Psychology Internship Program

Residential Treatment Center/Facility:

The Astor Home residential programs are housed in together in rural Rhinebeck, New York, and provide specialized services to 75 boys and girls between the ages of 5 and 13. There are two components to the residential program, the Residential Treatment Center (RTC) and the Residential Treatment Facility (RTF). The RTF serves 20 boys and is licensed and funded by the New York State Office of Mental Hygiene, while the RTC serves 55 children referred by county departments of Social Services (OCFS, Office of Child & Family Services) and by Committees on Special Education (CSE) from various school districts. The children in the RTF tend to have more severe emotional difficulties and more extensive histories of psychiatric hospitalization than do the children in the RTC. However, there is some overlap between the two populations and children in both programs receive a broad array of clinical services. Many of the children present with histories of chronic trauma, externalizing disorders, and mood disorders and some have psychotic disorders.

Children live in groups of 10 to 12 supervised by childcare staff under the direction of a childcare supervisor. Each living group has a psychologist as its clinical coordinator and a social worker who serves as the liaison between Astor and the children’s families. In addition to the therapeutic milieu which is based within the context of trauma informed care (Sanctuary), available treatment modalities include individual, family and group therapy, expressive arts therapy, and recreation activities. Psychiatric services and psychotropic medication treatment are available for those children that require it. The children attend school on site for a full day, at our three-time National Blue Ribbon Award-winning Astor Learning Center. In addition to academic instruction the program offers art, gym, library, music, computer lab and remedial reading. Children also receive speech/language and/or occupational therapy as needed. After school there are a variety of recreational activities as well as special events, community activities and trips.

All three interns spend three days in the residence. Within the residence, interns are assigned psychotherapy cases for a total of 8 hours of direct treatment cases that include a combination of individual child/play therapy, family therapy, and specialized group therapy per week. Individual therapy is conducted in one of three fully equipped play therapy rooms, which also include videotaping capabilities. Interns provide family therapy for at least one of their individual cases. A designated family therapy room is equipped with a one-way mirror for observation, along with taping capability.

The interns work closely with the clinical coordinators in treatment planning and progress review conferences. The average length of stay of the children is between 12 and 18 months, which gives the interns experience in long-term therapy. Within the residential setting the interns each complete up to twelve integrated psychological evaluations over the course of the year. This number is subject to change based on the needs of our residents. As needed testing may also occur in day treatment and the outpatient setting.

Interns offer consultation services to childcare, teaching staff, and others on a weekly basis regarding their therapy and testing cases. Interns are expected to attend a number of treatment team meetings, to prepare therapy progress reports and offer treatment goals and objectives for these meetings. Interns are also expected to present one or two testing batteries to clinical staff at the "Testing Roundtable". They are also expected to present one clinical in-service seminar on a topic of choice

Counseling Center:

Astor Services for Children & Families has Counseling Centers and several satellite clinics in Dutchess County. Both interns work at the Counseling Center in Poughkeepsie, a small urban city within the surrounding rural community. The client population is varied, and includes working class families, middle class families, as well as families on public assistance. The interns work as part of a multidisciplinary team that includes psychologist, social worker and psychiatrist, to provide a variety of consultative and direct treatment services to the child and adolescent clients and their families. The clinic serves a varied population with many of the families facing multiple challenges including poverty, chronic trauma, separation and divorce, domestic violence, and substance use issues.

Many of the children present with difficulties in the home, school and social domains. The strength-based treatment philosophy is oriented toward the involvement of the family in the treatment process. Treatment modalities include individual, family and group therapy. Therapeutic orientations include cognitive-behavioral, social learning, and family systems approaches. Treatment approaches may include child/play therapy; group therapy; family therapy; exposure to Parent Child Interaction Therapy and Trauma Focused-CBT. Interns conduct their sessions within their offices or in a separate therapy room supplied with videotaping capabilities for family and PCIT sessions.

Interns are expected to maintain 15 client contact hours (in varying combinations, e.g., weekly, biweekly, monthly), per week, plus accompanying paper work, in a combination of services (e.g., ADHD and cognitive/emotional assessment, treatment, intake, collateral contacts, etc.). They are expected to spend one to two evenings per week. Interns attend weekly treatment team meetings, and participate in monthly family therapy and/or REBT training as available.

