CHILDREN S HOSPITAL OF EASTERN ONTARIO The Children s Hospital of Eastern Ontario (CHEO), located in Ottawa, Canada is a 167-bed tertiary care paediatric hospital serving Eastern Ontario and Western Quebec. It has a catchment area of approximately 600,000 children, 18 years and under, and has provided specialized paediatric heath care and allied health services to children and their families in English and French since its opening in 1974. The hospital is committed to building partnerships with the community in order to provide a continuum of care to children and their families. The hospital also plays a leading role in providing advocacy for children s health issues, health promotion and injury prevention. In 2003, CHEO received designation as a provincial Centre of Excellence in Child and Youth Mental Health. The hospital is part of a large modern health science complex affiliated with the University of Ottawa with major responsibilities for clinical teaching and research in a number of disciplines. CHEO has also achieved excellence as a centre for both basic and applied research in children s health. In 1993, the Research Institute Building was completed, with a new wing added during 2003. This building consists of several laboratories for both basic and applied paediatric research. Many of the ongoing research projects being conducted by psychologists at the hospital are housed within the CHEO Research Institute. PSYCHOLOGY AT CHEO Psychology serves as the primary professional affiliation for psychologists working in the different patient services units. The Professional Practice Leader is responsible for issues of professional competence and standards, as well as both intra- and inter-disciplinary practice issues. The Professional Practice Leader and members of the profession actively collaborate with clinical program directors in the recruitment, hiring and allocation of staff. Bimonthly meetings are held to discuss professional issues. Psychologists within the hospital are members of a range of programs within the Mental Health, Rehabilitation, Paediatrics, Genetics, Autism and Oncology Patient Services Units. Psychologists affiliated with the Ottawa Children s Treatment Centre (OCTC) also participate in psychology training. Psychology staff provide comprehensive assessment and intervention services to children and their families, seen as both inpatients and outpatients. Children and adolescents are seen for assessment of their neuropsychological, cognitive, developmental, personality and behavioural functioning. Treatment services include individual, group, parent and family therapy. Emphasis is placed on assessing and treating children within a family and social context. Liaison and consultation to other agencies, such as schools or community, often form part of the assessment-intervention experience. Consultation to other professionals within the hospital is also an integral part of the work of psychologists. Many clinical services are offered in both English and French. Psychology staff members are active in teaching and training psychology residents and practicum students, as well as paediatric and psychiatric residents. Many staff members hold appointments with the University of Ottawa and Carleton University. Staff are also active in
community service, including offering workshops and lectures to both professional groups and the public. Psychology at CHEO is based on the scientist-practitioner model. Applied research is an important part of the goals and activities of psychologists in the hospital. Staff are involved in many independent and collaborative research projects, as well as in the supervision of student research theses. 2
THE INTERNSHIP IN PSYCHOLOGY AT CHEO We offer predoctoral internship training for graduate students in doctoral clinical psychology programs. The internship is accredited by the Canadian Psychological Association. The training program can accommodate both English speaking and bilingual (French-English speaking) residents. The training program provides trainees with the opportunity for a rich experience through active clinical work, intensive supervision, small group seminars, applied research, hospital speciality rounds, and interaction with other health professionals. The focus is on developing the trainee s basic clinical skills in assessment, treatment and consultation. Residents are exposed to different supervisors, a variety of treatment models and a broad range of child clinical and health psychology problems through participation in several rotations during the year. The Canadian and American Psychological Associations first accredited the Psychology Internship Program in 1990, with subsequent re-accreditation in 1995, and 2000. In 2005 we were re-accredited by the Canadian and American Psychological Associations for a 7-year term. In 2009, in light of the approaching end to APA accreditation in Canada, the program withdrew from APA accreditation. Philosophy and Model of Training The Internship Training Program in Clinical Psychology reflects our commitment to the scientist-practitioner model. In keeping with CHEO s mission statement, our model of education was developed to train psychologists to provide exceptional care that is informed by theory and research. We believe that the practice of psychology is enhanced by encouraging trainees, who have already demonstrated a commitment to the science of psychology, to develop their clinical skills in an environment that promotes research and education. Accordingly, our clinical training is provided by doctoral level psychologists engaged in ongoing research, program evaluation, and the communication of psychological knowledge to the public. Residents in our program are encouraged to anchor their clinical service in a thorough review of existing scientific literature and evaluate their interventions systematically. Residents are also encouraged to use their clinical practice to generate critical questions for further investigation. Another important aspect of our setting is the value placed on interdisciplinary teamwork, in order to provide the highest quality service to clients. Thus, we value the contribution of our colleagues and encourage the participation of other disciplines, such as medicine and social work, in our training program. Our model of training allows for a diversity of experience that will enable residents to develop both a sense of professional identity and the ability to work collaboratively in an interdisciplinary paediatric health care setting. We provide opportunities to expand clinical skills in working with children and youth across the developmental spectrum, many of whom may also have complex medical histories. Throughout our training program, the ethical practice of psychology is emphasized. Through instruction and modelling, staff teach the highest level of respect for the 3
