Child and Adolescent Services / West Haven Mental Health Clinic

Overview

Child and Adolescent Services is a satellite program of the Connecticut Mental Health Center that provides outpatient psychiatric services to children and adolescents. A secondary placement in Child and Adolescent Services provides psychology fellows from several primary placement sites with a focused, experience working with children and adolescents in an outpatient setting. Previous experience working with children and adolescents is desirable but not necessary for applicants to choose this option as a secondary placement.

Placement Options

SECONDARY PLACEMENT - A full year, 15 hour per week secondary placement, which can be combined with the following primary placements: Forensic Addiction Service / Forensic Drug Division Clinic; Hispanic Behavioral Health Services / The Hispanic Clinic; Substance Abuse Services / Substance Abuse Treatment Unit; or Consultation, Prevention, & Program Evaluation Services / The Consultation Center.

Applicants who choose the Young Adult Service (YAS) as their primary placement always have Child and Adolescent Services as their secondary placement.

PRIMARY PLACEMENT – Child and Adolescent Services is not offered as a primary placement.

Number of Fellows

Secondary placements only: 3 to 4.

The Setting

Child and Adolescent Services is a satellite program of the Connecticut Mental Health Center that provides outpatient psychiatric services to children and adolescents. It provides outpatient treatment to an ethnically diverse population of minor children experiencing both acute and chronic psychiatric difficulty. The service treats 70 to 100 clients annually. Most of the clients are 4 to 17 years of age, and many are of African American, Latino, Italian-American, or mixed racial-ethnic heritage. All of the clients are living in urban poverty, and most have experienced psychological trauma in the context of severe family stress. Many are also involved with the special education or child protection system.

Services available through Child and Adolescent Services include: (a) intake-triage, (b) crisis intervention, (c) individual psychotherapy, (d) group therapy, (e) parent intervention, (f) family therapy, (g) psychological assessment, (h) pharmacotherapy, and (i) clinical consultation with professionals in other service delivery systems. Most children admitted to the service receive a comprehensive initial assessment and some form of individual psychotherapy with complementary parent or family intervention. Clinical consultation with school and child protection systems is very common. The setting emphasizes the integration of a developmental perspective on child and adolescent psychopathology with a community perspective on service delivery. Although the validity of all theoretical perspectives is acknowledged, every effort is made to integrate the best available empirical evidence into a multisystemic perspective on assessment and treatment.

The Internship

Child and Adolescent Services provides psychology fellows from several primary sites with a focused, secondary experience working with children and adolescents in an outpatient setting. When coupled with one of the primary placements, this experience provides fellows with an opportunity to learn more about (a) service delivery systems for children and adolescents, (b) the intergenerational transmission of psychiatric difficulty, personality disturbance, substance abuse, and intimate partner violence, and (c) the outpatient psychiatric assessment and treatment of children and adolescents. Because the service cares for children and adolescents whose parents have often been in systems of care for adults, the placement provides fellows with an opportunity to see the impact of clinical problems being addressed at their primary site on children living with an affected parent. The placement also provides fellows with an opportunity to pursue the development of knowledge and skill needed to work with clients across the lifespan.

While working as a member of an interdisciplinary treatment team, psychology fellows with a secondary placement in Child and Adolescent Services serve as a primary clinician for a caseload of four clients. Attention is given to diversifying clinical assignments in terms of age, gender, ethnic heritage, and presenting problem. Every effort is also made to both match the special interests of the fellow and address gaps in their exposure to children and adolescents. Fellows also have the opportunity to choose a clinical project of interest to them. Choices vary from year to year, but they typically involve opportunities to learn more about a specific approach to psychotherapy with children and adolescents, psychological assessment of children and adolescents, or parent intervention.

Supervised experience in the delivery of clinical services is used as the primary mechanism to expose fellows to clinical work with children and adolescents in a local system of care. With support and supervision, fellows are responsible to conceptualize and coordinate a program of ambulatory assessment and treatment for their assigned clients. Throughout the year, fellows (a) complete comprehensive initial assessments, (b) provide individual psychotherapy, and (c) provide parent and family intervention. They also work collaboratively with an attending psychiatrist, consult with school staff, and consult with professionals working in other service delivery systems.

Evidence-Based Practices

Several evidence-based practices (EBPs) are used in this placement setting. Fellows generally have exposure to most of these EBPs, but they do not necessarily receive training or supervised experience in all of them. The EBPs include: (a) Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), (b) Circle of Security, (c) Coping Cat, (d) cognitive-behavioral therapies for depression, anxiety, anger management, and school refusal, (e) Interpersonal Therapy for Depressed Adolescents (ITP-A), (f) play therapy, (g) parent management training, and (h) mentalizing-based therapy for parents.

