Program Information

Location

Our internship is housed within the Children’s Hospital Michigan Department of Psychiatry/Psychology which is located at University Health Center, Suite 4B on the Detroit Medical Center Campus. Interns are provided offices with phones and computers. Telehealth equipment such as webcams and headsets for telehealth are included. Outpatient therapy patients and psychological assessment cases are primarily seen within the same suite. The Children’s Hospital of Michigan inpatient units are available via tunnel. Other training activities occur at sites within walking distance including the Children’s Hospital of Michigan Specialty Center and The Children’s Center of Wayne County.

The City of Detroit has been experiencing a significant renewal over the past 10 years. Our downtown area has become home to many young professionals who have found housing in both brand new apartment buildings and refurbished historic buildings. Our recent interns have enjoyed living in the city. Our downtown is home to four professional sports teams, museums, theaters, riverfront walking and biking trails, award-winning restaurants and hotels, shopping, year-round festivals, and the QLine streetcar. We are located just across the river from Canada, 30 minutes from Ann Arbor, Michigan, and less than 5 hours from Chicago, Toronto/Niagara Falls, Cleveland, and Pittsburgh. The state of Michigan offers some of the most beautiful outdoor and lakeshore scenery in both the Lower Peninsula (the “mitten”) and in the Upper Peninsula (the “U.P.”). In fact, Michigan has the nation’s longest freshwater coastline including two National Lakeshore Parks (Sleeping Bear Dunes and Pictured Rocks). You can find more travel information about Detroit here and about Michigan here.

Key Activities of Program

• Two training tracks with many similarities but different emphases. Track 1 is focused on general pediatric psychology; Track 2 is focused on pediatric neuropsychology.
• Two six month rotations:
  • Clinics Rotation includes three medical specialty clinics per week (e.g. Pain, Burn, HIV, Hem/Onc, Myelomeningecele), half day in each clinic. Multidisciplinary team meetings occur for some of these clinics. Pediatric Psychology (Track 1) interns start here.
  • Neurocognitive Rotation includes Pediatric Neuropsychology, Neurodevelopmental Disorder Clinic, and Concussion Clinic. Pediatric Neuropsychology (Track 2) interns starts here.
• Therapy: 12 months, totaling at least 100 contact hours of therapy by the end of the internship. Three to four therapy supervisors. Four to six cases per week. Therapy often includes inpatients as well as outpatients.
• Inpatient Pediatric Consultation: 12 months, up to two consults per week.
• Inpatient Rehabilitation Services: 12 months, up to two assessments per month, performed in teams.
• Weekly Didactic Seminars: Pediatric Psychology (includes intern dissertation presentations), Pediatric Neuropsychology, Pediatric Grand Rounds (when applicable)
• Supervision: At least two to three hours per week individual and three hours per week of group supervision. All supervision is face-to-face. or over secure video conferencing.
• Monthly Conferences: Psychiatry/Psychology Case Conference (including intern case presentations), Pediatric Psychology Journal Club
• Research Elective available

Detailed Description of Program

Overview

The interns complete two six-month rotations: the Clinics Rotation and the Neurocognitive Rotation. Each of the interns begins the training year immersed in their primary areas of interest in order to provide extensive exposure and training which will enhance their preparation for post-doctoral position applications. During the second half of the training year, interns will be exposed to additional opportunities to round out their training experience. Year-long activities include therapy cases, inpatient psychology consultations, attending supervision, and didactic seminars.

Children’s Hospital of Michigan has received a Health Resources and Services Administration (HRSA) Graduate Psychology Education (GPE) grant (#D40HP33377) which supports intern stipends and provides enhanced education and training to interns and faculty in telehealth, motivational interviewing, trauma, pain management, and opioid/substance use disorders within an interdisciplinary setting. Trainings include collaborations with Pharmacy, Child Life, and other disciplines. The internship Training Director, Jill Meade, Ph.D., serves as Program Director on the grant.

