Pediatrics-Psychology Internship Rotations

spoon and cherry

The primary training activities are organized through three rotations: (a) Child and Adolescent Psychiatry; (b) Pediatric Neuropsychology; and (c) Pediatric Psychology. Interns participate in two of the three rotations. In general, limited clinical experiences within the third rotation or with other services may be negotiated at the discretion of primary supervisors and the supervisors of the third rotation. Detailed descriptions of rotations are given to interns at the beginning of the rotations and may be reviewed at the time of interviews for the Internship.

The National Matching Services computerized matching system matches interns with their choice of rotations through their choice of tracks (i.e. combinations of two rotations). Applicants are strongly encouraged to apply separately to each track (i.e., pairs of rotations) in which they would be interested to participate. In other words, applicants are advised to rank all three tracks (i.e., 3 actual rankings) in the list they submit to the NMS for the computer match. Most applicants ultimately rank the internship three times when submitting rank orders to the APPIC-NMS match according to their preferences among the three tracks. In other words, applicants have three chances to apply to the Internship when they submit their rank order lists. This allows them to have maximal opportunity to determine their rotations as interns. 

Final rotation assignments (i.e., the sequence of rotations) have generally been determined after the match, based on input from the faculty and interns. In rare circumstances it may be necessary to negotiate changes in rotations later in the year in response to unforeseen developments.

Child and Adolescent Psychiatry

3 girls running outside

The Child and Adolescent Psychiatry rotation is in the Division of Child and Adolescent Psychiatry of the Department of Psychiatry. It provides opportunities for assessment and intervention with children and adolescents experiencing a broad range of psychopathology. Psychological assessment  is an integral part of this rotation. Interns gain experience in conducting psychiatric interviews, as well as intellectual, neuropsychological evaluations, and personality evaluations. Psychotherapy is an important component of  this rotation. This rotation provides the greatest opportunities for psychotherapy within the Internship. Interns are assigned to outpatient clinical settings and maintain outpatient therapy caseloads throughout the rotation. Interns are supervised directly by psychology and psychiatric faculty, and consult with additional faculty members and fellows about psychopharmacological interventions.

In the outpatient clinics, interns provide diagnostic evaluations and formulate comprehensive treatment plans. As part of the assessment process, interns are expected to collaborate closely with schools and other agencies to ensure accurate interpretation of evaluations, and to assist in implementing and assessing the outcome of intervention programs. Interns also participate in providing feedback to patients, families, and other professionals, and complete comprehensive psychological reports. The range of experiences in the outpatient clinics vary, and include participation in the following specialized clinics: 

  • Anxiety and Mood Disorders Clinic with Dr. Bernstein
  • Neuropsychology Clinic with Dr. Wozniak
  • Dialectical Behavioral Therapy (DBT) Clinic with Dr. Miller         

Interns are introduced to several empirically supported treatments including behavioral, cognitive-behavioral (CBT), dialectical behavior therapy (DBT), and interpersonal psychotherapy (IPT). Diverse cognitive and behavioral therapies are offered for children and adolescents with internalizing disorders such as depression, anxiety disorders, phobias and stress related disorders. Interns will also be involved in providing DBT to adolescents. The Child and Adolescent Psychiatry Clinic provides these therapies within the context of outpatient individual, group and family therapy modalities. Supervision from other supervisors may also be arranged. Supervised therapy experiences include:

  • CBT for various conditions with Dr. Zagoloff (including Trauma-Focused CBT)
  • IPT and CBT for mood disorders and anxiety disorders with Dr. Gunlicks-Stoessel
  • DBT for various conditions with Dr. Miller and Dr. Long

In addition to these structured supervision experiences, interns will also receive supervision from Dr. Lingras and Dr. Pisetsky on child and adolescent cases (both are new faculty members whose contributions to the internship are being formulated at present).  Interns are expected to complete an average of approximately 15-20 hours per week of direct clinical service delivery throughout the rotation (i.e., including assessment, therapy, and possibly consultation). Additional time is devoted to supervision, didactics, and documentation. Across the internship, approximately 50% of interns' clinical activity typically involves diagnostic interviewing and psychological assessment. Approximately 50% of interns' clinical activity involves therapeutic activities. Interns receive a minimum of two hours of individual supervision per week and participate in additional group supervision along with other interns, practicum students, psychiatric residents and fellows, and other staff and faculty. There may be opportunities for interns to participate in co-therapy with supervisors. Interns participate in Departmental and Division activities, including Anxiety Roundtable, Grand Rounds of the Department of Psychiatry, and other selected seminars and courses.

