Adolescent Services

APPIC #118328

Information updated August 2018

Overview

Located within Yale-New Haven Health’s (YNHH) Outpatient Services, this placement provides fellows with the opportunity to receive comprehensive clinical training within two multidisciplinary adolescent services. The bulk of the clinical training takes place within the Adolescent intensive outpatient program (IOP) where the emphasis is on developing competencies for assessing and treating acutely ill and demographically diverse adolescents and their families. Within the IOP, Fellows are exposed to supervision within both psychodynamic and cognitive-behavioral theoretical models which inform case conceptualization, psychotherapy, crisis management, and treatment planning. Fellows within this placement have the opportunity to engage in a range of clinical activities that are similar to those of a staff psychologist within the same setting. Additionally, fellows help to support clinical program development efforts by monitoring effectiveness of interventions and evaluating clinical outcomes for patients completing the program. Opportunities may also be available to supervise an advanced psychology graduate student.

Fellows are also provided the opportunity to serve in the Yale Pediatric Gender Program (YGP) where clinical care utilizes an affirmative approach to supporting youth and their families as they navigate their youth’s individual gender journey. This one-day per week, year-long primer offers fellows training in provision of consultation services for youth who are exploring their gender identity, family support during social transition, assessment of readiness for cross hormonal treatment, and ongoing support in the form of monthly groups for youth and families.

Above and beyond these core training activities, fellows have the option to receive individual psychodynamically-informed psychotherapy training, on an elective basis, through the hospital's Long-Term Care Clinic.

Placement Options

PRIMARY PLACEMENT - This track consists of a combined experience where fellows are engaged in a full-time, twelve-month placement within the YNHH Adolescent Intensive Outpatient Program and a 1-day per week, twelve-month placement in the YNHH Pediatric Gender Program (There are no secondary placements within YNHH).

Number of Fellows

One doctoral fellow will be selected for the Adolescent Services Track for the 2019-2020 academic year.

The Setting

The Adolescent Intensive Outpatient Program (IOP) of Yale-New Haven Psychiatric Hospital provides treatment to adolescents and their families in a group-based setting. Individuals enrolled in the IOP typically need more intensive intervention than is readily provided in outpatient settings, but do not require the level of supervision and support provided in an inpatient setting. About two thirds of newly admitted inpatients are referred to the IOPs for follow up treatment from one of the YNHPH inpatient units and about one third are referred from outpatient community providers.

The Adolescent IOP an afternoon program that treats adolescents between the ages of 12 and 18 for an average of six to eight weeks. Adolescents admitted to the program present with a wide spectrum of psychiatric diagnoses with a moderate to high level of severity. Commonly these teenagers present with any combination affective disturbance, behavioral and/or emotional dysregulation, conduct difficulties and aggression, emerging personality disturbance, substance use, developmental disability, and/or experiences of personal, familial and/or community trauma and violence. In keeping with the above, the vast majority of enrolled patients demonstrate compromised functioning at home and/or at school. These adolescents are high risk and in an acute state, recently discharged from the hospital and needing a step down in care before participating in outpatient psychotherapy. Alternatively admitted patients are escalating at home and in need of more than weekly outpatient therapy to prevent (re)hospitalization.

The Yale Pediatric Gender Program (YGP) is an interdisciplinary team that provides services for transgender and gender diverse youth in Connecticut. They are the only interdisciplinary team of this type in the state. The program includes a comprehensive medical and mental health approach in order to help youth and families explore and receive expert care around issues of gender identity. The overarching team includes professionals in the fields of psychology, endocrinology, psychiatry, obstetrics, gynecology, medical ethics and law. Providers within the program also consult with urology, plastics and general medicine.

The Gender Program serves economically and ethnically diverse groups of families who are interested in learning more about the social and medical transition options associated with diverse gender identities. Services available through YGP include: (a) intake-consultation, (b) readiness assessments, (c) individual psychotherapy, (d) group therapy, (e) parental support/consultation, (f) family therapy, and (g) clinical consultation with professionals in other service delivery systems. Lastly, providers in the program work to maintain close contact with community providers to facilitate ongoing provision of mental health and medication management services, for youth receiving care through the clinic.

