In order for the fellow to take a leadership role in program, our fellowships are designed to focus in a primary area. This focus allows fellows opportunities to work with teams over a year long period and to develop mastery of these skills.
One-three of the clinical fellowships will primarily work with the CHOC Consultation and Liaison Team with the possibility of working with a specialty team such as the Pain program or the Eating Disorders program, and three of the fellowships will work with our Pediatric Psychology Integrated Care Co-Occurring Clinic offering mental health services to children with co-occurring medical and mental health conditions. One fellowship (contingent upon funding) will focus on pediatric neuropsychology, working with the Neurology, Cardiac, and/or Neuro-Oncology Services, with a focus on neuropsychological assessment. One fellowship (contingent upon funding) will work with our Acute Services within our mental health inpatient center, emergency department, and intensive outpatient program. An additional fellowship with work within our Thompson Autism Center providing assessment and intervention services. One fellowship will work with a private high school providing school-based counseling services to students, wellness programming on campus, preventative and early intervention services to the student body, and educational programming for faculty, staff, and parents. Fellows will coordinate with the respective multidisciplinary 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 within their teams. They will provide inpatient and/or outpatient consultation services, outpatient therapy or assessment services, participate in outpatient clinics with the multidisciplinary team members, and potentially submit a poster and/ or write a paper within their area of specialization.
Pediatric Psychology Fellowship Positions (up to 6 positions)
Childhood chronic illness and mental health 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 typical 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 postdoctoral fellowships at CHOC seek to train psychologists to work effectively with medically fragile children and their families and/or children and adolescents experiencing significant mental health conditions within the context of hospital-based inpatient, clinic, and outpatient services. This is a particularly exciting time to be a part of mental health, both within pediatric psychology as the medical field increasingly understands the critical role of psychological factors in overall health and within child and adolescent clinical psychology, as psychology services are integrated 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 and mental health illness through a wide variety of experiences, such as inpatient consultation-liaison services to a variety of medical specialty units and/or within an inpatient mental health center and emergency department, more intensive experiences with specific medical specialty teams, intensive outpatient therapy programing, outpatient therapy, and assessment and evaluation.
I. Consultation and Liaison Track (1-3 positions):
One to two fellow(s) will work with the Consultation and Liaison Team which provides inpatient consultation to the medical units at CHOC Hospital in Orange. 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, neurologic complications, acute stress reactions, and adjusting to a new medical diagnosis. The fellows 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, medical students), and case managers. Depending on the diagnosis, physical and/or occupational therapists, dieticians, pharmacists, and other specialists might also be involved. Fellows may also have the opportunity to provide education and support to the medical residents in both informal and formal presentations. The fellow will have the opportunity to run consultation-liaison rounds for the Pediatric Psychology and Child and Adolescent Psychiatry services on a weekly basis.
One position (contingent upon funding) will focus on the Medical Stabilization of Eating Disorders Service at CHOC at Mission Hospital. This setting is a “hospital in a hospital” which is a pediatric inpatient medical setting. In this position, the fellow will work closely with the attending psychologists, hospitalists, nutritionists and child life specialists who provide services to the child and family. Additional providers include psychiatry and adolescent medicine specialists. The fellow will have the opportunity for an immersive training experience in treating various eating disorders (E.g., Anorexia Nervosa, ARFID, Bulimia) using a Family-based Treatment (FBT) approach. Interns will be involved adapting FBT principles into a busy inpatient medical stabilization setting to empower parents and equip them with the education necessary to restore their child back to health. Fellows may be involved in parent and patient psychoeducation, individual work with patients and facilitating group meals and group therapy. Fellows will also participate in non-eating disorder psychological consultation requested in this location (see above consultation-liaison description).
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 All Tracks.”