Interns who choose the Child and Adolescent Psychiatry rotation can expect to see a broad range of patients in the outpatient clinic. This prepares them for a range of mental health positions that span the continuum of severity of psychopathology. Two of the faculty psychologists for this rotation were interns in the Division of Child and Adolescent Psychiatry.

Interns on the Child and Adolescent Psychiatry rotation participate in several conferences and case supervision. These experiences are at the University of Minnesota Masonic Children's Hospital (Riverside Campus).

Monday

  • Case supervision following patient evaluations and prior to providing feedback in Child and Adolescent Psychiatry Clinic.
  • DBT Clinic from 9:00 until 11:00 AM with Michael Miller, Psy.D.
  • Psychotherapy in the afternoon·          

Tuesday

  • Tuesday is reserved for formal didactics.  Interns on the Child and Adolescent Psychiatry rotation are required to attend the following activities which are described in previous sections:
  • Psychotherapy Seminar: 11:00 - 12:00 PM
  • Psychotherapy Group Supervision: 12:00 - 1:00 PM
  • Topical Seminar: 1:00 – 2:00 PM
  • DBT co-therapy and Family Skills Group: 3:00 - 5:30 PM

Wednesday

  • Case supervision following patient evaluations and prior to providing feedback in Child and Adolescent Psychiatry Clinic.
  • Grand Rounds, Department of Psychiatry, 11:00 - 12:00 PM, Brennan Center, East Building, University of Minnesota Masonic Children's Hospital (Riverside)
  • Psychotherapy in the afternoon

Thursday

  • Anxiety Roundtable from 8:30 - 9:30 AM
  • Case supervision following patient evaluations and prior to providing feedback in Child and Adolescent Psychiatry Clinic.

Friday

  • Case supervision following patient evaluations and prior to providing feedback in Child and Adolescent Anxiety and Mood Disorders Clinic.
  • Case supervision during patient evaluations and prior to providing feedback in Neuropsychology Clinic.

Pediatric Neuropsychology

The Pediatric Neuropsychology rotation is in the Division of Clinical Behavioral Neuroscience of the Department of Pediatrics. It provides a multidisciplinary diagnostic service for children with complex learning and behavioral challenges associated with neurological and neurodevelopmental disorders. Children are referred by schools, clinics, practitioners in the community, and health professionals at the University of Minnesota Masonic Children's Hospital. The Division of Clinical Behavioral Neuroscience serves the community, state, five-state area, and, for specific disease entities, the entire country and internationally. The clinical orientation of the staff is developmental. The approach to neuropsychology is to integrate knowledge from multiple sources (e.g., parents, schools, other involved agencies) to quantify functional deficits developmentally in association with knowledge gained from neurological examinations, diagnostic imaging, neurophysiological, genetic, and other laboratory studies, and medical and psychosocial history. The goal of this rotation is to provide training in pediatric neuropsychology which emphasizes the scientist-practitioner model and follows Houston Conference Guidelines. Although interns’ experience is primarily clinical, there are also academic aspects to this experience, including weekly didactic and related training events, opportunities to engage with research studies, and/or preparation for a postdoctoral fellowship in pediatric neuropsychology. It is strongly preferred, but not required, that interns who participate in this rotation will have undertaken basic coursework and/or practicum level training in child or adult neuropsychological assessment prior to the internship.

Neuropsychological diagnostic services are provided for children with relatively common neurodevelopmental disorders (e.g., attention deficit hyperactivity disorder, autism spectrum disorder, dyslexia, developmental language impairment, learning disabilities, and intellectual disability) as well as for a wide range of neurological or medical conditions that can affect brain development, such as: Tourette’s syndrome, epilepsy, traumatic brain injury, infectious diseases, various forms of cancer, neurotoxic conditions (e.g., lead poisoning), or congenital disorders (e.g., cerebral palsy, agenesis of the corpus callosum, hydrocephalus). Notably, many of the supervisors on the Pediatric Neuropsychology rotation have special expertise in care for patients with rare genetic diseases that have neurodevelopmental or neurodegenerative sequelae. Psychiatric disorders such as depression, anxiety, and conduct disturbances (especially in children with possible attentional and learning difficulties) and somatoform disorders are also commonly assessed. Diagnostic evaluations typically consist of a day-long (or occasionally a multi-day visit) to the Pediatric Neuropsychology Clinic. 

As part of the diagnostic process, interns organize and integrate information about patients and families, including medical and neurological data, neuropsychological assessment data, educational information, interview observations and other data and related history. The focus is on neurocognitive functioning as well as behavioral and emotional aspects of children’s functioning. Both environmental and biological factors are considered in evaluating children in the Pediatric Neuropsychology Clinic. Interns refine skills involving neuropsychological assessment and assessment of emotional and social development through interviews, objective measures, and behavior observations. Interns are supervised closely on every case. Interns receive direct case supervision to promote formulation of diagnostic impressions and treatment recommendations. Interns then participate in feedback meetings in which the results of assessments are communicated to parents. Interns prepare chart notes documenting patient visits, complete formal neuropsychological reports for patients’ medical records, and consult appropriately with physicians and other involved professionals.

