CHILD PSYCHOLOGY TRACK
Introduction to the Child Psychology Track
I. Child Clinical Psychology Concentration
Primary Child Clinical rotations:
-Family Studies Program and Clinic,
-Center for Child and Family Health (CCFH),
-Psychosocial Treatment Clinic (PTC)
II. Pediatric Psychology Concentration
Primary Pediatric rotation:
-Pediatric Psychology (includes a variety of foci)
Minor Pediatric rotations:
-Family Studies Program and Clinic,
-Psychosocial Treatment Clinic (PTC)
The child psychology program provides interns with supervised assessment, treatment and consultative experience with the broad range of children, adolescents, and families treated at Duke University Medical Center. The child psychology program provides training in both traditional child clinical and pediatric psychology concentrations. The outpatient services of the Division of Child and Adolescent Psychiatry are the primary training sites for clinical child psychology, while the inpatient and outpatient clinics of the Department of Pediatrics and the Pediatric Psychology Service of the Division of Medical Psychology are the primary training sites for pediatric psychology. Child psychology interns also participate with the adult psychology interns in core seminars designed to expose them to both basic and advanced concepts in clinical practice. The available concentrations and rotations are described below. The specific combination of rotations for each intern will be determined by matching interns with their clinical interests. Applicants should elect either the Clinical Child Concentration (with a selection of either the General Clinical Child Major or the Clinical Child-Trauma Major), or the Pediatrics Concentration. Child interns do not rotate on adult rotations.
Philosophy of Training
Across and within the various rotations within the Child Concentration there is an emphasis on four major competency domains within the field of Child Clinical Psychology. These competency domains include: Therapeutic Alliance, Assessment and Diagnosis, Case Conceptualization, and Treatment and Intervention. The Duke Child Psychology Internship faculty recognizes that these four overarching competencies are skillfully integrated in the effective practice of Clinical Psychology. Across these competency domains the ability to utilize good clinical judgment and to respond adaptively and flexibly to complex and often co-morbid patient populations is highly valued. Although specific assessment or treatment technologies or patient populations may vary across rotation, the faculty in all rotations will be focused on providing training within these basis skill domains.
We expect that students will have received basic training within these domains in their graduate training programs. Evidence of such training is very useful in the application process. At the Internship level, we will continue to focus on more advanced practice within these domains and the ability to move within and across domains flexibly and skillfully. For students who wish to consult basic text prior to Internship a list is provided within each domain described below.
There is increasing recognition that establishing a good, treatment alliance is essential to the outcome of treatment and important in diagnosis and assessment as well. Reviews indicate that the so-called "nonspecific factors" in treatment account for a sizable proportion of treatment outcome. Furthermore, the therapeutic relationship is not just the necessary "container" or "platform" for the treatment technologies but has salutary effects in itself. Thus, evidence of a solid background and skills in therapeutic alliance is highly valued in the Duke Internship and further emphasis on this training is provided during Internship.
- Gilbert, P., & Leahy, R.L. (2007). The Therapeutic Relationship in the Cognitive Behavioral Psychotherapies. New York: Routledge.
- Safran J.D. & Muran, J.C. (2000). Negotiating the Therapeutic Alliance: A Relational Treatment Guide. New York: Guilford Press.
Assessment and Diagnosis:
Assessment across internship rotations includes evaluation across several domains including: cognitive, developmental, academic, behavioral, emotional, social and adaptive with patients across the age-span.
Interns are expected to have a solid foundation of both normal development and developmental psychopathology. Additionally, interns will be expected to arrive with basic skills in interviewing and test administration as well as knowledge of DSM-IV diagnostic criteria. Assessment training on most rotations will expand these skills by including diagnostic interviewing (semi-structured and unstructured formats) and specific test administration to aid in differential diagnosis. The ability to generate evaluation plans based on referral questions and information gathered from parent interview will also be emphasized, as well as skill in generating developmentally-appropriate, individually tailored recommendations based on empirically-supported approaches. In addition, interns will be expected to adapt their assessment skills to multiple evaluation settings (e.g., outpatient clinic, inpatient hospital, specialty clinic).
Interns are expected to demonstrate competency in assessment and will be evaluated with several criteria including: test administration and adherence to standard protocol; behavioral management and rapport building with patient; report writing including interpretation, integration and synthesis of the findings; communication of results to parents, physicians, and other relevant professionals.
