Introduction to Introduction to Behavioral PediatricsBehavioral Pediatrics

Jodi Polaha, Ph.D. and Rachel J. Valleley, Jodi Polaha, Ph.D. and Rachel J. Valleley, Ph.D.Ph.D.

Assistant Professors, PediatricsAssistant Professors, PediatricsDepartment of PsychologyDepartment of Psychology

Munroe-Meyer InstituteMunroe-Meyer Institute

What is Behavioral What is Behavioral Pediatrics?Pediatrics?

Field of psychology representing interface Field of psychology representing interface between behavioral health care and between behavioral health care and pediatric primary carepediatric primary care

Behavioral Health Medical HealthPediatricPsychology

BehavioralPediatrics

Behavioral Health Concerns Behavioral Health Concerns in Primary Carein Primary Care

Behavior problems ranked #1 by pediatricians Behavior problems ranked #1 by pediatricians (Arnorfer et al., 1999)(Arnorfer et al., 1999)

Established link between medical and behavioral Established link between medical and behavioral concerns (Wertleib et al., 1988) concerns (Wertleib et al., 1988)

ADHD evaluations increased three-fold in 1990s ADHD evaluations increased three-fold in 1990s (Hoagwood et al.,2000)(Hoagwood et al.,2000)

What Kinds of Problems Are What Kinds of Problems Are Seen?Seen?

Traditional Psychological ConcernsTraditional Psychological Concerns– ADHD, Conduct Problems, Anxiety ADHD, Conduct Problems, Anxiety

Disorders/Depression, Learning Problems, Disorders/Depression, Learning Problems, Developmental DelayDevelopmental Delay

What Kinds of Problems Are What Kinds of Problems Are Seen?Seen?

Traditional Psychological ConcernsTraditional Psychological Concerns– ADHD, Conduct Problems, Anxiety ADHD, Conduct Problems, Anxiety

Disorders/Depression, Learning Problems, Disorders/Depression, Learning Problems, Developmental DelayDevelopmental Delay

Medical Problems with Behavioral Medical Problems with Behavioral ComponentComponent– Diabetes, Asthma, Feeding Tubes, Diabetes, Asthma, Feeding Tubes,

EncopresisEncopresis

What Kinds of Problems Are What Kinds of Problems Are Seen?Seen?

Traditional Psychological ConcernsTraditional Psychological Concerns– ADHD, Conduct Problems, Anxiety ADHD, Conduct Problems, Anxiety

Disorders/Depression, Learning Problems, Disorders/Depression, Learning Problems, Developmental DelayDevelopmental Delay

Medical Problems with Behavioral ComponentMedical Problems with Behavioral Component– Diabetes, Asthma, Feeding Tubes, EncopresisDiabetes, Asthma, Feeding Tubes, Encopresis

““Common” Pediatric ConcernsCommon” Pediatric Concerns– Bedwetting, Temper Tantrums, Thumb Sucking, Bedwetting, Temper Tantrums, Thumb Sucking,

Sleep ProblemsSleep Problems

Newest Application: Newest Application: Behavioral Health In Primary Behavioral Health In Primary

CareCarePhysicians as “de facto” mental health Physicians as “de facto” mental health providers.providers.

Newest Application: Newest Application: Behavioral Health In Primary Behavioral Health In Primary

CareCarePhysicians as “de facto” mental health Physicians as “de facto” mental health providers.providers.

Better continuity of care.Better continuity of care.

Newest Application: Newest Application: Behavioral Health In Primary Behavioral Health In Primary

CareCarePhysicians as “de facto” mental health Physicians as “de facto” mental health providers.providers.

Better continuity of care.Better continuity of care.

De-stigmatization of behavioral health De-stigmatization of behavioral health services.services.

Newest Application: Newest Application: Behavioral Health In Primary Behavioral Health In Primary

CareCarePhysicians as “de facto” mental health Physicians as “de facto” mental health providers.providers.

Better continuity of care.Better continuity of care.

De-stigmatization of behavioral health De-stigmatization of behavioral health services.services.

