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.
Up to six of the clinical fellowships will specialize in Pediatric Psychology, including two-three fellowship positions specializing in Consultation and Liaison services on medical floors with opportunities to work with our Medical Stabilization of Eating Disorders program and three fellowships working with our Pediatric Psychology Project Health program offering mental health services to children with co-occurring medical and mental health conditions. One two-year fellowship will focus on pediatric neuropsychology, working with the Neurology, Cardiac, and/or Neuro-Oncology Services, with a focus on neuropsychological assessment. Two fellowships will work with our Acute Services within our mental health inpatient center, emergency department, and intensive outpatient program. Two fellowships with work within our Thompson Autism and Neurodevelopmental Center providing assessment and intervention services. 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 multidisciplinary team members, and complete a postdoctoral fellowship project which could be submitted as a poster or 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. Children with chronic illnesses 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, targeted interventions and 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 children with chronic illnesses 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 conditions 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.
A distinctive feature of our program is that pediatric psychology fellows receive training in managing behavioral emergencies through the provision of consultation services to the hospital inpatient medical units. The fellows will take 2-5 call days on a holiday or weekend during the training year. Fellows will be compensated for their time. Fellows 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 targeted clinical interview, provide crisis intervention, and generate disposition plans.
I. Consultation and Liaison Track (2-3 positions):
Two-three fellows will work with the Consultation and Liaison (CL) team which provides inpatient consultation to the medical units at CHOC Hospital in Orange and/or CHOC at Mission Hospital. Consults are requested by attending physicians, residents, nurses, or other health care practitioners for children who are hospitalized due to a medical need and are experiencing concomitant psychological symptoms. Referral questions range widely and include assessment and disposition planning for behavioral emergencies, assisting with adjustment to new diagnosis, diagnostic clarification for potential somatization disorders, proving target symptom reduction for pain and somatization disorders, facilitating problem-solving to address medical regimen adherence concerns, assessment and targeted intervention for acute stress reactions, and leading a family-based treatment approach to treat eating disorders. The Psychology Consultation Liaison team includes psychology attendings, psychology postdoctoral fellows, psychology interns, and resource specialists. The Psychology CL team works very closely with the Psychiatry CL team and round together daily. The Psychiatry CL team includes a child and adolescent psychiatry fellow and a psychiatry attending. The fellows work with interdisciplinary teams including medical attendings and house staff (medical residents and fellows, medical students), nurses, social workers, child life specialists, and case managers. Depending on the diagnosis, physical and/or occupational therapists, dieticians, pharmacists, and other specialists might also be involved.
Fellows also may have the opportunity to work with our 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. Fellows work closely with the attending psychologists, hospitalists, nutritionists, child life specialists, psychiatry, and adolescent medicine specialists. Patients are admitted with a variety of eating disorder presentations that require medical stabilization (e.g., Anorexia Nervosa, ARFID, Bulimia). Fellows receive training in a Family-based Treatment (FBT) approach and implement adapted FBT principles and interventions 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 provide diagnostic evaluations, parent and patient psychoeducation, individual and family interventions, and facilitate group meals and group therapy.
Fellows may have the opportunity to provide education and support to the medical residents and fellows in both informal and formal presentations.
In addition to the experiences working with the medical teams described above, the fellow will participate in a range of other pediatric psychology experiences described below in the section, “Activities Common to All Tracks.”
II. Pediatric Psychology Project HEALTH Medical and Mental Health Program Track (3 positions):
Three fellowship positions are within our Pediatric Psychology Project HEALTH Medical and Mental Health Program Track, specializing in providing outpatient therapy to patients with co-occurring medical and mental health diagnoses. Our pediatric psychology Project HEALTH (Harnessing Every Ability for Lifelong Total Health) program provides intensive intervention services for children, adolescents, and young adults (ages 3-21 years) with both medical and mental health conditions who need additional services beyond weekly therapy. Our Project HEALTH team highly values serving patients and families from a range of cultural and linguistic backgrounds, as well as gender diverse youth. Project HEALTH is a collaborative program between CHOC 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, coordination of care, and case management) to children and families with a broad range of complex medical and co-occurring psychological/ psychiatric diagnoses (e.g., oncology, genetic disorders, diabetes and other endocrine disorders, eating disorders, depression, anxiety, and complex trauma). Fellows have the opportunity to provide long-term therapy with patients and families and collaborate work with multidisciplinary team members including Personal Service Coordinators (PSC), psychiatrists, medical and other allied healthcare professionals, and schools. Fellows will also have the opportunity to participate in workshops and evidence-based trainings provided by Orange County Behavioral Health.
Project HEALTH Oncology Specialization
In addition to providing outpatient therapy services, one-two positions will include a year-long rotation within Oncology (inpatient and outpatient services). The Oncology rotation involves working with infants, children, adolescents and young adults with various types of cancer to conduct universal psychosocial screening and provide mental health support throughout their medical treatment and frequently beyond. Psychology has an important role in CHOC’s Oncology Program and supports patients and families across the care continuum. Often psychosocial services begin at, or shortly after diagnosis, and are available to patients and families as they navigate the unique challenges when receiving a cancer diagnosis, throughout active treatment, during long-term post treatment care, and during survivorship. Patients are seen across both inpatient (e.g., medical floors and intensive care units) and outpatient settings (e.g., outpatient infusion center, oncology medical clinics, outpatient psychology) to provide continuity of care throughout their medical treatment. Fellows will also work closely with the multidisciplinary medical team of oncologists, medical fellows/residents, nurse practitioners, nurses, and oncology psychosocial team (social work, child life, spiritual care, art therapy, music therapy, pet therapy) as a consultant and liaison to coordinate care.
