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Child and Adolescent Rotations

Family Therapy Training Center (FTTC)
(Leonard J. Woods, LCSW)
     The FTTC provides short-term treatment for children and adolescents and their families who are experiencing a wide range of psychiatric disorders (depression, suicidality, behavioral disturbances); phase-of-life problems (bereavement, divorce); and problems in coping with acute or chronic stressors (marital discord, chronic illness). The FTTC relies heavily on the Eco-Systemic-Structural Family Therapy model. A competency and strength-based focus is used to build upon family resources in creating solutions to problems. The training integrates various aspects of systemic, cognitive, behavioral, and biological theories in addressing the mental health needs of clients. The influences of gender, race, and culture, as well as therapists’ “use of self,” are addressed throughout the training year.

Center for Autism and Developmental Disorders
Merck Child Outpatient Program
(Benjamin L. Handen, PhD, BCBA)
     This outpatient program serves children and adolescents (ages 2 through 21) who have developmental disabilities coupled with psychiatric and behavior disorders. The primary types of disabilities seen are autism and intellectual disability. Psychology interns have typically been involved in a one-day a week diagnostic clinic for children and adolescents with autism spectrum disorders. Interns serve on an assessment team and are instructed in the use of state-of-the-art diagnostic tools. In addition, psychology interns have served as therapists in social skills training groups for children and adolescents with Asperger’s Disorder and High Functioning Autism. Finally, some interns have participated as co-therapists in our Parent Child Interaction Clinic (PCIT) afternoon clinics.
     The Merck Child Outpatient Program also is involved in a range of research studies examining the efficacy of pharmacologic and behavioral treatments with this population. Opportunities are also available for interested interns to become involved in various research efforts.

Youth and Family Research Program
(Brooke Molina, PhD; Srihari Bangalore, MD)
     We conduct research on the course and treatment of Attention Deficit Hyperactivity Disorder (ADHD), comorbid externalizing disorders, and substance abuse. Interns may participate in ongoing treatment studies or test new intervention ideas developed with the directors. Interns may also participate in the assessment and treatment of children, adolescents, and adults seen in the WPIC ADHD Clinic with supervision by Drs. Molina and Bangalore. This clinic provides evidence-based and evidence-informed treatment, including psychosocial and pharmacologic interventions, for the full developmental spectrum. Interns participate in multidisciplinary team meetings to review cases and contribute to research discussions. The Youth and Family Research Program includes ongoing longitudinal studies of ADHD and substance use in youth and young adults, and recently their offspring, using a developmental and neurobiological approach.

Personality Disorders in Adolescents
(Stephanie Stepp, PhD)
     This rotation provides an opportunity for the longitudinal assessment of personality disorders in a clinic-referred sample of young adolescents. The goal of the study is to identify markers that can be used in the early identification of borderline personality disorder. Interns develop expertise with semi-structured psychiatric interviews and how to adapt personality disorder assessments for adolescent populations.

Obsessive-Compulsive Disorder Intensive Outpatient Program for Children and Adolescents
(Shoshanna Shear, MD; Amy Kelly, MD)
     The Child and Adolescent Obsessive-Compulsive Disorder (OCD) Intensive Outpatient Program (IOP) is a clinical and research program devoted to the assessment, treatment, and study of children and adolescents with OCD and obsessive compulsive spectrum disorders. At the OCD IOP our main objectives include the following: assisting patients in appropriately identifying and labeling obsessions and compulsions; assisting patients in learning and utilizing Cognitive Behavioral Therapy (CBT)/Exposure with Response Prevention (E/RP) techniques; identifying and treating comorbid conditions frequently associated with pediatric OCD; educating children, adolescents, and families about OCD; providing psychoeducation about our treatment approach to patients, families and the community. The population includes children and adolescents aged 5-18 years with a primary diagnosis of Obsessive-Compulsive Disorder (OCD). The IOP runs MTTh for 3 hrs/day (afternoons during the school year, mornings during the summer). The program includes group and individual CBT, family therapy, parent/family support groups, and pharmacotherapy. Clinical psychology interns will have the opportunity to participate in all aspects of the clinic, with a particular focus on learning and carrying out CBT and ERP in a group setting and on an individual basis. There is a strong emphasis on clinical supervision, with weekly group and individual supervision and treatment team meetings, during which interns are encouraged to participate both as group members and as leaders. Other opportunities include conducting intake and clinical research assessments, contributing to the clinical research registry, and developing individual projects aimed at improving clinical care.