The counseling center experience gives the interns the opportunity to consult with various community agencies and school districts as well as to face the "real life" issues of productivity and managed care billing. The interns are expected to manage treatment responsibilities, billing, case consultation, treatment team meetings and timely completion of paperwork along with the seasoned staff members and are considered members of the treatment team. There may be an occasional as-needed psychological evaluation.

The interns spend three days in the residence which has a slower pace and less required paperwork than the more intensely paced counseling centers or day treatment program. Within the residence, interns are assigned psychotherapy cases for a total of 8 treatment hours (individual and group/social skills therapy) per week. They also provide family therapy for one of their individual cases. They work closely with the clinical coordinators in treatment planning and progress review conferences. The average length of stay of the children is between 12 and 18 months, which gives the interns experience in long-term therapy. Within the residential setting the interns each complete up to ten integrated psychological evaluations over the course of the year. They also offer consultation services to childcare and teaching staff on a weekly basis regarding their therapy and testing cases. Interns are expected to attend a number of treatment team meetings, to prepare therapy progress reports and offer treatment goals and objectives for these meetings.

School-age Day Treatment:

The Astor Services for Children & Families, day treatment center, located in the more urban Poughkeepsie, New York, provides treatment and educational services to 56 children aged 5 to 13 referred from school districts throughout Dutchess County and surrounding counties. It is licensed jointly by the Office of Mental Hygiene and the State Education Department. Children are referred for services by their district Committees on Special Education. All of the children have been designated as emotionally disturbed and have been unable to function adequately in less restrictive educational settings. The most common diagnoses are Attention Deficit Hyperactivity Disorder, Posttraumatic Stress Disorder and Oppositional Defiant Disorder. There are some children with psychotic disorders as well. Many of the children are also learning disabled. The children often come from multi-stressed families and some are in foster care. There is a satellite program for preschool children that is well integrated into Astor's Early Childhood Programs in Poughkeepsie.

Day Treatment is a school-based intensive treatment program with all treatment being provided during the course of the regular school day. The treatment approach is primarily a combination of psychodynamic, developmental, cognitive-behavioral, and family systems therapies, along with Ross Greene’s Collaborative Problem Solving method. The school also uses behavior modification and social skills training with an emphasis on helping children develop problem solving skills and working with them collaboratively. Each child receives individual, group and family therapy when possible. Psychiatric services are available for those children who require psychotropic medication. Other special services include speech/language therapy, occupational therapy, physical therapy and intensive reading remediation. Clinicians work closely with the teachers and other staff to develop an effective individualized, strength-based, treatment approach for the child. Most therapy is long-term in nature as children are generally placed in the program for an entire school year at a time.

The intern is assigned two days at the Day Treatment program (and three at the Residence. See above description of the Residence for specific details on training and caseload.) At Day Treatment the intern is expected to put in 14.0 hours and to carry a caseload of six treatment cases. The intern also conducts intakes (diagnostic interview and assessment) as needed to maintain his/her caseload. The intern is also responsible for the classroom consultation, treatment planning, and individual and family therapy for the cases assigned. The treatment modalities include individual verbal and play therapy, family therapy, group therapy, milieu therapy, parent counseling and case management, and cognitive behavioral therapy. The intern also participates in treatment team meetings, and clinical staff meetings.

The intern works closely with any other programs and agencies involved with the child, such as the Department of Social Services (OCFS), Astor Intensive Case Management, and Child Protective Services. The intern may also complete as-needed psychological assessments during the course of the year referred due to diagnostic questions. The intern works closely with and consults with parents, and other disciplines including social work, nursing, psychiatry and teaching.

BRONX COUNTY PROGRAMS (Match #148814)

The Bronx programs, known collectively as The Astor Child Guidance Center (ACGC), are located in the urban northeast Bronx in New York City and include The ACGC Outpatient Clinic (Tilden and Highbridge); The Astor Day Treatment Program; The Lawrence F. Hickey Center for Child Development (a therapeutic nursery); and Astor Family Services. The interns spend three days per week in a Day Treatment Program and two days per week in the Outpatient Clinic (Tilden Street). Interns in the Bronx programs experience a varied client population from inner-city life, with accompanying multiple problems and crises, including low socio-economic status, drug, alcohol, single-parent, domestic violence, and abuse histories.

Day Treatment Program:

The Astor Day Treatment Program serves 216 three to fourteen year-olds in four sites. The program strives to provide an intensive therapeutic program for severely emotionally disturbed children and their families through the combined efforts of an interdisciplinary team of certified mental health professionals and educators.

