The Neurobehavioral Continuum track is part of the Kennedy Krieger Institute/Johns Hopkins School of Medicine/Behavioral Psychology & Neuropsychology APA-accredited Internship.
The Neurobehavioral Unit-Inpatient (NBU-IP) participates in the Neurobehavioral Continuum track (NMS: 134412). This track is designed to provide broad training to Interns who want to become leaders in the field of psychology and applied behavior analysis (ABA). The Neurobehavioral Continuum is designed to serve individuals with intellectual and developmental disabilities who have severe behavioral dysfunction, including self-injury, aggression, pica, elopement and other behaviors that put them and others at risk for injury and interferes with functioning effectively at home, school, and in the community. A broad continuum of care is provided across three levels of service: the Neurobehavioral Outpatient Clinic, which provides weekly outpatient services to patients who can be safely managed in the home; the Neurobehavioral Intensive Outpatient Program, which serves patients with more severe problems by providing outpatient therapy services to patients up to six hours per day, four to five days per week; and the Neurobehavioral Inpatient Unit, which serves patients with severe and treatment resistant behavioral dysfunction that necessitates hospitalization and interdisciplinary care. The mission of the Neurobehavioral Unit is to fully integrate clinical service with research, education, and advocacy to achieve the best possible outcomes with the patients we serve, and to benefit the larger community of individuals who engage in these problems. The integration of these activities was foundational to the establishment of the Johns Hopkins University School of Medicine, the Kennedy Krieger Institute as the first University Center of Excellence in Developmental Disabilities, as well as the Neurobehavioral Programs. Education through the Internship is central to the mission of the program. The Neurobehavioral Continuum track provides a variety of training experiences in direct clinical service provision, program evaluation and administration activities, and research experiences to inculcate Interns in this service delivery model.
Interns receive training in applied behavior analysis for the assessment and treatment of severe, treatment resistant problem behavior, learn how program evaluation and analysis of patient outcomes can be used to refine clinical services, and how research can be used to inform clinical care and advance knowledge. After completing the track, the Intern should be prepared to function as a psychologist in a variety of settings including inpatient or outpatient hospital units, academia, traditional clinics, residential, and school systems. To achieve these goals, the Intern will provide clinical services across all three clinical programs that are integrated within the Neurobehavioral Continuum. Foundational training pillars that are experienced across all three clinical programs are: (1) Clinical Application of ABA, (2) Program Evaluation and Administration, (3) Research, and (4) Mentoring and Case Supervision.
Clinical Application of ABA
Patients in each of the three clinical programs are diagnosed with developmental disabilities (primarily autism and intellectual disability) and present with severe behavioral dysfunction. These patients engage in a variety of problem behaviors including but not limited to self-injurious behavior, aggression, disruption, property destruction, pica, and ritualistic behaviors, all of which affect their quality of life, and that of their families and other caregivers. These programs serve patients with severe problems that pose a risk for injury, and can result in permanent disfigurement and loss of function. As part of the Neurobehavioral Continuum, during the first 3-4 months the Intern completes activities primarily in the Neurobehavioral Inpatient Unit. This experience will provide the Interns with advanced training in applied behavior analysis with very severe and treatment resistant problem behavior in a highly controlled environment, to become familiar in the application of the most evidence-based assessment and treatment procedures.
During the following 2-3 months, the Intern will participate in a unique opportunity known as the Neurobehavioral Intensive Outpatient Program. This involves the Intern working with a patient and their family for 5 hours a day, 5 days a week, during a 3-week period to design a treatment that can be generalized to the relevant discharge settings such as home and school. During the final 6 months of internship, the Intern is expected to maintain a caseload on the Neurobehavioral Outpatient Clinic while also moving into a supervisory role on the Inpatient Unit, where in conjunction with a licensed psychologist, they will co-supervise multiple behavior teams in assessment and treatment processes.
Throughout the internship, the Intern’s level of responsibility in the provision of care is tailored for his or her experience and comfort level, with the goal of maximizing independence over time. Activities will include but are not limited to: developing and implementing individualized clinical protocols to develop a function-based treatment; summarizing and graphically depicting behavioral data to enable interpretation and analysis of behavior assessment and treatment evaluation outcomes; overseeing and directing activities of a behavioral treatment team; providing co-supervision of cases in concert with a licensed psychologist; training caregivers (e.g., direct care, parents, and school staff); reviewing and critiquing relevant literature; working within an interdisciplinary team composed of psychologists, psychiatrists, nurses, social workers, and speech and language pathologists; participating in daily supervision; presenting case reviews; and completing progress notes and behavior plans.
Program Evaluation and Administration
Throughout the year, the Intern will be involved in multiple systems-level projects designed to increase his/her skills in how to properly develop, implement, and evaluate program improvement goals applied to a system on a large scale. Additionally, Interns have the opportunity to participate in administrative opportunities including conducting clinical screening evaluations to identify the appropriate level of service on the continuum of care, learning to obtain insurance authorization for admission and for ongoing funding, and conducting staff trainings. During the final 6 months the Intern has increased administrative responsibilities that are commensurate with his/her individual career goals.
During internship, the Intern is expected to collaborate with their supervisors to complete at least one single-subject design project and one systems level program evaluation project with the goal of disseminating the findings through publication in a chapter, a peer-reviewed journal, and/or presentation at a regional or national conference. The intern will be able to choose from a variety of extant clinical research projects to co-lead, or if time and opportunities permit, to develop a protocol for implementation during the year. Research can occur within or across programs, and research activities intensify during the final 6 months of internship to ensure quality research projects can be completed.
Mentoring and Supervision
Mentoring and supervision of other professionals are critical aspects for all early career psychologists to develop for future employment. During the first 6 months of internship, the Intern will mentor and supervise direct care staff, practicum students, and members of their behavior team in completing behavioral assessment and treatment procedures. During months 7-12, the intern will co-supervise cases collaboratively with a licensed psychologist.
Individual and Group Supervision
Ample supervision is provided to the intern from psychologists at multiple levels of the Neurobehavioral Continuum, from Senior Behavior Analysts to Program Directors, and when possible, is tailored for the Intern’s desired experiences. Supervision will initially be more didactic, and towards the end of internship more collaborative in nature, with the Intern exhibiting increased independence. Each Intern will receive at least 2 hours per week of individual supervision from a licensed psychologist. Additionally, Interns will receive 2 hours or more of group supervision each week by participating in supervision with psychologists and behavior analysts for case management, interdisciplinary team meetings, journal clubs, peer reviews, and research seminars. Opportunities may exist for interns to receive supervision hours towards Board Certified Behavior Analyst (BCBA) certification.