II. Pediatric Psychology Outpatient Therapy Track (3 positions):
Three fellowship positions are within our Pediatric Psychology Chronic Illness Integrated Care Track. Our pediatric psychology chronic illness integrated care program is a collaborative program between the psychology department at CHOC Hospital in Orange and Orange County Behavioral Health. As such, fellows will be working within the Department of Mental Health county system documentation guidelines. All three positions will have a primary focus on the provision of outpatient mental health services (psychotherapy and case management) to children and families with a broad range of medical disorders and co-occurring psychological/ psychiatric diagnoses. In addition to providing outpatient therapy services, the positions will include a year-long rotation within either Oncology (inpatient and outpatient services) or the general inpatient medical Consultation-Liaison service. Finally, two positions will work within our outpatient eating disorders medical specialty clinic. Common medical diagnoses include diabetes, eating disorders, cancer, pain disorders, headaches, epilepsy, and GI conditions. Fellows will regularly communicate with the medical teams to coordinate psychological services with medical care. The fellows in these positions will have some opportunities to provide continuity of care to patients through outpatient mental health visits, medical subspecialty clinics, and inpatient stays. Fellows will work with providers from a variety of disciplines including psychologists, psychiatrists, licensed clinical social workers, license marriage & family therapists, behaviorists, physicians, and nurses/case managers. Fellows will also have the opportunity to participate in workshops and evidence-based trainings provided by Orange County Behavioral Health.
All three fellows will have the opportunity to provide outpatient therapy for children with medical illnesses and general mental health conditions. All fellows also will have the opportunity to work with interdisciplinary medical teams and provide some pediatric inpatient consultation.
In addition to the experiences working with medical teams described above, the fellows will also participate in a range of other pediatric psychology experiences described below in the section, “Activities Common to All Tracks.”
III. Pediatric Neuropsychology Track (1 position, 2-year fellowship to meet Division 40 Houston Conference Guidelines, contingent upon funding):
In this track we have 1 first year and 1 second year fellow position. The fellows in this position will work closely with our board-certified neuropsychologists in performing pediatric neuropsychological assessments, with a focus on pre-surgery epilepsy evaluations, oncology brain tumor and long-term survivorship evaluations, cardiac conditions, and metabolic conditions. In addition, the fellows may have the opportunity to participate in a specialized neurology clinic with a focus on concussion, conduct psychological evaluations with patients in our Mental Health Inpatient Center (MHIC), and provide assessments within the Thompson Autism Center at CHOC Hospital in Orange. The fellows will work closely with the Neurology service, with a focus on patients with epilepsy. CHOC has a Level IV Epilepsy Center and has a busy EEG monitoring program and also conducts epilepsy surgeries. The fellow in this position may also serve as a teaching assistant for the Child and Adolescent Assessment Seminar, which is a weekly, year-long teaching seminar. Finally, the fellow in this position will participate in a biweekly journal club focused on neuropsychological literature. Fellows will also participate in an Advanced Neuropsychological Seminar which includes both fellows and faculty neuropsychologists, and focuses on neuroanatomy, neuropsychological case conceptualization, neuropsychology law and ethics, and relevant neuropsychology literature.
In addition to the experiences working with medical teams described above, the fellows will also participate in a range of other pediatric psychology experiences described below in the section, “Activities Common to All Tracks.”
IV. Acute Mental Health Services Track (1 position):
One fellow will work with CHOC spectrum of acute mental health services over the course of the training year. This fellowship will provide the trainee with the opportunity for an immersive training experience in 1-3 acute mental health settings with multidisciplinary teams, including inpatient psychiatric services (on the Mental Health Inpatient Center), emergency room psychiatric evaluations (in the CHOC Emergency Department, Mental Health Emergency Services team) and an intensive outpatient program for adolescents. Presenting problems range from suicidal ideation, suicide attempt, non-suicidal self-injury, psychosis, aggressive behavior/danger to others, altered mental status, and severe psychopathology. In each setting, patients and families are experiencing some degree of a mental health crisis and the fellow will deliver evidence-based services to the family with the goal of reducing risk and alleviating distress. Activities in each setting are detailed below. Fellows will participate in a variety of seminars over the course of the training year. Fellows will have the opportunity to practice supervision competencies with doctoral practicum students and/or doctoral interns.