Interns will be expected to develop proficiency in their knowledge of DSM-IV TR diagnostic criteria for ADHD, LD, and developmental disabilities (including pervasive developmental disorders). Moreover, interns will be expected to expand their understanding of the impact of emotional and behavioral disorders on learning as well as the influence of medical diagnoses and treatments on psychological functioning.
- Sattler, J.M. Assessment of Children: Cognitive Foundations, Fifth Edition.
- Sattler, J.M. Assessment of Children: Behavioral, Social and Clinical Foundations, Fifth Edition.
- Brown, R.T. (Ed.). (2004). Handbook of Pediatric Psychology in School Settings. Lawrence Erlbaum Associates.
The successful applicant will demonstrate the ability to organize complex clinical information and use theory-driven principles to develop a well-formulated case conceptualization. The case conceptualization serves the purpose of organizing clinically relevant client information into a coherent "map" that guides both the therapist and client. This conceptualization effectively translates theory and research into a useful individualized treatment plan. This process in clinical psychology is universally accepted as essential yet often neglected in training. Many times clinicians go from assessment to intervention without a well-formulated map to refer to when "lost". The recent proliferation of empirically supported treatment manuals and increase in specialization appears to have had some unintended consequences for Clinical Psychology. All too often, trainees are interested in learning "how to do" a specific treatment rather than understanding, adapting, and using principles to implement an effective treatment in a flexible and individualized manner.
Thus, in the Duke Internship, Interns will learn and be expected to integrate and synthesize their understanding of multiple theories and apply this to an effective case conceptualization. There is a particular emphasis on empirically supported approaches to assessment and treatment; however, interns will be exposed to a variety of theoretical perspectives. Interns are expected to demonstrate competence in a theory-driven conceptualization and principle-based assessment/treatment. In developing and implementing treatments plans, important perspectives that interns will be challenged to evaluate and integrate include Functional Contextualism, Cognitive and Emotion theories, Biological and Developmental models, Systems theory, as well as useful concepts from Humanistic, and Experiential influences.
- Persons, J.B. & Thompkins, M.A. (2007). Cognitive-Behavioral Case Formulation. In T.D. Eells (Ed.). Handbook of Psychotherapy Case Formulation (2nd Edition), pp. 290-316.
- Persons, J.B. (2008). The Case Formulation Approach to Cognitive-Behavior Therapy. New York: Guilford Press.
- Ramnero, J. & Torneke, N. (2008). The ABCs of Human Behavior: Behavioral Principles for the Practicing Clinician. Oakland, CA: New Harbinger Publications, Inc.
Treatment and Intervention:
The Duke Child Psychology Internship provides opportunity for advanced training in a number of empirically-supported treatment approaches for a range of difficulties in children and families. Across rotations, training is provided in evidenced-based protocols with a cognitive-behavioral approach through the Psychosocial Treatment Clinic, in parent training, academic support skills, school consultation and coping skills training through the ADHD Program, in parent-child interaction therapy and an array of developmentally-appropriate trauma-focused interventions (e.g., Trauma Focused Cognitive Behavioral Therapy) at the Center for Child and Family Health, and in evidenced based couples therapy and family therapy approaches, such as cognitive behavioral couples therapy, cognitive behavioral parent-adolescent therapy, emotion focused couples therapy, and attachment-based family therapy in the Family Studies Clinic. Similar training experiences are also available through the Durham Child Development and Behavioral Health Clinic, including training in cognitive-behavioral therapy, parent training, and family therapy. Of note, not all interns will participate in all rotations as training varies across internship positions.
Interns are expected to arrive with basic cognitive-behavioral skills for common internalizing and externalizing disorders in children including parent management training and an understanding of the cognitive-behavioral model as it applies across diagnoses. However, technical skills and rigid adherence to specific treatment manuals are not valued as highly as the ability to understand, adapt, and utilize core treatment principles in a flexible and individualized manner with children and families from different cultural, socio-economic, and ethnic backgrounds and at different developmental stages.
Although some specific intervention skills will be taught in our internship program, we emphasize core treatment competencies that are critical for case conceptualization and subsequent treatment across protocols, populations, and clinics. Interns will be expected to develop proficiency in selecting, applying, and adapting evidence-based treatments in practice, ethical decision-making and professional conduct, engaging and motivating patients and parents through nonspecific relationship factors, and evaluating treatment efficacy and efficiency and modifying treatment plans as appropriate.