Referrals are accepted from school systems, social service agencies, psychiatric hospitals, day care centers, psychologists, psychiatrists, pediatricians and parents who believe their child needs an intensive treatment program. Most children referred to the program have been unable to function adequately in less restrictive special education programs or have been discharged from more restrictive residential programs (e.g., inpatient psychiatric facilities, residential treatment facilities).

The clinical component of the program is based upon behavioral, social learning and cognitive-behavioral principles. Evidence-based interventions are woven into the clinical work. Therapy focuses on helping the child develop affective regulation, adaptive problem solving, interpersonal, and cognitive skills. Interns have mostly groups, in-classroom consultation and some individual therapy cases. Classroom management techniques are based on an ongoing, highly structured, and consistently administered token economy. Family participation is required to address problems occurring in the child's home and to maximize therapeutic effectiveness. Some children require psychiatric consultation and psychotropic medication. Where appropriate, the child's treatment team and parents meet to discuss rationale, recommendations, and procedures.

Two interns are placed in the Byron Avenue day treatment program, working with school age children for 21 hours per week. One intern is placed in the Tilden Street day treatment program with younger children for 21 hours per week. Interns are called upon to help staff in initiating or assisting in physical holds, and to be available for crisis intervention within the classroom. Interns will need to be flexible and have coping strategies for managing personal stress that can be created by repeated client crises that interfere with scheduled appointments, and the demands of timely completion of regularly required paperwork. All interns receive TCI training for crisis intervention before receiving cases.

Outpatient Clinic:

The Outpatient Clinic of the Astor Child Guidance Center at Tilden Street provides a range of services to the urban communities of the northeast Bronx. It is licensed by the State Office of Mental Health (OMH) and holds contracts with the New York City Department of Health and Mental Hygiene (DoH&MH) to provide services for children and their families. The services are open to all regardless of ability to pay, provided admission criteria are met. Prospective clients must be between the ages of four and eighteen, must live within the specified catchment area, and must have a diagnosable psychiatric disability. Preference is given to those cases which meet the OMH criteria for Severe Emotional Disturbance, or who present with serious psychiatric symptoms. Exclusion criteria include a primary diagnosis of substance abuse, mental retardation or severe developmental delays (e.g., autism).

The program is staffed by an inter-disciplinary team of psychiatrists, psychologists, social workers, and art therapists. There is also an active student internship program in social work and art therapy, along with the APA-Accredited Psychology Internship program.

The services provided by the program include individual counseling and psychotherapy, group therapy, family therapy, psychiatric evaluation and medication evaluation, psychological testing, crisis intervention and case management. Cognitive Behavioral Therapy is the core treatment model employed in the clinic, although senior staff are well-versed in psychodynamically-oriented psychotherapy, object relations orientations, narrative therapy and collaborative approaches. Treatment is primarily guided by a number of evidence-based protocols that have proven efficacious for the typical presenting problems of our urban population: Parent Child Interaction Therapy (PCIT); Trauma Systems Therapy (TST); Trauma Focused CBT; a CBT protocol for depression; specific protocols for disruptive behavior disorders; and parent management techniques.

Referrals are received primarily from schools, psychiatric emergency rooms, inpatient units, general hospital outpatient units, other agencies, and community members who know Astor through word of mouth, and former clients. Clients are initially evaluated during their first three visits. During the initial phase of treatment, all clients undergo extensive psychodiagnostic assessments that guide the next phase of treatment planning.

Interns are able to work with a varied inner-city population with a variety of referring problems, that include externalizing behaviors, mood disorders, parent-child problems, family difficulties stemming from drug, alcohol addictions, domestic violence and single-parent stress. Evening work is required in order to see individual and family cases, as well as complete intakes and psychological assessments. The interns are together in the outpatient setting on the same two days per week. Interns are required to help maintain insurance billing processes, as well as being up-to-date on paperwork demands as per OMH and New York State time requirements.