Child and Adolescent Bipolar Services (CABS)
(Tina R. Goldstein, PhD; Boris Birmaher, MD)
     The Child and Adolescent Bipolar Services (CABS) is an integrated clinical research program at WPIC devoted to the assessment, treatment, and study of children and adolescents with bipolar spectrum disorders. Clinical services include thorough diagnostic evaluation, as well as pharmacological and psychosocial treatment interventions provided by a multidisciplinary treatment team that includes psychiatrists, psychologists, nurses, social workers, and other clinicians. CABS clinicians also work closely with community-based providers (i.e., case management, Wraparound) and schools to coordinate services. Ongoing research studies at CABS include multiple NIH- and foundation-funded studies examining the efficacy of psychosocial treatments for this population. Longitudinal studies follow children and adolescents diagnosed with, and at-risk for, bipolar disorder through adolescence into adulthood to examine course and outcome. Studies incorporating neuroimaging, neuropsychological testing, and genetics aim to better understand the neurobiology of the illness. Opportunities for interns include training in assessment focused on differential diagnosis, formulation of case conceptualization, and implementation of treatment plans. Interns may gain experience with research protocols, and learn about the pharmacological and psychosocial management of pediatric bipolar disorder.

Services for Teens at Risk (STAR)
(David A. Brent, MD; Kimberly D. Poling, LCSW)
     Services for Teens at Risk (STAR) is a specialty clinic funded by the Commonwealth of Pennsylvania since 1987. The mission of STAR is the prevention of adolescent suicide through research, community outreach, clinical training and supervision, parental psychoeducation, and clinical interventions. Clinical interventions focus on the assessment and psychiatric outpatient treatment of adolescents at risk for suicidal behavior, especially those with major depression. Intensive outpatient treatment is provided through our STAR IOP, which provides 9 hours of treatment per week, comprised of group & individual therapy and medication management sessions. In addition, we see patients with primary anxiety disorders and bereaved youth.

Science and Practice for Effective Children’s Services (SPECS)
(David J. Kolko, PhD, ABPP; Barbara L. Baumann, PhD; Oliver Lindhiem, PhD)
     SPECS offers interns an opportunity to expand their clinical and research experiences by working with child or adolescent populations presenting with family conflict, physical/sexual aggression, and/or victimization/abuse who are involved in alternative service systems. Some are referred by Family Court after an incident of sexually inappropriate behavior (Services for Adolescent and Family Enrichment, SAFE; www.safessu.org). Interns can deliver assessment, education, individual and family treatment of the child/adolescent and their caregivers, and participate in a group program in collaboration with probation officers and SAFE clinicians. Many of these cases have histories of maltreatment (e.g., PTSD) and limited family support/involvement. Others are referred by child welfare or mental health due to family conflict or concerns about physical discipline/child physical abuse to a second program (Partnerships for Families, PFF). Interns here can learn to apply an EBP with caregivers and their children (Alternatives for Families: A Cognitive Behavioral Therapy, AF-CBT; www.afcbt.org). Additional cases may be referred for firesetting by the fire service or mental health (Services Aimed at Fire Education and Training of Youth, SAFETY; www.wpic.pitt.edu/research/safety). Finally, opportunities are available to deliver behavioral health services in collaboration with primary care providers in local pediatric or family medicine practices (Services for Kids In Primary-Care, SKIP; www.skipproject.org). These experiences provide access to collaboration with a faculty member, training to develop personal competencies in administering clinical assessments and multimodal EBPs (e.g., CBT, PMT, family treatment, motivational interviewing, school and medication consultation) and opportunities to consult with/train other practitioners. Participation in program evaluation or research is strongly encouraged. Supervision is provided by a licensed clinical psychologist on an individual and/or group basis, possibly supported by observations or videotapes and supervision by a member of our multidisciplinary treatment team (e.g., psychiatrists, social workers, other clinicians).

Matilda H. Theiss Child Development Center
(Kimberly A. Blair, PhD; Dianne Jandrasits, PsyD; Lindsey Venesky, PhD)
     The Matilda Theiss Child Development Center provides center-based, mobile therapy, and outpatient treatment programs designed to be appropriate for young children ages six weeks through eight years who are at-risk for behavioral or developmental concerns, exhibit disruptive and other challenging behaviors and/or have experienced traumatic stress. Within the center-based program, treatment is provided within natural settings and includes both child-oriented and family-oriented activities and interventions. For young children, it is during play that behaviors are learned, practiced, and tested. Therefore, five days per week our center-based program provides individualized, child-centered, and family-focused behavioral health treatment is delivered within — or in conjunction with — a stimulating, naturalistic, early-learning classroom environment. The following supplementary clinical services are utilized in conjunction with the therapeutic classroom milieu and may include: individualized behavior plans and reinforcement systems; play therapy; dyadic therapy; family psychotherapy; parenting education; family support; medication management. These same supplementary clinical services may also be provided within our mobile therapy program, where mobile therapists provide treatment within the child’s daycare, preschool, or home setting, up to six hours per week. The Theiss Center also provides two evidenced based treatments to families within our center-based and outpatient programs: Parent Child Interaction Therapy (PCIT) and Child Parent Psychotherapy (CPP). With all of these resources and treatment options, the Theiss Center strives to support the emotional and behavioral health of the young children in our communities.