Treatment competencies that interns will be evaluated on are as follows: implementation of interventions with fidelity to empirical models; ability to adapt interventions to a range of special circumstances including co-morbidity; therapeutic alliance and rapport building; utilization of supervision and ability to self-reflect on practice; demonstration of sensitivity to individual and cultural context in working with diverse populations; knowledge of ethical guidelines and professional codes; judgment about unexpected issues including crises; and ability to collaborate with other medical, educational, and mental health professionals in the implementation of treatment plans.
- Weiss, J.R. & Kazdin, A.E. (Eds.). (2010). Evidence-Based Psychotherapies for Children and Adolescents, 2nd Edition. New York, NY: Guilford Press.
I. Child Clinical Concentration
Interns in this concentration generally rotate across the placements described in A-E below.
A. Family Studies Program & Clinic:
The Family Studies Program and Clinic is composed of a multi-disciplinary faculty of Psychologists, Psychiatrists, and Social Workers who have expertise in family therapy, as well as a multi-disciplinary trainee group (Psychology Interns, Psychiatry Residents). The program provides interns with supervised training in family assessment and family therapy, parenting therapy, and couples therapy using a live, behind-the-one-way-mirror supervision model. Supervisors and other team members observe all therapy sessions, and supervisors provide immediate call-in supervision via telephone link-up between the observation room and the therapy room. Therapy supervision is also provided by supervisors typing specific supervisory comments via computer monitors in the therapy rooms that are viewable by the trainee therapist. All sessions are also audio-recorded with dubbed in supervisor commentary for later trainee review.
In addition to live and observed couples therapy, parenting therapy and general family therapy, interns also attend a weekly didactic seminar in general and specialty topics in the fields of family functioning and family and couples intervention. Patients for the Families Studies Program and Clinic are referred from the adult and child psychiatry programs and from specialty services within the Psychiatry Department. Families are also referred from other medical services and from the community.
Supervisor(s): Karen C. Wells, Ph.D., P. Susan Hazlett, Ph.D., Christian Mauro, Ph.D.
B. Center for Child and Family Health – North Carolina:
The Center for Child and Family Health (CCFH) is a collaborative endeavor of Duke University, University of North Carolina-Chapel Hill, North Carolina Central University, and Child and Parent Support Services. CCFH is a community-based, multi-disciplinary setting which specializes in the assessment and treatment of children and families who have experienced trauma. Many of the families who receive services at CCFH have been referred by social services, schools, law enforcement, or the court. Although CCFH serves an ethnically diverse clientele, the majority of the children and families served are low income or Medicaid eligible clients. Services offered at CCFH include early intervention and prevention services, assessment of traumatic sequelae, trauma-focused treatment, forensic evaluations, and family and legal support.
The rotation at CCFH involves working primarily with evidence based treatments with a culturally diverse clientele of traumatized youth and their families. Interns will have an opportunity to learn several trauma informed interventions (e.g., Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and Parent-Child Interaction Therapy (PCIT)). Interns will also utilize a range of treatment modalities including: individual therapy with children and adolescents, family therapy, parent education, intensive in-home treatment, community-based interventions, as well as group interventions with children, adolescents, and parents. The intern will serve as a liaison with multiple community agencies including schools, social services, and the court system for each assigned case. The intern also participates in initial evaluations and limited psychological assessments.
Interns on this rotation participate in a year-long didactic series on trauma and trauma-informed interventions and services. Live and video-based supervision is available. Supervision is generally conducted through a combination of individual and treatment specific group discussions as well as multi-disciplinary team presentations.
On average, one to two interns are selected to participate on this rotation for approximately 50% of their time for the entire year. For more information about CCFH visit our website at http://www.ccfhnc.org/ 
Supervisor(s): Ernestine Briggs-King, Ph.D.; George (Tripp) Ake, Ph.D.
C. ADHD Clinic:
The ADHD Program at the Duke University Medical Center is one of the nation's leading programs for research and clinical services for ADHD and related behavior problems. The program is staffed by three licensed psychologists, one board-certified child psychiatrist, and a number of study coordinators and research assistants. In the last five years we have also provided support for 1-2 post-docs per year. The ADHD Program participates actively in three primary activities: 1) Adult and child clinical services; 2) Federally-funded (e.g., NIMH) research grants; and 3) Industry-funded (e.g., pharmaceutical companies) clinical trials.
