Child and Adolescent Services

Secondary Placement

A full year, 15 hour per week secondary placement, which can be combined with the following primary placements:

• 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.

Services available through Child and Adolescent Services include:

1. intake-triage,
2. crisis intervention,
3. individual psychotherapy,
4. group therapy,
5. parent intervention,
6. family therapy,
7. psychological assessment,
8. pharmacotherapy, and
9. 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.

Child and Adolescent Services provides psychology fellows from several primary sites with a focused, secondary experience working with children and adolescents in a community-based outpatient setting. When coupled with one of the primary placements, this experience provides fellows with an opportunity to learn more about

1. (service delivery systems for children and adolescents,
2. the intergenerational transmission of psychiatric difficulty, personality disturbance, substance use, and intimate partner violence, and
3. the outpatient psychiatric assessment and treatment of children and adolescents.

The placement provides fellows with an opportunity to see the impact of clinical or systemic issues being addressed at their primary site on children and adolescents receiving community-based care. Every effort is made to assign fellows cases that complement their interests at their primary placement. 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 participate in consultation and direct clinical services provided to youth and staff in the local system of preschool programs as part of the clinic’s larger commitment to and collaboration with the local board of education. Consultation and direct clinical services provided by fellows to the preschool programs may include direct on-site staff coaching, modeling, and education as well as direct on-site youth or parent intervention, and also include opportunities for provision of group therapy, in-services, and more comprehensive psychological assessment of preschoolers.

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

1. complete comprehensive initial assessments,
2. provide individual psychotherapy, and
3. 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.

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:

1. Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT),
2. Circle of Security
3. Coping Cat
4. Cognitive-behavioral therapies for depression, anxiety, anger management, and school refusal
5. Interpersonal Therapy for Depressed Adolescents (ITP-A)
6. Play therapy
7. Parent management training
8. Parent-Child Interaction Therapy
9. entalizing-based therapy for parents.

Child and Adolescent Services is a secondary placement. The psychological assessment experience for these fellows involves routinely conducting several 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 to assess change in symptoms over time.

Fellows with a secondary placement in Child and Adolescent Services also conduct one comprehensive psychological assessment with a child or adolescent. There are three types of comprehensive assessments:

1. general psychological assessments that include measures of cognitive abilities, achievement, executive functioning, vocational functioning, various symptom clusters, and personality
2. behavioral assessments designed to better understand patterns of behavior
3. specialized assessments that focus on trauma, substance use, problematic sexual behaviors, and other high-risk behaviors such as violence.

• Michelle Comas, Ph.D., Primary Advisor
• Michelle Silva, Psy.D., Supervisor
• Adrienne Allen, Psy.D., Supervisor
• Thomas McMahon, Ph.D., Supervisor
• Elizabeth Connors, Ph.D., Supervisor
  

Secondary placement fellows participate in an applied site-specific 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.

Fellows also have the opportunity to participate in a trauma-specific didactic training seminar, which particularly focuses on the instruction and application of the Attachment, Regulation, and Competency (ARC) Framework and Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT). The training takes place within an open and supportive learning environment that allows for trainees to learn both ARC and TF-CBT in a developmentally appropriate and systems-oriented manner.

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. Relevant background checks must also be completed before beginning 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.