1. Introduction to Behavioral Pediatrics Jodi Polaha, Ph.D. and Rachel J. Valleley, Ph.D. Assistant Professors, Pediatrics Department of Psychology Munroe-Meyer Institute

2. What is Behavioral Pediatrics? Field of psychology representing interface between behavioral health care and pediatric primary care Behavioral Health Medical Health Pediatric Psychology Behavioral Pediatrics

3. Behavioral Health Concerns in Primary Care Behavior problems ranked #1 by pediatricians (Arnorfer et al., 1999) Established link between medical and behavioral concerns (Wertleib et al., 1988) ADHD evaluations increased three-fold in 1990s (Hoagwood et al.,2000)

4. What Kinds of Problems Are Seen? Traditional Psychological Concerns –ADHD, Conduct Problems, Anxiety Disorders/Depression, Learning Problems, Developmental Delay

5. What Kinds of Problems Are Seen? Traditional Psychological Concerns –ADHD, Conduct Problems, Anxiety Disorders/Depression, Learning Problems, Developmental Delay Medical Problems with Behavioral Component –Diabetes, Asthma, Feeding Tubes, Encopresis

6. What Kinds of Problems Are Seen? Traditional Psychological Concerns –ADHD, Conduct Problems, Anxiety Disorders/Depression, Learning Problems, Developmental Delay Medical Problems with Behavioral Component –Diabetes, Asthma, Feeding Tubes, Encopresis “Common” Pediatric Concerns –Bedwetting, Temper Tantrums, Thumb Sucking, Sleep Problems

7. Newest Application: Behavioral Health In Primary Care Physicians as “de facto” mental health providers.

8. Newest Application: Behavioral Health In Primary Care Physicians as “de facto” mental health providers. Better continuity of care.

9. Newest Application: Behavioral Health In Primary Care Physicians as “de facto” mental health providers. Better continuity of care. De-stigmatization of behavioral health services.

10. Newest Application: Behavioral Health In Primary Care Physicians as “de facto” mental health providers. Better continuity of care. De-stigmatization of behavioral health services. Potential for better early intervention/maximized services.

11. Newest Application: Behavioral Health In Primary Care Physicians as “de facto” mental health providers. Better continuity of care. De-stigmatization of behavioral health services. Potential for better early intervention/maximized services. Improved physician practice.

12. Behavioral Health Clinics Nebraska City Behavioral Health Clinic Est. 2004 at Physicians Clinic Kearney Behavioral Health Clinic Est. 2004 at Kearney Clinic, P.C. Chadron Behavioral Health Clinic Est. 2004 at Chadron Health Gordon Behavioral Health Clinic Est. 2004 at Gordon Clinic

13. Our Experiences 1. See patients

14. Our Experiences 1. See patients 2. Provide training to variety of students

15. Our Experiences 1. See patients 2. Provide training to variety of students 3. Hallway consultations with physicians/staff

16. Our Experiences 1. See patients 2. Provide training to variety of students 3. Hallway consultations with physicians/staff 4. Continuing education talks to physicians/staff (and community providers)

17. Our Experiences 1. See patients 2. Provide training to variety of students 3. Hallway consultations with physicians/staff 4. Continuing education talks to physicians/staff (and community providers) 5. Systems change within the primary care setting

18. Physicians Use of Empirically Supported ADHD Assessment Measure% Present Pre- Protocol (N=76) % Present First Year After Training (N=28) % Present Third Year After Training (N=26) CBCL/Parent BASC 1%93% TRF/Teacher BASC 0%88%93% CPRS-R:S1%93% CTRS-R:S1%93%88% Parent ADHD-IV3%88%93% Teacher ADHD-IV1%88%93% ECBI3%93%88%

19. Our Experiences 1. See patients 2. Provide training to variety of students 3. Hallway consultations with physicians/staff 4. Continuing education talks to physicians/staff (and community providers) 5. Systems change within the primary care setting 6. Community involvement

20. What Do I Need to Have a Job like that? 1. Ph.D. vs. M.S.

21. What Do I Need to Have a Job like that? 1. Ph.D. vs. M.S. 2. At least some experience in a primary care setting

22. What Do I Need to Have a Job like that? 1. Ph.D. vs. M.S. 2. At least some experience in a primary care setting 3. Licensed or supervised by a licensed psychologist

23. What Do I Need to Have a Job like that? 1. Ph.D. vs. M.S. 2. At least some experience in a primary care setting 3. Licensed or supervised by a licensed psychologist 4. Paneled with insurance companies that serve the PC where you work

24. What Do I Need to Have a Job like that? 1. Ph.D. vs. M.S. 2. At least some experience in a primary care setting 3. Licensed or supervised by a licensed psychologist 4. Paneled with insurance companies that serve the PC where you work 5. Mechanism for administrative support and getting paid

25. Time Table 1. Ph.D. – 6-8 yrs. vs. M.S. – 2-3 yrs. 2. At least some experience in a primary care setting 3. Licensed or supervised by a licensed psychologist Ph.D. 1 yr, M.S. 1.5 yrs. 4. Paneled with insurance companies that serve the PC where you work min. 6 mos. 5. Mechanism for administrative support and getting paid Total time Ph.D. = 7.5 yrs min. M.S. = 4 yrs.

26. Preparation Caveats Where can you get experience working in primary care?

27. Preparation Caveats Where can you get experience working in primary care? What PC will be interested in your services?

28. Preparation Caveats Where can you get experience working in primary care? What PC will be interested in your services? How will you get supervision until licensed?

29. Preparation Caveats Where can you get experience working in primary care? What PC will be interested in your services? How will you get supervision until licensed? How will you get paid until paneled?

30. Training at MMI in the BHC For-credit practicum/externship Some paid practicum experiences Pre-doctoral internship (APA approved) Post-doctoral fellowships

31. UNL Trainees School –Stacey Kosse –Jody Lieske –Emily Warnes –Ann Galloway Clinical –Cate Jones-Hazledine –Corrie Davies

32. Other Resources Merilee McCurdy, Ph.D. –Assistant Professor, School Psych –(402)472-5191 Rachel Valleley, Ph.D. –Assistant Professor, Pediatrics, MMI –(402) 559-2401 Jodi Polaha, Ph.D. –Assistant Professor, Pediatrics, MMI –(402) 59-4362

33. Visit a Clinic Hastings –Stephanie Cooper, Ph.D. 402-463-6828Columbus –Tawnya Meadows, Ph.D. 402-552-4444