout the entire training year. Trainees participate in two six-month specialty rotations through an array of CHOC specialty services and clinics. Trainees also participate in up to three targeted three-month minor rotations. Each training experience is described below.
While time spent in each activity can differ on a week to week basis, the basic breakdown of time spent in each activity is as follows (chart based on 40 hour week):
Consultation and Liaison Service (6 month rotation): Breadth of experience with a variety of medical diagnoses comes from an intensive 6-month rotations with the consultation and liaison service at CHOC. Interns not only serve as consultants for the patient and/or family, but for the medical team, around a variety of issues. Consults are requested by attending physicians, residents, nurses, or other health care providers for children who are hospitalized for medical diagnoses and are experiencing concomitant psychological problems. Referral questions range from behavioral emergencies to coping with an initial diagnosis to adherence to complicated medical regimens to parental discipline to coping with death and dying issues. Medical diagnoses also run the gamut from diabetes to epilepsy to eating disorders to hemophilia to sickle cell disease to juvenile rheumatoid arthritis to oncology to pain disorders. After an initial assessment, interventions may range from a referral for outpatient psychotherapy to referrals for psychological or neuropsychological assessment to interventions with the child and/or family while in the hospital to consultation and interventions with the medical team. Interns participate on a more general consultation service two days a week with a faculty supervisor. Interns will learn to conduct a brief clinical evaluation, formulate an impression, and formulate disposition plans. While cases can be complex, interns always work with a supervising faculty member, are part of a consultation liaison team which includes psychology attendings, psychology postdoctoral fellows, and another psychology intern, and participate in weekly C & L rounds. The C & L team also includes child and adolescent psychiatry fellows and psychiatry attendings. It is a busy consultation service, so you will be able to see 2 or more cases per week while on the service.
Neuropsychological/Psychological Assessment Experience: All interns will participate in 6 months of assessment experience during the internship. Depending on interest and rotations selected, interns can participate in an additional 6 months of neurodevelopmental assessment and/or neuropsychological assessment. Within the 6 months of neurodevelopmental assessment, interns will complete 40-60 neurodevelopmental evaluations within a multidisciplinary high risk infant follow-up clinic with a broad age range of infants and toddlers. Within the 6 months of additional neuropsychological assessment, interns will complete 1-2 neuropsychological evaluations per month (please see below for a further description). All interns participating in the assessment experience will complete 4-5 assessments during the 6 month rotation. The assessment clinic receives a wide variety of referrals ranging from ADHD evaluations to complex neuropsychological assessments to diagnostic questions regarding learning to developmental assessments and screenings. The general approach adopted in the clinic is one of hypothesis testing and testing to the referral questions. At the end of the training year, all interns will have proficiency with a variety of assessment instruments, referral questions, ability to provide difficult feedback to children and families, and the ability to recognize when to seek consultation. In many cases, you will also work with the child’s rehabilitation therapists, community agencies, and/or school in order to assist them in appropriate educational planning and may attend IEP meetings.
Screening Clinic: All interns participate in CHOC Children’s Department of Pediatric Psychology Screening/Triage Clinic. Patients referred for outpatient psychological treatment are first seen in an initial screening clinic. Through the screening clinic interns receive exposure to a wide range of referral questions and in making decisions about what services are needed. The screening clinic sees children referred by primary care physicians or medical specialists due to suspected psychological concerns affecting medical care or for more traditional child oriented psychological services. Participation in this clinic provides interns the ability to refine their skills in rapid interviewing, diagnosis, and disposition of outpatient therapy cases.
Outpatient Therapy: In addition to cases that are followed on a major rotation, over the course of the year, each intern will carry –up to 5 outpatient cases at any given time depending upon rotations selected. Referrals will include children and families coping with a medical diagnosis, noncompliance with medical treatment recommendations, pain control, and more traditional outpatient referrals, including depression, attention and behavior problems, anxiety, and family conflict. Interns will have the opportunity to see a variety of clients ranging in age, socioeconomic status, and cultural diversity.
Behavioral Emergency Services/On Call: A distinctive feature of our program is that all interns receive training in managing behavioral emergencies through the provision of consultation services to the CHOC Emergency Department and hospital inpatient medical units. Interns and postdoctoral fellows rotate taking after hours call throughout the year for high risk consults. Trainees are always paired with a faculty member for this coverage. High risk consults include assessment of suicide risk or acute mental status changes. Interns will conduct a brief clinical interview, provide crisis intervention and immediate disposition plans for the suicidal patient, the potentially aggressive patient, and the psychotic patient. This training experience helps to increase your competence and comfort in assessing and managing behavioral emergencies.
Specialty rotations are designed to be an in-depth experience within a specific area. By focusing on a single medical service for six months, interns have the opportunity to become an integral part of the medical team. Interns will play a central and vital role in providing psychosocial interventions and consulting with the medical team. Rotations may vary each year, but at least 4 of the following rotations will be offered each year.
Possible rotations include:
- Oncology (Main supervisor: Nadia Torres-Eaton, Psy.D., ABPP)
- Young Child (Main supervisor: Marni Switkin Nagel, Ph.D.)
- Neuropsychology (Main supervisor: Amy Veenstra, Ph..D.)
- Emergency Department/Primary Care (Main Supervisor: Sharonne Herbert, Ph.D.)
- Endocrinology/ Cystic Fibrosis (Main Supervisors: Kelli Rugless, Psy.D., Adrianne Alpern, Ph.D.)