The ADHD Program offers a clinical rotation for the clinical psychology internship program. Interns will be involved in evidence-based evaluation and treatment for children, adolescents and adults, primarily through our outpatient fee-for-service clinic. Our assessment procedures conform to the practice parameters outlined by the American Academics of Pediatrics and Child and Adolescent Psychiatry and include the use of rating scales from multiple informants, interviews, and brief cognitive testing as indicated. These assessments also include formulation of treatment plans and comprehensive written reports. Interns also spend time conducting psycho-educational testing for learning disorders. Other clinical services in which interns participate include a parent-training group, child coping skills group, an adult ADHD cognitive-behavioral therapy group, academic support skills training for middle and high school students (group or individual treatment), and individual treatment cases (typically focused on parent training or academic support skills for children, and cognitive-behavioral therapy for adults). Though ADHD is the primary presenting concern for assessment and treatment cases, comorbidity is quite common and thus interns are exposed to a diverse variety of clinical presentations. We also provide presentations to schools and the community upon request, and encourage intern participation in these activities.
There are a number of clinical research activities within the Duke ADHD Program to which interns are exposed through regular didactic presentations. These include two NIH-funded, multi-site treatment outcome studies: the Multimodal Treatment Study of ADHD Children (MTA) and the Preschool ADHD Treatment Study (PATS). With Dr. Karen Wells, we are also participating in a trial of organizational skills treatment for ADHD children. In addition, opportunities exist for interns to be involved in preparation of papers based upon our extensive databases and nationally recognized research activities. For instance, we maintain a large database which was developed in order to examine the association between ADHD and environmental factors among our clinic patients. With regard to individual faculty projects, Dr. Scott Kollins has several grants evaluating the relationship between ADHD and smoking, Dr. Desiree Murray, an affiliated faculty member, is conducting a Department of Education-sponsored study evaluating teacher training in classroom management within several rural elementary schools, and Dr. John Mitchell is conducting a NIDA-sponsored study of affective regulation in adult ADHD cigarette smokers and a privately funded study on the assessment and treatment of executive functioning in adults diagnosed with ADHD.
Supervisor(s): Scott Kollins, Ph.D, John Mitchell, Ph.D., Naomi Ornstein Davis, Ph.D.
D. Psychosocial Treatment Clinic:
The Psychosocial Treatment Clinic at the Duke Child and Family Study Center serves children, adolescents, and families utilizing evidence-based practice. This rotation includes training in empirically supported treatments for children and adolescents primarily with anxiety and mood disorders. The rotation includes a weekly didactic seminar or case conference and all participants will experience live supervision and participate in the observation of their peers. Example didactics include: Functional Analysis, CBT for childhood anxiety, CBT E/RP for OCD, CBT for Adolescent Depression, Habit Reversal Training for Tourette Syndrome and Tic Disorders, and Addressing Comorbidity.
The Psychosocial Treatment Clinic works in conjunction with the Psychopharmacology Clinic at the Duke Child and Family Study Center. Seminars, case conferences and multidisciplinary treatment teams consist of psychology interns, clinical psychology graduate students, psychiatry residents and child psychiatry fellows. Individual supervision is guaranteed for all psychology interns and case conferences are utilized to provide maximize exposure to a diversity of presenting problems and treatment approaches.
Supervisor(s): Chris Mauro, PhD, David Goldston, PhD, Nicole Heilbron, PhD
II. Pediatric Psychology Concentration
Primary interns in this concentration generally spend 70% of their time engaged in Pediatric Psychology clinical work and the remaining time on at least two of the rotations under the Child Clinical concentration. The role of Pediatric Psychology at Duke is to assess neuropsychological and behavioral changes secondary to disease processes, treatment regimen, as well as to assess the child and parent coping and adjustment. These assessments are done in the context of a weekly outpatient clinic at the Duke Child and Family Study Center; via consultation-liaison in the Duke Children's Hospital; and in the context of the Duke Specialty Clinics.
Foci for Pediatric Psychology include:
-Pediatric Neuropsychology Clinic;
-Pediatric Bone Marrow Transplant;
-Pediatric Pain Program;
-Special Infant Care Clinic; and
The Pediatric Psychology Service is composed of medical psychology faculty, post-doctoral fellow, interns, clinical psychology graduate students, psychodiagnostic technicians, and support staff who work in a hierarchical supervision model.
Current research by pediatric psychology faculty focuses on coping with chronic childhood illness and on the cognitive and behavioral changes associated with disease processes and treatment. Interns have the opportunity to participate in these projects.
Supervisor: Melanie J. Bonner, Ph.D