Potential for better early Potential for better early intervention/maximized services.intervention/maximized services.

Newest Application: Newest Application: Behavioral Health In Primary Behavioral Health In Primary

CareCarePhysicians as “de facto” mental health Physicians as “de facto” mental health providers.providers.Better continuity of care.Better continuity of care.De-stigmatization of behavioral health De-stigmatization of behavioral health services.services.Potential for better early Potential for better early intervention/maximized services.intervention/maximized services.Improved physician practice.Improved physician practice.

Behavioral Health ClinicsBehavioral Health Clinics

Nebraska City Behavioral Health ClinicEst. 2004 at Physicians Clinic

Kearney Behavioral Health Clinic

Est. 2004 at Kearney Clinic, P.C.

Chadron Behavioral Health ClinicEst. 2004 at Chadron HealthGordon Behavioral Health ClinicEst. 2004 at Gordon Clinic

Our ExperiencesOur Experiences

1.1. See patients See patients

Our ExperiencesOur Experiences

1.1. See patientsSee patients

2.2. Provide training to variety of students Provide training to variety of students

Our ExperiencesOur Experiences

1.1. See patientsSee patients

2.2. Provide training to variety of studentsProvide training to variety of students

3.3. Hallway consultations with Hallway consultations with physicians/staffphysicians/staff

Our ExperiencesOur Experiences

1.1. See patientsSee patients2.2. Provide training to variety of studentsProvide training to variety of students3.3. Hallway consultations with Hallway consultations with

physicians/staffphysicians/staff4.4. Continuing education talks to Continuing education talks to

physicians/staff (and community physicians/staff (and community providers)providers)

Our ExperiencesOur Experiences

1.1. See patientsSee patients2.2. Provide training to variety of studentsProvide training to variety of students3.3. Hallway consultations with physicians/staffHallway consultations with physicians/staff4.4. Continuing education talks to physicians/staff Continuing education talks to physicians/staff

(and community providers) (and community providers) 5.5. Systems change within the primary care Systems change within the primary care

settingsetting

Physicians Use of Physicians Use of Empirically Supported Empirically Supported

ADHD AssessmentADHD AssessmentMeasure % Present

Pre-Protocol(N=76)

% Present First Year After Training(N=28)

% Present ThirdYear After

Training(N=26)

CBCL/Parent BASC

1% 93% 93%

TRF/Teacher BASC

0% 88% 93%

CPRS-R:S 1% 93% 93%

CTRS-R:S 1% 93% 88%

Parent ADHD-IV 3% 88% 93%

Teacher ADHD-IV 1% 88% 93%

ECBI 3% 93% 88%

Our ExperiencesOur Experiences

1.1. See patientsSee patients2.2. Provide training to variety of studentsProvide training to variety of students3.3. Hallway consultations with physicians/staffHallway consultations with physicians/staff4.4. Continuing education talks to physicians/staff Continuing education talks to physicians/staff

(and community providers) (and community providers) 5.5. Systems change within the primary care Systems change within the primary care

settingsetting6.6. Community involvementCommunity involvement

What Do I Need to Have a What Do I Need to Have a Job like that?Job like that?

1.1. Ph.D. vs. M.S.Ph.D. vs. M.S.

What Do I Need to Have a What Do I Need to Have a Job like that?Job like that?

1.1. Ph.D. vs. M.S.Ph.D. vs. M.S.

2.2. At least some experience in a primary At least some experience in a primary care settingcare setting

What Do I Need to Have a What Do I Need to Have a Job like that?Job like that?

1.1. Ph.D. vs. M.S.Ph.D. vs. M.S.

2.2. At least some experience in a primary At least some experience in a primary care settingcare setting

3.3. Licensed or supervised by a licensed Licensed or supervised by a licensed psychologistpsychologist

What Do I Need to Have a What Do I Need to Have a Job like that?Job like that?

