Children’s Intellectual and Developmental Disabilities (IDD) Services
CIDDS serves approximately 250 children and adolescents in 10 campus-based and 7 community-based residential treatment facilities, treatment foster care homes, and approved private school educational placements. Due the growing need for specialized services for children and adolescents with autism spectrum disorders, CIDDS opened two new programs in 2014, STAIRS (short-term autism intensive residential services) and the Devereux Autism Assessment Center.
The primary age range for clients served is 6 to 21; however, CIDDS may accept children younger than age 6 to a treatment foster care home or continue to serve individuals over the age of 21 until an appropriate adult placement can be obtained for that individual.
The individuals served by CIDDS have intellectual and/or developmental disabilities and concomitant psychiatric and behavioral challenges. Intellectual functioning of the clients ranges from the severe range of intellectual disability to the borderline range of cognitive functioning. Over half of the client population also has an autism spectrum disorder diagnosis. Referral problems include the full range of psychiatric disorders, behavioral concerns such as aggression and self-injurious behavior, and juvenile justice concerns such as sexual offending behaviors and drug and alcohol abuse.
Treatment Program Overview
CIDDS provides services under Devereux’s Philosophy of Care model. In the CIDDS programs, a positive behavioral support environment is developed within the residential milieu and school programs that teaches and reinforces appropriate, communicative, pro-social, and other adaptive behaviors. Further, each client is surrounded by a team of interdisciplinary professionals working to provide specialized assessments and interventions that build on client strengths and assist with remediating client needs. Psychological interventions are grounded in behavioral and cognitive-behavioral theory, and the psychology staff works very closely with medical, psychiatric, residential, educational, and social services staff to provide a comprehensive and integrated system of care. For the individuals served, improvements in communication, self-regulatory, and other adaptive skills lead to more appropriate and enjoyable social relationships, more personal independence, and opportunities for movement to less restrictive settings such as re-integration to home or transfer to community living arrangements.
Assessment. Functional behavioral assessment is a key component for understanding why challenging behaviors occur. Interns are provided with treatment method seminars to introduce them to different functional behavioral assessment tools and interpretation of assessment results. Supervision is also provided at CIDDS for functional behavioral assessment, development of functional hypotheses, and developing positive behavior support plans which link to the results of the functional behavior assessments.
Interns also receive training and supervision in psychological and neuropsychological assessments designed to answer specific diagnostic questions. With the opening of the Autism Assessment Center, interns may also receive training in the ADOS-II administration, scoring, and interpretation. Further, interns at CIDDS can gain experience in administering a wide array of cognitive assessments, adaptive behavior assessments, social-emotional assessments, forensic risk assessments, and neuropsychological assessments. Assessment supervision and training also focuses on integration of assessment data, clinical formulation, and provision of meaningful recommendations and feedback.
Intervention. Clinical case assignments are selected to give the intern a diverse group of clients to broaden his/her expertise with the presenting problems of children and adolescents autism and/or ID. However, if the intern has a particular interest in a special clinical population, the case assignments can also be modified to reflect this interest in the latter portion of the internship. Clinical interventions can take an individual, group, or family focus. Interventions range from skill training, positive behavior support planning, cognitive-behavioral therapy, and parent training and therapy. Supervision is provided in clinical formulation, treatment planning, and progress monitoring. The intern will also have opportunities to observe supervisors or senior clinical staff as they conduct interventions, and the intern will also experience live supervision when conducting his/her own interventions. Further, all Devereux interns have the opportunity to participate in treatment methods seminars on alternate Fridays.
Consultation. Given the different treatment settings that comprise CIDDS, a significant part of the role of all clinicians is providing staff consultation. Interns have the opportunity to consult with school, medical, psychiatric, and residential staff regarding successes or challenges that an assigned client might experience. Consultation may involve assessment, observation, and/or interviews to formulate hypotheses. From the hypotheses, the intern will formulate both informal and formal recommendations. In cases where a specific training or a behavior support plan may be recommended, the intern will provide training and follow-up to ensure treatment integrity.
Case Management. As a part of a multidisciplinary team, the intern is responsible for the clinical needs of assigned clients. Each team has an assigned social services coordinator who is responsible for general case management duties such as arranging home visits and setting up discharge resources. Interns and clinical staff are responsible for any clinical case management that involves reports to behavioral health care funders on client progress and requests for additional authorization of clinical services.
Research/ Program Evaluation. Each intern is expected to complete one research or treatment outcome study during the training year. Interns are encouraged to participate in an existing research study in collaboration with another clinician at CIDDS or to develop a new project. As an alternative to an experimental design, interns may choose to participate in a treatment outcome study on a topic that is relevant to the center and will aid Devereux’s treatment outcome initiatives. Interns present their research/treatment outcome findings at a formal presentation to peers and other clinical staff. Interns are supported in their research by the Devereux Behavioral HealthCare Library, staff at ICTR, and the intern supervisory staff at CIDDS.
Diversity/Cultural Competency. Interns are provided training and supervision surrounding issues of cultural and individual diversity. Diversity dynamics are integrated in all parts of training, including assessment, intervention, consultation, case management, research, and supervision. These dynamics are crucial to the understanding of the individual and in planning and delivery of treatment. The interns have the opportunity to work with culturally and individually diverse clients as well as staff. CIDDS recruits staff internationally and supports cultural and individual diversity in the workplace. English-only speaking interns and psychology staff have access to an interpretation service for working with clients and families whose primary language is not English.
Supervision. Interns have the opportunity to learn about the process of the supervision of others during the training year. In their role as consultants, interns may need to supervise direct support staff in carrying out treatment recommendations and treatment protocols. Goal-setting, coaching, mentoring, and providing performance feedback are all skills that the interns develop to improve his/her competence as a supervisor. During some training years, interns may have opportunities to also supervise clinical pre-professional trainees.
Professional Skills and Development. Professional skills and development begin during the first week of the internship and are continuously evaluated throughout the year. After an initial self-assessment is completed, specific goals and objectives will be established. These targeted areas will be reviewed and discussed during individual supervision.
The intern is supervised by three licensed, doctoral level psychologists who provide four hours of individual, face-to-face supervision each week. The intern also participates in a weekly hour of group supervision with the other clinical staff. Live supervision is provided by supervisors participating in meetings, assessment and intervention sessions, and consultation sessions with the intern. Additional mentoring may be provided by senior clinicians and consultants who have specialized clinical expertise. Supervision hours for obtaining behavior analysis board certification (BCBA) is also available for the internship year.
Desired Intern Qualifications and Competencies
Intern candidates should have a strong professional interest in working with children and adolescents with autism and/or intellectual and developmental disabilities. Ideal candidates will have a strong foundation of assessment and intervention experiences with child and adolescent autism/ID populations by the time they apply for internship. A background and preference for behavioral/cognitive behavioral theory and its application is desired. Intern candidates should also enjoy working with a multidisciplinary team.
Outcomes of Training
Over the course of the training year, the intern will develop competencies and independence in providing clinical services using a best practices model where clinical assessment, formulation, intervention, and analysis are supported by relevant clinical data. After completing the internship, interns most commonly continue their training in formal post-doctoral fellowship placements in clinical setting such as hospitals and residential treatment facilities. Past interns have also taken positions in clinical settings that provide them with the necessary post-doctoral supervision to obtain professional licenses. Additionally, some interns have accepted academic appointments upon completion of internship.