Rotations

Clinics Rotation:Pediatric Psychology (Track 1) interns start here. For six months, interns participate in the Clinics Rotation where they gain experience providing behavioral health services within multidisciplinary clinics for three half days per week. This experience addresses the following two Program Specific competencies of our internship:

• Develop skills in working with multidisciplinary teams.
• Develop understanding and treatment skills for the treatment and prevention of chronic illness in children and adolescents.

Most of the clinics served are chronic illness clinics where interns become familiar with the unique medical and psychological aspects of a specific chronic illness, as well as empirically-based assessment and treatment of that disease. Together with the supervisor, the intern learns to conduct psychosocial screenings with the patients and families in each clinic, including assessing mental health functioning, coping with illness, regimen adherence, school functioning and developmental status, peer functioning, and family functioning. Brief interventions and/or referrals are provided as needed, and information is shared with team members. These clinics are by definition multi-disciplinary, with the core team comprised of physicians, social workers, nurses, dieticians, psychologists, and more. The exact clinics have varied slightly from year to year, depending upon feedback from previous interns, scheduling, and staffing. Clinics served by the interns may include Pain Management, Burn, Oncology, Diabetes, Sickle Cell, Pediatric and Youth HIV, Myelomeningocele, Developmental Assessment, and others.

Neurocognitive Rotation: Pediatric Neuropsychology (Track 2) interns starts here. The Neurocognitive Rotation includes six months of participation in Pediatric Neuropsychology, Neurodevelopmental Disorders Clinic, and Concussion Clinic.

In their work with Pediatric Neuropsychology, interns learn, administer, and interpret neuropsychological test batteries for children with various neurologic disorders. They will receive guided instruction in all the professional aspects of neuropsychological evaluation including test interpretation and report writing, and providing feedback to families. Interns have the opportunity to observe intracarotid amobarbital procedures, language and motor electrical stimulation mapping, fMRI studies, and to participate in multi-disciplinary team evaluations of children undergoing epilepsy surgery (all pending occurences of each).

Interns devote a full day to Neurodevelopmental Disorder (ND) Clinic where interns p articipate in comprehensive assessments of children suspected of having autism spectrum disorders and/or other neurodevelopmental disorders, including ADHD and learning and intellectual disabilities. Interns are trained to use a range of validated measures to assess autism spectrum disorders and developmental disabilities, and they participate in formulating and recommending educational and behavioral interventions for the children whom they have evaluated.

Interns also participate in the Concussion Clinic which is a multidisciplinary clinic co-staffed by neurologists, physiatrists, and nurses. In the concussion clinic, interns will learn to evaluate and manage the cognitive and emotional symptoms of concussion. Patients are typically first seen when facing acute symptoms and then are followed in the clinic as their symptoms resolve and they return to full contact sports, school, and social participation.

The Neurodevelopmental Sub-rotation is a new option offered for the Pediatric Psychology Track interns as an alternative to the traditional Neurocognitive Rotation. These modifications will help the intern gain increased competence with developmental conditions such as Learning Disability, Attention-Deficit/Hyperactivity Disorder, Autism, Fetal Alcohol Spectrum Disorders, emotional and behavioral disorders, the interplay between medical history and emotional/cognitive/and social functioning, and differential diagnosis. In addition to school-aged children, interns may also be able to gain experience with neuropsychological assessment in preschoolers.

Twelve-Month Activities

Inpatient Psychology Consultation Liaison

Throughout the internship year, interns participate in inpatient consultation-liaison services for approximately 2-4 hours per week. These consultations involve psychological screening, evaluation, and recommendations for the Children’s Hospital of Michigan inpatients at the request of the medical teams. Inpatient teams may ask psychology to evaluate patients for mood or anxiety disorders, pain or illness coping, or need for therapy. Often interns can follow these patients for therapy after discharge. Consults may also involve providing treatment while patients are in the hospital for such things as eating or feeding disorders, adjustment to injuries, trauma, behavior problems, depression/anxiety, and/or Somatic Symptom and Related Disorders.

