There are three fellowship opportunities, with separate areas of focus. One fellowship will focus on research with a NIH funded research lab, focusing on factors associated with adaptation to perioperative pain and anxiety and procedural pain. Two fellowships will focus on clinical work in Pediatric Psychology.
Pediatric Psychology Post-Doctoral Fellowship – Research Focus (1 position)
This Fellowship position focuses on the Cultural Influences on Pediatric Health. This position is a joint offering from the University of California-Irvine and CHOC Children's. This fellowship position is pending funding from the National Institutes of Health (NIH) at the Center for the Advancement of Pediatric Health (CAPH) in the Department of Anesthesiology and Perioperative Care, at the University of California-Irvine (UCI) and Department of Pediatric Psychology at CHOC Childrne's. CAPH is a collaborative group from diverse areas in medicine, nursing, and psychology. Under the executive direction of Dr. Zeev Kain, Chair of Anesthesiology, CAPH conducts cutting edge research on children’s health with particular interests in medical anxiety and pain. The fellow will work with a team of experienced pediatric psychologists, including Heather Huszti, Ph.D., Jill MacLaren, Ph.D., and Michelle Fortier, Ph.D. Additionally, you will have the opportunity to work with the Pediatric Psychology Training Program at CHOC. These experiences will be clinical in nature and can be negotiated.
CAPH relocated from Yale University to UCI/CHOC in July 2008 and a current focus of its research agenda is the examination of cultural influences on children’s medical experiences. The fellow in this position will facilitate new research on the interaction between culture and children’s pain and medical anxiety. We are particularly interested in fellows who have demonstrated an interest in diversity issues in their graduate training and/or research experiences. Both CAPH and the Department of Pediatric Psychology are committed to furthering an understanding of the influences of culture on children’s health and developing interventions that are culturally sensitive and appropriate.
This is a one year position with the option to renew for second year. Start date is negotiable. Experience conducting research with culturally diverse populations is preferred. Mentorship in research design and methods, manuscript preparation, and grantsmanship will be provided.
The Department of Anesthesiology and Perioperative Care offers a competitive salary and benefit package including paid vacation and holidays. For more information about CAPH, please view our website at www.perioperativehealth.org.
For this position, please direct programmatic questions to:
Michelle Fortier, Ph.D.
Children’s Hospital of Orange County
505 S. Main Street, Ste. 940
Orange, CA 92868
Pediatric Psychology Post-Doctoral Fellowship – Clinical Focus (2 positions)
Childhood chronic illness is a significant health concern. As medical treatments improve, more children are living longer with chronic illnesses. It has been estimated that 15 to 18% of children in the US are living with a chronic illness. Of these, about half experience a restriction in their ability to participate in normal activities. Medically fragile children and their families experience a wide range of unique stressors, yet many do not have access to quality mental health services. Uniquely tailored psychological services, such as specialized assessments, psychosocial support, more intensive psychotherapy and consultation with medical teams can have a very positive effect on quality of life for children and their families. In recognition of these positive effects children’s hospitals and clinics are increasingly working closely with psychologists and other mental health professionals to provide comprehensive services to their patients. The psychology post-doctoral fellowship at CHOC seeks to train psychologists to work effectively with medically fragile children and their families within the context of hospital based inpatient and outpatient services. This is a particularly exciting time to be a part of pediatric psychology as the medical field increasingly understands the critical role of psychological factors in overall health and is thus increasingly involving psychology services into standard health care services. Fellows will apply their knowledge of child development and their skills as a child therapist to children affected by medical illness 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 therapy. In addition to the intensive experiences with children with medical diagnoses, fellows will work with more traditional child outpatient therapy and assessment cases.
One of the clinical fellowships will primarily work with the oncology program and one fellow will primarily work with CHOC Consultation and Liaison Team. Fellows will coordinate with the respective medical teams throughout the year, participating in clinical work, program development and clinical research activities within the teams. Fellows will see more complex cases and be responsible for further developing clinical services with the medical teams. They will participate in outpatient clinics with the multi-disciplinary medical teams, provide inpatient consultation services to patients followed by the medical team, and potentially submit a poster or write a paper within their area of specialization.
