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.

Internship Structure

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.

The structure of the training program is also represented by the diagram below:

Consultation and Liaison
Outpatient Psychotherapy
Assessment Clinic
Screening Clinic
Supervision
Seminars (Pediatric Psychology, Assessment, Multicultural, Ethics, CHiSPA (for interns who are Spanish speaking))
Support Group
Behavioral Emergencies Screening (10 weeks over the year)
Major rotation 1 (6 months)		Major rotation 2 (6 months)
Minor rotation 1 (4 months)	Minor rotation 2 (4 months)	Minor rotation 3 (4 months)

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):

Year Long Experiences

Consultation and Liaison Service: Breadth of experience with a variety of medical diagnoses comes through a 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 physicians, residents, nurses or other health care providers for children who are hospitalized for medical diagnoses and are experiencing concomitant psychological problems. Referral questions have ranged from 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 in medical inpatient consultations through two avenues. Each of the major rotations provides specific inpatient experiences through work with medical diagnoses that are a part of that rotation. In addition, interns participate on a more general consultation service one day a week with a faculty supervisor. Consults on this service include behavioral emergencies (such as assessing potentially suicidal patients) and a range of diagnoses (such as JRA, pain disorders, eating disorders, etc.). In both of these consultation experiences interns will learn to conduct a brief clinical evaluation by interview, formulate an impression, and formulate disposition plans. While cases can be complex, interns always work with a supervising faculty member and participate in twice weekly C & L rounds.

Neuropsychological Assessment Clinic: Interns also participate in the Pediatric Psychology Neuropsychological Assessment Clinic. 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. Interns will complete a total of at least 7 assessments over the year through the Assessment Clinic, but may also complete additional assessments as part of their major and minor rotations. At the end of the training year, 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 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.

Outpatient Therapy: In addition to cases that are followed on the major rotation, each intern will carry approximately 6 - 8 outpatient cases at a time. 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.

Language Screening Clinic: Interns who are Spanish speaking will have the opportunity to participate in Spanish language assessments as well as administering full batteries in Spanish. This experience will include initial screening to evaluate the dominant language of the referred child and to make recommendations regarding the full assessment. Children whose language is Spanish dominant will then be tested using culturally appropriate assessment instruments. Bilingual faculty can assist with administration questions and questions about feedback.