Tracks

NEURODEVELOPMENTAL ASSESSMENT AND EARLY INTERVENTION TRACK (2-3 positions)

Interns in this track split their time between two year-long major rotations with the Clinical Assessment and Diagnostics (CAD) Department and Project ImPACT Early Intervention (EI) Clinic at the Marcus Autism Center, with options for minor rotations in other CHOA clinics. These major rotations offer a shared focus on early identification of and supports for neurodevelopmental disorders as well as family engagement and empowerment. Families served represent diverse ethnocultural, racial, linguistic, and socioeconomic backgrounds, and most families qualify for state or federal Medicaid. An example of how interns may split their time each week is: 1 day in the EI Clinic, 2 days in CAD, as well as time committed to a minor rotation and administrative commitments, follow-up client care, and training commitments like didactics.

CAD emphasizes flexible, empirically supported approaches to clinical assessment with an emphasis on family-centered care. Within half- and full-day diagnostic assessments, interns support individuals ranging from infancy to late adolescence with a range of neurodevelopmental disorders, all with a presenting diagnostic question of autism. Although we serve a full age range of clients from 12 months to 18 years, most children seen are ages 5 and under. Children are commonly assessed for autism spectrum disorder as well as common differential diagnoses such as intellectual disability, language disorders, anxiety disorders, and ADHD. Assessments are designed to identify cognitive and developmental strengths and areas of challenge, assess adaptive functioning, provide diagnostic clarification, and aid families in identifying and accessing community-based supports. There are opportunities to join psychologists for evaluations across various research studies as well.

Assessment teams often consist of one psychologist working alongside an intern or postdoctoral fellow, with opportunities to consult with related professionals. Located alongside our clinic are psychiatrists, nurse practitioners, speech language pathologists, and social workers. Interns may also join psychologists conducting multidisciplinary evaluations with developmental behavioral pediatricians and neurologists. Interns will have the opportunity to participate in assessments that include interpreters and, for interested trainees proficient in Spanish, bilingual assessments, interventions, and supervision is available.

EI uses an outpatient parent coaching model to support families of autistic toddlers or those with social communication delays. EI centers on the evidence-based Project ImPACT curriculum while also supporting families in navigating barriers to care. The program emphasizes family engagement by coaching families on how to implement developmental and behavioral teaching strategies across daily routines and then creating plans for weekly practice. Children seen range from 12 to 40 months and demonstrate varying degrees of social and communication delays (e.g., skills ranging from limited vocal and gestural communication to speaking in short sentences with challenges engaging with others). Presenting concerns include autism but also language disorders, genetic disorders, cerebral palsy, and factors associated with preterm birth.

With respect to intern supervision across the EI and CAD major rotations, all psychologists are a part of the same team, with many working in both CAD and EI. Supervisors have broad training in clinical psychology with experience working with pediatric populations with and without autism. Supervisors generally ascribe to a cognitive behavioral theoretical orientation. CAD and EI supervisors place high value on training and enjoy working closely with trainees from varied backgrounds.

BEHAVIORAL MENTAL HEALTH TRACK (2 positions)

The Behavioral and Mental Health Track in a part of Children’s Healthcare of Atlanta seeks to ensure patients receive access to behavioral and mental health services that will improve their quality of life and ability to thrive. Interns spend time in the Outpatient Clinic as well as the Integrated Primary Care Clinic at Hughes Spalding. 

The BMH Outpatient Clinic serves a general pediatric population referred from internal Children’s specialty medical clinics and aims to increase the continuity of care available to Children’s patients to include behavioral and mental health care. The outpatient clinic serves children with a broad range of concerns associated with anxiety, mood disorders, somatic symptoms, medical adherence concerns, and behavioral problems. Many patients have comorbid medical conditions and are referred from endocrinology, oncology, neurology, transplant, and orthopedics. A multi-disciplinary team of psychologists, social workers, nurse practitioners, and physicians provide both assessment and treatment services for children. Treatment modalities include individual therapy, group therapy, and parent training. Evidence based practices such as cognitive behavioral therapy, acceptance and commitment therapy, parent-child interaction therapy, and trauma-focused cognitive behavioral therapy are used. Medication management is provided as needed for patients. Faculty have interests in treating trauma, mood disorders, anxiety, chronic pain, and developmental disabilities. Interns will participate in monthly multidisciplinary case consultations and staff meetings.