I. Oncology Track:
The fellow will work with the Oncology Medical team and the interdisciplinary psychosocial team (which includes psychologists, social workers, child life specialists, teachers, and chaplain) to provide coordinated services to children diagnosed with cancer and their families. Fellows will be involved with the new diagnosis program, which includes initial coping assessments of all newly diagnosed patients and their families. After these individualized initial assessments, the fellow will provide ongoing therapeutic services as needed to each child/family (in both medical inpatient and outpatient settings). Therapeutic services include assisting children and families in the initial adjustment to a new cancer diagnosis and facilitating effective coping, helping parents and/or the medical team with behavioral management issues, psychotherapy to address pre-existing or secondary mental health issues (e.g., depression, anxiety), pain management assistance, and help in dealing with death and dying issues as well as with survivorship issues. In addition, the fellow may assist in school reintegration activities, which includes working with children who are ready to return to the school setting after completing their intensive treatment or who are struggling in school after completing their treatment. Activities might include assessments to determine their particular learning strengthens and challenges, working with schools to develop appropriate educational programs (which might include attending IEP meetings), attending educational programs in the schools to fellow students and/or teachers, or providing psychotherapy to reduce anxiety or depression. The fellow will attend Long Term Survivors Clinic. Children who have completed their medical treatment for cancer are followed annually through this clinic. Psychosocial needs are evaluated and the fellow will assist in providing referrals and services to these families.
Fellows on this rotation also have the opportunity to participate in the Department of Pediatric Psychology Neurospsychological Assessment Clinic over the training year. The clinic receives a wide variety of referrals ranging from complex neuropsychological assessments to diagnostic questions regarding psychopathology to developmental assessments and screenings. The general approach adopted in the assessment clinic is one of hypothesis testing and testing to the referral questions. For those Fellows who are Spanish speaking, we have a library of Spanish assessment instruments and can provide training in bilingual assessment. Fellows will complete approximately 4 assessments over the year, with a focus on oncological diagnoses when possible. The fellow will be supervised by the Neuropsychologist who works with the Oncology Service.
In addition to the experiences working with the medical teams described above, the fellow will also participate in a range of other pediatric psychology experiences described below in the section, “Activities Common to Both Tracks.”
II. Consultation and Liaison Track:
The fellow will work with the Consultation and Liasion Team which provides inpatient consultation to the medical units at Children’s Hospital of Orange County. Common consults include ruling out psychosomatic causes of medical symptoms, assessing depression and anxiety and providing referrals and/or treatment, teaching children and families non-pharmacologic pain control strategies, acute stabilization of children or adolescents with eating disorders, neurologic complications, acute stress reactions. The fellow will work with interdisciplinary psychosocial teams (social workers and child life specialists) as well as with nurses, medical attendings and house staff (medical residents and fellows) as well as medical students, and case managers. Depending on the diagnosis, physical and/or occupational therapists, dieticians, pharmacists, and other specialists might also be involved. Fellows will attend medical rounds on several floors to provide information to medical professionals. The fellow will have the opportunity to run psychosocial rounds on the Medical-Surigical Floors on a weekly basis. The fellow will also have an opportunity to work with the interdisciplinary Hematology team which consists of physicians, nurses, physical therapists, social workers and psychologists and provides treatment to a wide range of children with hematologic disorders and bone marrow mediated disorders (including certain congenital immunodeficiencies). The fellow will also have an opportunity to work closely with the Pediatric Intensive Care Unit (PICU) at CHOC. The PICU team consists of attendings, fellows, medical residents, social work, child life, psychology, nutrition, pharmacists and physical and occupational therapists.
The fellow will also have the opportunity to participate in the research activities of the Center for the Advancement of Pediatric Health (CAPH) (described above). This research experience will be somewhat more limited than that of the research fellowship, but the fellow will have an opportunity to participate in projects and potentially complete a poster or paper.
Activities Common to Both Tracks:
The fellow in the Pediatric Psychology track will have the opportunity to participate in and eventually supervise interns and practicum students participating in the CHOC 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 students 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 psychological services. Participation in this clinic provides fellows the ability to refine their skills in rapid interviewing, diagnosis, and essential treatment planning, and then potentially teach these skills to interns by providing supervision under the guidance of a faculty member.
The fellows will also see a limited number of child outpatient cases. The focus will be more on children with medical diagnoses and many cases may be referred from the primary medical team placement (oncology or consultation and liaison). Referrals may include children and families coping with a medical diagnosis, noncompliance with medical treatment recommendations, and pain control. Fellows may also follow children with more traditional outpatient referrals, including depression, attention and behavior problems, anxiety, and family conflict.
Fellows also have the opportunity to participate in the Department of Psychology Assessment Clinic over the training year. The clinic receives a wide variety of referrals ranging from complex neuropsychological assessments to diagnostic questions regarding psychopathology to developmental assessments and screenings. The general approach adopted in the assessment clinic is one of hypothesis testing and testing to the referral questions. For those Fellows who are Spanish speaking, we have a library of Spanish assessment instruments and can provide training in bilingual assessment. Fellows will complete approximately 4 assessments over the year.
