Training Model and Competencies

Internship Training Model

The doctoral internship at the Children’s Hospital of Michigan is fully accredited by the American Psychological Association. It abides by the guidelines and rules of the American Psychological Association and Association of Psychology Postdoctoral and Internship Centers (APPIC). The internship program is designed as a one year experience (minimum 2000 hours). Interns start the program at the beginning of September and complete it at the end of August. Broad based Pediatric Psychology training is provided, with inpatient and outpatient work, along with opportunities for scholarship and administrative experiences.

The doctoral internship at the Children’s Hospital of Michigan adheres to the recommendations for training in pediatric psychology espoused by the Society for Pediatric Psychology Task Force on the Training of Pediatric Psychology (Spirito et al., 2003). This Task Force recommended that an internship focused on pediatric psychology include training in:

1. Life span developmental psychology: Effects of disease process and medical regimen on emotional, social, and behavioral development.
2. Life span developmental psychopathology: Differentiate emotional distress within normal limits for children with acute and chronic medical conditions.
3. Child, adolescent, and family assessment: Experience with the assessment of health- related concerns such as health promotion, health risk, health outcome, and quality of life.
4. Intervention strategies: Exposure to and experience with empirically supported interventions specifically applicable in pediatric psychology and delivered in health care settings.
5. Research methods and systems evaluations: Exposure to research design issues especially pertinent to pediatric psychology such as health services research and clinical trials.
6. Professional, ethical, and legal issues: Knowledge and experience with issues such as health care delivery, practice of psychology in medical settings, and rights of caregivers versus children when making decisions regarding medical care.
7. Diversity: Experience with patients from diverse ethnic and cultural backgrounds, as well as sexual orientation, in health care settings and understanding of non-mainstream health practices influenced by a family’s cultural or religious beliefs.
8. Role of multiple disciplines in service delivery systems: Experience on multidisciplinary teams delivering health care services.
9. Prevention, family support, and health promotion: Understanding the principles of behavior change as they relate to healthy development, health-risk behavior, and prevention of disease.
10. Social issues affecting children, adolescents, and families: Exposure to and experience with advocacy in pediatric health care including social issues that affect health care delivery.
11. Consultation and liaison roles: Exposure to different consultation-liaison models and supervised experience providing consultation in health care settings.
12. Disease process and medical management: A basic understanding of various diseases and their medical management.

The internship also adheres to a number of additional philosophical assumptions. A trainee must develop an appreciation of the biological, psychological, and social forces that play important roles in the etiology and treatment of behavioral disorders. Such an extensive breadth of understanding is achieved only by an eclectically balanced program. The teaching environment integrates both biological approaches (genetic, psychopharmacology) and psychological approaches (cognitive, behavioral, family systems, dynamic) and includes the study of people in American culture.

Health Service Psychology Competencies

The Commission on Accreditation of the American Psychological Association (CoA) has accredited our internship according to the Standards of Accreditation (SoA) for Health Service Psychology. These standards can be found at this link.

All interns graduating from APA accredited Health Service Psychology Internships have to demonstrate mastery of certain core competencies, known as “profession wide competencies.” Internship programs must provide opportunities for all of the interns to achieve and demonstrate that each of the required profession-wide competencies has been met. Furthermore, since science is at the core of health service psychology, programs must demonstrate that they rely on the current evidence base when training and assessing interns in these competencies.

We are permitted to have our own program specific competencies, in addition to the required core competencies. These give us the flavor of a hospital based clinical psychology internship with an emphasis on pediatric psychology and training in pediatric neuropsychology. You will see three such competencies listed below.

Below is a list of the core professional competencies, in the order given by the Commission on Accreditation (CoA). This order does not necessarily reflect the priority or amount of emphasis on these competencies in our internship- we have our own priorities and methods to get these all covered. A brief definition of what the competency looks like in our internship and a few examples of the clinical and didactic activities that will help master the competencies will be provided.

