Tracks

AUTISM AND PEDIATRIC OUTPATIENT CARE TRACK (5 positions)

Interns in this Track split their time between the Clinical Assessment and Diagnostics Department, Early Intervention Clinic, and Behavioral Mental Health Outpatient Clinic. This Track offers a focus on neurodevelopmental disabilities as well as experience with a broader pediatric population.

The Clinical Assessment and Diagnostics (CAD) department at the Marcus Autism Center emphasizes flexible, empirically supported approaches to clinical assessment in the context of an interdisciplinary framework. Across the year, interns will train within the clinic and research enterprise that provides diagnostic assessments of individuals with a wide range of neurodevelopmental disorders. Children seen in the CAD clinic range from infancy to late adolescence with a focus on children ages 16 months to 6 years. Each child is assessed for Autism Spectrum Disorder as well as the many differential diagnoses commonly seen in this population, including developmental delay, intellectual disability, anxiety disorders, behavioral disorders, ADHD, genetic syndromes, such as Fragile X syndrome, as well as many others. The children seen in the CAD are highly diverse in their race, ethnicity, urbanacity, socioeconomic status, and age. These assessments are designed to identify cognitive and developmental strengths and weaknesses, assess adaptive functioning, provide diagnostic clarification, and to determine the need for intervention. Assessments incorporate measures of development, cognition, play, and adaptive behavior. Assessment of language, visual-motor skills, and behavior are included as needed. This rotation provides the opportunity to work on cases within a multidisciplinary team that includes clinical psychologists, as well as developmental pediatricians, psychiatrists, nurse practitioners, speech and language pathologists, and social workers/case managers on a case-by-case basis.

Opportunities to conduct diagnostic assessments within one or more of the over 25 active research studies are also available. In addition, opportunities to participate in evaluations through the Developmental Neurology Clinic (DNC) at the Center for Advanced Pediatrics exist. The DNC consists of a multidisciplinary team including a developmental neurologist, a developmental pediatrician, a genetic counselor, a social worker, a parent liaison, and psychologists. It focuses on assessing children with developmental disabilities other than idiopathic autism spectrum disorders.

The Early Intervention Clinic (EI) is an outpatient based at the Marcus Autism Center parent coaching program designed to support families of toddlers with or at-risk for ASD in developing play, communication, social engagement, and imitation skills. Under the supervision of a licensed psychologist, the intern will use the evidence-based Project ImPACT curriculum through weekly parent appointments with families. The manualized program emphasizes active family participation by coaching families on how to implement developmental and behavioral teaching strategies across daily routines and then creating plans for weekly practice. Children are typically between the ages of 15 and 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 reciprocally with others). Children with and without ASD diagnoses are often referred from within the Marcus Autism Center but also by Children’s collaborating clinics, like the Developmental Progress Clinic and DNC.

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

As interns in this Track split their time between the Clinical Assessment and Diagnostics Department, Early Intervention Clinic, and Behavioral Mental Health Outpatient Clinic, an additional minor is not included.

PEDIATRIC FEEDING PROGRAM TRACK (4 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.

Interns will also have the opportunity to conduct a minor rotation (1/2 day a week) in a clinic outside of the Pediatric Feeding Program throughout the entire year. Minor rotations may be available in the Clinical Assessment and Diagnostics Department or Severe Behaviors Department.

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).

Interns in the full-year track will gain experiences in School Consultation. In addition to the School Consultation, interns will also be given the opportunity to conduct a minor rotation (1/2 day a week), typically within the RUBI Severe Behavior Program.

SEVERE BEHAVIOR PROGRAM TRACK (1 position)

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. In addition to the severe behavior minor rotations, interns will also be given the opportunity to conduct a minor rotation (1/2 day a week) in a clinic outside of the severe behavior program throughout the entire year. Minor rotations may be available in the Clinical Assessment and Diagnostics Department or Feeding Department.

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 Severe Behavior Program for a total of 2, 6-month major rotations. They will also complete a year-long minor rotation (1/2 day a week) and complete a brief exposure experience in assessment.

The Severe Behaviors Program 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 with a 6-month major rotation in the severe behavior program will lead at least one case at a time in our day treatment unit, working with the most severe and complex cases of problem behavior in the region.  Clients are served 6-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 staffing ratio available in the intensive outpatient program.  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. 

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 the Pediatric Feeding, Severe Behavior, Treatment, and School Consultation Tracks participate in a ½ day a week Minor Rotation. Minor Rotations are determined after the match. Possible minor rotations are listed below. In addition, all interns who do not complete a major or minor rotation in Clinical Assessment and Diagnostics (CAD) complete a 3 day mini-rotation in CAD in the spring.

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. This is the typical minor for this track.

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.

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.  

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.