CHOC Pediatric Psychology Fellowship

Pediatric Psychology Post-Doctoral Fellowship (2 positions)

Childhood chronic illness 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 normal 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 post-doctoral fellowship at CHOC seeks to train psychologists to work effectively with medically fragile children and their families within the context of hospital based inpatient and outpatient services. This is a particularly exciting time to be a part of pediatric psychology as the medical field increasingly understands the critical role of psychological factors in overall health and is thus increasingly involving psychology services 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 illness 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 therapy. In addition to the intensive experiences with children with medical diagnoses, fellows will work with more traditional child outpatient therapy and assessment cases.

There are two fellowship opportunities, with separate areas of focus. One fellow will primarily work with the oncology program and one fellow will primarily work with CHOC Consultation and Liaison Team. Fellows will coordinate with the respective medical 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 with the medical teams. They will participate in outpatient clinics with the multi-disciplinary medical teams, provide inpatient consultation services to patients followed by the medical team, and potentially submit a poster or write a paper within their area of specialization.

I. Oncology Track: The fellow will work with the Oncology Medical team and the interdisciplinary psychosocial team (which includes psychologists, social workers, child life specialists, teachers, and chaplain) to provide coordinated services to children diagnosed with cancer and their families. Fellows will be involved with the new diagnosis program, which includes initial coping assessments of all newly diagnosed patients and their families. In addition, the fellow may assist in school reintegration activities, which includes working with children who are ready to return to the school setting after completing their intensive treatment or who are struggling in school after completing their treatment. Activities might include assessments to determine their particular learning strengthens and challenges, working with schools to develop appropriate educational programs (which might include attending IEP meetings), attendinding educational programs in the schools to fellow students and/or teachers, or providing psychotherapy to reduce anxiety or depression. The fellow will attend Long Term Survivors Clinic. Children who have completed their medical treatment for cancer are followed annually through this clinic. Psychosocial needs are evaluated and the fellow will assist in providing referrals and services to these families.

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 Both Tracks.”…

II. Consultation and Liaison Track: The fellow will work with the Consultation and Liasion Team which provides inpatient consultation to the medical units at Children’s Hospital of Orange County. 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, acute stabilization of children or adolescents with eating disorders, neurologic complications, acute stress reactions. The fellow will work with interdisciplinary psychosocial teams (social workers and child life specialists) as well as with nurses, medical attendings and house staff (medical interns and residents) as well as medical students, and case managers. Depending on the diagnosis, physical and/or occupational therapists, dieticians, pharmacists, and other specialists might also be involved. Fellows will attend medical rounds on several floors to provide information to medical professionals. The fellow will also have an opportunity to work with the interdisciplinary Hematology team which consists of physicians, nurses, physical therapists, social workers and psychologists and provides treatment to a wide range of children with hematologic disorders and bone marrow mediated disorders (including certain congenital immunodeficiencies).

Activities Common to Both Tracks:

Screening Clinic: The fellow in the Pediatric Psychology track will have the opportunity to participate in and eventually supervise interns participating in the CHOC Department of 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 psychological services. Participation in this clinic provides fellows the ability to refine their skills in rapid interviewing, diagnosis, and essential treatment planning, and then potentially teach these skills to interns by providing supervision under the guidance of a faculty member

Outpatient Therapy: The fellow on this track will also 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. 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.

Assessment Clinic: Fellows also have the opportunity to participate in the Department of Psychology Assessment Clinic over the training year. 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. For those Fellows who are Spanish speaking, we have a library of Spanish assessment instruments and can provide training in bilingual assessment. Fellows will complete approximately 5 - 6 assessments over the year.

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 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. Trainees 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. The Post-doctoral fellow will participate in no more than 10 weeks of call per year.

Supervision

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 Hospital’s Medical Staff qualifications.

Fellows are offered at least two hours of individual supervision per week for ongoing therapy cases and rotational experiences. Supervision of the consultation-liaison service 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 supervisor who will work with them throughout the year on more long term outpatient therapy cases. For Fellows who are Spanish speaking, we do offer a weekly Spanish group supervision which focuses on working with Latino families, providing practice and guidance in explaining psychological and medical diagnoses and treatments in Spanish, and case presentations.

Training Program Seminars

Pediatric Psychology Seminar (weekly)
Assessment Seminar (weekly)
Multiculturalism & Ethics Seminar (weekly, each approximately 5 months)

Seminar content is focused on the material needed for CHOC clinical activities and to aid in the further development in your role as a child/pediatric psychologist in general. 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. Post-doctoral fellows will also be expected to present at least two seminars during the training year to enhance their professional development. Fellows may also attend the CHOC Grand Rounds and Pediatric Residency Seminar Series, time permitting.

Support Group

A process group is provided for the interns and fellows weekly and is led by adjunct faculty who is not involved in any training evaluation. The group is intended for support and is not therapy oriented.