rights and freedoms of the children, youth and families that we serve. We foster residents independence clinically and professionally (i.e. in their participation on hospital committees) to facilitate a sense of professional identity as they move from viewing themselves as students to fully functioning practitioners of psychology. We believe that in providing excellent training within the scientist-practitioner model we are able to prepare residents for a range of career options, including research and academic positions. This statement of philosophy and model of training describes the foundation of our training program, which is further elaborated and operationalized in the following goals and objectives. Training Goals and Objectives GOAL 1 Residents will demonstrate proficiency in psychodiagnostic assessment with children and adolescents, using clinical interviews, as well as behavioural, personality, and cognitive assessment measures. Objective 1: Residents will develop competence in conducting comprehensive intake/diagnostic interviews. This includes obtaining comprehensive developmental histories, conducting clinical interviews with children and adolescents and conducting family/parental interviews/assessments. Objective 2: Residents will develop competence in administering and interpreting psychometric measures to assess behaviour, personality and social-emotional functioning. This includes developing skills in using both objective and projective assessment instruments. Objective 3: Objective 4: Objective 5: Residents will develop competence in the administration and interpretation of standardized psychometric measures of cognitive functioning and academic achievement. Residents will develop competence in providing feedback, both oral and written, to families, referring agents, community agencies and members of interdisciplinary treatment teams. Residents will develop competence in independently planning and implementing comprehensive psychological assessments that take into consideration relevant medical, developmental and social-contextual factors. GOAL 2 Residents will develop proficiency in the use of diverse empirically and theoretically based approaches to therapy with children, adolescents and their families. This will include supervision and training in individual, family and group psychotherapy, as well as parentmediated interventions. Objective 1: Residents will develop competence in conducting individual therapy with children and/or adolescents. This may include development of skills in play therapy, 4
behavioural or cognitive/behavioural interventions, systemic, or interpersonal approaches. Objective 2: Objective 3: Objective 4: Residents will gain experience in conducting group based psychotherapeutic interventions with children, adolescents and/or parents. This may include processoriented groups, structured behaviour and/or cognitive-behavioural interventions and parent-training groups. Residents will develop competence in conducting family-based interventions. Residents will develop competency in planning, implementing and monitoring interventions that take into consideration developmental, medical and sociocontextual factors. GOAL 3 The training program will prepare residents to function within an interdisciplinary paediatric health care environment. Objective 1: Objective 2: Objective 3: Residents will develop and refine skills in working collaboratively with other professionals as members of interdisciplinary teams. Specific skills residents will acquire include developing a sense of their professional role and respecting the unique contribution of other team members, as well as the ability to contribute appropriately to team discussions. Residents will develop competence in providing consultation to other professionals in the care of a child or adolescent and their families. This may include developing, implementing, and evaluating inpatient and outpatient interventions, implemented by treatment teams. Residents will develop the skills required to obtain the medical information necessary to provide competent assessment, treatment and consultation services. This includes obtaining relevant information about the client s medical condition through a review of the medical chart, and scientific literature, and liaison with other health care professionals. GOAL 4 The training program will instil in its residents the ethical and professional principles needed to ensure that they are prepared for independent practice. Objective 1: Objective 2: Objective 3: Residents will develop an awareness and understanding of the provincial and federal legislation relevant to conducting research and providing psychological services to children, adolescents, and their families. Residents will participate in a range of activities that refine their understanding of ethical issues and enhance their ability to apply this knowledge to their clinical, research and professional activities. Residents will demonstrate an appropriate awareness of the limits to their clinical competence, based on their level of professional training and experience. 5
GOAL 5 Residents will refine the skills required to integrate science and clinical practice. Objective 1: Objective 2: Objective 3: Residents will demonstrate initiative in seeking out and critically evaluating scientific literature relevant to clinical cases and issues. Residents will gain exposure to key concepts and methods in program evaluation. Residents will have the opportunity to refine previously acquired research skills in order to address some of the unique challenges in conducting research within a clinical setting. The opportunities may include learning to formulate questions that are clinically relevant and feasible, working collaboratively on the development and implementation of research projects with other disciplines, gaining exposure to ethical issues in conducting clinical research, communicating research results, and consulting with other professionals about research issues. GOAL 6 Residents will develop an awareness and sensitivity to cultural and individual differences in their clinical, research and professional activities. Objective 1: Objective 2: Residents will gain experience working in a health care setting with children, youth and families representing a diversity of cultures and individual differences. This will include considering the role of cultural and individual factors in the selection, administration, and interpretation of psychological tests, as well as in providing feedback, consultation and treatment to children and their families. Residents will have the opportunity to learn about individual and cultural differences relevant to their clinical practice. GOAL 7 The training program will foster the development of the resident s professional identity as a psychologist. Objective 1: Objective 2: Objective 3: Residents will become knowledgeable about models, skills, and ethical issues related to supervision. Residents will gain experience in providing supervision, through participation in peer consultation, group supervision, and line-supervision of practicum students. Residents awareness of the role of a psychologist within a health care setting will be promoted by their participation in discipline or hospital-wide administrative committees. 6
