Major 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.)
- Young Child (Main supervisor: Marni Switkin Nagel, Ph.D.)
- Endocrinology (Main supervisor: Mery Taylor, Ph.D.)
- Primary Care (Main Supervisor: Marni Switkin Nagel, Ph.D.)
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 trainee 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. 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. Interested interns may also participate in the CHOC Feeding team, which includes nursing, physical and occupational therapists, and physicians. This experience would include participating in interdisciplinary feeding assessments and will provide knowledge about complex feeding disorders and techniques to treat feeding difficulties. Trainees on the Young Child rotation will develop a better understanding of the relationships between prenatal, perinatal, and postnatal complications and related neurodevelopmental outcome.
The Endocrinology (Diabetes) Rotation has several foci: 1) providing health and wellness psychological screening for patients with diabetes. Interns in this rotation will have the opportunity to work in a multi-disciplinary (endocrinologists, diabetes educators, residents, medical students, nurses) clinic setting within which they are embedded. Interns will work collaboratively with endocrinologists and receive referrals to see patients (children through adults with Type I and Type II diabetes) during their endocrinology clinic visit. Interns then conduct a brief psychological screening for the purpose of identification of any mental health problems that may need further psychological assessment, and helping patients identify potential problems and assisting them with appropriate recommendations and referrals. Interns are expected to provide the endocrinologists with verbal feedback after screening a patient as well as complete a brief electronic report. 2) As part of this rotation there is also the opportunity to provide group psychological treatment for patients and their parents. The groups are held weekly and target patients and their families who have been identified as have difficulty or emerging challenges with adherence, depression, and/or family conflict surrounding the diabetes diagnosis/treatment. 3) Finally, interns in this rotation will also be required to reserve a weekly emergency screen slot for patients who have had a recent hospitalization for DKA and require an evaluation for possible treatment in our Psychology Clinic.
The Primary Care Rotation is designed to learn about the various roles of a pediatric psychologist within an integrated primary care clinic setting for children and adolescents of all ages. A complete understanding of child development is important in working with children of all ages. Most child/adolescent behavioral issues first present to primary care, thus early intervention and even prevention opportunities are rich. Many behavioral health issues are mild and specific, and can easily be treated within a brief 1-3 session model. Further, co-treating the physical and mental health aspects of these diagnoses simultaneously leads to better long-term outcomes and greater patient and family satisfaction. Thus treating the patient/family within primary care is effective, efficient, convenient, and appreciated by families. Moreover, many parents of children and adolescents are hesitant to seek psychological services because of fears about problems with their children’s development, stigma associated with mental health conditions, isolation, or lack of understanding about the importance of child/adolescent mental health, which is another reason why provision of services within primary care can be so effective. Mental health professionals working within primary care are often a family’s first introduction to psychological services. A positive early experience is key to the family’s willingness to seek mental health services in the future. Integrating behavioral health into primary care reduces the stigma associated with mental health issues and normalizes the treatment of these issues faced by many families. In addition, by integrating behavioral health within primary care, it improves communication between mental health providers and pediatricians, encourages cross-training and collaboration within healthcare provider areas of expertise, and provides coordinated care to patients and families. Interns will work closely with General Pediatrics Attendings as well as pediatrics residents. Primary focus will be on children at risk for obesity as well as those at risk for psychological disorders. Brief interventions will be provided within the primary care clinic setting.
Additional Clinical Activities
Interns will have an opportunity to participate in four minor rotation experiences, each rotation lasting 3 months. These rotations may differ somewhat from year to year, but training opportunities are comparable each year. Currently offered minor rotation experiences include;
Psychopharmacology: In this innovative experience, you will work with our child and adolescent psychiatrist in his medication clinic once a week. Tasks include participating in initial interviews with patients to determine what, if any, psychotropic medication might be indicated, or if currently prescribed medications require adjustment. This experience also includes education about different medications, mechanisms of action and indications for use. The team includes pediatrics residents and child and adolescent psychiatry fellows. (Supervisor: Wayne Nguyen, M.D.)
Primary Care: Interns on the Primary Care minor rotation will work within a primary clinic. Interns will work closely with General Pediatrics Attendings as well as pediatrics residents and provide brief evaluations as a part of the child’s visit. Interns will have the opportunity to provide teaching to the pediatrics residents about psychological evaluation and treatment. (Supervisor: Sharonne Herbert, Ph.D.)
Research: Interns will have an opportunity to spend up to 10% time on either their dissertation or an ongoing research project within the Psychology Department. (Supervisor: Will vary according to project).
Administration: Interns will have an opportunity to participate with the Chief Psychologist in a community wide effort to create a pediatric behavioral health system of care. This rotation will provide the intern with beginning experience in administrative leadership roles. Interns will have the opportunity to complete a small project to contribute to the overall system of care development. (Supervisor: Heather Huszti, Ph.D.)
BAN Clinic: In this experience, interns will participate in the Bulimia Anorexia Nervosa Clinic in the Adolescent Medicine Clinic. Interns will rotate with Child and Adolescent Psychiatry Fellows. The focus is on preventing futher deterioration in adolescents at risk for or with eating disorders. Interns will work with families in a consultative role and will provide feedback to the patients' primary psychotherapists. (Supervisor: Wayne Nguyen, M.D.)