Inpatient Rehabilitation Services

Twice per month (pending patient referral volume), the intern conducts assessment of children hospitalized for traumatic brain injury, orthopedic problems, spinal cord injuries, spina bifida, and other rehabilitation issues. The intern can participate in the daily activities of the multidisciplinary teams on the inpatient Rehabilitation unit. Assessment follows a recovery model in which the timing and components of the neuropsychological battery are tailored to the recovery status of the child and to the specific referral questions that are being addressed. Interns will learn to write targeted consultation reports and to provide recommendations based on the recovery status of the child. The interns also participate in inpatient rehabilitation team rounds. The rounds allow them the opportunity to learn about acute phases of brain injury, as well as rehabilitation treatments and programs. On the Rehabilitation Unit, pediatric psychology consultation and treatment focus on identifying and treating psychological factors that interfere with a child’s participation in rehabilitative therapies.

Therapy

Interns are required to have and document a minimum of 100 hours of therapy to graduate from our internship. We have found that interns must maintain a case load of 4-6 cases in order to have 3-4 hours of actual therapy sessions per week and attain the 100 or more therapy contact hours. Most of the cases come from the Children’s Hospital of Michigan specialty clinics, primary care clinics here, or inpatient consults. Supervision in Empirically-Based Treatment is provided by internship faculty.

Didactic Seminars

Pediatric Psychology Didactic Seminar involves presentations by faculty members and outside speakers on a variety of topics related to the medical specialty and pediatric psychology clinics and consults that the interns encounter in our setting. Psychopharmacology, ethics, professional issues, self-care and cultural/ethnic topics are also covered. Interns each present their disseration to the department. Pediatric Neuropsychology Seminar and Case Conference focuses on developing skills in the interpretation of cognitive deficiency patterns from test data (including the WISC-V and a full range of neuropsychological tests). The format is to practice blind interpretation of data derived from a library of cases collected by Robert Rothermel Jr., Ph.D. A monthly Children’s Hospital of Michigan Psychiatry/Psychology Case Conference allows interns and psychiatry trainees to formally present cases and engage in multidisciplinary discussions. Interns also have opportunities to attend the weekly Children’s Hospital of Michigan Pediatric Grand Rounds.

Research Elective

Interns can participate in research by developing a Research Elective in place of some Neuropsychology activities. Interns can explore research opportunities in our Department and with our partners at Wayne State. Options include working on a particular faculty project or developing a spinoff project. Generally interns who opt to complete a research elective leave with at least one publication in a peer-reviewed journal or a chapter coauthored with a faculty member.

Supervision

Interns receive a minimum of two hours of individual and three hours of group supervision per week. Supervisors often are in the room with the interns during medical specialty clinic patient encounters, so that supervision takes place instantaneously after the patient visit. Interns will be able to practice supervising others such as peers and practicum students within group therapy supervision, neuropsychological assessments, and multidisciplinary clinic work.

Across all clinical activities there is a sequential process of learning. The supervisor models the interview; then, the intern conducts part of the interview with assistance from the supervisor; later, the intern conducts the entire interview and receives feedback afterwards from the supervisor. With regard to testing, the supervisor at first watches the intern administer various psychological tests to the patients. When the supervisor is satisfied that the intern is competent with test administration, the supervisor no longer observes the testing, but reviews it afterwards with the intern. The supervisor reviews all of the reports, case notes, and treatment forms completed by the intern and provides the intern with constructive feedback.

Evaluations

We have three mechanisms of providing interns with formal written feedback in a timely manner: Clinic Checklists: Most of our clinical activities have an associated Clinic Checklist. The supervisor observes a specific interaction between you and a patient/family, and the checklist is used to rate your interactions with the patient and family. Progress Reports: At the 3 and 9 months intervals in the internship, each supervisor completes a Progress Report. The Rotation Competency Evaluation (RCE) is completed at the end of each rotation (end of February and end of August). Both the Progress Reports and the RCE assess interns on the nine SoA Core Profession-Wide Competencies and the three program specific competencies.

The interns anonymously evaluate the faculty at the six- and 12-month intervals. Frequent evaluations provide the interns with a great deal of positive feedback regarding the performance and help the faculty customize their teaching and supervision to the needs of the interns.