ORGANIZATION OF TRAINING ACTIVITIES The overall organization of the internship is designed to provide residents with specialized training in specific areas of interest while at the same time ensuring breadth of training in child clinical psychology. During the year residents will participate in two six-month major rotations for approximately three days per week. The focus of the major rotations is on providing in-depth training experiences in the areas selected. Concurrent with the major rotations, residents will select minor rotations, which require approximately a half a day per week. The function of the minor rotations is to ensure a broad based training experience, by exposing residents to clinical areas outside of their major rotations. Across their rotations, trainees may be supervised in cognitive, developmental, personality and behavioural assessment, and individual, family and group therapy. In addition, within each rotation residents gain experience working as part of an interdisciplinary team. The resident and the supervisor jointly establish individual rotation-based training goals. This core program is augmented by participation in the Family Therapy Training Experience, the Individual Psychotherapy Training Experience, the Professional and Clinical Issues Seminar, and a monthly City Wide Seminar Series. Residents also complete a program evaluation project that is rooted in one of their clinical rotations. Opportunities for involvement in applied research can be incorporated into trainees programs. In addition, whenever possible, residents have the opportunity to develop their supervision skills by participating in the supervision of practicum students. Residents are also expected to attend bimonthly Psychology Discipline meetings. Attendance at hospital rounds and research seminars is highly encouraged, but is optional. The table below provides an overview of the organization of the internship training activities. ORGANIZATION OF INTERNSHIP ACTIVITIES September 1 March 1 August 31 MAJOR ROTATION 1 3 days per week MINOR ROTATION 1 1/2 a day per week MAJOR ROTATION 2 3 days per week MINOR ROTATION 2 1/2 a day per week FAMILY THERAPY TRAINING EXPERIENCE 2 hours per week INDIVIDUAL PSYCHOTHERAPY TRAINING EXPERIENCE 3 hours per week SEMINARS/MEETINGS/ROUNDS 4 hours per week PROGRAM EVALUATION EXPERIENCE 7
Major Rotations There are nine major rotations offered to residents: Inpatient Mental Health, Outpatient Mental Health, Dual Diagnosis, Health Psychology, Neuropsychology, Eating Disorders, Child Development (OCTC), Paediatric Rehabilitation (OCTC) and Autism. Each of these rotations is described in section, Clinical Emphasis Within Each Major Training Rotation. Decisions regarding the assignment of the major rotations for each resident are made in consultation with the resident, taking into account the specific interests of the resident, as well as considering their training needs. In particular, an effort is made to provide each resident with advanced skills in an area of primary interest, while also allowing them to develop skills in areas where they may have had little prior experience. This ensures that the resident completes the internship with a well-rounded experience. An effort is also made to ensure that residents participate in one rotation where the focus is on assessment and one in which there is more of an emphasis on treatment. Finally, practical administrative issues such as the number of supervisors available within a rotation and the language preferences of the resident and supervisor are also considered in assigning major rotations. In each major rotation the resident is assigned a primary supervisor who assumes supervisory and administrative responsibility for the resident. Residents may have more than one supervisor in a rotation. This is arranged when it is felt that the resident desires or can benefit from experiencing different supervisory styles, or when a particular psychologist has an area of special interest or expertise that the resident shares. In all cases, registered doctoral level psychologists supervise residents. Minor Rotations The goal of the minor rotations is to provide residents with the opportunity to round out their clinical training experiences by gaining exposure to areas of practice outside of their major rotations, or by developing a specific skill or interest. A minor rotation might consist of a specialized focus selected from within one of the major rotations (i.e., ADHD, Pain Management, Anxiety Coping Group) or an additional clinical experience which falls outside the major rotations (i.e., Crisis Team, Regional Eating Disorders Program for Adolescents). In addition, there is an option of completing a minor rotation in Research. The number of minor rotations completed by a resident during the year will depend upon the nature of the experiences selected, although it is expected that residents will complete a minimum of two minor experiences during the internship year. Interns will have the opportunity to discuss options for minor rotations with the Director of Training prior to the start of the training year, however final assignments may not occur until September. 8