1.1. Ph.D. vs. M.S.Ph.D. vs. M.S.

2.2. At least some experience in a primary At least some experience in a primary care settingcare setting

3.3. Licensed or supervised by a licensed Licensed or supervised by a licensed psychologistpsychologist

4.4. Paneled with insurance companies that Paneled with insurance companies that serve the PC where you workserve the PC where you work

What Do I Need to Have a What Do I Need to Have a Job like that?Job like that?

1.1. Ph.D. vs. M.S.Ph.D. vs. M.S.2.2. At least some experience in a primary At least some experience in a primary

care settingcare setting3.3. Licensed or supervised by a licensed Licensed or supervised by a licensed

psychologistpsychologist4.4. Paneled with insurance companies that Paneled with insurance companies that

serve the PC where you workserve the PC where you work5.5. Mechanism for administrative support Mechanism for administrative support

and getting paidand getting paid

Time TableTime Table

1.1. Ph.D. – Ph.D. – 6-8 yrs6-8 yrs. vs. M.S. – . vs. M.S. – 2-3 yrs.2-3 yrs.2.2. At least some experience in a primary care At least some experience in a primary care

settingsetting3.3. Licensed or supervised by a licensed Licensed or supervised by a licensed

psychologist psychologist Ph.D. 1 yr, M.S. 1.5 yrs.Ph.D. 1 yr, M.S. 1.5 yrs.4.4. Paneled with insurance companies that serve Paneled with insurance companies that serve

the PC where you work the PC where you work min. 6 mos.min. 6 mos.5.5. Mechanism for administrative support and Mechanism for administrative support and

getting paidgetting paid

Total time Ph.D. = 7.5 yrs min. M.S. = 4 yrs.Total time Ph.D. = 7.5 yrs min. M.S. = 4 yrs.

Preparation CaveatsPreparation Caveats

Where can you get experience working in Where can you get experience working in primary care?primary care?

Preparation CaveatsPreparation Caveats

Where can you get experience working in Where can you get experience working in primary care?primary care?

What PC will be interested in your What PC will be interested in your services?services?

Preparation CaveatsPreparation Caveats

Where can you get experience working in Where can you get experience working in primary care?primary care?

What PC will be interested in your What PC will be interested in your services?services?

How will you get supervision until How will you get supervision until licensed?licensed?

Preparation CaveatsPreparation Caveats

Where can you get experience working in Where can you get experience working in primary care?primary care?

What PC will be interested in your What PC will be interested in your services?services?

How will you get supervision until How will you get supervision until licensed?licensed?

How will you get paid until paneled?How will you get paid until paneled?

Training at MMI in the BHCTraining at MMI in the BHC

For-credit practicum/externshipFor-credit practicum/externship

Some paid practicum experiencesSome paid practicum experiences

Pre-doctoral internship (APA approved)Pre-doctoral internship (APA approved)

Post-doctoral fellowshipsPost-doctoral fellowships

UNL TraineesUNL Trainees

SchoolSchool– Stacey KosseStacey Kosse– Jody LieskeJody Lieske– Emily WarnesEmily Warnes– Ann GallowayAnn Galloway

ClinicalClinical– Cate Jones-HazledineCate Jones-Hazledine– Corrie DaviesCorrie Davies

Other ResourcesOther Resources

Merilee McCurdy, Ph.D.Merilee McCurdy, Ph.D.– Assistant Professor, School PsychAssistant Professor, School Psych– (402)472-5191(402)472-5191

Rachel Valleley, Ph.D.Rachel Valleley, Ph.D.– Assistant Professor, Pediatrics, MMIAssistant Professor, Pediatrics, MMI– (402) 559-2401(402) 559-2401

Jodi Polaha, Ph.D.Jodi Polaha, Ph.D.– Assistant Professor, Pediatrics, MMIAssistant Professor, Pediatrics, MMI– (402) 59-4362(402) 59-4362

Visit a ClinicVisit a Clinic

HastingsHastings– Stephanie Cooper, Ph.D.Stephanie Cooper, Ph.D.

402-463-6828402-463-6828

ColumbusColumbus– Tawnya Meadows, Ph.D.Tawnya Meadows, Ph.D.

402-552-4444402-552-4444