Pediatric integrated primary care track
Geisinger’s pediatric integrated primary care track offers a comprehensive training program in short-term, evidence-based treatment within the primary care setting. As an innovative healthcare system serving thousands of patients within rural settings, Geisinger is focused on improving patient access to both physical and mental healthcare. As such, pediatric psychologists are fully integrated into primary care teams throughout the system. This training program offers an exciting opportunity for interns to work side by side with medical professionals to provide effective interventions to children, adolescents and families across central Pennsylvania.
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 fast-paced field by immersing trainees full time in an established integrated primary care model. Interns will leave the program with a strong knowledge of clinical skills, operational factors, administrative procedures and program evaluation approaches unique to integrated care. Trainees will be able to build and maintain strong relationships with medical partners, conduct brief consultation and intervention, implement systems-level interventions and design program evaluation. Many program graduates pursue careers in integrated primary care and serve as leaders in implementation of this model at major health systems and universities.
At Geisinger, 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
Over the training year, 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, acceptance and commitment therapy, and motivational interviewing.
Integrated primary care clinics are currently located in 10 practices across central Pennsylvania, nine of which will house interns. These clinics are divided into three regions: Western, Central and Eastern. Some clinics, known as “hubs," also accept patients from nearby partnering clinics, known as “extensions.” Interns are assigned to regions and have multiple clinical experiences within that region. Primary care sites vary in terms of level of integration, patient populations and treatment experiences. Intern cohorts in each region meet for a half-day of training per month in addition to the monthly seminar day for all trainees. During half-day trainings, interns participate in trainings on current evidence-based care, receive time to collaborate on shared research projects, and build connections with within cohorts. Additional opportunities for bonding among the entire training class are available during monthly seminar days.
“Having pediatric psychology integrated into our office has been a wonderful addition to help complete our team. We work collaboratively to help patients, which increases patient and staff satisfaction to get the best and most appropriate care in a timely manner. The staff feel much more comfortable helping with psychological issues and have the support to answer questions that they may not know the answer to by going down the hall and asking our team. We love integrated behavioral health in Pottsville and are so blessed to be a part of this model.”
Clinical practice in integrated primary care setting
Interns provide evidence-based individual, group and family therapy approaches in the primary care setting. In this setting, there 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. Trainees operate on a similar schedule as faculty, offering 60-minute new patient evaluations and 30-minute return therapy sessions.
Consultation & collaboration
Integrated psychologists and trainees function as central members of the primary care team. As such, consultation time is built into the schedule to allow for frequent face-to-face consultation to primary care providers throughout the clinic day. This consultation may include education on a behavioral health topic or specific guidance on their approach to a patient issue. Trainees 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 and scheduling of services, or assistance with behavioral issues during the medical visit (e.g., shot administration).
Crisis evaluation & treatment
Integrated primary care clinics aim to provide timely patient care close to home and reduce unnecessary utilization of high intensity services in the emergency room or inpatient setting. Consistent with this goal, interns and faculty support primary care providers (PCPs) in the same-day management of crisis situations. Trainees expand skills in crisis risk assessment, safety planning and stabilization within the primary care setting.
Integrated care interns provide valuable training and education to primary care providers, medical residents, nurses and office staff within the primary care setting. Formats vary across clinics and may include scheduled lectures and trainings, individual consultation, case conference and clinical observation. 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, interns often supervise undergraduate students, master’s level trainees and medical residents.
Group treatment programs
Group treatment programs in primary care include:
- Behavioral parent training and children's problem-solving skills training for school-age children with disruptive behavior disorders/ADHD
- Acceptance and commitment therapy (ACT) for adolescents via the DNA-V model
- Gender group for members of the LGBTQ+ community
Not all primary care sites offer groups; however, trainees will spend time in multiple sites throughout the training year.
Interns with interest in autism spectrum disorder (ASD) participate in psychological testing of children and adolescents presenting with a question of possible ASD. At least one supervisor in each region administers the Autism Diagnostic Observation Schedule (ADOS), as well as intelligence and cognitive measures to aid in diagnosis and treatment planning.
Camp counseling (optional)
Geisinger offers a unique opportunity for interns to volunteer as a camp counselor at weeklong camps for children with chronic medical conditions, such as pediatric cancer and weight management concerns. Interns who elect to volunteer at camps learn first-hand about these conditions and the challenges faced by families who are impacted by them. Camp counselors make a difference in the campers’ lives and also build strong relationships with fellow interns during these fun-filled, high-energy weeks. More information about camps can be found at campvictory.org.
Program development & evaluation
Psychology trainees 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 a token economy to improve compliance during medical visits, development of school note policies, 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 interns are strongly encouraged to participate in evaluation and dissemination efforts during their training. Trainees have routinely presented at national IPC conferences, and are working on submitting manuscripts for publication.
Interns attend a full day of educational seminars each month in a central location (typically on the GMC campus). Educational experiences during the training year include the following:
- Clinical didactics: Trainees 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 professional development and career planning
- Integrated care journal club: Trainees 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
- Faculty-led seminars on evidence-based techniques, ethical and professional issues, supervision, and diversity and culture
Selection procedures and benefits
Seven pediatric integrated primary care interns will be accepted for the 2020-2021 academic year. Preference is given to applicants who meet four admission criteria:
- Enrolled in an APA- or CPA-approved doctoral training program;
- At least three years of full-time graduate level training (four years preferred);
- Passed the comprehensive or qualifying exam by the application deadline; and
- 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 2020-2021 academic year, each intern will receive a $27,000 yearly stipend, paid bi-weekly. Paid time off includes nine vacation days, six personal holidays and five sick days. Interns also receive five days that may be used for relocation or interview purposes, five days for external CMEs and three internal CME days to be used for conferences and activities within Geisinger. Attendance and presentations at appropriate psychology conferences is encouraged, and $600 is provided to support conference expenses. An additional $500 is available to purchase educational materials and pay dues for professional organizations. Further benefits include comprehensive health insurance for interns and dependents, professional liability insurance, life insurance and assistance with moving expenses.