Interdisciplinary Family Therapy Training Experience In addition to the clinical rotations and therapy experiences, the core program requires all residents to participate in the Interdisciplinary Family Therapy Training Experience. This consists of residents participation as members of a family therapy reflecting team with the use of a one-way mirror. Residents are expected to see a minimum of one family therapy case with the team for which they function as the primary therapist. They receive group and in-vivo supervision. This experience is jointly conducted by the Disciplines of Psychology and Psychiatry. Individual Psychotherapy Training Experience This experience provides residents with psychotherapy training outside their rotation experiences. Each resident will be expected to carry one therapy case and will participate in group supervision sessions with other residents. Supervision sessions will focus on discussing theoretical and clinical issues in conducting psychotherapy. Program Evaluation Experience Psychology residents will be exposed to key concepts and methods of program evaluation through both didactic and experiential components. Didactic group sessions will focus on the basic aspects of program evaluation (e.g., purposes and types of evaluation, application within a health care setting). For the experiential component, residents will develop an individual evaluation project under the supervision of a psychologist within the Mental Health Patient Service Unit with experience in program evaluation, with support from the Mental Health Research Program. This project could include participation in mental health quality improvement initiatives or adding an evaluative component to one of their existing clinical activities. Seminars Residents attend a weekly seminar on Professional and Clinical Issues. Case presentations and discussion of specific clinical issues form part of the curriculum. In addition, residents participate in a monthly series of presentations jointly with residents in other local internship settings. These address issues of cultural and individual diversity, as well as those of general professional interest (City Wide Seminar Series). 9
SUPERVISION Supervisors draw from many theoretical orientations including cognitive-behavioural, social learning theory, psychodynamic, developmental, systemic and strategic. Individual supervision is provided on a case-by-case basis and is individually tailored to meet the developmental learning needs and training goals of each resident. At the beginning of a rotation, more direct forms of supervision will be employed, such as co-therapy and direct observation of the residents clinical activities. As the residents skills increase it is anticipated that they will begin to function more independently, and supervision may increasingly take the form of post-session discussion of clinical cases. In practice, residents receive up to 3 hours of individual supervision per week in their major rotation. An additional hour of individual supervision is provided in minor rotations. Supervision is also provided through the family and individual psychotherapy training experiences. Overall, the amount of supervision that residents receive typically exceeds 4 hours per week. CLINICAL EMPHASIS WITHIN EACH MAJOR TRAINING ROTATION Health Psychology Rotation This rotation is designed to develop the resident s skills in paediatric health psychology. The rotation is organized around the Behavioural Neurosciences and Consultation Liaison Team. This is an interdisciplinary team with representatives from psychology, psychiatry, and social work. The team provides assessment, consultation and intervention to paediatric inpatients and outpatients seen in the hospital medical clinics who present with both medical and mental health issues which may adversely impact their treatment or recovery. Typical referral problems seen by psychologists include coping with chronic illness (e.g., asthma, diabetes) or an acute medical condition, non-compliance to medical treatment, pain and stress management, trauma (e.g., burns, motor vehicle accidents), bereavement, feeding problems, encopresis, sleep problems, anxiety related to medical procedures and behavioural difficulties secondary to neurodevelopmental conditions. The resident will be expected to function as a full member of the interdisciplinary team. The resident will gain experience with various clinical activities consisting of assessment, consultation-liaison, and short-term individual and family intervention. In this rotation, three registered psychologists provide supervision and training. Eating Disorders Rotation This rotation is designed to develop residents skills in eating disorders, a specialized area within paediatric health psychology. The rotation is organized around the Regional Eating Disorders 10
Program for Children and Adolescents. The program provides services along a stepped-down continuum of care, including an inpatient unit, day treatment program, and outpatient services. Services are provided to children and adolescents (ages 10 to 18 years) with diagnosis of an eating disorder. Most individuals also struggle with a co-morbid diagnosis, such as depression, anxiety or obsessive-compulsive disorder. The eating disorder team is an interdisciplinary team including paediatricians, nurses, social workers, child and youth counsellors, psychiatrists, psychologists, dieticians and psychometrists. The team provides comprehensive interdisciplinary assessments for individuals with an eating disorder. The inpatient unit is a 6-bed unit designed to meet the needs of patients who are medically unstable. The day treatment program is an 8-patient program that offers intensive treatment. Outpatient services include a medical/nutritional clinic, support-education groups for parents, recovery groups for patients, and individual and family therapy. The role of the psychologist on the Eating Disorders Team includes assessment, treatment, and research responsibilities. In this rotation the resident will gain experience in conducting comprehensive assessments, in collaboration with an interdisciplinary team. The resident will also have an opportunity to provide individual and family therapy to patients across the full continuum of care. Furthermore, the resident will be able to participate as a group co-leader in the inpatient, day treatment, or outpatient program. As well, the resident will gain experience functioning as a full member of the interdisciplinary team and collaborating with other professionals. In this rotation, three registered psychologists are available to provide supervision and training. Neuropsychology Rotation This rotation focuses on providing clinical diagnostic services to children and adolescents who present with medical conditions or a number of risk factors that are known to be associated with various aspects of neuropsychological dysfunction. Examples of patients seen in this rotation include individuals with seizure disorders, traumatic brain injury, brain tumors, demyelinating disorders, cancer and immune system disorders, hydrocephalus or stroke. Comprehensive assessments of attention, memory, intelligence, learning, motor and perceptual functioning, executive functioning and academic achievement as well as socioemotional health are conducted. Consultation to families and professionals is provided regarding specific interventions (e.g., cognitive, academic, and/or behavioural). Residents may obtain experience with single or diverse populations, depending upon their interests and backgrounds. Residents in this rotation will have the opportunity to participate in the various interdisciplinary teams in which neuropsychologists participate. There is also the possibility for short-term intervention experience within a rehabilitation unit. Six registered neuropsychologists provide training and supervision in this rotation. Outpatient Mental Health Rotation Mental health outpatient services at CHEO are organized around four speciality teams, each with a different focus. The four teams are: Abuse and Trauma: ADHD and Disruptive Behaviour Disorders; Mood and Anxiety; and Urgent Care, Assessment and Consultation. A major rotation 11
