Autism 101 Judith Aronson-Ramos, M.D. Developmental & Behavioral Pediatrics of South Florida .
Introduction to Behavioral Pediatrics
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Transcript of Introduction to Behavioral Pediatrics
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