Children's Integrated Care Team provides behavioral health in primary care and provides consultative and brief intervention services in the pediatric primary care practice at Hughes-Spalding. The practice serves a high proportion of children insured by Medicaid and is comprised of a team of pediatricians, medical residents and interns, psychiatrists, psychiatric nurse practitioners, psychologists, nurses, medical assistants, social workers, nutritionist, interpreters, and a growing team of behavioral and mental health therapists (LCSWs and LPCs). Interns can expect to provide brief behavioral and mental health consultations during patients’ medical appointments. Common presenting concerns seen in consultations include disruptive behavior, trauma, autism spectrum disorder, ADHD, anxiety, and depression. Interns will also participate in follow-up visits focusing on brief, solution-focused interventions, either in conjunction with medical visits or during standalone behavioral and mental health visits. In addition, interns may participate in conducting expedited autism assessments for young children. Interns will participate in consultation and assessments with the supervisor initially and will gradually be given independence to conduct sessions as they demonstrate competency with the presenting concerns. Given the fast-paced nature of the Integrated Primary Care setting, the timeline will differ for each intern and each professional activity. 

The Children’s Behavioral and Mental Health Outpatient Clinic and Integrated Care Clinic are relatively new, opening in 2021. This allows a unique opportunity for interns to gain experience in program development from both clinical and operational standpoints.

Interns will split their time between the Behavioral Mental Health Outpatient Clinic (Chantilly/Zalik location) and Integrated Primary Care at Hughes Spalding.

PEDIATRIC FEEDING PROGRAM TRACK (3 positions)

The Pediatric Feeding Track offers an intern the opportunity to work with children ages 9 months to 21 years who do not consume enough volume or variety of food to maintain adequate growth or nutrition. Children with this level of feeding disorder fall under the broader psychiatric diagnosis of Avoidant-Restrictive Food Intake Disorder (ARFID). ARFID in pediatric populations often co-occurs with complex medical and/or developmental conditions (e.g., pre-maturity, gastrointestinal, cardiac, food allergy, autism); therefore, this rotation offers interns a breadth of training opportunities with a diverse range of patients. Our model of care involves multidisciplinary assessment and treatment and throughout the training year interns gain experience working with a team that includes physicians, nurse practitioners, dietitians, speech-language pathologists, an occupational therapist, and a social worker.

The Pediatric Feeding Track offers a scientist practitioner model of training. Our clinic integrates science and best practices by involving a data-driven decision-pathway model of care that also facilitates new discoveries through single-subject research. The model of supervision is behavioral and involves competence-based benchmarks. The supervisor provides modeling and performance feedback with heavy oversight initially and support is faded as the internship progresses.

The intern in the Pediatric Feeding Track will spend a full year training in clinical experiences that include feeding assessments, intensive day treatment, and outpatient therapy. Across these areas, interns will gain experience with treatment approaches that include applied behavior analysis, parent training, parent-child interaction therapy, and manual-based interventions. Interns will split their time between Marcus Autism Center, the Center for Advanced Pediatrics, and community outpatient settings. In addition to feeding, treatment often focuses on associated behavioral/pediatric concerns including sleep, toileting, and disruptive behavior. Professional opportunities include participating in grant funded and/or clinical research projects, presentations at regional and national conferences, and supervision of others.

SCHOOL CONSULTATION (1 position)

The Marcus Autism Center’s School Consultation Track provides an intern opportunities to engage consultation and training with school professionals and parents to increase the behavioral functioning of children with developmental disabilities. The School Consultation Program provides consultation, direct assistance, and professional development for school systems to help them effectively serve students with educational needs and behavioral challenges—especially those diagnosed with autism and related disorders. Interns provide a variety of behavior analytic services within the school setting aimed at both increasing students’ appropriate skills and decreasing aberrant behaviors that are disruptive in the classroom. In addition to school consultation, this intern provides direct service through the RUBI Parent Training Program. RUBI is an outpatient program developed and shown to decrease challenging behaviors in children with Autism Spectrum Disorder (ASD) between the ages of 3 and 10. The program involves teaching parents a number of strategies to prevent, manage, and reduce occurrences of problem behaviors of mild to moderate severity while promoting skill development.  Applicants must have a BCBA to be considered for this Track.