The Internship

Adolescent Intensive Outpatient Program (12 months, Full-Time): The fellow will spend the bulk of their clinical hours each week at the YNHPH Adolescent Intensive Outpatient Program (IOP). Specifically, fellows serve as the primary clinician for a caseload of up to four adolescent IOP patients and receive training in intake evaluation and diagnosis, provision of individual and family psychotherapy, treatment planning and collaboration with community providers to guide IOP treatment and establish after-care supports. Broader clinical training within the program includes co-leading psychotherapy groups, conducting routine risk assessments, conducting brief, consultative psychodiagnostic assessments for diagnostically complex patients within the milieu, crisis management, and participation in interdisciplinary clinical and consultation team meetings.

In order to help adolescents manage dysregulated affect and high-risk behaviors, psychotherapy groups focus on implementation of skills to encourage identification of thoughts, feelings and behavioral triggers, problem solving to help manage distress and interpersonal conflict, identification of personally meaningful values and development of values-based goals. Psychotherapy groups necessarily draw upon and integrate behavioral technique in addition to allowing for attention to group process and assessment of group and individual level interpersonal dynamics. Through supervision and training, fellows gain knowledge of the developmental stages and issues prominent in childhood and adolescence. There is a particular emphasis on how trauma and impoverished backgrounds intersect with and effect developmental outcomes.

The adolescent IOP has recently undergone a series of clinical programming shifts, including implementation of evidence-based psychotherapy groups and measurement-based care initiatives (i.e., systematic, objective assessment on intake and discharge and multiple time-points during treatment). Fellows will have the opportunity to support this development clinically, by way of interpreting data to support treatment planning, monitoring patient progress using objective data, and increasing staff understanding of patient presentation, diagnosis and dynamics. Scholarly opportunities are also available to utilize existing clinical data to examine program outcomes, predictors of repeat IOP admissions, program completion and/or hospitalizations, and other relations of interest. Fellows may choose to prepare their scholarly product for presentation at conferences and/or manuscript.

Yale Pediatric Gender Program (12 months, 1-day per week placement): Fellows will spend one day per week engaged in clinical activity at the YGP. Fellows will provide ongoing consultation to the YGP interdisciplinary team, complete comprehensive readiness evaluations with youth and families and provide individual and family therapy to patients served in the program. The fellow will also have the opportunity to participate in monthly Journal Club meetings with other fellows, residents and medical faculty, and will co-lead a monthly treatment group for gender expansive youth. YGP also provides regular training to medical residents, staff and community providers, which the fellow will be able to assist with.

All of the clinical work done within YGP is supervised by an interdisciplinary treatment team comprised of faculty representing the disciplines of psychiatry, psychology, pediatrics, and nursing. Fellows also have 60 to 90 minutes of individual supervision weekly with a licensed child psychologist. Interdisciplinary huddles within the program to deal with immediate problems that occur in the treatment of patients are common.

Should the fellow be interested, scholarly opportunities are also available within the YGP, including access to existing data and collaboration with ongoing projects. YGP currently has a HIC-approved registry which allows the program to track a multitude of health outcomes for patients throughout their treatment with our program.

Long Term Care Clinic: All YNHH doctoral fellows have the option of receiving weekly supervised individual psychotherapy training within the Long Term Care Clinic (LTCC). This is an outpatient psychotherapy training clinic operated by the Department of Psychiatry and YNHH. Individual patients are referred to this clinic by the Yale University Health Services, and as such, are typically members of the University community who are seeking insight-oriented psychotherapy for a variety of issues, most commonly related to developmental, relationship, mood, and/or anxiety concerns.

Within the LTCC, individual weekly supervision from a psychodynamic perspective is provided to guide the fellow in conceptualizing and implementing treatment from an insight-oriented therapeutic approach most appropriate to the assigned cases. Typically, doctoral fellows see one individual therapy patient in once-a-week psychotherapy for the full duration of their training year.

Evidence-Based Practices

The following evidence-based practices (EBPs) are used in these placement settings: Cognitive Behavior Therapy (CBT), Acceptance and Commitment Therapy, & Positive Psychology. Skills training in the spirit of Dialectical Behavior Therapy (DBT), though modified from the comprehensive DBT paradigm, are also incorporated. Fellows generally have exposure to most of these EBPs though do not necessarily receive training or supervised experience in all of them.

