I. Specific Objectives

Child and adolescent training is dedicated to state-of-the-art delivery of psychological services for infants, children, adolescents, young adults, parents and families. The goal is to produce competent clinical psychologists for applied and academic careers in child and adolescent health care. The training philosophy is grounded in two guiding principles: one, that health care is best provided through multidisciplinary collaboration between medical and behavioral sciences, and two, that psychopathology and mental health are best understood from a developmental perspective. Residents gain competency in traditional diagnostic and therapeutic approaches, cognitive-behavioral strategies, new and innovative techniques, brief and long-term treatments, consultation, and specialized services. This is done through general inpatient and outpatient services and seven specialty programs.

II. Structure

Training is concentrated within three clinical departments: Pediatrics, Psychiatry, and Behavioral Sciences. All training experiences are coordinated through a single program directive. Clinical settings include two outpatient clinics, a therapeutic day school, a psychiatric inpatient unit, and four pediatric inpatient units within the central campus.

Residents participate in all clinical services which include a general outpatient service, a general inpatient consultation service, and seven specialty service programs (see below). Seven of the nine training experiences extend throughout the full training year. Two of the specialty services rotate for 6 months each. This allows greater depth of learning and longer-term patient follow-up. For residents with special interests, the program provides some opportunity for elective experiences and more focused training in particular clinical areas during the second semester. For residents who have completed their dissertations, a research and/or program development experience is also available. These projects are designed to be short-term, to compliment the interests of a Rush faculty member, and culminate in the submission of a paper or poster presentation at a professional meeting.

III. Program Description

A. General Outpatient Services

One of the foundations of clinical training occurs within the outpatient clinics where residents manage ongoing case loads of 6-8 patients. Evaluations and therapy are provided for toddlers through young adults with developmental disorders, behavioral disturbances, emotional problems, learning and school-related difficulties, family and social adjustment problems, and other medically related problems. Both short and long-term interventions are employed. Collaboration with parents, schools, physicians, and other health care providers is a standard component of care.

B. Inpatient Consultation Service

Fundamentals of inpatient consultation on medical and psychiatric units are taught. Residents interact closely with multi-disciplinary teams of health care providers. Consultations may include diagnostic evaluations, developmental and psychological assessments, neuropsychological evaluations, behavior management, parent and family counseling, individual therapy, staff guidance, and in-service presentations. The focus here is brief assessment and intervention where the primary goal is providing other healthcare providers with clinical information.

C. Specialty Services

1. Developmental Disabilities and High Risk Infant Follow-Up. This is a 12-month experience in developmental screening and evaluation of infants and young children.. Fundamentals of early development and assessment of normal, abnormal, and high-risk populations is taught through the use of the Brazelton Neonatal Behavioral Assessment Scale, the Bayley Scales of Infant Development, the Wechsler Preschool and Primary Scale of Intelligence, and others. (Available, in part, for cross-track training.)

2. Eating Disorders. A 12-month experience in a multidisciplinary approach to evaluation and treatment of anorexia, bulimia, and related eating disorders is provided. Residents function as primary therapists/case managers in coordinating each clinical phase, including intakes and diagnostics, inpatient treatment, outpatient management, and follow-up. Current concepts of etiology, natural history, assessment and treatment are taught. (Available, in part, for cross-track training.)

3. Pediatric Neuropsychology and Neurodevelopmental Psychology. This service is divided into six months of neuropsychology and six months of neurodevelopmental psychology. Evaluations of children with learning disabilities, attention deficit disorders, and neuropathologies are provided. Training includes initial family interviews, child assessments, school liaison, report writing, and interpretive sessions. Current approaches to testing, scoring, and interpretation are taught. Didactics include case presentations of neurological, neurobehavioral, and psychiatric syndromes. Therapeutic follow-up on a selective basis is available. (Available, in part, for cross-track training.)

4. Behavioral Pediatrics. A 10-month experience in assessment and treatment of common behavior problems of infancy, childhood, and adolescence is provided. Didactics include protocols for management of enuresis, encopresis, attention deficit disorder, conversion disorder, school phobia, obesity, sleep disturbance, feeding problems, medical adherence, failure-to-thrive, diabetic management, parent-child interaction, and others. (Available, in part, for cross-track training.)

5. Rush Day School. A six-month experience in observation and treatment of emotionally and behaviorally disturbed children is provided within a psychoeducational day treatment facility. Residents serve as a co-therapist in group therapy for 6-8 severely disturbed children. Residents develop practical knowledge in childhood psychopathology, group dynamics, and group intervention.

6. Pediatric Psychosocial Oncology, Hemodialysis, and Palliative Care. A 12-month experience in collaborative work between psychologists and other health care professionals is provided in a setting of chronic and life-threatening illness. Training focuses on treatment of the most common clinical symptoms found in cancer, kidney failure, and other life threatening conditions. These include depression, anxiety, pain, nausea, swallowing difficulties, adherence problems, and loss of quality of life. Training includes supportive work in death and dying. (Offered, in part, as cross-track training.)

7. Child Psychiatry Inpatient Assessment. A six-month experience in assessment of children with classic psychiatric disorders such as depression, psychosis, autism, obsessive-compulsion, dissociation, somatoform, and post-traumatic stress are included. Didactics in the basics of case management of psychiatrically hospitalized children is provided through review and evaluation of patients on the unit. Milieu, individual and group therapies, medication management, family involvement, and discharge planning are examined.

IV. Seminars and Supervision

Residents participate in didactic seminars specific to each of the seven specialty services. A semimonthly staff development series on current topics in child and adolescent psychology is also provided. Attendance at Pediatric and Psychiatry Grand Rounds is encouraged. Residents also attend all seminars and teaching conferences designed for the residency program at large. Clinical teaching is provided by a training faculty of clinical psychologist of various theoretical backgrounds and a physician in adolescent medicine. Supervision and training include direct observation and modeling, co-participation, didactic teaching, and a combination of individual and group supervision.