Mental Health Inpatient Center (MHIC)
The fellow will engage in training opportunities at MHIC with children and adolescents (ages 3-17) experiencing acute psychiatric crises that warrant hospitalization, such as suicidality, non-suicidal self-harm, aggression, and psychosis. Clinical training opportunities include following individual cases, co-facilitating group therapy, and conducting brief psychological assessments. Individual cases involve conducting brief, targeted individual and family therapy, safety planning, and discharge planning with the goal of increasing safety and linkage to appropriate aftercare services. Fellow will become proficient in following areas: developing targeted treatment plans to address acute psychiatric presentation, developing patient- and family-centered aftercare plans, assessing for appropriate level of care post-discharge, working in tandem with psychiatrists and nurses, and conducting psychological testing with children/adolescents presenting with wide range of mental health concerns.
Must be available for multidisciplinary rounds Monday through Friday at 9:30am when not in conflict with seminars required by Psychology Training program.
Mental Health Emergency Service (MHES)
The fellow will engage in a training opportunity with the MHES with children and adolescents who present to the emergency department due to concern for suicidal ideation and all suicide attempts, violent behavior and/or injury to self or others, marked changes in behavior, and psychosis or altered mental status. Training opportunities include conducting mental health evaluations, using evidence-based measures (e.g., Columbia-Suicide Severity Rating Scale [C-SSRS]), using evidence-based crisis intervention (Family Based Crisis Intervention [FBCI]), completing safety and coping planning with patients and families, and linking patients to appropriate services.
Must be available for MHES weekly meeting on Tuesday at 9:00am when not in conflict with seminars required by Psychology Training program.
CHOC Intensive Outpatient Program
The fellow will engage in training opportunity with CHOC’s IOP for high school students. The IOP is an 8-week structured curriculum based on a DBT framework and serves teens experiencing suicidal ideation, non-suicidal self-injury, significant impairments in daily functioning, and/or emotional, behavioral, and interpersonal dysregulation. Teens attend program 4 days per week for 3 hours each afternoon and parents attend two one-hour groups. The IOP is DBT-adherent. Fellow will co-facilitate skills groups, lead mindfulness exercises, coach active skill use throughout group programming, conduct individual, family, and parent skills coaching as needed, conduct risk assessments, and complete safety plans. Additionally, fellow will participate in Treatment Team and Consult Team, components of DBT to address patient care, clinician care, and adherence to the DBT model. Fellow will become proficient in the following areas: DBT skills training, functional analysis of self-harm and other risk-related behaviors, use of mindfulness to adaptively regulate emotions in treatment, determine appropriate level of care for high risk teens, and managing effective self-care to promote clinician well-being and delivery of optimal services.
Must work 10:30am-7:00pm Monday through Friday while on IOP rotation when not in conflict with seminars required by Psychology Training program.
Top candidates will have clinical experience with children and adolescents, fluent knowledge of risk and protective factors for suicide in children and adolescents, strong grasp of severe psychopathology as it presents in children and adolescents, and training in fast-paced settings requiring flexible response. Experience with evidence-based therapies is heavily preferred; training in DBT is not required.
In addition to the experiences described above, the fellows will also participate in a range of other child/adolescent psychology experiences described below in the section, “Activities Common to All Tracks.”
V. Autism Spectrum Disorders Track (1-2 positions):
The Autism Spectrum Disorders fellow at the Thompson Autism Center at CHOC will gain experience and skills in providing psychodiagnostic assessments and treatment for patients with Autism Spectrum Disorder and other mental health needs. During the assessment rotation, the fellow will conduct psychological assessment and testing for diagnostic purposes, including test administration, scoring, and comprehensive report writing. During the intervention rotation, the fellow will identify preliminary issues for treatment focus, develop treatment plans under supervision, and deliver individual and/or group therapy in multiple settings including the center, the home, and/or community. The fellow will gain experience in providing care to patients and their families in a multidisciplinary setting and will coordinate closely with the medical team and other members of the team (e.g., social work, behavioral analysts, occupational therapist, physical therapists).
Duration: 6 months in assessment and 6 months in intervention.