- Feeding Disorders (Main Supervisor: Cindy Kim, Ph.D., ABPP)
The Oncology rotation involves working with infants, children and teens with many types of cancer and following them throughout their inpatient medical treatment and frequently beyond. It is common on the Oncology Rotation to work not only with patients, but also parents, siblings, and even extended family members at times. The Oncology intern will work on the Oncology inpatient floor (as well as on an outpatient basis) to assist families with a new diagnosis, address depression, pain management, anticipatory anxiety and noncompliance, and help patients and families maintain hope throughout their treatment. Fortunately, the majority of children diagnosed with cancer will survive their illness. However, families are also assisted in dealing with issues of loss and grief, as appropriate. Some assessment may be included to establish the patient’s baseline cognitive functioning and to follow any cognitive changes after bone marrow transplantation.
The Oncology rotation has a large interdisciplinary training aspect, as Psychology plays an important role within the Oncology Division, and is involved in ongoing coordination with physicians, nursing, and the other members of the Oncology Psychosocial Team (social workers, child life specialists, CHOC schoolteachers, and chaplains).
The Young Child rotation includes the screening and assessment of infants and toddlers who are at higher risk for developmental delays due to prematurity, medical diagnoses identified at birth or shortly after, or term infants who are not achieving their developmental milestones on time, by using the Bayley Scales of Infant and Toddler Development- 3rd Edition (Bayley-III). This experience involves working with an interdisciplinary team made up of neonatologists, physical therapists, occupational therapists, speech therapists, dieticians, nurses, and social workers. Psychology’s roles include provision of developmental assessment, consultation with team members regarding cognitive, behavioral, or psychosocial concerns, and provision of feedback to families. Interns also work within our developmental assessment clinic in the Department of Pediatric Psychology. Here they conduct neuro-developmental evaluations with toddlers, preschoolers, and early school aged children to assist with clarifying diagnoses and treatment planning. Many of these children also have co-occurring medical conditions.
Other experiences include working with parents/families with an infant in the Neonatal Intensive Care Unit (NICU) to assist them in managing their anxiety/stress, attaching to the newborn, and adjusting to having an infant in the hospital. At times, NICU consultation may include assisting families with issues of loss and grief as needed. When providing NICU consultation, interns will have the opportunity to interact with multidisciplinary team members including physicians, residents and fellows, nurses, social workers, case managers, dieticians, developmental team members, and the chaplain.Trainees on the Young Child rotation will develop a better understanding of the relationships between prenatal, perinatal, and postnatal complications and related neurodevelopmental outcome.
Interns on the Neuropsychology rotation will conduct neuropsychological evaluations for children and adolescents with a variety of medical and possible mental health diagnoses including children with ALL, brain tumors, epilepsy, traumatic brain injuries, spina bifida, HIV, etc. The intern participates in concussion clinic as well, conducting initial evaluations, administering testing, and providing feedback regarding optimal timing for returning to school and/or sports. The intern will also have the opportunity to learn about and observe EEGs anddo bedside neuropsychological exams. As a part of this rotation interns will learn about the evaluation process for pre-epilepsy surgery by observing faculty, attending pre-surgery rounds, and testing pre-surgery candidates.
Interns on the Emergency Department/ Primary Care rotation will work in the Emergency Department (ED) and in a primary care clinic with patients who are presenting with social, emotional, and/or behavioral issues. Interns will learn about the most common behavioral health concerns that present to primary care, with a focus on adolescents. Interns will participate in screens of the adolescents, present brief interventions, with a particular focus on the use of Motivational Interviewing (MI) elements. Dr. Herbert will provide coaching in MI. In the ED, interns will participate in evaluations of children presenting in a psychiatric crisis and help to determine what level of care is needed (such as admission to an inpatient psychiatric unit or intensive outpatient services) and what are appropriate discharge recommendations. In the ED, interns will also participate in an evidence supported family based intervention for children in crisis. Interns will work with a variety of health care providers in both settings, including physicians, residents, nurses, and case managers. (Supervisor: Sharonne Herbert, Ph.D.)
Interns on the Endocrinology/ Cystic Fibrosis rotation work closely with the multi-disciplinary Endocrine team and Cystic Fibrosis (CF) team, with a focus on patients with diabetes and cystic fibrosis. Interns will participate in both the Endocrine Clinic and CF clinic, with a variety of health care providers in both clinics, including physicians, nurses, case managers, nutritionists, social workers, respiratory therapists, diabetes nurse educators, and at times rehabilitation therapists and pharmacists. Additionally, interns will provide screenings for depression and anxiety for adolescent patients. In the CF clinic, interns will also provide screenings for depression and anxiety for parents. As the psychological consultant in these clinics, you triage and assess clinic attendees. Identified problems have included, coping with new diagnosis or treatment, adherence issues, school issues, and psychological factors affecting the medical condition. Interns will also have the opportunity to work with patients with diabetes or CF who are admitted to the hospital for medical exacerbations. (Supervisors: Kelli Rugless, Psy.D., Adrianne Alpern, Ph.D.)
Interns on the Feeding Disorders rotation will participate in multidisciplinary outpatient feeding evaluations within the CHOC Feeding team’s multidisciplinary outpatient evaluation clinic. This team includes physicians, nurse practitioners, physical and occupational therapists, and social workers. Interns will also participate in the innovative intensive 21-day inpatient feeding program for G-tube weaning. Interns will work closely with children and families participating in the observation of meals in a state of the art multi-media room and in providing behavioral interventions to the patients and parent training for the parents. Interns will work with both patients and parents during the inpatient admission. Interns on this rotation will gain knowledge about complex feeding disorders and techniques to treat feeding difficulties. (Supervisor: Cindy Kim, Ph.D., ABPP)