Child clinical/pediatric psychology track

Geisinger's Child Clinical/Pediatric Psychology track offers a comprehensive two-year training program which combines one year of internship and one year of postdoctoral fellowship training. Upon completion, trainees are license-eligible and highly competitive for a range of career opportunities. Program graduates are exceptionally prepared to serve as leaders, clinicians, and clinical supervisors in children's hospitals, pediatric primary care, pediatric specialty teams, and academic medical centers.

We adhere to the scientist-practitioner model of psychological practice. Clinical training experiences follow the apprentice model. Trainees are supervised by faculty members with active clinical practices and function with considerable autonomy, assuming junior level staff responsibilities.

Participants in the program are expected to:

  • Develop clinical skills to support independent practice
  • Collaborate in the medical setting by learning about the medical culture, serving as interdisciplinary team members and consulting with physicians
  • Work with culturally diverse groups and respect individual differences
  • Apply research skills in a clinical setting
  • Uphold high standards of patient care and professional ethics
  • Use scientific evidence to guide practice
  • Advocate for the profession of psychology

Interns expand their skills in the areas of assessment, treatment, consultation, and research. Clinical experiences are of primary importance with particular emphasis placed on learning behavior change methods. Faculty members provide supervision in empirically supported therapies including cognitive-behavioral therapy, behavioral therapy, acceptance and commitment therapy, and motivational interviewing.

Internship Experiences – Year 1

During the first year, interns work in an outpatient behavioral health clinic located inside Geisinger Medical Center (GMC), in the Janet Weis Children's Hospital (directly connected to GMC), in the emergency department at GMC, and in a pediatric primary care clinic in the community. Approximately four days per week are spent at GMC, while one day per week is dedicated to the initial experience in integrated care in a community-based Geisinger outpatient clinic, with licensed psychologists in all sites.

Pediatric Psychology Outpatient Clinic
Interns develop skills in assessing and treating behavioral and emotional problems in young children through adolescence. Children as young as infants are referred to our practice, but the main age range seen is preschool through 18 years old. Clinical work includes assessment and individual, family and group psychotherapy. Examples of presenting problems are: ADHD, anxiety, depression, disruptive/oppositional behavior, sleep problems, eating problems, elimination problems, social skills, parent-child relationship, family problems, divorce, adjustment issues, identity issues, suicidality, self-harm, school refusal, somatization, development, trauma, adjustment to acute and chronic illness, and medical adherence.

Consultation in the Janet Weis Children's Hospital
Geisinger has its own children's hospital and pediatricians representing all of the common pediatric subspecialties. Pediatric oncologists, neurologists, intensive care specialists, endocrinologists, pulmonologists, gastroenterologists, and nephrologists are frequent collaborators in patient care. Interns conduct inpatient consultations in the Janet Weis Children's Hospital.

Psychiatric emergency services
Interns learn emergency psychiatric assessment and intervention skills. Acquired skills include assessment and triage of suicidal or aggressive patients, management of family crises, understanding contributions of medical conditions and substances on acute symptoms, and coordination of follow up care including psychiatric admission. These experiences occur during the day and are provided yearlong in the outpatient setting and emergency department.

ADHD & Disruptive Behavior Disorders Clinic
Interns assess and treat children with disruptive behavior disorders such as attention-deficit/hyperactivity disorder and oppositional defiant disorder. This experience involves providing assessment, practical recommendations, and evidence-based treatment (see “groups ”).

Preschool Development and Behavior Clinic
Interns conduct psychological assessments of preschool-age children, most of whom present with behavioral problems, and some of whom have developmental delays. Geisinger has a separate institute focused on evaluating very young children with developmental delays and concerns of Autism, whereas our Pediatric Psychology Preschool Development and Behavior Clinic serves mostly typically-developing 3-5 year old children with primary behavioral problems. Like the school-age Disruptive Behavior Clinic, the preschool clinic involves providing assessment, practical recommendations, and evidence-based treatment (see “groups ”).

Anxiety Disorders Clinic
Interns participate in an anxiety disorders clinic using comprehensive evidence-based assessment and treatment strategies, such as cognitive-behavioral therapy (e.g., Dr. Philip Kendall’s Coping Cat) and exposure & response prevention.

Multidisciplinary Specialty clinics
Collaboration with medical teams occurs in a variety of settings. Interns may participate in team-based care in one or more of the following specialty clinics: cleft palate/craniofacial, neurology, hematology/oncology, or cystic fibrosis.