VI. School-based Mental Health Services Track (1 position):
The fellow in this position will work with Mater Dei High School, a private Catholic school in Orange, CA. The fellow will work with the school to help further develop their wellness activities for the student body, which might include items such as resilience activities, mindfulness training, guided imagery, etc., to support teacher and counselor continuing education in how to identify and support children with mental health needs in the school, and provide direct services to students, with appropriate parental consent. The fellow will work closely with head of Counseling Services in making recommendations for new programs and to identify the needs of students, families, teachers and counselors. In addition, under supervision, the fellow will help develop a more robust program in managing children in crisis. In addition, the fellow will rotate through the Emergency Department, Mental Health Emergency Services (MHES) team to develop skills in the assessment and disposition of youth in psychiatric crises.
Activities Common to All Tracks:
The fellows in the Pediatric Psychology Integrated Care tracks will see a larger outpatient caseload (see types of cases described above in the co-occurring clinic description), while the fellows in the Consultation-Liaison track will 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, eating disorders, or consultation-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 in the Acute Services track will work within our Mental Health Emergency Service and/or Intensive Outpatient Program. Fellows in the School-Based Mental Health track will see outpatient cases within the school context. Fellows in the Autism track will see outpatient cases within the Autism center for both assessment and intervention, and possibly a limited number of cases within the psychology department. Fellows within the Neuropsychology track focus on neuropsychological assessment rather than outpatient therapy.
Postdoctoral Fellowship Project
All fellows will have the opportunity to generate a postdoctoral fellowship project that is clinical or research oriented. Projects have included formal research questions, quality improvement initiatives, needs assessments, generation of individual or group manualized treatments, and development of psychoeducational materials. In addition to the core pediatric psychology faculty listed below, many of whom have ongoing programs of clinical research.
Upon completion of the postdoctoral fellowship project, fellows will have an opportunity to present their results as presentations, posters, and/or papers within local, regional, and national forums, or to use the results to build upon in future programs or research development.
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/or 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, assessment for rule out somatization disorders, and assessment of patients with eating disorders admitted for medical stabilization. Trainees will conduct a brief clinical interview, provide crisis intervention, and generate disposition plans. The postdoctoral fellows will participate in no more than 7 weeks of call per year.
Postdoctoral fellows will be provided with an opportunity to supervise interns and/or practicum students. 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. Depending on the specialty track, fellows will either supervise therapy cases, assessments, or inpatient consult cases.
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 Medical Staff qualifications.
Fellows are offered at least two hours of individual supervision per week for ongoing therapy cases and rotational experiences. Supervision of consults 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 and/or assessment supervisor who will work with them throughout the year on more long term outpatient therapy cases.
Fellows will have the opportunity to deliver presentations on mental health topics within our training program seminars, hospital, and/or community. They will observe faculty members’ presentations and generate feedback on presentation style, content, and achievement of objectives. Then, fellows will work with our supervisors, faculty mentors, and/or community education team to develop presentations, which may include hospital teams, schools, parent groups, pediatricians, and other community organizations.
All fellows have the opportunity to serve as a teaching assistant for a seminar or rounds throughout the training year. Teaching assistantship assignments are determined based on fellowship track and fellow interests. As a teaching assistant, fellows will work with a faculty mentor to develop competencies in designing didactic series for psychology trainees, formal presentation skills, ways to facilitate meaningful discussion, and how to elicit seminar feedback from participants.
Training Program Seminars
Postdoctoral Fellow Seminar (weekly, year-long)
Professional Practice Seminar (weekly, year-long): includes Diversity, Ethics, & Supervision Seminars
Child and Adolescent Psychological Principles Seminar (occurs weekly, fellows may serve as teaching assistants and assist in coordinating the seminar, attend at least 5 weekly sessions to address any training gaps and all trainee presentations)
Diversity, Equity and Inclusion Training: In addition to the topics on DEI embedded in each Seminar series, there will also be several trainings provided during the year for the entire Department in which Fellows will also participate.
Advanced Neuropsychology Seminar (weekly, year-long): required for neuropsychology fellow, optional for other fellows
Child and Adolescent Assessment Seminar (occurs weekly, the neuropsychology fellow would serve as a teaching assistant, other fellows may attend any sessions to address any training gaps)
CHiSPA (bi-weekly): This seminar is for students who speak Spanish Pediatrics Grand Rounds (weekly)
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 as time permits.