Core Profession-Wide Competencies

1. Research: critically evaluate and discuss research articles, demonstrate knowledge of empirically based interventions, and make effective presentations/publications. In our internship, this would apply in particular to pediatric psychology and pediatric neuropsychology research, as well as child/adolescent therapy research. You will each present a case to the entire Department, and you will show how evidence based practices impacted the case. Pediatric Psychology seminar will include presentations and journal club style meetings on clinical research. Anyone who wishes to do a research elective can do so, working with faculty such as Deborah Ellis, Ph.D., a nationally known pediatric researcher associated with the Department.
2. Ethical and Legal Standards: demonstrate knowledge and act in accordance with APA Ethics, relevant state and federal laws, and Detroit Medical Center (DMC) corporate compliance policies- you will have sessions on ethics in Pediatric Psychology Seminar and during supervision meetings. Before you start here, you are required to do online training modules about the DMC policies on ethics, HIPPA, and other laws relevant to professional practice in a health care setting.
3. Individual and Cultural Diversity- demonstrate knowledge about diversity for individuals of many ethnic/cultural groups; attend to cultural diversity and individual differences in assessment, intervention, and consultation; and understand how the intern’s own personal background contributes to working with people of different cultures- this will permeate all supervision meetings, as well as Pediatric Psychology seminar. We have a highly diverse population in Michigan, and you will learn to do inpatient consults and specialty clinic patient contacts using interpreter phones (Spanish and Arabic languages, most often). You will highlight relevant cultural/ ethnic variables in your case presentation to our Department.
4. Professional Values, Attitudes, and Behaviors- complete all written work in a timely manner, maintain appropriate professional relationships with supervisors, peers, and all medical/allied health staff, engage in self-reflection and self-care to promote well-being. Attendance at relevant sessions of the Pediatric Psychology Seminar and Neuropsychology Seminar will focus on this. Each supervisor will set boundaries for you regarding completion of reports and notes. We will model appropriate professional behavior, and you will have opportunities to interact with a wide variety of medical center personnel.
5. Communication and Interpersonal Skills- communicate appropriately and effectively with patients, parents, peers, supervisors, and medical center staff- You will learn how to deal with a wide variety of personality types in a medical setting and how to blend into multidisciplinary teams. You will learn to deal with highly charged clinical situations.
6. Assessment- select, administer, score, and interpret psychometrically sound assessment measures of cognitive functions, achievement, personality, family relationships, and health behaviors. Conduct differential diagnostic interviews and appropriately use DSM-5 and ICD-10-CM diagnoses. Appropriately formulate clinical profiles and write effective reports. This is one of our most heavily emphasized competencies. Most of your Neurocognitive rotation will heavily focus on testing and clinical evaluations, as will specialty clinics on the Clinics rotation. ASD, Rehab Services, and Neuropsychology are primarily assessment.
7. Intervention- establish and maintain effective relationships with recipients of psychological services, effectively develop and implement evidence- based interventions for individual and family therapy, apply research to clinical decision making, and evaluate the outcome of interventions. This is the second of our most heavily emphasized competencies. You will receive supervised experience with CBT, family therapy, and translating manualized interventions into real world change processes.
8. Supervision- demonstrate knowledge of theories and knowledge of supervision; apply this knowledge to supervision of practicum students. Ask for supervision as needed. Accept supervisor feedback, and modify your clinical behavior in accordance with supervisor feedback. You will learn to supervise practicum students in a variety of settings, including Neuropsychology and HIV Clinic. You will learn when to ask for supervision and when to proceed independently in all of your clinical activities.
9. Consultation & Inter-professional Skills- effectively conduct inpatient pediatric consultations by establishing the consult question with the referring physicians, interviewing the patient and family, formulating the case for discussion with the supervising psychologist, implementing brief interventions, maintaining contact with the referrals sources and other health care professionals, and writing up the consult.

Program Specific Competencies: Emphasis on Pediatric Psychology and Neuropsychology

The specific goals of our Psychology internship are to: (1) prepare you for an entry level job in pediatric psychology, (2) prepare you for a post-doctoral fellowship in pediatric psychology, or (3) prepare you for a post-doctoral fellowship in pediatric neuropsychology. The following three competencies, which characterize the essence of our program, best capture the unique features of our internship, and they are our program-specific competencies:

1. Develop skills in working with multidisciplinary teams- interact appropriately with all health care professionals working on such a team in either an outpatient specialty clinic or an inpatient setting. Contribute to team meetings. Understand medical center dynamics. All of your experiences in specialty clinics, inpatient consultation, and Rehabilitation will help you achieve this competency.
2. Develop understanding and treatment skills for the treatment and prevention of chronic illness in children and adolescents. The specialty clinic experience on the Clinics Rotation, inpatient consults, and many lectures on chronic disease in Pediatric Psychology Seminar address this competency. This prepares you to deal with a wide variety of chronic medical conditions and their accompanying behavioral and emotional problems.
3. Demonstrate appropriate Neuropsychological Testing skills- selecting, administering, scoring and interpreting neuropsychological tests, providing feedback to referral sources and families, and writing reports. About half of our interns head for pediatric neuropsychology, and together with Rehabilitation Services, we have a definite strength in this area. Our Neuropsychology program emphasizes patients with medical problems (seizures, head injuries, etc.) and neurodevelopmental disorders.