Behavioral health in primary care
To begin building a foundation in primary care practice, interns work one day per week throughout the internship year in integrated pediatric primary care settings.

Group treatment programs
The training program offers experience in delivering evidence-based treatment in a group format. Group treatment programs during the internship year include:

  • Behavioral parent training and children's problem-solving skills training for school-age children with ADHD/disruptive behavior disorders
  • Parent-Child Interaction Therapy (PCIT)/behavior parent training and children’s social competence & emotional/behavioral regulation for preschool-age children (Dr. Carolyn Webster-Stratton's Incredible Years programs)
  • High school age adolescent group with conjoint family therapy, for a variety of issues (depression, anxiety, family stress, peer relationship problems, etc.)
  • Middle school age adolescent group focused on social skills (not primary disruptive behavior)
  • Weight management for adolescents, with concurrent parents’ group using behavioral principles and addressing family issues

Psychological testing
Interns participate in psychological testing of children and adolescents presenting with a variety of neurological, psychiatric, and neurodevelopmental conditions. Interns learn assessment skills involving standardized tests for diagnostic and treatment planning purposes. Testing is supervised by a pediatric neuropsychologist.

Camp counseling (optional)
Interns are allowed to volunteer for one week as a counselor in a camp setting for children with chronic medical problems, such as pediatric cancer or children and adolescents with weight management issues. More information about camps can be found at http://campvictory.org.

Educational conferences
Three weekly educational conferences complement the clinical component of the internship. There is also a bi-weekly group supervision experience focused on treating children with cancer and cystic fibrosis.

Didactic seminar
A weekly didactic seminar is designed specifically for the interns. A sample of topics presented by faculty include:

  • ADHD
  • Child abuse
  • Emergency evaluations including suicide risk assessment
  • Practical issues for psychologists in medical settings
  • Anxiety disorders
  • Conducting clinical research in a medical setting
  • Getting your first job
  • Cultural diversity in clinical practice
  • Ethics
  • Helping people change health risk behavior
  • Behavioral interventions with pediatric patients
  • Evidence-based treatments
  • Depression
  • Motivational Interviewing
  • Chronic illness
  • Psychopharmacology
  • Advocacy

Case conference
The faculty and interns meet weekly for a case conference in which interns and staff present and discuss challenging and interesting clinical cases. The atmosphere is supportive and collegial and provides a regular forum for interaction amongst faculty and interns, to supplement individual supervision.

Psychiatry grand rounds
Interns attend weekly psychiatry grand rounds, which include presentations by Geisinger faculty as well as outside speakers. Each intern makes a presentation at psychiatry grand rounds near the end of the internship year. Interns are also encouraged to attend conferences sponsored by other medical center departments.

Research
In addition to using evidence based practice in their clinical work, interns are encouraged to participate in a research project with the training faculty. Up to 4 hours of protected time per week is available for research activities.

Fellowship Experiences – Year 2

The Geisinger Child Clinical/Pediatric Psychology training program has a strong commitment to integrated care and improving patient access to services. Pediatric psychologists are fully integrated into primary care teams throughout the system. Practice in pediatric primary care requires a unique set of skills including strong knowledge of evidence-based practice, increased fluency in skills to match a high-paced environment, building and maintaining strong relationships with medical partners, conducting brief consultation and intervention, implementing systems-level interventions, and designing program evaluation.

As the field of psychology continues to shift toward emphasis on team-based care, the demand for well-qualified integrated primary care psychologists is growing. Our program offers a unique opportunity to acquire skills and knowledge needed to thrive in this field by immersing fellows full time in an established integrated primary care model. Fellows will leave the program with strong knowledge of clinical skills, operational factors, administrative procedures, and program evaluation approaches unique to integrated care. Many program graduates have pursued careers in integrated primary care and serve as leaders in implementation of this model at major health systems and universities.

Clinical practice in integrated primary care setting
Fellows continue to expand skills in evidence-based individual and family therapy approaches in the primary care setting. Unique to the second year of training is an emphasis on short-term problem-focused assessment and brief intervention. Interns develop treatment plans in collaboration with primary care providers and deliver all services on-site in medical practices, which are the primary worksite for the entire fellowship year.

Consultation & collaboration
Integrated psychologists and fellows function as central members of the primary care team. As such, fellows will provide frequent face-to-face consultation to primary care providers throughout the clinic day. This may include education on a behavioral health topic or specific guidance in their approach to a patient issue. Fellows are also receive warm hand-offs from medical providers throughout the day. During a warm hand-off, a medical provider introduces a patient to the pediatric psychologist for an unscheduled visit or consultation. Warm hand-offs may involve patient education, brief intervention, triage for evaluation, introduction to services, or assistance with behavioral issues during medical visit.

