The Clinical Child/Adolescent Psychology Training Track has been designed to offer the intern a well-balanced and comprehensive clinical experience, a formal curriculum covering major areas in child and adolescent psychology, supervision in various clinical settings resulting in hands-on and graduated learning experience over the year. Upon completing this program, the intern will have a comprehensive knowledge of normal child and adolescent development and will be able to differentiate normal from abnormal development.

The intern will conduct comprehensive evaluations of children, adolescents and families with a broad spectrum of psychopathology and varying socio-cultural and ethnic backgrounds. The intern will also gain competence in the major treatment modalities and learn the knowledge and skills to practice within a variety of child and adolescent settings.

The intern will have the opportunity to teach professionals in other disciplines (psychiatry, school, pediatrics), parents, and members of other agencies. The intern will become familiar with research methodology and professional/scientific literature on child and adolescent psychology and clinical intervention. The intern will learn to participate effectively in multidisciplinary team meetings.

I. Child/Adolescent Clinic: Attendance and participation in the following clinics is required: 1) Child and Adolescent Anxiety Clinic 2) Infant and Preschool Clinic 3) Preadolescent Clinic and 4) Adolescent and Young Adult Clinic.

Description: Evaluations take place in two sessions (intake and follow-up assessment). During the intake session, family, medical, developmental, school, physical/sexual abuse, substance abuse and legal history is obtained from parents and the child. The follow-up session is largely focused on addressing additional issues not covered during the intake session, finalizing diagnosis and treatment planning, evaluating the medication regimen of the patient, and providing feedback to the family.

Objectives

1. Conduct diagnostic interviews with children, adolescents, young adults and their parents/guardians.
2. Use standardized questionnaires and external records effectively.
3. Develop a differential diagnosis and initial treatment plan.
4. Become comfortable interacting with children and adolescents in a developmentally appropriate manner.
5. Learn to develop a trusting, empathic relationship with parents/guardians.
6. Understand biological, psychological and social dynamics which impact children and youth in relation to their diagnosis and treatment.

Location: Clinics are conducted in the Child and Adolescent Psychiatry Playroom in the department of Psychiatry and the Tucson Alliance for Autism.

Child/Adolescent Clinic Rotations:

A. Infant and Preschool Clinic (ages birth through 6)

Objectives: This clinic provides evaluation and treatment services for children from birth to 6 years of age. Evaluation and treatment services are provided for children with autistic disorder or other developmental disorders regardless of their age.

Tucson Alliance for Autism (TAFA), 1002 Country Club Road (Telephone 319-5857). Clinic evaluations are interdisciplinary and include child psychology, occupational therapy, and speech and communication sciences. There is usually one new evaluation and one follow-up appointment to provide feedback for a previously completed evaluation. The intern will have an opportunity to observe and learn how to administer the Autism Diagnostic Interview-Revised (ADI-R) to parents, and the Autism Diagnostic Observation Schedule (ADOS) to children. In addition to the ADI-R and ADOS, the intern will have an opportunity to observe speech evaluations as well as take the initiative to make arrangements to observe psychological testing, behavioral analysis evaluations, occupational therapy evaluations, and nutritional consultations.

B. Preadolescent Clinic (Ages 7-12)

Objectives: The Preadolescent Clinic specializes in behavior disorders and serves families with children who are experiencing problems with  hyperactivity, inattention, aggression, depression, mood swings, and suicidal thoughts. 

C. Adolescent and Young Adult Clinic (Ages 13-21)

Objectives: The adolescent and young adult clinic specializes in mood and anxiety disorders and serves families with adolescents and young adults with mood problems such as depression, mood swings and suicidal thoughts, sleep and appetite disturbances, problems related to severe physical or emotional trauma, aggression, and problems with attention and concentration leading to academic difficulties in school, college and at work.

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II. Child and Adolescent Anxiety Clinic (Ages birth - 18)

Objectives:

1. Provide comprehensive assessment and treatment of anxiety disorders in children and adolescents (ages 0 to 18 years).
2. Provide education on assessment of childhood anxiety disorders and the delivery of psychotherapy and pharmacotherapy to psychology interns, psychiatry residents, and child psychiatry fellows in the Department of Psychiatry at the University of Arizona College of Medicine.

Pre-evaluation: Prior to seeing patients, background information is collected on psychiatric/psychological history, psychological/neurological testing, and medical history. This is accomplished by using some or all of the following rating scales:

Conners-March Developmental Questionnaire (CMDQ)
Conners’ Parent Rating Scale – Revised (L)
Conners’ Teacher Rating Scale – Revised (L)
Child Behavior Checklist for Ages 6-18 (CBCL)
Teacher’s Report Form for Ages 6-18 (TRF)
Youth Self-Report for Ages 11-18 (YSR)
The Multidimensional Anxiety Scale for Children (MASC)
The Children’s Depression Inventory (CDI)

Parents are mailed the aforementioned behavioral rating scales prior to the intake appointment.

Psychological Testing: In some cases, more extensive psychological evaluation will be requested of the intern.

