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Introduction to Behavioral Pediatrics. Jodi Polaha, Ph.D. Assistant Professor, Pediatrics Munroe-Meyer Institute University of Nebraska Medical Center. Overview. Sleep disorders Troubleshooting other presenting problems Homework Habits Anxiety Behavioral Pediatrics as a Career.
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Introduction to Behavioral Pediatrics Jodi Polaha, Ph.D. Assistant Professor, Pediatrics Munroe-Meyer Institute University of Nebraska Medical Center
Overview • Sleep disorders • Troubleshooting other presenting problems • Homework • Habits • Anxiety • Behavioral Pediatrics as a Career
Sleep Problems • DSM-IV Types • Insomnia/Hypersomnia • Nightmare Disorder • Sleep Terror Disorder • Sleepwalking Disorder
Sleep Problems • Most common: Bedtime resistance • Morning wake-up problems • Sleep-onset delays up to 1 hour • Night awakening
Sleep Problems • Most common: Bedtime resistance • Sleeping independently is a skill
Sleep Problems • Most common: Bedtime resistance • Sleeping independently is a skill • Laying in bed is “time-out”
Sleep Problems • Bedtime resistance • Assess overall noncompliance.
Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data.
Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data. • Address consistency of pre-bed routine.
Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data. • Address consistency of pre-bed routine. • Move bedtime closer to sleep onset.
Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data. • Address consistency of pre-bed routine. • Move bedtime closer to sleep onset. • Set “sleep window.”
Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data. • Address consistency of pre-bed routine. • Move bedtime closer to sleep onset. • Set “sleep window.” • Use “differential attention” (or high contrast).
Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data. • Address consistency of pre-bed routine. • Move bedtime closer to sleep onset. • Set “sleep window.” • Use “differential attention.” • Use reward program.
Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data. • Address consistency of pre-bed routine. • Move bedtime closer to sleep onset. • Set “sleep window.” • Use differential attention. • Use reward program. • Extend sleep window.
Troubleshooting other presenting problems • Homework Problems • What is the purpose? • What behavioral skills are necessary?
Troubleshooting other presenting problems • Homework Problems • Predictability • Homework daily, structured area/routine
Troubleshooting other presenting problems • Homework Problems • Predictability • Homework daily, structured area/routine • Repetition • Frequent, small trials with success in completing tasks to designated criteria.
Troubleshooting other presenting problems • Homework Problems • Predictability • Homework daily, structured area/routine. • Repetition • Frequent, small trials with success in completing tasks to designated criteria. • High Contrast • Use of tokens, attention, and escape.
Troubleshooting other presenting problems • Habits – Simplified Habit Reversal • Awareness training • Incompatible response • Support (with contingencies) • Predictable • Repetition • High contrast
Troubleshooting other presenting problems • Anxiety – Exposure and Response Prevention • Identify feared stimuli (rank order) • Teach relaxation or strategy • Engage in predictable practices with high contrast, using shaping.
Behavioral Pediatrics as a Career • Graduate training • Other programs • Our program
Behavioral Pediatrics as a Career • Doctoral vs. Masters? • Independence • Salary • Other responsibilities
Behavioral Pediatrics as a Career • At the Doctoral level (7-8 yrs. to licensure) • Practicum experience during class/research • 1 year Pre-doctoral Internship (match program) • 1+ yr. supervision as Postdoctoral fellow
Behavioral Pediatrics as a Career • At the Masters level (4-5 yrs. to licensure) • Practicum during classwork • Internship experience (300 hrs.) • 1+year (3,000 hrs.) supervision with Provisional License
Behavioral Pediatrics as a Career • Accessing a Mental Health Practitioner License www.hhs.state.ne.us/crl/mhcs/mental.htm
Behavioral Pediatrics as a Career Process: 1. Apply for a Provisional License (PLMHP) 2. Apply for a Mental Health Practitioner License (LMHP)
Behavioral Pediatrics as a Career To apply for a Provisional License (PLMHP), you must document • A practicum or internship with min. of 300 hrs direct client contact under supervision of LP or LMHP • 1 credit in each of the following: • Theories and techniques of human behavior intervention • Professional ethics and orientation • Assessment techniques related to mental health practice • Human grown and development • Research and evaluation • A supervisor for your PLMHP.
Behavioral Pediatrics as a Career With a Provisional License: • Get 3,000 hours supervised clinical hours (1500 direct). • Take the National Counseling Examination (NCC). • Can get reimbursed for services you provide.
Behavioral Pediatrics as a Career To get licensed as a Mental Health Practitioner, you must: • Document supervised hours with PLMHP • Pass National Counseling Exam • Complete application
Behavioral Pediatrics as a Career Additional Credentialing for LMHP: • Counseling • Marriage and Family Therapy • Social Work
Potential for LMHP work in Nebraska’s pediatric primary care Columbus Omaha Plattsmouth Hastings
LMHP work in pediatric primary care • Supervision • Space • Panelled with relevant insurance companies • Start-up costs • Support for transcription/billing/ scheduling/credentialing • 40% overhead