Psychological Assessment

The Adolescent Fellow participates in the administration and interpretation of a variety of psychological assessments above and beyond the routine assessments described in the Yale Pediatric Gender Program portion of the placement. Assessments include brief psychodiagnostic batteries for patients with unusually complex presentations or multiple IOP admissions and/or hospitalizations. These batteries serve as a clinical consultation to the IOP treatment team and are utilized early in the IOP treatment to help support a more individualized treatment plan and aftercare services. These batteries include brief cognitive screening, domain and symptom functioning, personality and narrative-based measurements (Rorschach, TAT). Additionally, each patient, upon admission to the IOP is administered a series of objective measures to support the subjective primary clinician intake interview. The fellow and psychologist score and interpret these data and present findings, including any recommendations to the treatment team. Periodically, adolescent fellows will consult to the psychiatric inpatient unit, to provide brief batteries to assist in differential diagnosis and disposition planning. Generally, each assessment involves the administration and interpretation a variety of instruments, participation in individual testing supervision, consultation with the treatment team about the implications of test results for the patient's treatment, provision of feedback to the patient in consultation with the treatment team, and preparing final reports.

Diversity

At Yale-New Haven Hospital diversity and inclusion are important values. The hospital is committed to providing an environment of inclusion that supports the diversity among its patients, visitors, employees, business partners and communities. Serving the Greater New Haven area and surrounding Southern New England region, YNHH admits a diverse population of patients, both diagnostically as well as demographically. Racially, approximately 65 percent of patients admitted to the hospital are Caucasian, 15 percent Black, 15 percent Hispanic and 5 percent Asian. Nearly 60 percent of patient hospital costs are covered through Medicare or Medicaid. The hospital is committed to providing the highest standard of care to all patients regardless of socioeconomic status, race, ethnicity, language, nationality, sex, gender identity, sexual orientation, religion, geography, disability and age.

Scholarly Activity

Four hours per week of protected time is provided to allow fellows the opportunity to design and conduct a scholarly project of their choice. Individual project objectives are coordinated with the primary advisor, or another faculty mentor involved in a program of active research. Fellows may design a project with faculty within their primary training placement, or request to be matched with other faculty in the Yale School of Medicine based on their shared interests and faculty availability. The fellow’s scholarly activity can take many forms. In consultation with the faculty advisor, the fellow may choose to engage in an ongoing research project, evaluate a clinical service or program, or help design and implement a new project that will benefit the individuals receiving services within the YNHH system.

Faculty

Amber W. Childs, Ph.D., Primary Advisor
Christy Olezeski, Ph.D., Secondary Advisor
Debra Bond, Ph.D., Clinical Supervisor
Donna DiCello, Psy.D., Clinical Supervisor

Supervision

The fellow has weekly individual supervision with a primary advisor, secondary advisor and additional clinical supervisors. She, He or They also participate weekly in clinical consultation team meetings and adolescent rounds and receives assessment supervision as needed. Fellows may receive additional individual supervision for optional clinical activities such as with the Long Term Care Clinic. Formal evaluations are completed and serve as opportunities to review progress on training goals and address progress toward achieving the required core competencies.

Seminars and Specialized Training

In addition to the internships Core seminar and a hospital-based seminar with other YNHH fellows, the Adolescent Intensive Outpatient fellow is invited to attend the Dialectical Behavior Therapy Summer Seminar during July and August. This seminar covers theory, formulation, and major strategies of Dialectical Behavior Therapy (DBT) as it is applied to treating severe borderline personality disorder in outpatient and day hospital settings. Attendees actively engage the material through discussions of cases and video examples, skills practice, self-monitoring and problem solving exercises, and role play.

Applicant Qualifications

Strong applicants for this placement generally have prior experience working with adolescents and their families including individuals who struggle with high-risk impulsive behaviors. In addition, strong applicants will have experience conducting evidence based therapies and have an interest in program development. Fellows who match with this placement typically have strong interests in treatment and/or scholarship related to adolescent psychopathology or personality pathology and show promise for developing a leadership role in the field.

Applicants selected for this placement must successfully pass background checks conducted by Yale University and Yale-New Haven Hospital.

For Further Information

For more information about this placement site, please e-mail amber.childs@yale.edu and/or christy.olezeski@yale.edu.