Postdoctoral Fellowship Seminar:
This seminar is held weekly 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.
Professional Practice Seminar:
This seminar consists of three main topic areas; diversity, ethics, and supervision. It is designed to focus on learning and application to your clinical work that supports increased competency in these three areas. The diversity series within the seminar consists of department wide diversity, equity, and inclusion training opportunities that are interactive in nature and consists of self-exploration activities. In addition, there will be seminars that focus on unique diversity aspects of patient populations and exploration of the surrounding community. While we expect diversity awareness to permeate all of your work throughout the year, this seminar is designed to help you develop your model of learning and practice. The ethics series within the seminar focus on cases in medical settings that bring a multitude of ethical challenges, which can be complex and difficult to identify a clear path forward. In this seminar, faculty present cases they have worked on that have presented ethical challenges. In these interactive presentations, faculty and interns discuss systems and strategies to assess ethical dilemmas and determine courses of action. The supervision series within the seminar are focused on models and theories of supervision, roles of the supervisor and setting up supervisory relationships, assessing supervisee competency, and providing feedback, including evaluative feedback.
Children and Adolescent Assessment Seminar (CAAS):
This weekly seminar focuses on topics relevant to assessment and evaluation within the practice of Psychology with children and adolescents. Presentations will focus on various evidence-based assessment approaches for youth, as well as assessment considerations when working with specialized pediatric populations. We will also have guest speakers from other disciplines that psychologists frequently collaborate with on multidisciplinary teams. Postdoctoral fellows make formal case presentations in the Child and Adolescent Psychological Principles Seminar or Child and Adolescent Assessment Seminar in an area highlighting their expertise. In addition, they present cases, facilitate consultation, or make informational presentations in Diversity Seminar, Postdoctoral Fellowship Seminar, Ethics, and CHiSPA.
Children and Adolescent Psychological Principles Seminar (CAPPS):
This weekly seminar focuses on topics relevant to the practice of Psychology with children and adolescents. Presentations will focus on various evidence-based treatments for youth, as well as use of these treatments in specialized pediatric populations. We will also have guest speakers from other disciplines that psychologists frequently collaborate with on multidisciplinary teams. This will be an opportunity to learn how different disciplines function both at CHOC and as a broader specialization with youth and how psychologists can help integrate skills on a team to better serve the mental health needs of children and adolescents. Postdoctoral fellows make formal case presentations in the Child and Adolescent Psychological Principles Seminar or Child and Adolescent Assessment Seminar in an area highlighting their expertise. In addition, they present cases, facilitate consultation, or make informational presentations in Diversity Seminar, Postdoctoral Fellowship Seminar, Ethics, and CHiSPA.
Postdoctoral fellows may serve as teaching assistants for Professional Practice Seminar, CAAS, or CAPPS and help to coordinate the seminar. They alternate attending the seminar throughout the year and all fellows attend all trainee presentations at the end of the year.
Training Opportunities for Spanish Speaking Fellows:
Our fellowship is dedicated to providing training opportunities for fellows who speak Spanish. These experiences include the ability to conduct evaluations, consultations, and treatment in Spanish.
In addition, interns who speak Spanish have the opportunity to participate in a monthly seminar, CHiSPA, led by several bilingual faculty and staff members The seminar is designed to help increase skills in and comfort with conducting psychological interventions and assessments in Spanish. Activities include working on psychological vocabulary, practice in discussing cases, case conceptualizations in Spanish, and cultural modifications of interventions for Spanish speaking populations. The goal of the seminar is to provide support and build on participants’ individual strengths. You will attend seminar monthly, as well as have individual supervision in Spanish with a Spanish speaking faculty member.
We currently have 7 full time licensed psychologists and 1 in the licensure process (Dr. Mery Taylor, Dr. Carlos Konishi, Dr. Adrianne Alpern, Dr. Wendy Gray, Dr. Micaela Thordarson, Dr. Katelyn Anderson, Dr. Sarah Ruiz), 9 full time social workers, as well as 1 part time licensed psychologist (Dr. Elisa Corrales) who are bilingual in Spanish.