Children’s Hospital of Pittsburgh - Consultation/Liaison Service
(Roberto Ortiz-Aguayo, MD; Viveca Meyer, MD; Donette Svidron RN MSN; Eva Szigethy MD, PhD; Doug Henry, PhD)
     The Children's C&L service provides a full array of behavioral health assessments and interventions for hospitalized children and their families. The goal is to provide family-centered care that mobilizes family resources to manage the challenges arising from their children’s chronic and acute health problems. Members of this team also conduct research on novel psychosocial interventions and investigations examining the impact of chronic conditions on children and their families (notably pediatric cancers, gastroenterology, sickle cell, sleep, IBD, transplant, weight management). Interns have opportunities to work with children with a wide variety of chronic and acute medical problems, including exposure to end-of life and palliative care as well as the interface with health care systems and delivery of behavioral health care in pediatric patients. Other opportunities can be facilitated based on individual interest. The majority of work takes place on a short-term, inpatient basis though opportunities exist for follow-up care needed to facilitate ongoing adjustment to medical challenges.

Children’s Hospital of Pittsburgh - Transplant Psychology
(Diana Shellmer, PhD)
     The Transplant Psychology service at CHP provides behavioral health services including assessment and intervention for solid organ transplant patients and their families. The service cares for children with inborn errors of metabolism (e.g., Maple Syrup Urine Disease [MSUD] and Crigler Najjar Syndrome [CNS]) who are assessed and treated with liver transplantation; children with chronic liver disease; children with bowel disorders including short gut, gastroschisis, and Hirschsprung’s disease; children with cystic fibrosis and other lung diseases requiring lung transplantation; children who have heart failure requiring heart transplantation; children with end stage renal disease requiring kidney transplantation; and/or who are candidates for or have previously received a solid organ transplant. The focus of the service is to provide family-centered evaluation, intervention, and care. Transplant evaluations (1) examine the family’s experience in the medical environment, (2) assess the patient and family’s readiness for transplantation, (3) assess risk factors for maladjustment and non-adherence post-transplantation, and (4) provide clear recommendations to the medical team to assist in the amelioration of risk-factors predicting maladjustment of patients and caregivers post-transplantation. For patients with MSUD detailed neuropsychological evaluations both pre- and post-liver transplantation are also undertaken in order to provide accurate and detailed evaluation of cognitive, neurodevelopmental, adaptive, and academic functioning of patients. Interventions are geared toward addressing psychosocial, organizational, and systematic barriers to successful transplantation and post-transplant adherence. An integral component of the service includes active, ongoing communication and consultation with the various medical teams involved in the care of these patients and families. Current research efforts for the service include development and testing of a novel mobile health application to improve adherence among adolescent solid organ transplant patients; examination of neuropsychological functioning in patients with MSUD; examination of parameters of adherence in transplant patients; and examination of the psychosocial functioning and adjustment of transplant patients.

Children’s Hospital of Pittsburgh - Pediatric Gastroenterology Cognitive Behavior Therapy Program
(Eva Szigethy, MD, PhD)
     This rotation provides an opportunity to learn a manualized cognitive behavioral approach (CBT) to help children and adolescents who have inflammatory bowel disease and depression cope with both their physical and emotional illness. The CBT is based on a model designed by John Weisz PhD, Primary and Secondary Control Enhancement Training (PASCET) with added components to explore the child’s illness narrative and enhance family communication and problem-solving. The CBT approach also includes self-hypnosis techniques to address abdominal pain, anxiety and enhance immune functioning. There is also exposure to how behavioral health is integrated with medical treatment as well as psychopharmacology when needed.

Other Opportunities
     We are committed to providing training, where opportunities allow, in empirically supported treatments delivered across various hospital-based settings that may be individualized to meet interns training needs. Training may utilize a variety of empirically-supported assessment and intervention modalities, including (but not limited to) cognitive behavioral therapy (CBT), motivational interviewing (MI), interpersonal psychotherapy (IPT), exposure and response prevention (ERP) for anxiety disorders, and dialectical behavior therapy (DBT).