Introduction to Behavioral Pediatrics

1. Introduction to Behavioral Pediatrics Jodi Polaha, Ph.D. Assistant Professor, Pediatrics Munroe-Meyer Institute University of Nebraska Medical Center

2. Overview • Sleep disorders • Troubleshooting other presenting problems • Homework • Habits • Anxiety • Behavioral Pediatrics as a Career

3. Sleep Problems • DSM-IV Types • Insomnia/Hypersomnia • Nightmare Disorder • Sleep Terror Disorder • Sleepwalking Disorder

4. Sleep Problems • Most common: Bedtime resistance • Morning wake-up problems • Sleep-onset delays up to 1 hour • Night awakening

5. Sleep Problems • Most common: Bedtime resistance • Sleeping independently is a skill

6. Sleep Problems • Most common: Bedtime resistance • Sleeping independently is a skill • Laying in bed is “time-out”

7. Sleep Problems • Bedtime resistance • Assess overall noncompliance.

8. Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data.

9. Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data. • Address consistency of pre-bed routine.

10. Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data. • Address consistency of pre-bed routine. • Move bedtime closer to sleep onset.

11. Sleep Problems • Bedtime resistance • Assess overall noncompliance. • Take data. • Address consistency of pre-bed routine. • Move bedtime closer to sleep onset. • Set “sleep window.”

12. 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).

13. 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.

14. 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.

15. Troubleshooting other presenting problems • Homework Problems • What is the purpose? • What behavioral skills are necessary?

16. Troubleshooting other presenting problems • Homework Problems • Predictability • Homework daily, structured area/routine

17. Troubleshooting other presenting problems • Homework Problems • Predictability • Homework daily, structured area/routine • Repetition • Frequent, small trials with success in completing tasks to designated criteria.

18. 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.

19. Troubleshooting other presenting problems • Habits – Simplified Habit Reversal • Awareness training • Incompatible response • Support (with contingencies) • Predictable • Repetition • High contrast

20. 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.

21. Behavioral Pediatrics as a Career • Graduate training • Other programs • Our program

22. Behavioral Pediatrics as a Career • Doctoral vs. Masters? • Independence • Salary • Other responsibilities

23. 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

24. 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

25. Behavioral Pediatrics as a Career • Accessing a Mental Health Practitioner License www.hhs.state.ne.us/crl/mhcs/mental.htm

26. Behavioral Pediatrics as a Career Process: 1. Apply for a Provisional License (PLMHP) 2. Apply for a Mental Health Practitioner License (LMHP)

27. 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.

28. 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.

29. 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

30. Behavioral Pediatrics as a Career Additional Credentialing for LMHP: • Counseling • Marriage and Family Therapy • Social Work

31. Potential for LMHP work in Nebraska’s pediatric primary care Columbus Omaha Plattsmouth Hastings

32. LMHP work in pediatric primary care • Supervision • Space • Panelled with relevant insurance companies • Start-up costs • Support for transcription/billing/ scheduling/credentialing • 40% overhead