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Child and Adolescent Rotations

Child and Adolescent Inpatient Services (CAI)
(Melissa Nossal, PsyD; Patrick Driscoll, MD; Garrett Sparks, MD)

CAI is a newly renovated 26-bed inpatient unit that consists of two programs, child (ages 3-12) and adolescent (ages 13-18). Patients are referred for acute crisis stabilization from a variety of outside sources (e.g. outpatient, schools, residential, detention, family) and often have a diverse range of psychiatric disorders (ADHD, PTSD, depression, anxiety, ODD, conduct disorder). CAI utilizes a Collaborative & Proactive Solutions (CPS) philosophy of treatment. Rather than viewing challenging behavior as a lack of motivation to improve, in CPS, challenging behavior is believed to occur due to a lack of crucial developmental skills (e.g. flexibility, language processing, problem solving). With the underlying philosophy of “Kids do well if they can,” individuals can solve problems collaboratively in ways that decrease challenging behaviors, improve safety, and help them build key problem solving skills. On this rotation, interns will be given the opportunity to learn this empirically supported treatment modality by certified CPS providers. Additional opportunities will be given for interns to provide individual, group, and family therapy, behavior analysis, parent training, and assessment.

Family Therapy Training Center (FTTC)
(Leonard J. Woods, LCSW; Mike McNabb, 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.

Adolescent and Young Adult Division of Children’s Hospital of Pittsburgh
(Dana Rofey, PhD)

The UPMC Center for Adolescent and Young Adult Health (CAYAH) Division of Children’s Hospital of Pittsburgh strives to improve the health and well-being of youth. Interns will participate in an integrative care model to improve outcomes for adolescents and young adults not only with psychopathology, but also with the behavioral health/medical interface. Trainees will participate in mental health treatment team meetings to discuss cases, and may be involved in various projects within the clinic which currently include adolescent relationship abuse: prevention of pregnancy, HIV, and sexually transmitted infections; mental health disparities among sexual minorities; evidence-based practice for pediatric obesity; innovative health services delivery for marginalized youth; transition to adult care for youth with complex medical conditions; adolescent contraceptive and sexual decision making.

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; Lori Scott, PhD)

This rotation provides an opportunity for the longitudinal assessment of personality disorders in two populations: 1. a clinic-referred sample of young adolescents and 2. young women from the community. The goal of these studies are to identify markers that can be used in the early identification of borderline personality disorder and understand risk processes that lead to violence and suicide among those afflicted with the disorder. Interns develop expertise with semi-structured psychiatric interviews and how to adapt personality disorder assessments for adolescent populations. Interns will also gain experience in risk assessments for violence and suicide.

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.

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 some focused specialty populations (e.g., children/adolescents and their caregivers referred for family conflict, physical/sexual aggression, and/or victimization/maltreatment) and families who seek services for diverse behavioral health needs in healthcare settings. Many of these cases are involved in other service systems (e.g., juvenile justice, child welfare, primary care). An intern can participate in more than one of the programs, as described below.

The SAFE Program (Services for Adolescent and Family Enrichment, serves children/youth referred by Family Court due to sexually inappropriate behavior. 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 include histories of behavioral and emotional disorders, maltreatment (e.g., PTSD), caregiver dysfunction, and limited family support.

The Partnerships for Families (PFF) program addresses family conflict or concerns about physical discipline/child physical abuse in families referred by child welfare or mental health due to. Interns here can learn to apply an EBP with caregivers and their children (Alternatives for Families: A Cognitive Behavioral Therapy, AF-CBT; on both an individual and family basis.

Our SAFETY program (Services Aimed at Fire Education and Training of Youth; serves children/youth referred for firesetting behavior from local and surrounding counties. An intern can participate in assessment, education, treatment, and provider consultation.

The SKIP program (Services for Kids In Primary-Care; offers an opportunity to deliver behavioral health services in collaboration with primary care providers in local pediatric or family medicine practices. An intern can participate in service delivery to promote personal competencies in administering clinical assessments and multimodal EBPs (e.g., CBT, PMT, family treatment, motivational interviewing, school and medication consultation) and staff consultation/training with affiliated healthcare providers.

In all of these programs, 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
(Kayleigh Bantum, PhD; Kimberly Blair, PhD; Candace Hawthorne, PhD; Dianne Jandrasits, PsyD)

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. Funded in 2012 by the US Substance Abuse and Mental Health Services Administration, the Early Childhood Trauma Treatment Center was created as a Community Treatment and Services Center within the National Child Traumatic Stress Network (NCTSN) to provide services to children age birth to seven who have experienced trauma, along with their caregivers and/or families. This goal is achieved through the use of evidence-based practices, including 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; Eva Szigethy MD, PhD; Kristin Dalope, MD; Nicolette Guerrieri, DNP; Kathryn Barbash, PhD; Carrina Scotti-Degnan, PhD; Leslie Dahl, PhD; Melissa Milbert, LCSW; Jenny Halper, LCSW;, Susan Turner, PhD; David Benhayon, MD; Kelley Victor, MD; Victoria Winkeller, MD; Abigail Schesinger, MD; Martin Lubetsky, MD; Sheri Goldstrohm, 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. 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.

Adult, Child, & Adolescent Inpatient Bipolar (ACABS)
(Melissa Nossal, PsyD; Rasim Diler, MD; Frank DePietro, MD)

The ACABS unit is a 23-bed inpatient unit comprised of two separate programs, Inpatient Child & Adolescent Pediatric Bipolar Services Program (In-CABS) and the new Adult Bipolar Program. The multi-award winning In-CABS Program facilitates early identification and treatment of bipolar disorder in adolescents between the ages of 13 and 18. While in this program patients may benefit from receiving extensive diagnostic assessment and participating in the comprehensive inpatient program that includes Dialectical Behavioral Therapy (DBT) skills group, actigraphy, neurocognitive assessments, electronic mood/energy charting, light therapy, sleep scheduling, diet/exercise/medication education, individual therapy, and family groups. The inpatient Adult Bipolar Program utilizes specialized chronotherapeutic interventions in the treatment of bipolar disorder in adults. The new triple chronotherapy program utilizes sleep deprivation, sleep phase advancement, and light therapy to accelerate antidepressant response in patients currently in a bipolar depressive episode. Dark therapy and blue light blocking technology is offered as a supplemental treatment for patients currently presenting in a manic or rapid cycling state. Patients in this program are first assessed with the Structured Clinical Interview for DSM-5 (SCID) to determine diagnosis assist in treatment recommendations. Milieu group therapy programming primarily consists of Dialectical Behavioral Therapy (DBT) and Interpersonal Social Rhythm Therapy (IPSRT). Patients in this program may also benefit from individual therapy, family groups, actigraphy, and electronic mood/energy charting. During this rotation interns may choose to work with one program or both.