is available on the Mood and Anxiety Team with the option of some involvement on the ADHD team. A minor rotation is available on the Assessment and Consultation and Urgent Care team. The resident in this outpatient rotation would be assigned to a primary supervisor affiliated with one of the teams (e.g., Mood and Anxiety Disorders). The opportunity also exists for a resident to be supervised on some cases taken from outpatient areas outside of their major focus. Residents will participate in all aspects of the services provided to outpatients and are expected to function as full members of the team with which they are affiliated. Four registered psychologists provide training and supervision in this rotation. The Mood and Anxiety Team provides services to children and adolescents up to age 16, who present with prominent mood and /or anxiety symptoms. Professional representation on this team includes psychology, social work, psychiatry, occupational therapy and paediatrics. Services provided by this team include diagnostic assessment, consultation and review of medications, short-term individual and family therapy, and group therapy (e.g. adolescent depression group, anxiety/stress management group for children and youth). Clinical research initiatives are also encouraged as part of ongoing program development. The ADHD team is a multidisciplinary team comprising psychology, psychiatry and social work. The services provided by this team include diagnostic and neuropsychological assessment, consultation and review of medications, parent-training groups, and on a limited basis, assistance for parents with behavioural management. These services are offered to children with a primary diagnosis of ADHD, as well as those for whom a diagnosis of ADHD is strongly suspected, but not yet confirmed. A resident completing a rotation in this program would therefore have the opportunity to participate in diagnostic assessments of complex cases, parent-training groups, and multidisciplinary team meetings. The ADHD team embraces a scientist-practitioner model and the resident should therefore have the opportunity to learn how appropriate research questions can be developed and addressed systematically in the course of providing clinical services. The Assessment and Consultation/Urgent Care team consists of staff members from Psychology and Psychiatry. Team members conduct brief, focussed assessments of children and adolescents presenting with a wide range of mental health problems. Reasons for referral to this team may include diagnostic clarification, medication review, or identification of treatment needs. Triage criteria are in place to determine which children and adolescents need to be assessed on an urgent basis (i.e., within one week of referral). Team members work with members of other CHEO Mental Health Outpatient Teams and mental health resources in the Ottawa and outlying regions in order to facilitate appropriate and timely follow-up services, as needed. Presently, several supervising psychologists on the outpatient teams provide outreach services to children and families in surrounding counties. Residents will have the opportunity to participate on an outreach team on a limited basis, if time permits. The scope of outreach in terms of the number of teams providing the services, as well as the specific nature of services provided is continuing to evolve. Typically, each team travels to an outlying county every other week. Team membership consists of staff from psychology and psychiatry. Referring sources are primarily physicians and community agencies. Currently, the main services provided by psychologists on the outreach teams include psychological/diagnostic assessment, and consultation regarding treatment approaches. 12
Dual Diagnosis Rotation The Dual Diagnosis Service provides interdisciplinary mental health outpatient services to children and youth living with intellectual and developmental disabilities up to age 18. This is a subspecialty service of the hospital-based Behavioural Neurosciences and Consultation Liaison Team. Services provided include diagnostic assessment, individual and family therapy, sibling intervention, social skills group therapy, consultation/liaison and advocacy. Members of the Dual Diagnosis Service include a psychologist, a psychiatrist, a nurse, a social work, two occupational therapists and a speech-language pathologist. The psychology resident will gain experience in conducting interdisciplinary mental health assessments and psychological assessments of cognitive, academic and adaptive skills. The resident will also have the opportunity to develop and implement treatment with some of these vulnerable children and youth. In this rotation, one registered psychologist is available to provide supervision and training. Inpatient Mental Health Rotation This rotation includes training opportunities provided through the Inpatient Mental Health Services at CHEO, which include both a child and an adolescent unit. The Child Mental Health Inpatient Unit (CMHIU) is a 4-bed unit designed to address the needs of children between the ages of 6 and 12, who present with acute, complex mental health needs, and who are not functioning in a less restrictive setting. The unit provides short-term crisis stabilization and elective inter-disciplinary assessment within a safe, structured and supervised environment. Service is tailored to the individual needs of the child and family. Common presentations include severe externalizing behaviour disorders, impact of trauma, anxiety and mood issues, and in most cases there are a number of psychosocial stressors. The team works closely with community partners including schools and treatment centers, as well as with