Outpatient services
The largest of the programs, outpatient services meets
the needs of children and their families in approximately 9,000 visits
each year. Children are referred for virtually every
reason, including developmental delay, mental retardation, anxiety disorders, psychoses,
antisocial behavior, school problems, affective disorders, post-traumatic stress disorder and a
range of adjustment problems.
All psychologists and interns in outpatient services see a variety of
children during the course of the year. Their duties include psychological
assessment, psychotherapy, and school and community consultation. Psychologists
make decisions regarding the most appropriate assessment procedures or
therapeutic approaches for different cases in conjunction with other members of
the outpatient services staff.
Psychological involvement might include traditional assessment, behavioral
assessment, individual dynamic therapy, family therapy, behavioral therapy,
cognitive-behavioral therapy or group therapy. Decisions regarding assessment
and treatment are generally made on the basis of the psychological needs of the
case and the theoretical orientation of the psychologist and other professionals
involved. Each intern devotes approximately 12 hours per week to the outpatient
clinic, eight as a primary therapist (four for general outpatient and four for
medical psychology cases) and four hours as an evaluator for the neuropsychology
and testing service. Two hours a week are devoted to Intake Services.
Outpatient services include a disruptive behavior disorders clinic, a
school-based intervention project, an anxiety disorder clinic, and a psychosis
clinic. All interns co-lead either a parents" or Children's group in the
disruptive behavior disorders clinic and participate in a three-month rotation
in the school-based intervention project. Participation in the psychosis clinic
and the anxiety disorders clinic is optional; participating interns can be
involved in assessment, individual or family treatment, and case management.
- Neuropsychology and testing service - Interns spend a full
year on the neuropsychology and testing service. One-third of this time is
devoted to the neuropsychology, one-third to the developmental evaluation
clinic and one-third to the general testing service. The neuropsychology
service conducts evaluations of patients referred from both psychiatric and
medical settings for questions regarding cognitive functioning and its
relationship to underlying neurologic dysfunction. Referrals span a broad age
range (three years +), and include concerns such as developmentally-based
deficiencies of attention and learning, anomalies of neural development,
seizure disorders, traumatic head injuries, toxin exposure (pre and
postnatal), brain tumors, and systemic medical disorders.
The developmental clinic assesses children from birth to five years who
have developmental delays or are considered at risk due to prenatal or
perinatal injury or complications.
The general testing service conducts evaluations for other professionals in
the department whose patients require psychological testing for purposes of
determining an appropriate school placement or therapeutic course of
treatment.
- Medical psychology service - The medical psychology service
responds rapidly to the clinical needs of both the outpatient clinics and the
inpatient units of the hospital. Clinical activity in medical psychology
includes evaluation and treatment of medical patients and consultation with
physicians, nurses, and allied health care personnel within the hospital.
Inpatient medical psychology, operating in conjunction with the psychiatry
consultation/liaison service, is subsumed under the intake and mobile services
team. Interns participate in the C & L Service during a four-month
rotation.
Physicians frequently request psychological assessments of children both pre-
and post-surgery, consultations regarding the psychological factors contributing
to a child"s physical condition, assistance in helping a child deal with
difficult medical treatments, assistance with the promotion of medical
compliance after an illness or surgery, or the treatment of psychophysiologic
disorders such as abdominal pain, headache, psychogenic vomiting, enuresis or
encopresis. Presently, medical psychology provides regular coverage to several
of the major pediatric services, including a general medical clinic, neurology,
neurosurgery, urology, endocrinology, hematology/oncology, pain clinic, and to
all services on the inpatient floors.
A variety of assessment and treatment approaches are used by inpatient
medical psychology, but behavioral interventions are most often employed because
of the unique problems that present in the medical setting. Psychological
assessments of all kinds are also very useful within the medical setting, and
assessment plays a vital role in the work of the psychologist and the interns on
this service.
After the initial evaluation and treatment, the medical psychologist may
provide outpatient services on a long-term basis, including individual,
behavioral, or family therapy as needed. Other outpatient medical psychology
services, which consist of outpatient psychiatric services to patients with
medical complications, fall under the auspices of the outpatient services team.
Interns devote three to four hours per week for the entire year to outpatient
medical psychology.
Other opportunities to work with particular illnesses or clinics are
available in medical psychology and are arranged on an individual basis, often
in conjunction with research interests and opportunities. Examples of such
opportunities include work with the HIV team, the renal transplant team, or the
Neonatal Intensive Care Unit.