Behavioral Emergencies/On Call:
A distinctive feature of our program is that all trainees receive training in managing behavioral emergencies through the provision of consultation services to the CHOC Emergency Department and hospital inpatient medical units. Interns and post doctoral 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. Trainees 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. The Post-doctoral fellow will participate in no more than 10 weeks of call per year.
Fellows receive a combination of individual and group supervision (a minimum of four hours) per week. Supervision occurs on an individual basis, during group rounds, within clinic settings and within the Training Program seminars. All supervision is performed by departmental staff who meet the California Board of Psychology requirements and CHOC Hospital’s Medical Staff qualifications.
Fellows are offered at least two hours of individual supervision per week for ongoing therapy cases and rotational experiences. Supervision of the consultation-liaison service is handled with both individual supervision and via group supervision (rounds). Rounds are co-led by a board certified child and adolescent psychiatrist/ pediatrician and a licensed psychologist. The amount and frequency of this supervision will vary depending on the complexity and number of consults received. Typically, consultation supervision occurs for 1 to 2 hours weekly. Additionally, consultation services are often provided using co-therapy, especially for high risk and complex consults. Therefore, fellows are able to observe their supervisors providing psychological services. They are also able to do co-therapy and receive immediate feedback based on direct observation of clinical skills. Supervision is also provided informally during medical rounds. Fellows will be assigned one outpatient therapy supervisor who will work with them throughout the year on more long term outpatient therapy cases.
Postdoctoral fellows will be provided with an opportunity to supervise practicum students in a group supervision group over the second half of the year. Training in the provision of supervision will be provided. Supervision and responsibility for the patients will ultimately be the responsibility of a licensed clinical psychologist on staff.
Training Program Seminars
- Pediatric Psychology Seminar (attend at least 5 weekly sessions and presentations)
- Neuropsychology Seminar (weekly)
- Multicultural Seminar (weekly, 5 months)
- Ethics Seminar (weekly, 3 – 4 months)
- Postdoctoral Fellow Seminar
- Chispa (weekly)
- Pediatrics Grand Rounds (weekly)
- Hematology Teaching Rounds (monthly)
Content of required seminars is biased in the direction of material needed for CHOC clinical activities. A didactic element is included in all seminars. Professional issues are addressed throughout the training year. Outside speakers with a particular area of expertise are invited to present several of the seminars. Trainees may also attend the CHOC Grand Rounds and/or Hematology Teaching Rounds as time permits.
Pediatric Psychology Seminar:
This weekly seminar focuses on topics relevant to the practice of Pediatric Psychology. Presenters include physicians and other medical staff as well as psychologists experienced in particular areas. Topics include medical treatments for common medical problems, as well as psychological problems associated with those disorders. Special topics include issues such as pain control, acupuncture and traditional Chinese medicine, helping children and families cope with death and dying, and feeding issues, etc. Post doctoral fellows are required to attend at least 5 sessions of their choice and to attend all trainee presentations at the end of the year.
Neuropsychological Assessment Seminar:
This weekly seminar focuses initially on learning assessment instruments commonly used at CHOC, from there the seminar reviews the areas of function assessed in the neuropsychological evaluation, and then focuses on specific illnesses and disorders that are typically seen at CHOC, including epilepsy, traumatic brain injuries, and infant and developmental problems.
This seminar is designed to focus on learning an applying an approach to your clinical work that supports increased cultural competency. The seminar is interactive in nature and consists of self-exploration activities, exploration of the surrounding community (through research and an experiential activity), presentations from professionals as well as trainee case presentations. While we expect multicultural awareness to permeate all of your work throughout the year, this seminar is designed to help you develop your model of learning and practice.
Cases in medical settings can bring a multitude of ethical challenges, which don’t always offer clear directions for change. In this seminar faculty present cases they have worked on that have presented ethical challenges. In these interactive presentations, faculty, Postdoctoral fellows, and interns discuss systems and strategies to assess ethical dilemmas and determine courses of action.
Postdoctoral Fellowship Seminar:
This seminar is held biweekly throughout the year. The seminar focuses on professional development and also provides training in supervision. The seminar is informal in nature and covers topics relevant to your own training interests and needs.
Postdoctoral fellows make formal case presentations in the Pediatric Psychology Seminar (one therapy case) and Neuropsychology Seminar (one assessment case) as well as more information presentations/consultations in Multicultural Seminar (case presentation), Neuropsychology Seminar (case consultation), Ethics (case presentation) and Chispa (case consultation).