In addition to diagnostic assessment and case formulation, interns are expected to follow through with patients to facilitate use of appropriate resources in The University of Minnesota Masonic Children's Hospital or the community. Many patients with neurological and neurodevelopmental difficulties are monitored periodically by both a pediatric neuropsychologist and a pediatric neurologist. This is especially true for patients who are required to take medications and for patients whose interventions require periodic reassessment. Because the University of Minnesota Masonic Children's Hospital is a tertiary care center, monitoring treatments of rare and complicated disorders including transplants, epilepsy surgery, brain tumors, and experimental medication is also conducted, as part of both clinical and research protocols. Also, emphasis is placed on providing consultation regarding educational planning. Meetings with school personnel and telephone consultation regarding placement and interventions are important facets of the consultative process in this rotation. 

Opportunities to learn about brain-behavior relationships from a developmental standpoint are abundant in informal and formal contexts on the Pediatric Neuropsychology rotation. Interns attend a didactic seminar in neuropsychology and present cases at the weekly Pediatric Neuropsychology Group Staffing. The neuropsychology seminar includes weekly didactic presentations by the neuropsychology staff or invited guest lecturers. Attendance at Grand Rounds for the Departments of Neurology and Pediatrics is optional but encouraged.

Research opportunities are varied in the Pediatric Neuropsychology rotation. Ongoing studies address childhood inherited metabolic diseases, effects of bone marrow transplants, social-emotional development in various populations, and a variety of other topics. Interns may participate in a research project or a case study during the year, either independently or as part of a larger ongoing project led by one of their supervisors.

Interns are expected to complete approximately three neuropsychological evaluations per week while on the Pediatric Neuropsychology rotation. Days not in clinic allow interns time to attend training activities, devote attention to clinical management issues, and participate in other professional activities, such as psychotherapy or research. On the Pediatric Neuropsychology rotation, interns are supervised by all of the participating supervisors on the rotation

Postdoctoral fellowships in Pediatric Neuropsychology are sometimes available following the internship year. Several interns have remained within the Pediatric Neuropsychology Division as postdoctoral fellows after completing the internship. 

Monday

  • Case supervision in clinic (only for the interns with cases that day) - 8:30 A. M. to 8:45 A.M. in the Discovery Clinic and after evaluations in clinic rooms (generally for a half hour between 11 A.M. and 3 P.M. [before feedback]).

Tuesday

  • Internship didactics.
  • Pediatric Neuropsychology Clinical Case Conference - 2:00 P.M. to 3:00 P.M. in East Building, Room MB675-2 or the Wilf Conference Center.
  • Neuropsychology Didactics- 3:00 P.M. to 4:30 P.M. in the East Building, Room MB675-2 or the Wilf Conference Center.

Wednesday

  • Optional weekly Department of Pediatrics Grand Rounds7:30 A.M. to 8:30 A.M. in the Wilf Conference Room. 
  • Case supervision in clinic (only for the interns with cases that day) - 8:30 A. M. to 8:45 A.M in Discovery Clinic and after evaluations in clinic rooms (generally for a half hour between 11 A.M. and 3 P.M. [before feedback]). 

Thursday

  • Case supervision in clinic (only for the interns with cases that day) - 8:30 A. M. to 8:45 A.M in Discovery Clinic and after evaluations in clinic rooms (generally for a half hour between 11 A.M. and 3 P.M. [before feedback]).

Friday

  • Case supervision in clinic (only for the interns with cases that day) - 8:30 A. M. to 8:45 A.M in Discovery Clinic and after evaluations in clinic rooms (generally for a half hour between 11 A.M. and 3 P.M. [before feedback]).
  • Optional weekly Neurology Grand Rounds/Case Presentations/Research Presentations 12:00 P.M. to 1:00 P.M. in the Neurology Conference Room (PWB 12-109).

Pediatric Psychology

The Pediatric Psychology rotation is in the Division of Clinical Behavioral Neuroscience of the Department of Pediatrics. It addresses problems of behavior, child development, coping with illness, and learning. It focuses on the developmental and psychological aspects of pediatric medical care. Because a variety of social, educational, psychological and medical factors contribute to childrens’ total well-being, interns on the Pediatric Psychology rotation participate and work cooperatively with many subspecialty services of the Department of Pediatrics. The interdisciplinary approach is utilized because the behavioral, psychological, psychosocial, and medical problems are affected by childrens’ stages of development and often are too complex to be resolved by any single professional or discipline.

