Child Clinical Psychology Elective

The Child Clinical Psychology Elective has a long history of providing outstanding generalist training in working with children, adolescents and families through MassGeneral for Children with several elective opportunities for greater specialization. Child track interns gain experience in integrative and cognitive-behavioral therapy, family therapy, consultation, short-term interventions in an acute setting, diagnostic and pediatric neuropsychological assessment, and research. They participate in didactics with interns from other tracks, as well as attend seminars specific to pediatric and family work. Across all clinical experiences, there is an emphasis on providing developmentally appropriate, evidence-based services to varied populations of children and families in an academic medical center.

Outpatient Treatment

Interns in the Child Clinical Psychology Elective spend most of their direct clinical services time in the Child and Adolescent Psychiatry Outpatient Clinic (CAP). This patient population is varied and includes children and families with multiple psychological, social, and medical challenges. Interns see patients and families referred by pediatricians, subspecialty medical providers and from across the Division of Child Psychiatry clinical programs (e.g., Child CBT, Pediatric Behavioral Medicine).

Typical referral problems include anxiety disorders, depression/mood disorders, ADHD and parenting difficulties. Interns obtain closely supervised experiences in individual child therapy (play therapy and integrated approaches), cognitive behavioral therapy (CBT, ACT, DBT, TF-CBT), parent guidance interventions and family therapy. There is frequent collaboration with child psychiatry fellows for treatment and case management. Intern caseloads are determined depending on their areas of interest and focus, in consultation with the track director.

Additionally, interns have the option of gaining specialized experience by choosing up to two elective rotations over the course of the year including:

• Pediatric behavioral medicine: Seeing patients referred by various pediatric medical services, including gastroenterology and endocrinology through the outpatient clinic with supervision by a pediatric psychologist
• Dialectical behavior therapy: Co-leading a weekly multifamily DBT skills group for adolescents and their caregivers or for parents of elementary age patients, attending weekly consultation team meeting, weekly supervision with group leader, and optionally providing family check-in sessions or individual DBT for group participants
• ARMS Program: Providing individual therapy to youth under age 26 years of age and/ or co-leading parent groups for families of patients with substance abuse related problems, attending clinic rounds, weekly group supervision
• Transgender Health Program: Providing individual and/or family therapy to pediatric patients seen through the MGH Transgender Health Program with weekly group supervision
• Early Intervention with Young Anxious Children: Evaluating and treating children ages 3-7 years who have shy or fearful temperament or anxiety disorders using family-based CBT, with weekly supervision

Interns typically carry a caseload of 6-8 individual patients in addition to a family therapy case with additional clinical hours determined by their elective rotations up to 12 hours direct clinical time. Note that the availability of elective rotations may vary depending upon program schedules and patient enrollment.

Pediatric Neuropsychological Assessment

Child interns complete a six-month rotation in pediatric assessment through the Learning and Emotional Assessment Program (LEAP). Interns will gain experience in the assessment of school-aged children and adolescents presenting with neurodevelopmental (e.g., autism spectrum disorder, learning disorders, ADHD), psychiatric (e.g., anxiety, mood disorders), and/or medical conditions (e.g., epilepsy, genetic disorders, stroke, prematurity). Interns generally complete 2-3 evaluations per month. Interns may also engage in consultation work with parents.

Pediatric Acute Psychiatry Service

All interns do a six-month, four-hour per week rotation providing intervention services in an acute setting. Child interns may choose to either: 1) provide short-term individual and family-based intervention for children and adolescents who are being evaluated in the MGH Emergency Department’s Pediatric Acute Psychiatry Service (APS) or, 2) complete their acute rotation on our medical psychiatric inpatient unit (Blake 11) attending patient rounds, seeing patients individually, and co-leading groups. While Blake is a mixed adult unit, there are often opportunities for child interns to see transitional age youth (age 18 to 26) for individual inpatient psychotherapy.

Research

Child interns have a minimum of 4 hours per week dedicated research time throughout the year to focus on activities such as participating in mentor-led research projects, publishing papers, and/or preparing grant applications for post-doctoral fellowship. There is a strong history of child interns collaborating on ongoing research projects within the department of psychiatry, within specialty areas of medicine (e.g., neurology, endocrinology, behavioral medicine), and within LEAP. Many interns secure research funding for post-doctoral fellowship.