Crisis evaluation & treatment
Integrated primary care clinics aim to provide timely patient care close to home. Consistent with this goal, fellows and faculty support primary care providers (PCPs) in the management of risk situations and provide same-day crisis assessments. Fellows continue to expand skills in assessment of high-risk patients, manage safety-planning and intervention, and offer ongoing therapy in the home clinic. During this year of training, fellows also provide off-hours phone consultation to the emergency department.

Interdisciplinary training
Integrated care fellows serve as a source of training and education to the primary care team. Fellows provide education to primary care providers, medical residents, nurses, and office staff through both informal consultation and scheduled lectures and trainings. Educational topics are tailored to meet the needs of the clinic and have included motivational interviewing, school anxiety and refusal, behavioral parent training skills, supporting transgender youth, and behavioral strategies for shot administration. In addition to training the medical staff, many fellows have the opportunity to supervise psychology interns, undergraduate students, or medical residents.

Group treatment programs
Group treatment programs during the fellowship year include:

  • Behavioral parent training and children's problem-solving skills training for school-age children with disruptive behavior disorders
  • Acceptance and Commitment Therapy (ACT) for adolescents
  • Anxiety group (focused on teaching CBT skills)

Program development & evaluation
Work in integrated primary care offers opportunity to engage in systems-level intervention. Psychology fellows often contribute to clinic-wide improvement efforts and assist staff in implementation, problem solving, and evaluation of these approaches. Examples of past efforts include creating token economy to improve compliance during medical visits, development of school note policies that support attendance, and revision of shot administration procedures.

The Geisinger team is committed to conducting clinical outcomes research on the integrated primary care model. Schedules include protected research time, and fellows are strongly encouraged to participate in evaluation and dissemination efforts during their training. Fellows have routinely presented at national IPC conferences, and are working on submitting manuscripts for publication.

Educational conferences
Fellows attend a full day of educational conferences each month in a central location (typically on the GMC campus). Education and supervision experiences during the fellowship year include the following:

  • Clinical seminar: Fellows take turns leading educational seminars in advanced therapy techniques of Motivational Interviewing, acceptance and commitment therapy and dialectical behavioral therapy.
  • Integrated care team meeting: Includes discussion of administrative and operational factors, ethical concerns in integrated care settings, faculty lectures, and focus on career planning and job search   
  • Integrated care journal club: Fellows and faculty lead discussions of recent literature from integrated primary care settings with focus on clinical applications.
  • Case conference: Discussion and problem solving of challenging integrated care cases   

Common themes across both years

  • Evidence-based practice
  • Learning through experience with supervision
  • Service of a diverse patient population with a variety of presenting problems
  • Consultation & Collaboration: Interns and fellows collaborate with pediatric specialists, school personnel, children's services agencies, and primary care physicians.
  • Program Development and Evaluation: Practical review of service delivery and applied outcome research)

Sample rotation schedule
View sample rotation schedule (PDF).

Selection Procedures and Benefits

Eligibility
Six child clinical/pediatric interns are accepted each academic year to join a total intern class of 10 interns. Preference is given to applicants who meet four admission criteria:

  1. Enrolled in an APA or CPA approved doctoral training program;
  2. At least three years of full-time graduate level training (four years preferred);
  3. Passed the comprehensive or qualifying exam by the application deadline; and
  4. Approved dissertation proposal by application deadline. All qualified applicants regardless of race, color, sex, marital status, age, religion or national origin are encouraged to apply.

Salary & benefits for interns
For the 2016-17 academic year, each intern will receive a $23,420 yearly stipend (paid bi-weekly) with two weeks paid vacation. One week of educational leave is provided, along with $1,100 for educational expenses. In addition, research presentations at appropriate psychology conferences are encouraged and financially supported. Excellent health insurance coverage is provided for interns and dependents. Professional liability insurance and a $30,000 life insurance policy are also included as benefits.

There is a significant salary increase for the fellowship year, and in addition to the benefits received by interns, fellows are also given one week of job search or relocation time.

"By the end of our two year program, interns will be license eligible and able to function independently in any of a variety of pediatric medical settings, using evidence based care and working collaboratively with interdisciplinary teams to provide the best care possible for their patients."