Psychological Assessment

Child and Adolescent Services is a secondary placement. The psychological assessment experience for these fellows involves routinely conducting a number of brief, symptom-focused assessments, which are conducted when a clinician is looking to better understand a client’s symptoms or to assess change in symptoms. In addition to a clinical interview and record review, the psychology fellow typically will use specific instruments (e.g. Conners Rating Scales, Children's Depression Inventory, Revised Children's Manifest Anxiety Scale) to assess level of symptomatology and change in symptoms over time.

Fellows with a secondary placement in Child and Adolescent Services may also conduct a comprehensive psychological assessment with a child or adolescent as an elective assignment. With approval of a primary advisor, elective assignments with children and adolescents may count toward the two comprehensive assessments all fellows must complete. There are three types of comprehensive assessments: (a) general assessments that include measures of cognitive abilities, achievement, executive functioning, vocational functioning, and personality; (b) behavioral assessments designed to better understand patterns of behavior; and (c) specialized assessments that focus on substance abuse, problematic sexual behaviors, other high-risk behaviors such as violence.

Diversity

The clinical and support staff for Child and Adolescent Services is a diverse group of faculty, staff, and trainees who vary significantly in terms of personal and professional backgrounds. As a publicly funded program, Child and Adolescent Services is committed to reducing health disparities associated with social and economic disadvantage. This is accomplished by examining the emotional-behavioral difficulties of children and adolescents in a cultural context and delivering culturally and linguistically sensitive clinical services. The program defines culture as that gestalt of geographic, gendered, racial, ethnic, linguistic, religious, economic, and other socio-demographic influences that shape the psychosocial identity, belief system, and behavior of clients, parents, and professionals. Many of the children and adolescents admitted to the program are of African American, Latino, Italian-American, or mixed racial-ethnic heritage. Recently, the program has begun to see children and adolescents whose parents have recently immigrated from the Middle East, Africa, and parts of Europe. All of the children and adolescents are negotiating socioeconomic stressors associated with urban poverty.

Scholarly Activity

Fellows at this secondary placement usually pursue a scholarly activity at their primary placement site. With approval from their primary placement advisor, fellows interested in service delivery to children and adolescents could pursue a program evaluation or quality improvement project at this site as their scholarly project.

Faculty

Thomas McMahon, Ph.D., Secondary Advisor
Christy Olezeski, Ph.D., Secondary Advisor
Michelle Silva, Psy.D., Supervisor
Myriel Rodriguez, Ph.D., Supervisor

Supervision

All of the clinical work done within Child and Adolescent Services is supervised by an interdisciplinary treatment team comprised of faculty representing the disciplines of psychiatry, psychology, social work, and nursing. All secondary fellows at this site attend a weekly treatment team meeting. They also have 60 to 90 minutes of individual supervision weekly with a licensed child psychologist who serves as a clinical consultant concerning the assessment and treatment of assigned cases. Individual supervision is tailored to match the fellow's previous experience working with children and adolescents. Fellows may also have 60 minutes of group supervision weekly as part of their clinical project. Interdisciplinary huddles within the program to deal with immediate problems that occur in the treatment of children and adolescents are common. All supervisors have specialized training and expertise in clinical child and adolescent psychology.

Seminar & Specialized Training

Secondary placement fellows participate in an applied seminar that focuses on the psychiatric assessment of children, adolescents, and young adults. During the summer, the seminar is used to orient fellows to clinical work with children and adolescents in the local system of care. During the remainder of the year, didactic presentations by faculty, with complementary reviews of clinical material presented by trainees, are used to explore clinical issues frequently encountered in developmentally oriented assessment and treatment of younger clients. These include questions about culturally and linguistically sensitive delivery of clinical services. Participation in this seminar is a requirement for all fellows with a secondary placement on the Child and Adolescent Service.

Applicant Qualifications

Applicants choosing Child and Adolescent Services as a secondary placement site must have an interest in working with children and adolescents in an ambulatory setting. Previous experience working with children and adolescents in a clinical setting is desirable but not necessary.

Regulations issued by the Connecticut Department of Children and Families require that applicants who match to this secondary placement have a physical examination, tuberculosis screen, and additional background checks completed before they begin the internship. These special requirements are reviewed during the interview process, and forms to complete the requirements are mailed with letters of acceptance following the APPIC match. Because this placement is based outside downtown New Haven, previous fellows have found it is essential to have access to a car.

For Further Information

For further information, contact Dr. Christy Olezeski at christy.olezeski@yale.edu or Dr. Thomas McMahon at thomas.mcmahon@yale.edu.