family. The Adolescent Mental Health Inpatient Unit (AMHIU) is designed to address the needs of youth between the ages of 13 and 17 who present with acute, severe, and complex mental health difficulties. These services include crisis stabilization, and elective inter-disciplinary assessment. Common presentations include severe depression, anxiety, suicidality and psychosis, typically experienced at a level in which healthy daily functioning has been substantially impaired. The role of the psychologists on both units is to provide comprehensive assessments, act as consultant to the team for crisis and behavioural management interventions, and in some cases provide short-term individual/family treatment as a member of an interdisciplinary team. Comprehensive assessments are undertaken in order to provide case conceptualization and differential diagnoses, identify needs and strengths of children/youths and their caregivers, and offer post-discharge recommendations. Psychologists are also involved in designing interventions and approaches for children/youth requiring specifically tailored crisis and behavioural management services. Additionally, psychologists may, if clinically and ethically appropriate, work with children/youth and caregivers requiring transitional care to provide shortterm individual and family support/treatment designed to help them move on to outpatient services. The psychologists work closely with interdisciplinary team members in all aspects of patient care and unit functioning. 13
The psychology resident will participate as an active member of the interdisciplinary team comprised of child and youth workers, nurses, psychiatrists, psychologists, social workers, teachers, occupational therapists, and other trainees. The resident will have opportunities to gain experience in all services provided by psychology on the units. The resident in this rotation would be assigned to a supervisor affiliated with either the Child or Adolescent Inpatient Unit. The opportunity will exist for the resident to be supervised on selected cases taken from the other unit in order to ensure breadth of experience in either assessment or treatment. Four registered psychologists provide supervision and training in this rotation. OUTREACH ROTATIONS: The Ottawa Children s Treatment Centre (OCTC) is a regional centre serving Ottawa-Carleton and surrounding Eastern Ontario counties, as well as providing specialized services to Northern Ontario and Baffin Island. The OCTC provides comprehensive bilingual ambulatory services to children and youth with physical (cerebral palsy, spina bifida and/or other neuromuscular impairments) and/or developmental disorders (developmental disabilities and/or pervasive developmental disorders). In addition, adults with developmental disabilities and/or pervasive developmental disorders receive behavioural intervention in one of the OCTC programs. The focus of care at OCTC is to optimize independence so that clients can maximize their potential and become more fully integrated into their community. Each psychologist works as part of an interdisciplinary team, which may include a physician, nurse, social worker, speech-language pathologist, occupational therapist, physiotherapist, behaviour consultant, early childhood consultant and teacher. OCTC currently has seven psychologists providing supervision and training across these two rotations. Two outreach rotations are offered to residents at the Ottawa Children s Treatment Centre (OCTC): the Child Development Rotation and the Paediatric Rehabilitation Rotation. OCTC is directly adjacent to CHEO and is connected to CHEO by an underground walkway. OCTC Child Development Rotation The Child Development Rotation is designed to develop the resident s skills in developmental assessment and intervention within the population of children presenting with significant cognitive, adaptive and behavioural challenges indicative of developmental disabilities and/or pervasive developmental disorders. The rotation is organized around the Early Childhood Program (ECP) and Behavioural Services and may include involvement with the OCTC preschool depending on the resident s training needs and interests. The psychological assessment of a child s intellectual functioning and adaptive behaviour comprises an integral part of the initial assessment for children seen in the ECP, who primarily range in age from 3 to 6 years. Occasionally, school-aged children are seen for a psychological assessment upon query of a pervasive developmental disorder. The assessment information is used for diagnostic purposes and to determine eligibility for specialized intervention and support programs. Through 14
Behavioural Services, psychologists provide intervention for clients up to the age of 17 years, which includes the development and monitoring of psychotherapeutic and/or behavioural programs provided either individually or in groups. The resident in this rotation will gain experience in diagnostic assessment, development and monitoring of behavioural interventions and consultation to behaviour therapists. There may also be opportunities for the resident to provide short-term individual or group interventions. While most of the clinical training experiences occur within the centre, there may be some opportunity to participate in communitybased (i.e. school, day-care, group home) clinical visits. Five registered psychologists provide supervision and training in this rotation. OCTC Paediatric Rehabilitation Rotation This rotation is designed to develop the resident s knowledge and skills with children and adolescents who have complex physical disabilities and associated developmental and behavioural needs. Many children and youth served within this rotation have cerebral palsy, spina bifida, and/or other neuromuscular impairments. The resident will have opportunity to be involved with two programs: the Lifespan Program that, in part, focuses on school age children, and the Special Education Program, a specialized school program for children with physical impairments. Sometimes, a child of preschool age may be referred to assist planning for school entry. The primary goal of these programs is to optimize independence within the client s abilities. Psychology staff work closely with families, other team members and community providers (e.g. daycare staff community therapists, school personnel, etc.) so that integration of the children with physical disabilities can be meaningful and successful. Training opportunities are provided through diagnostic and intervention services to individuals, therapeutic groups for children with physical disabilities and therapeutic