Intern Caseloads and Responsibilities

The Bronx internship programs provide a primarily clinical psychology experience, but do involve opportunities for consultation directly with educational staff. Interns have cases in both the outpatient clinic and the Day Treatment Program. Interns provide individual, group, and family therapy, parent collateral service (e.g., parent training), crisis intervention, teacher consultation, and psychological assessment. Interns also work closely with foster agencies, law guardians, and the Administration for Children’s Services (ACS). On occasion, interns provide adult individual counseling to the parents of clients. Moreover, they also serve on the Day Treatment Program’s Intake team and perform mental status evaluations for Day Treatment candidates. They have also been asked to provide information to ACS and appear in Family Court. All interns are expected to put in a minimum of 50 hours per week in order to meet the necessary treatment, assessment and paperwork requirements.

Within the outpatient program, interns provide assessment and treatment services to individual and family cases (sufficient to produce 15 billable contacts per week) and complete intakes and a variety of full and partial testing batteries and assessments (up to ten) throughout the year.

Within the Day Treatment Program, interns are expected to carry a total of eight cases. Treatment modalities include: milieu treatment, group therapy, individual/play therapy, family therapy, crisis intervention (Therapeutic Crisis Intervention – Cornell Model training provided), Parent Child Interaction Therapy (PCIT), evidence-based CBT models, including Trauma-Focused Cognitive Behavior Therapy (TF-CBT) and psychiatric treatment. The specific modalities used with each child and family are individualized based on their needs and program resources. Other responsibilities include: (a) consultation with parents, teachers, and other collaterals; (b) coordination of treatment and services with other collaterals including home-based waiver services, ICM workers, preventative case workers, ACS workers, and inpatient psychiatric hospital staff; and (c) advocacy for the children and families via case management. Interns are also expected to conduct regular mental health status exams as part of intake into the day treatment program.

Supervision

Each intern is assigned a licensed psychologist as a supervisor at each site where he or she works. Each intern receives a minimum of 2 hours per week of individual supervision with a licensed psychologist. Often there is additional individual supervision available up to 4 hours per week. In addition the interns receive group supervision in family therapy, child/play therapy and testing with licensed psychologists.

Where possible, Interns use videotape to record individual and family sessions for use in supervision and group seminars in family and child/play therapy. The agency supplies the necessary video equipment, and in two Residence therapy rooms and one Bronx family therapy room a one-way mirror is also available for live supervision.

Clinical Seminars

Clinical seminars are presented by Astor staff and provide training on a variety of clinical topics relevant to child and family mental health. Interns attend these seminars regularly and each intern has an opportunity to present to the clinical staff up to twice during the year, either on testing cases and/or another topic of interest to the intern.

Training

Family Therapy

Didactic training and supervision in family therapy are provided bi-weekly in the Bronx by Dr. Ronna Weber, certified by the American Association of Marriage and Family Therapy; and by Dr. Jody Popple and Dr. Sheila Doherty in Dutchess County. Each intern presents a family therapy case either via videotape or for live supervision. Special outside consultants, such as Andrew Fussner, MSW and Edith Winx Lawrence, Ph.D. are brought in contingent on agency funding for special training and consulting opportunities for staff. Interns are invited to attend and present cases when possible.

Child/Play Therapy

Astor Services for Children & Families is an approved provider of CE hours and certificates of attendance by the Association for Play Therapy. All training and seminars in play therapy count toward becoming a Registered Play Therapist. The Director of the APA internship conducts a three-hour per month child play therapy seminar in both Dutchess and the Bronx Counties. The interns present, in rotation, videotaped or detailed process notes of their work in therapy with one child throughout the year-long seminar. All 6 interns meet together with the Director once per quarter.

Additional Training Opportunities

Attendance at special agency-wide training is available during the year with supervisor approval pending status of the intern's productivity levels and paperwork completion. The Director of the APA Internship and Clinical Training distributes a monthly listing of additional clinical training available to all agency staff.

Development of Professional Identity

All six interns meet quarterly for lunch with the Director of the APA Internship and Clinical Training giving them an opportunity to share their experiences and personal and professional interests as well as to discuss clinical and ethical issues. This time allows for the formation of professional friendships, professional identity as a psychologist, and provides peer support. Interns also meet weekly during training modules in the Bronx, and in Dutchess County, and have ample opportunities to network with one another during their weekly contact.

Professional Library

A professional library containing over 2,300 professional books and journals is located at the main agency site in Rhinebeck. The librarian will assist interns in obtaining any books, reference materials or literature reviews needed. Materials not available in-house can be obtained through Inter-Library Loan. Requests for material can be emailed to the librarian and material received and sent via inter-office mail.

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