The Training Program
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 experiences that take place throughout the entire training year. Trainees participate in two six-month rotations through an array of CHOC specialty services and clinics. Trainees also participate in three targeted four-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):
(Estimated percent ime in each activity)
Year Long Experiences
Consultation and Liaison Service: Consultation and Liaison Service: Breadth of experience with a variety of medical diagnoses comes through year-long participation 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 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 one day 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 and participate in weekly C & L rounds. The C & L team includes psychology interns and post-doctoral fellows as well as child and adolescent psychiatry fellows.
Neuropsychological Assessment Experience: Interns will participate in 12 months of assessment experience during the internship. Depending on interest and rotations selected, interns can participate in 6 months of neurodevelopmental assessment and 6 months of neurpsychological assessment. Within this experience, 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 during 6 months. The other 6 months will consist of completing 4-5 more traditional neuropsychological evaluations (please see below for a further description). For those interns interested in more intensive neuropsychological training, there is an option to spend 12 months in the neuropsychological assessment clinic. The clinic receives a wide variety of referrals ranging from 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. Interns opting for the 12 month neuropsycological assessment clinic experience will complete at least 7-8 assessments over the year through the clinic, but may also complete additional assessments as part of their major and minor rotations. 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 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 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. Group supervision allows exposure to a wide variety of cases.
Outpatient Therapy: In addition to cases that are followed on the major rotation, over the course of the year, each intern will carry 4 - 8 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 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. 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.