Patients are referred to the Pediatric Psychology program both from within The University of Minnesota Masonic Children's Hospital as well as from the community for a broad range of psychological concerns. The patient population comprises both general mental health services and specialty services related to health issues. Psychotherapeutic services may include behavioral therapy, cognitive-behavioral therapy, crisis intervention, family therapy, parent counseling, stress management, supportive therapy, as well as exploration of issues related to chronic illness, death, dying, and bereavement. Interns provide both outpatient and inpatient consultative services, primarily on an individual and family basis. They may also become involved in group interventions. Interns are estimated to direct their time and effort among assessment (50-70%), outpatient psychotherapy (5-20%), and inpatient/outpatient consultation (5-20%) activities. Throughout the rotation interns have opportunities to work with outpatients and medical inpatients. Interns typically complete two psychological evaluations per week on the Pediatric Psychology rotation.

Interns work primarily with child and adolescent patients and have opportunities to work with patients ranging in age from preschool to adult. Because certain medical conditions (e.g., cystic fibrosis) have historically been treated primarily by pediatricians, interns may work with a few young or even middle-aged adults with specific medical conditions. In addition, interns may become involved with the schools, courts, child protection services, and other agencies. The rotation offers the following services:

  • Assessment of Neurodevelopmental Disorders: Standardized psychological tests, structured interviews, and conferences with outside agencies (i.e., education, public health, social services) are utilized in the comprehensive assessment of a variety of neurodevelopmental issues.  Opportunities may be available for participating in developmental assessments of children with fetal substance exposures, metabolic/genetic disorder, late effects of prematurity, organ and bone marrow transplantation recipients, and hematology/oncology patients, international/domestic adoption, and other referrals from medical sub-specialties.  Assessments have a neuropsychological focus including measurements of intelligence, academic achievement, memory, language, executive functions, emotional/behavior functioning, and adaptive behavior.
  • Psychological Management of Patients with Acute and Chronic Illnesses: Pediatric Psychology interns participate as team members in the care and management of patients with diabetes, cystic fibrosis, pancreatitis, obesity, childhood cancer, renal disease, and other chronic issues. The focus is on the promotion of positive adjustment and successful coping in children and families within the context of the continuum of acute, chronic, and life-threatening illness. Systematic parent training programs may be used, as warranted by referrals, to help parents accept and cope with the diagnosis and care of medically ill children. Psychological assessments of patients, parents, and families provide information pertinent to patient management. Psychological evaluations focus on cognitive functioning, emotional and personality development, relationships with parents and siblings, understanding of illness, adherence and participation in care, family composition, parents' management of the child patient and siblings, and family members' support systems. Such profiles of patients and families functioning help in designing and implementing medical and psychosocial care of medically ill children.
  • Management of Common Problems in Pediatrics: Pediatric Psychology interns consult and collaborate with families in the application of behavioral principles in the assessment and management of behavioral and familial problems. Such problems include failure to thrive, recurrent pain, enuresis, encopresis, obesity, anxiety, depression, and fears.
  • Parent Counseling and Developmental Guidance: In primary care settings pediatricians and nurse practitioners have estimated spending approximately 70% of their time counseling parents on developmental and behavioral issues. Because pediatricians see more people during critical developmental phases than do other professionals, they are in unique positions to provide early detection and intervention. The Pediatric Psychology service provides consultation to parents in regard to behavioral management and parent/child relationship issues.
  • Preparation for Medical Procedures and Hospitalization for Children and Adolescents: A child’s experience in the hospital environment can cause transient behavioral disturbances in ranging from mild to severe levels. Hospitalization and illness can result in fears and stress including those related to separation from parents, unfamiliar surroundings and professionals, painful or complicated diagnostic or surgical procedures, medication effects and complex treatment regimens, discomfort related to injury or illness, lengthy recovery periods, and so forth. Behavioral disturbances can include increased dependency, loss of toilet training, excessive fears, sleeping and eating disorders, and a range of regressive behaviors. On a referral basis, interns may assist children and families to adjust to the hospital environment and health problems.

Interns on the Pediatric Psychology rotation are required to attend a variety of conferences:

Monday

  • Case Conceptualization Conference  – 7:30-8:30 A.M. – Discovery Clinic

Wednesday

  • Topical Seminar/Journal Club -7:30-8:30 A.M. – Discovery Clinic
  • Grand Rounds, Department of Pediatrics-7:30-to 8:30 A.M. (As appropriate)

Thursday

  • Therapy Group Supervision – 7:30-8:30 A.M. – Discovery Clinic