In the School Consultation role, the intern will travel to schools across Georgia (mileage will be reimbursed) and provide consultation or training in a variety of settings – from Head Start classrooms to classrooms designed for transitioning to adulthood with students 18-21.  The majority of our classrooms are in rural settings in low income districts where private therapy services are scarce.  Therefore, high quality education using behavior analytic strategies are the only services many of our students receive.  We work with teachers and administrators to build classroom structure that is understandable to students, create IEP goals that are informed from direct assessment (e.g., AFLS, ABLLS-R), train teachers to utilize behavior analytic teaching strategies to reach those IEP goals, and conduct functional behavior assessments (FBA) and behavior intervention plans (BIP).  Furthermore, we have the Behavioral Consultative Assessment Support in Education Team (B-CASE Team) Project.  In the B-CASE project we train school-based professionals to conduct the full range of FBAs, including experimental methods (i.e., functional analysis, structural analysis, concurrent operants assessments).

SEVERE BEHAVIOR PROGRAM TRACK (2 positions)

The Severe Behavior Program at the Marcus Autism Center provides a continuum of services for individuals with developmental disabilities between the ages of 2 and 21 years who display severe destructive behavior such as self-injurious behavior (SIB), aggression, property destruction, noncompliance, tantrums, elopement, pica and toileting deficits. The primary goals of the program are to: (a) serve as a model for the evaluation and treatment of destructive behavior displayed by persons with developmental disabilities, (b) foster the development of new therapeutic procedures through systematic research on the nature and management of destructive behaviors, and (c) promote the effective application of currently available treatments through training and consultation.

The goal for each child is to decrease the occurrence of his/her problem behavior and generalize gains made in treatment to the child’s home environment, community, and school. Social and ecological validity of interventions is a significant area of emphasis in all Severe Behavior treatment programs. Four clinical services are available, with level of care matched to child and caregiver characteristics to provide the services warranted for each child.  Interns in the full-year severe behavior program will lead at least one case at a time in our Intensive Outpatient Program, working with the most severe and complex cases of problem behavior in the region.  Clients are served 5-hours a day, 5-days a week, for an average of 3 months.  Individuals are referred to this program if their problem behavior is placing their family in a state of crisis (e.g., problem behavior is causing significant injuries or the family is considering residential placement for the individual) or if their problem behavior cannot safely be managed by the caregivers.  Common treatment courses include detailed functional analysis, teaching of adaptive behaviors (e.g., functional communication training), reinforcement for appropriate behaviors on a dense schedule, schedule thinning, caregiver training, and generalization.  Applicants must be working toward a BCBA and have completed some coursework to be considered for this Track.

Interns in the full-year track will gain experiences providing short-term follow-up to clients after discharge from the Intensive Outpatient Program to build skills in the area of maintenance of behavioral interventions and caregiver training. Interns in the full-year program will also have opportunities to increase the variety of clients they see through the minor rotation options in the severe behavior program.  These minor severe behavior rotations will occur throughout the year, but with a heavier emphasis on in the second six months.

TREATMENT TRACK (2 positions)

Interns in this track will spend 6 months in in the Language and Leaning Center program and 6-months in the Pediatric Feeding Program for a total of 2, 6-month major rotations. They will also complete a year-long minor rotation and complete a brief exposure experience in assessment.

The Pediatric Feeding Track offers an intern the opportunity to work with children ages 9 months to 21 years who do not consume enough volume or variety of food to maintain adequate growth or nutrition. Children with this level of feeding disorder fall under the broader psychiatric diagnosis of Avoidant-Restrictive Food Intake Disorder (ARFID). ARFID in pediatric populations often co-occurs with complex medical and/or developmental conditions (e.g., pre-maturity, gastrointestinal, cardiac, food allergy, autism); therefore, this rotation offers interns a breadth of training opportunities with a diverse range of patients. Our model of care involves multidisciplinary assessment and treatment and throughout the training year interns gain experience working with a team that includes physicians, nurse practitioners, dietitians, speech-language pathologists, an occupational therapist, and a social worker.