Interns committed to a career in academic research, as reflected by a strong record of publications and/or extramural grant funding, are encouraged to seek additional mentorship to develop their research skills, including through publication opportunities and guidance on preparing F32, K-level, or foundation grant applications. Interns who benefit most from these opportunities typically have their dissertation mostly or entirely finished prior to the start of internship. Interns who are on a clear research track may work with the child track director to choose clinical rotations to allow for more time for research (up to 8 hours per week).

Example faculty research interests include:

• Modeling risk for depression and suicide in preadolescents, adolescents, and young adults, leveraging life stress, neurocognitive, epidemiological, and meta-analytic methods, social media content, EMA, and ambulatory technologies; other areas include child maltreatment, and underrepresented communities (Liu)
• Suicidal and nonsuicidal self-injury prediction and prevention in youth and young adults using novel methodologies and computational approaches (Burke)
• Early and preventative interventions for childhood anxiety (Hirshfeld-Becker)
• Digital single-session interventions for child anxiety (Abel)
• Self-directed parent interventions for reducing anxiety in young children with and without autism (Hirschfeld-Becker and Abel)
• Development and evaluation of interventions in Type 1 diabetes including a three-session preventative program for parents in the first year of a child’s diagnosis and of a CBT group focused on diabetes problem-solving for teens (O’Donnell)
• Development, evaluation, and implementation studies of mental health interventions for people with cystic fibrosis, including a CF-CBT coping skills program for teens and mind-body approaches to pain management in CF (Friedman)
• Observational research of biobehavioral mechanism underlying childhood adversity sequelae; clinical research examining trauma-informed transdiagnostic interventions to address adversity-associated health outcomes (Basu)
• Predicting changes in psychopathology using multimodal approaches (e.g., EMAs and passive sensors); developing and evaluating digital interventions in depression and substance use (Collins)

• Novel cognitive-behavioral treatments for eating disorders and neurobiological basis of eating disorders including avoidant/restrictive food intake disorder and anorexia nervosa (Eddy, Thomas)
• Multidisciplinary research examining mechanisms driving the progression of substance use and co-occurring mental health concerns in youth and the development and evaluation of innovative, school-based early interventions (Schuster)

Didactics

In addition to the internship core didactics, the following seminars are required for child interns:

• Family therapy seminar: 1 hour per week (September – June)
• Child cognitive behavioral seminar: 1 hour per week (September – December)
• Child psychology seminar: 1 hour per week (Yearlong)
• LEAP Clinical Rounds: 1 hour per week (6 months)

Supervision

• Individual psychotherapy supervision:  2 hours per week (1 hour of cognitive behavioral therapy supervision, 1 hour of integrative psychotherapy supervision)
• Family therapy group supervision: 1 hour per week (September – June)
• Assessment supervision: 1 hour per week 6 months
• Acute rotation supervision: 1 hour per week 6 months
• Research supervision: 1 hour per week

Mentorship

In addition to the many opportunities for informal mentorship at MGH,

• Child interns are paired with a non-evaluative mentor for informal support throughout the year. Non-evaluative mentors are post-doctoral fellows or early career psychologists, often who have previously completed the child internship elective at MGH themselves.
• Child interns also meet biweekly, with the child internship track director for formal mentorship of the internship experience and planning for post-doctoral fellowship.

After Internship

Many child interns choose to apply to stay at MGH for post-doctoral fellowship and, later, for faculty positions. Clinical post-doctoral fellowship positions are typically offered through LEAP and the Pediatric Behavioral Medicine Program. For research-oriented interns, there are several opportunities to stay on after internship through T32s and intramural post-doctoral fellowships within MGH and Harvard. Clinical opportunities are often available through CAP and/ or Child CBT.

Related Links

• Child and Adolescent Psychiatry
• Learning and Emotional Assessment Program (LEAP)
• Pediatric Behavioral Medicine Program
• Addiction Recovery Management Service (ARMS)
• Child Cognitive Behavioral Therapy (CBT) Program
• Transgender Health Program
• Depression Clinical & Research Program