The Oncology team at CHOC is involved in many cutting-edge research endeavors. Psychology Fellows will have the opportunity to engage in research and/or clinical projects, and take a leadership role in program development. These projects are supported by primary psychology mentors within the psychology oncology team. Current ongoing endeavors include sibling and parent group therapy opportunities, expanded support in medical clinics and unique needs of patients in remission and their families, and school-based psychoeducational services.
Project HEALTH Additional Specialization Areas
One interested fellow may have the opportunity to work with our Medical Stabilization of Eating Disorders Service at CHOC at Mission Hospital and/or CHOC Orange campus. Patients are admitted to CHOC for medical stabilization of a range of eating disorders (e.g., Anorexia Nervosa, ARFID, Bulimia). The Medical Stabilization of Eating Disorders program uses a modified Family-Based Treatment (FBT) approach for an inpatient setting. Fellows would be involved in providing consultation-liaison services, conducting comprehensive diagnostic interviews, providing parent and patient psychoeducation, and conducting warm hand-offs and linking to outpatient care as part of the disposition planning. Fellows may have the opportunity to provide inpatient brief, targeted individual and family intervention and meal coaching.
One fellow may have the opportunity to work within CHOC’s Gender, Puberty, and Sex Development (GPS) clinic, a multidisciplinary medical clinic for transgender and gender diverse youth. Fellows would conduct assessments and brief interventions with gender diverse youth and families from a range of cultural, linguistic, and religious communities; coordinate closely with the multidisciplinary medical team; and provide short-term therapy to gender-diverse youth. Depending on their interests and training goals, fellows in GPS clinic will also have opportunities to cultivate relationships with community agencies (e.g., the LGBTQ Center of Orange County), develop training materials for medical and mental health providers, and participate in program development and evaluation.
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 designed to meet Division 40 Houston Conference Guidelines):
In this track we have 1 first year and 1 second year fellow position. The fellowship offers a major area of study in clinical neuropsychology which adheres to the Houston Conference Guidelines for specialty training. Fellows will work closely with our 6 board-certified and board-certified eligible neuropsychologists in performing pediatric neuropsychological assessments for a wide range of populations, with a focus on pre-surgery epilepsy evaluations, oncology brain tumor and long-term cancer survivorship evaluations, cardiac neurodevelopmental evaluations, and neuro-metabolic conditions. CHOC has a Level IV Epilepsy Center with a busy EEG monitoring program and also conducts epilepsy surgeries. Additionally, CHOC’s Cardiac Neurodevelopmental Program is a member of the Cardiac Neurodevelopmental Outcome Collaborative and participates in national multi-site clinical and research initiatives. First-year fellows also participate in our unique Multidisciplinary Concussion Clinic.
Educational training experiences include our biweekly Advanced Neuropsychology Seminar which includes both fellows and faculty neuropsychologists and focuses on neuropsychological populations, neuroanatomy, case conceptualization, and literature, in addition to biweekly preparation for board certification (e.g., fact finding). Fellows also serve as lecturers and teaching assistants for the weekly Child and Adolescent Seminar and 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. Additional weekly seminars focused on professional development, supervision, and ethics are offered through the broader CHOC psychology fellowship. Fellows will also have the opportunity to deliver presentations on neuropsychology related topics within our training program seminars, hospital, and/or community.
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 (2 positions):
Two fellows 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 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 (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.
In addition to the experiences described above, the fellow(s) will also participate in a range of other child/adolescent psychology experiences described below in the section, “Activities Common to All Tracks.”
Activities Common to All Tracks:
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.
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, assessment 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.
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 the psychology training program, hospital teams, schools, parent groups, pediatricians, and other community organizations.
Teaching Assistantship/Department Committee Representative
Fellows have the opportunity to serve as a teaching assistant for a seminar or rounds or serve as the representative for the training program on a department committee during the training year. Teaching assistantship/department committee 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. As a department committee representative, fellows will attend department committee meetings as scheduled, serve as a liaison between the committee and the training class, illicit feedback from the training class and present to the committee, and provide feedback back to the training class regarding relevant issues raised at committee meetings.
Training Program Seminars
Postdoctoral Fellowship Seminar (once weekly for 1 hour, year-long)
Professional Practice Seminar (once-twice monthly for 2 hours, year-long): includes Diversity & Ethics Seminars
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 (twice monthly for 1 hour, year-long): required for neuropsychology fellow(s), optional for other fellows
CHiSPA (twice monthly for 1 hour): required for students who are proficient in Spanish
Child and Adolescent Assessment Seminar (twice monthly for 2 hours, year long; fellows may serve as teaching assistants and assist in coordinating the seminar, attend any seminars of interest or to address any training gaps, attend trainee presentations)
Child and Adolescent Psychological Principles Seminar (twice monthly for 2 hours, year long; fellows may serve as teaching assistants and assist in coordinating the seminar, attend any seminars of interest or to address any training gaps, attend trainee presentations)
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 two main topic areas; diversity and ethics. It is designed to focus on learning and application to your clinical work that supports increased competency in these 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.
Children and Adolescent Assessment Seminar (CAAS)
This bi-monthly 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 bi-monthly 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 have the opportunity to attend seminar twice monthly, as well as have individual supervision in Spanish with a Spanish speaking faculty member.
We currently have 11 full time licensed psychologists who are bilingual in Spanish, in addition to bilingual and bicultural department mental health providers.