The Language and Learning Clinic (LLC) at Marcus Autism Center serves children diagnosed with autism spectrum disorders between the ages of 2 and 12 years (average 4 years of age) who are exhibiting significant language and social communication delays. Services provided in the LLC focus on building communication and vocal skills, bolstering appropriate play and social skills, targeting foundational learning skills such as imitation and matching, and reducing barriers to learning (e.g., limited reinforcers, mild to moderate problem behavior). The goal for each child admitted to the LLC is to acquire the critical skills they need in order to thrive in a less intensive setting. Children receive services between 3 and 6 hours per day, 5 days per week. All services are provided in a 1:1 format that utilizes a combination of discrete trial training and natural environment teaching to meet each child’s individual and developmental needs. Intervention in the LLC also heavily involves caregivers via both didactic and in-vivo training in order to facilitate generalization and speed treatment progress.

Interns in the LLC have the opportunity to gain a diverse set of experiences that include working directly with children, providing consultation, and delivering caregiver training. They learn to conduct and utilize comprehensive language assessments to aid in the development of intervention programming that focuses on improving language skills, play skills, and adaptive skills and that addresses barriers that may interfere with learning. In addition, they learn how to integrate child development with evidenced-based practice in order to produce meaningful outcomes in the daily life of the children they work with. Interns will also have potential opportunities to participate in ongoing departmental research projects in the roles of designing and implementing research protocols, assisting with data collection and analysis, and manuscript writing.

POSSIBLE MINOR ROTATIONS

Interns in all tracks participate in a ½ day a week Minor Rotation. Minor Rotations are determined after the match. Possible minor rotations are listed below. The availability of minors varies from year to year.

Behavior Mental Health Outpatient Clinic (minor rotation) offers interns the opportunity to work with children ages 4-21 years of age for individual therapy. The Clinic serves children with a broad range of concerns associated with anxiety, mood disorders, somatic symptoms, medical adherence concerns, and behavioral problems. Many patients have comorbid medical conditions and are referred from endocrinology, oncology, neurology, transplant, and orthopedics.

RUBI-Parent Training Program (minor rotation) within the Severe Behaviors Program is an outpatient program developed and shown to decrease challenging behaviors in children with an Autism Spectrum Disorder (ASD) between the ages of 3 and 10. The program involves teaching parents a number of strategies to prevent, manage, and reduce occurrences of problem behaviors of mild to moderate severity while promoting skill development.

The Brief Behavior Intervention (BBI) Program (minor rotation) is a weekly outpatient program. Children have a variety of problem behaviors of moderate to high severity, including aggression, self-injury, noncompliance, disruptive behavior, elopement, and pica. Targeted treatment goals are achieved through the therapist coaching the caregiver in completing a functional analysis and implementing treatment. There is a heavy emphasis on parent training, with the caregivers rehearsing skills both during the appointment as well as between appointments. ABA experience is required.

Long-term Follow Up (minor rotation) is a service provided to children after completion of day-treatment and short-term follow-up within Severe Behavior.  Clients are transferred to long-term follow-up approximately 6 months after discharge and most clients are seen every 1-3 months.  This program provides experiences in maintenance of behavioral interventions. ABA experience is required.  

The Clinical Assessment and Diagnostic Department (minor rotation) is a multidisciplinary clinic that provides diagnostic assessments of individuals with a wide range of neurodevelopmental disorders with a possible autism spectrum disorder. Children seen in the CAD clinic range from infancy to late adolescence with a focus on children ages 16 months to 6 years.

The Pediatric Feeding Clinic (minor rotation) offers interns the opportunity to work with children ages 9 months to 21 years who do not consume enough volume or variety of food to maintain adequate growth or nutrition. Children with this level of feeding disorder fall under the broader psychiatric diagnosis of Avoidant-Restrictive Food Intake Disorder (ARFID).

The Early Intervention Program (minor rotation) is an outpatient parent coaching program designed to support families of toddlers with or at-risk for autism spectrum disorder (ASD) in developing play, communication, social engagement, and imitation skills. The program uses the Project ImPACT curriculum, which has been shown to build skill in young children with ASD and other developmental delays through integrating behavioral and developmental treatment strategies. The program emphasizes active parent participation within and between sessions.