groups for siblings. Through this rotation, the resident will learn to conduct a developmental or psycho-educational assessment depending on the client s age which addresses the needs of children with physical disabilities, develop skills in behavioural consultation and management, become knowledgeable about community resources, and develop an appreciation of the impact of physical disabilities on child development and on family relationships. Two registered psychologists currently provide supervision and training in this rotation. Autism Program Rotation A third outreach rotation is offered at the Autism Intervention Program Eastern Ontario, which is located a short drive from the hospital site at 1661 Montreal Road, Ottawa. This rotation is designed to develop the resident s skills in the assessment and intervention in autism, a specialized area within paediatric developmental disabilities. The mandate of the program is to provide Intensive Behavioural Intervention (IBI) based on an evaluation of a child s strengths and needs. Intervention follows a team approach including psychologists, senior therapists, instructor therapists, social worker, transition care worker and parents. Services also include eligibility assessments to confirm diagnosis and to determine number of hours of intervention as well as annual psychological assessments to review and monitor a child s progress. This is a community-based service offering both home and centre-based intervention. 15
In this rotation, the resident will function as a full member of the assessment and treatment team. The resident will gain experience with a variety of assessment and intervention experiences, working with a treatment team as well as families. Opportunities to participate in parent education groups also exist in this rotation. The autism program supports a scientist-practitioner model. In this rotation, five registered psychologists provide supervision and training. ADDITIONAL CLINICAL TEAMS Psychology is also involved in several other interdisciplinary clinical teams. Although a major rotation is not offered as part of these teams, it is possible for a resident to complete a minor rotation in one of these areas: Autism Intervention Program Eastern Ontario The Autism Intervention Program is a provincial government initiative, which provides intensive behavioural intervention to children at the severe end of the autism continuum. The primary focus is on the development and supervision of individualized behavioural intervention programs for skill development based on an evaluation of a child s strengths and weaknesses. Intervention follows a team approach including psychologists, senior therapists, instructor therapists and parents. Services also include diagnostic assessments to confirm eligibility and to determine number of hours of intervention. This is a community-based service offering both home- and centre-based intervention. Regional Psychiatric Emergency Service for Children and Youth - This service has two components. The Crisis service provides assessments and short-term interventions to children and adolescents who present with psychiatric crises in the Emergency Department at CHEO. The Urgent Care service provides follow-up urgent assessments on an outpatient basis to children and youth who present in the CHEO Emergency Department who are in a crisis state but do not require hospital admission. Children and youth requiring urgent (but not immediate) mental health services are also referred by paediatricians, family doctors, emergency department medical personnel of regional hospitals, and school board social workers/psychologists in the CHEO catchment area. Assessments are brief and focused on diagnostic clarification and identification of current strengths and resources. The psychologist provides short-term follow-up for many of the children and youth and routinely liaises with other mental health professionals and school personnel to assist with the implementation of appropriate interventions. The psychologist also coordinates the outcomes management and research activities of this service. Rehabilitation Team - This team provides rehabilitation services to inpatients who are medically stable and outpatients. The team consists of professionals from psychology, psychiatry, nursing, occupational therapy, physiotherapy, speech language pathology, social work, child life, pastoral care and clinical nutrition. The primary goal of the Rehabilitation Team is to help individuals reach their optimal potential for independent living and social integration. Psychology services within this team include neuropsychological assessments, individual therapy, family education, and school consultations. There are weekly rounds for case discussions, and psychology residents have the opportunity to present cases during these rounds. School Day Treatment Program - Day Treatment Programs for adolescents and school-aged children (ranging in ages from 4 to 18 years-old) are also provided in partnership with the Francophone and Anglophone school boards of the greater Ottawa region. Psychiatrists, social 16
workers, resource teachers, child and youth counselors as well as a consultation team comprised of a psychologist, an occupational therapist and a speech therapist are located in the Day Treatment Programs in selected community schools. Psychology services include comprehensive assessments, brief cognitive-behavioural and family interventions, and consultation to parents, professionals, community agencies and schools. RESEARCH OPPORTUNITIES WITHIN THE CLINICAL TRAINING PROGRAM Psychologists at CHEO are very active in independent and collaborative research activities, many of which are supported by the major funding agencies. Psychology s strong commitment to research has fostered considerable cross-fertilization between the clinical and research activities of residents who have participated in our program. Residents can become involved in research in a number of ways during the year. They are invited to attend and participate in the series of research seminars organized by the Mental Health Patient Service Unit. These seminars provide the opportunity to learn about ongoing research projects as well as contribute their expertise to others who are developing research projects. Residents are expected to present their own research projects or ideas at this forum at least once during the year. Residents are also expected to conduct a program evaluation project typically linked to one of their clinical rotations. Residents who would like a more in-depth research experience may choose to complete a minor rotation in Research. This might involve participating in the research or clinical aspects of many of the ongoing research programs being conducted by psychology staff or developing a short term project, such as completing a case study, developing and evaluating a clinical intervention, or developing a research proposal. Residents who conduct research are encouraged to present their findings at scientific meetings and may receive financial support to this end. 17
