Introduction

Julie N. Germann, PhD, Jamie A. Grollman, PhD, Jami N. Gross, PhD, Crista E. Wetherington, PhD, Gabriela Reed, PhD, & Mary C. Lazarus, PhD

Center for Pediatric Psychiatry, Children’s Medical Center Dallas & Department of Psychiatry, UT Southwestern Medical Center

Developing a new pediatric psychology training program requires a great deal of initiative, organization, and competence. Such an endeavor presents a unique set of challenges for early career psychologists, who are establishing their professional identity while also just beginning to gain supervisory experience.

Such challenges for early career psychologists may include obtaining training and competency in supervision, achieving confidence in supervision, navigating a change in roles and boundaries (when changing from a trainee to a supervisor), establishing credibility as a supervisor with past trainee peers, professional role-modeling, and artfully giving feedback.

This presentation highlights the challenges and skills needed for early career psychologists in developing a training program while drawing on the experiences of the early career psychologists in the newly developed Pediatric Psychology service at Children’s Medical Center Dallas (CMCD).

Needs Assessment

Future Directions• Serve as a model for psychology training at CMCD: Expand educational

components to incorporate trainees & supervisors from other areas• Promote more formal opportunities for teaching and role-modeling (e.g., case

presentations by faculty and trainees)• Continued program evaluation to assess and modify the program to meet the

needs of trainees, supervising psychologists, and the patient families• Promote visibility of the CMCD pediatric psychology training program• Pursue APA-accreditation for the pediatric psychology fellowship • Develop recommendations for other newly formed training programs• In forthcoming years, monitor the needs of mid-career psychologists and adapt

supervisory support to continued professional development

• Rapid growth in the CMCD psychology training program over the past 5 years– 2006-2007: First pediatric psychology fellow– 2007-2008: 2 fellows, 1 intern – 2008-2009: 1 fellow, 3 interns

• Need to develop a more formally structured training program

• Needs identified for developing a quality training program– Form an organization (Training Team) to develop and oversee the training

program, while considering:• Needs and support at an institutional level• Balancing clinical needs of patients/families with the training/supervisory

needs of the trainees • Identification of team members• Professional development of team members

– Identify and detail a training model and structure

– Ensure adequate supervisory skills, as the majority of the potential supervisors were early career psychologists who had just completed fellowship

• Formed in 2008

• Comprised of the 6 current pediatric psychologists at CMCD: – All hired in 2007 (2) and 2008 (4) – 5 embedded within specific medical teams – 4 recently completed fellowship– 3 currently licensed in the state of Texas to provide independent supervision– 2 provisionally licensed and supervise via umbrella supervision

• Diverse training backgrounds (e.g., Clinical, Counseling, School Psychology) with commonality of training in pediatric psychology

• Faculty appointments in the Department of Psychiatry at UT Southwestern Medical Center (UTSW)

• Postdoctoral trainees: Traditional interview and selection process for a one-year clinical fellowship

• Predoctoral interns: Placed through the UTSW Clinical Psychology Ph.D. program which has an encapsulated internship– All interns are UTSW graduate students in the 3rd & 4th year – Internship placement is a 20-hour/week half-time position for one year

concurrent with a half-time research placement – Supervising psychologists maintain ongoing dialogue with the UTSW program

through participation on both Clinical and Research Training Committees

• Psychology encouraged to focus a portion of time on training due to faculty appointments and involvement with the Clinical Psychology program

Need #1: Develop a Training Organization

• Weekly Training Team meetings:– Review trainee progress, accomplishments & concerns– Address program development advancements or needs

• Improvement of training experiences• Modifications based on trainee feedback

– Provide opportunities for peer consultation on trainee-supervisor issues– Foster cohesion among psychologists who primarily function independently

within their respective medical teams

• Maintain identity and autonomy for psychology training while balancing integration within the multi-disciplinary psychiatry C/L team

• Training and supervision are different for psychology & psychiatry fellows• Each discipline maintains independent paperwork that addresses the unique

aspects of their consultations

• Balance clinical needs of medical services while ensuring depth and breadth of training – Five services have embedded psychologists: cystic fibrosis, gastroenterology,

oncology, sickle cell disease, & solid organ transplant– Two services include psychology in multidisciplinary clinics (endocrinology & pain

management)– Embedded psychologists spend approximately 48-65% of time in patient care

and 12-14% engaged in training-related activities– Trainees conduct psychology consults triaged by the C/L psychiatry service and

supervised by the pediatric psychologist on the general consult team– Trainees rotate through 3 four-month elective placements of the more than 15

available in specific clinics or medical services of interest• Supervised by specialist psychologist or their primary supervisor

• Patient care and training efforts often overlap, presenting unique challenges, including role conflict and role ambiguity (Campbell, 2000), which can be especially demanding on the skill sets of newly-supervising psychologists

Need #3: Ensure Adequate Supervisory Skills

• Goal of providing excellent supervision to trainees– Foster the supervision skills of early career psychologists– Further develop the skills of more experienced supervisors

• Weekly Training Team meetings – Peer consultation on supervision skills, feedback methods, challenges

• Constructive yet direct verbal and written feedback • Broaching difficult topics• Intervening with trainees who are not meeting expectations• Feeling credible and confident with advanced trainees, with whom there

may be a small developmental difference from trainee to supervisor– Observe others’ conceptualization of supervisory issues – Utilize supervisors’ skills in diverse knowledge and competency areas

• Weekly trainee-focused meetings– Group supervision: Opportunities to role-model and observe others’

supervisory skills– Multi-disciplinary C/L rounds: Opportunities to learn feedback and teaching

styles of other disciplines • Psychiatry: “Teaching moments” to provide feedback in a group format• Psychologists: Role-model the process of case conceptualization to

trainees and professionals in other disciplines (e.g., play therapy, psychiatry)

• Monthly didactic supervision seminar – Early career psychologists from Pediatric Psychology, Outpatient Clinical

Psychology and Neuropsychology; 2 senior psychologists to provide guidance and experience

– A supervision workbook (Campbell, 2000) guides learning and discussion topics

• Participants reflect on how readings apply to past experiences as trainees, current experiences as supervisors, and how past trainee experiences have influenced their current supervisory style

– Anecdotal reports of feeling invigorated by readings and discussion• Increased focus on implementing specific supervision skills/strategies

immediately after the seminar• Senior psychologists report helpfulness of seminar as their supervisory

responsibilities continue to evolve

Need #2: Identify a Training Model

• Adhere to APA Guidelines for Internship

• Draw on past experiences and models as supervisors/supervisees

• Handbook detailing concrete framework – Establish organization and divide responsibilities among psychologists– Reference for trainees, outlines expectations

• Solicit feedback throughout training year about structure and components

• Two-way evaluation at regular intervals– Trainees completed self-evaluation at the start of the training year, reviewed at

each interval – UTSW evaluation forms from the encapsulated internship– Trainees completed supervisor evaluations

Training ActivitiesPediatric Psychology DidacticsConsult/Liaison Grand RoundsConsult/Liaison Patient Rounds

Professional Development Seminar

Clinical ServicesPsychiatry C/L Team

Psychology elective rotationsArea of specialization for fellows

SupervisionLive supervision

Individual w/primary supervisor Individual w/rotation supervisor

Group supervision

Pediatric Psychology Training Components

The 2008-2009 Pediatric Psychology Faculty

CHALLENGES FOR EARLY CAREER PSYCHOLOGISTS IN DEVELOPING A TRAINING PROGRAM

Pediatric Psychology Team

Program Development (cont’d)Program Development