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III. Pediatric Consultation-Liaison (Ages birth - 17)

Purpose: To provide clinical experience to the intern in a wide variety of behavioral and psychological difficulties in inpatient pediatric settings. To practice short-term, focused crisis counseling skills and to acquire knowledge of legal and ethical issues surrounding consultation work (i.e., confidentiality, mandatory reporting, authority of various parties involved with a child). To become familiar with, and comfortable in, providing consultation services to physicians and medical staff.

Description: The Consultation-Liaison service is based at the University Medical Center. The clinical populations seen and the intern's duties vary between the primary settings in which consultation takes place: the University Medical Center Emergency Department, the Pediatrics inpatient units (including pediatric ICU), pediatric outpatient clinics. Patients under 18 may also be seen on the Obstetrics/Gynecology service as well as on the Trauma service.

On the Pediatric inpatient units, consultations include evaluations for somatization or anxiety, or behavioral management of chronic medical illnesses such as cystic fibrosis or asthma. In the past, calls from the emergency department required consultation on patients presenting with a suicide attempt and/or aggressive acting out behavior. Emergency psychological consultations are done and recommendations are made concerning disposition and need for further treatment. Consultations may also include advice on managing behavioral decompensation, as well as psychosomatic presentations.

The Intern is expected to shadow three to four evaluations prior to completing the minimum of ten evaluations in order to complete this rotation.

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IV. Insomnia Clinic

Purpose: Familiarize psychology interns with the diagnosis and treatment of sleep disorders and their relationship to psychiatric and physical disorders. Although the major focus will be on the diagnosis and treatment of insomnia, interns will learn to identify sleep disorders such as sleep apnea, periodic movement during sleep, REM behavior disorder, narcolepsy, and parasomnias for possible referral or treatment.

Description: The rotation will include a four-month, part-time assignment to the Insomnia Clinic (every other Friday at 12:30 pm in Room 7439 in the Department of Psychiatry), which provides assessment consultation, and treatment services. The intern will attend the weekly staffing and group supervision meetings, complete one to two new sleep disorder evaluations a week, and provide short-term treatment. The intern will also attend the twice-monthly Sleep Disorder Center Case Conference (first and third Tuesdays at 5:00 pm).

As part of the initial intake process, all patients receive psychological assessment. A referral for a polysomnogram in the Sleep Lab is made for patients for whom physiological and psychological sleep disorders are suspected. Treatment modalities carried out as part of the Insomnia Clinic include stress coping techniques, cognitive-behavioral therapy, and educational and supportive treatments for families. Patients may require a medication review and referral for evaluation and treatment of psychiatric and physical disorders.

V. Outpatient Psychotherapy

In addition to fulfilling responsibilities of their primary rotations throughout the year, the intern serves as the primary therapist for two to three adult outpatient psychotherapy cases and six to eight child/adolescent/family therapy cases. The intern has the opportunity to develop experience in psychotherapy with special interest groups through their rotations (e.g., substance abuse, autism, sleep disorders). The cases will be assigned by the director of the Psychiatry Outpatient Clinic in consultation with the Coordinator of Child Psychology Training.

Medication coverage, if necessary, will be provided by a psychiatry resident assigned to the case. Although some of the cases may be seen for the entire year, brief psychotherapy is also encouraged; therefore, the intern will be exposed to a variable number of cases during the year. The intern will be encouraged to develop therapeutic skills in various modalities including cognitive behavior therapy, dialectical behavior therapy, play therapy, group therapy, parent management training and family therapy.

Supervision by a clinical psychologist will occur on a weekly basis.

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VI. Psychological Assessment

The intern will have the opportunity to develop skills in psychological assessment and interpretation throughout their training. The intern will use these measures in various settings and to address interdisciplinary issues including diagnostic (autism, depression, sleep disorders), academic (learning disability), medical (presurgical evaluations) and legal (competency to stand trial, psychosexual evaluations). Some assessment instruments used include:

• Cognitive Functioning
  • General functioning
    • Mental Status Examination
    • Mini-Mental Status Examination (MMSE)
  • Intellectual Functioning
    • Wechsler Adult Intelligence Scale
    • Wechsler Intelligence Scale for Children
    • Woodcock-Johnson Psychoeducational Battery
  • Memory Functioning
    • Wechsler Memory Scale
    • California Verbal Learning Test
• Emotional Functioning and Level of Psychopathology
  • Minnesota Multiphasic Personality Inventory (adult and adolescent)
  • Beck Depression Inventory
  • State-Trait Anxiety Inventory
  • Conners-March Developmental Questionnaire (CMDQ)
  • Conners‚Äô Parent Rating Scale ‚Äì Revised (L)
  • Conners‚Äô Teacher Rating Scale ‚Äì Revised (L)
  • Child Behavior Checklist for Ages 6-18 (CBCL)
  • Teacher‚Äôs Report Form for Ages 6-18 (TRF)
  • Youth Self-Report for Ages 11-18 (YSR)
  • The Multidimensional Anxiety Scale for Children (MASC)
  • The Children‚Äôs Depression Inventory (CDI)
  • Autism Diagnostic Interview-Revised (ADI-R)
  • Autism Diagnostic Observation Schedule (ADOS)

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