REGISTERED PSYCHOLOGISTS CHILDREN S HOSPITAL OF EASTERN ONTARIO Peter Anderson Christine Beauregard Patricia Behnke Joanne Bélair Virginia Bourget Paediatric Neuropsychologist, Behavioural Neurosciences and Consultation Liaison Team (University of Windsor, Ph.D., 1997) Clinical Interests: Neuropsychological assessment of children and adolescents with known or suspected central nervous system dysfunction. Research Interests: Behavioural and neuropsychological correlates of a variety of disorders of the central nervous system dysfunction in children and adolescents; assessing the efficacy of neuropsychological assessments and recommendations completed in a clinical context. Psychologist, Inpatient Psychiatry Program (University of Ottawa, Ph.D., 2002) Clinical Interests: Child and Adolescent psychopathology, Family functioning, Learning, Attention, and Behaviour Disorders. Research Interests: ADHD, Parenting, Impact of parent separation and divorce, Co-parent relationship. Psychologist, Autism Intervention Program Eastern Ontario, CHEO (University of Toronto, Ph.D., 2006) Clinical Interests: Assessment and Intensive Behavioural Intervention (IBI) for children with disorders on the autism spectrum. Parent training in the promotion of adaptive child behaviours and management of child maladaptive behaviours. Research Interests: Outcome evaluation of the effectiveness of IBI; Identifying predictors of treatment success in IBI; Impact of parent involvement in IBI. Psychologist, Autism Intervention Program Eastern Ontario, CHEO (University of Ottawa, Ph.D., 1987) Clinical Interests: Assessment and treatment of children presenting with developmental delays/autistic disorder. Research Interests: Behavioural interventions with children with autism. Psychologist, Behavioural Neurosciences and Consultation Liaison Team (CHEO) (Concordia University, Ph.D., 1990) Clinical Interests: Paediatric health psychology especially interventions for parents of children with severe behavioural disturbances. 18
Research Interests: Interdisciplinary, group interventions for parents of young children with feeding problems. Annick Buchholz Clarissa Bush Mario Cappelli Janice Cohen Psychologist, Eating Disorders Program (Concordia University, Ph.D., 1998) Clinical Interests: Assessment and treatment of adolescents with eating disorders; Psycho diagnostic assessments; Group psychotherapy; Family therapy. Research Interests: Psychosocial factors related to poor body image and disordered eating in adolescents; Clinical outcome studies in children and adolescents; Prevention of eating disorders in high-risk youth. Neuropsychologist, Oncology/MDU Patient Service Unit Director of Training, Psychology (McGill University, Ph.D., 1984) Academic Appointment: Clinical Professor, School of Psychology, University of Ottawa Clinical Interests: Neuropsychological assessment across the age span, capacity assessment. Research Interests: Central nervous system dysfunction in children and adults, cognitive functioning and driving capacity. Psychologist, Director of Mental Health Research, CHEO; Program Director, Mental Health, CHEO Research Institute (Carleton University, Ph.D., 1990) Academic Appointment: Clinical Professor of Psychology, School of Psychology and School of Management; Member, Faculty of Graduate and Post-Doctoral Studies, University of Ottawa. Clinical Interests: Assessment and treatment of childhood disorders. Research Interests: Health service research in genetics; and mental health. Psychologist, Clinical Head, Behavioural Neurosciences and Consultation Liaison Team (University of Waterloo, Ph.D., 1990) Academic Appointment: Clinical Professor, School of Psychology, University of Ottawa. Clinical Interests: Paediatric Health Psychology; Paediatric Pain; Paediatric Chronic Illness: Child and Adolescent Psychopathology; Parent Training; Treatment of Children and Adolescents who have experienced trauma. Research Interests: Program evaluation and outcomes management for consultation-liaison services; Adjustment to Chronic Medical Conditions, Paediatric Pain, Training Issues. Jenny Demark Psychologist, Autism Intervention Program Eastern Ontario, 19
CHEO (York University, Ph.D., 2004) Clinical Interests: Assessment and Intensive Behavioural Intervention for children with autism spectrum disorders. Research Interests: Augmentative systems for developing language in children with autism; Etiological factors in autism; predictive factors for success in IBI; Home vs. centre-based models of intervention. Jennifer Dunn Geier Margaret Flintoff Carole Gentile Neil Gottheil Clinical Director, Autism Intervention Program Eastern Ontario, CHEO (University of Windsor, Ph.D., 1985) Academic Appointment: Adjunct Research Professor, Department of Psychology, Carleton University Clinical Interests: Assessment and treatment of children with autism and developmental disabilities and their families. Research Interests: Assessment and diagnostic measures of Autism and Developmental Disorders; intervention outcome of children with Autism. Psychologist, Dual Diagnosis Service, Family Therapy Training Team (University of Calgary, Ph.D., 1988) Academic Appointment: Clinical Professor, School of Psychology, University of Ottawa. Clinical Interests: Dual Diagnosis, Developmental Disabilities, Obsessive Compulsive Disorder, Family therapy; Community liaison. Research Interests: Developmental Disabilities Psychologist, Infectious Disease Team (University of Ottawa, Ph.D., 1994) Chair, CHEO Research Ethics Board Clinical Interests: Psychodiagnostic assessment, treatment and consultation with children and adolescents living with chronic illnesses. Research Interests: Research Ethics. Psychologist, Inpatient Psychiatry Program (Bowling Green State University, Ph.D., 1999) Clinical Interests: Differential Diagnosis; Transitional Care: Bully and Victim Behaviour; Peer Violence; Malingering and Deception; Mood, Anxiety and Thought Disorders, Child and Adolescent Psychopathology. Research Interests: Transitional Care Concerns: Psychological Correlates of Differential Presentation Styles in Child and Adolescent Inpatients; Malingering and Deception; Relationship of Peer Victimization and Psychopathology; Hopelessness and Treatment Outcome. 20