BC CHILDREN’S

In the roughly eight months that the resident spends on site at BC Children’s, they will gain experience in both assessment and therapy. Depending on the specific skill set of assessment tools and experience with various populations that the resident brings to the training experience, specific assessment goals will be set for the time that the resident is at BC Children’s. In addition, subsets of therapy, such as group work with anxious pre-adolescents will be identified. These are based on discussion between the Director of Training and the student in order to meet our goals of broad based experience as well as to match the student’s pre-existing interests. The resident’s time commitments at BC Children’s will be prioritized based on these goals. There is a great deal of flexibility in working out exactly what any one resident’s schedule would look like. Thus, for example, if a resident identified working with Eating Disordered clients as a preference, the best plan would likely involve total immersion in their program for a number of months, followed by carrying a case load of this population while gradually adding in other populations or skill sets as the year progressed. For other residents, they might be better served by being involved in one assessment program for two days a week and then simultaneously also being involved in a therapy program on a different service. Throughout the rotations, residents will observe psychologists in all aspects of their work that may include assessment, therapy, consultation, multi-disciplinary team functioning, report writing, and community/school liaison. The focus will be on developing skills leading to increasingly independent practice.

Residents have the opportunity to work with the psychologists on a wide variety of psychology services. Residents will be involved in a combination of major and minor rotations organized into a Pediatric Psychology block and a Child and Youth Mental Health block. Both blocks include assessment and therapy. Both blocks may involve inpatients and/or outpatients.

Within the Pediatric Psychology block, residents may complete assessments focused on the cognitive impact of premature birth, genetic or metabolic disorders, epilepsy, or medical treatments such as chemotherapy or surgery to remove a tumour. Assessment and therapy may address the social-emotional impact of chronic pain, differences in one’s physical appearance related to a medical condition, or dietary and lifestyle changes required by a chronic illness. Residents may also work with family members around grief and coping in relation to a sudden traumatic event or a chronic condition, or with children who have experienced abuse or neglect.

Within the Child and Youth Mental Health block, residents may consult with families and other professionals regarding issues of differential diagnosis and treatment planning for children with ADHD, mood or anxiety disorders, neuropsychiatric disorders, or concurrent mental health and substance abuse disorders. They may provide intensive treatment in a group milieu for eating disorders. They may specify the contributing factors and differential diagnoses involved in complex psychiatric conditions or assist with crisis intervention and planning for youth admitted with suicidal or psychotic symptoms.

A detailed list of psychology services at BC Children’s begins on the next page. Sample rotations from previous years are also included, but please keep in mind: there is a great deal of flexibility in working out exactly what any one resident’s schedule/rotations would look like.

BC CHILDREN’S PSYCHOLOGY DEPARTMENT SERVICES: ASSIGNMENTS

SUNNY HILL

The resident completes a series of activities which lead to increasingly independent practice. Residents have the opportunity to observe the multi-disciplinary assessment/consultation team, which may include paediatric medicine, occupational therapy, physiotherapy, social work, speech/language pathology, and psychology. Residents initially observe psychology assessments/consultations. Subsequently, residents perform part and then all of assessments/consultations including psycho-diagnostic testing and interpretation, report writing, presenting results to families and community teams, and follow-up telephone calls. Most cases focus on differential diagnosis of developmental disabilities. However, there is considerable variety in age and presenting problem. For example, a resident would learn to determine whether an autism spectrum disorder is present in a preschool-aged child with developmental delays, and to describe the complex interaction of prenatal alcohol exposure and traumatic life experiences in contributing to the difficulties of a teenager with poor school performance and many risk-taking behaviours. Opportunities for developing more specialized assessment skills (e.g. visually and hearing impaired children) may become available later in the rotation as the resident’s skill level grows. Sunny Hill offers residents experiences in communicating across disciplines as a multidisciplinary team attempts to integrate information and reach consensus on a diagnosis, and in communicating across systems so that programming in schools and community agencies is well-suited to a child’s developmental needs.

Residents have the opportunity for discussion of general professional issues, ongoing research projects, and psychologists' special interests. Residents also have the opportunity for discussion with other professional disciplines and to attend departmental meetings, program meetings, and Health Centre rounds.

More specifically, as the majority of children served through Sunny Hill have Developmental Disabilities, there is an expectation that residents will develop a general knowledge base in the field of Developmental Disabilities and residents will be encouraged to select a spcific area to learn about more intensively. Residents will also gain knowledge and experience in the demands of working within a multidisciplinary team, including how to communicate effectively and how to integrate multiple perspectives into a coherent conclusion. Residents will become familiar with the resources available to children in systems outside of health care, including education, child protection, and various social service agencies. Residents will gain knowledge of ethical and practical considerations around the sharing of information in order to best support a child.

EXAMPLES OF ROTATIONS AND BLOCKS: Flexibility Emphasized

These sample rotations reflect what a resident might do over the course of the year at the BC Children’s Hospital Residency. Note that the depiction of major and minor rotations here is oversimplified; while a major rotation usually occupies about two-thirds of the time in each block, and one or more minor rotations fill in the rest of the time, these proportions are for the block as a whole and are not rigidly assigned to days of the week. Depending on the nature of the work, a minor rotation might be best scheduled as three days a week for four weeks, one day a week for twelve weeks, or two mornings a week for twelve weeks. This sample of rotations is meant to provide some understanding of how blocks and rotations at BC Children’s might work, but there is a lot of flexibility to meet each resident’s training goals, including having more than one resident working on the same clinical service.

Block One – October to December: BCCH Child and Youth Mental Health

Block Two – January to March: BCCH Pediatric Psychology

Block Three – April to June: SHHC Developmental Disabilities