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Introduction to Behavioral Pediatrics. Jodi Polaha, Ph.D. Assistant Professor, Pediatrics Munroe-Meyer Institute University of Nebraska Medical Center. Overview of this class. Goals Use of class time Expectations Questions. Overview of today. Behavioral pediatrics Definition History
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Introduction to Behavioral Pediatrics Jodi Polaha, Ph.D. Assistant Professor, Pediatrics Munroe-Meyer Institute University of Nebraska Medical Center
Overview of this class • Goals • Use of class time • Expectations • Questions
Overview of today • Behavioral pediatrics • Definition • History • Models • The theory behind a behavioral approach • Definition • “Three essentials” for teaching behavioral skills • Assessment of function
What is Behavioral Pediatrics? • Field of psychology representing interface between behavioral health care and pediatric primary care. Pediatric Psychology & Behavioral Pediatrics Behavioral Health Medical Health
What is Behavioral Pediatrics? • Pediatrics • Emerged in late 1800s. • Concerned with infection, mortality. • Grew to identified specialty in 1930s. • Focus on public policy for children.
What is Behavioral Pediatrics? • Clinical Psychology • First clinic in 1899. • First documented collaboration with pediatrics in 1930. • First call to collaboration in 1965.
What is Behavioral Pediatrics? • Developmental and Behavioral Pediatrics • 1967, 1975 incorporate child development training into pediatric practice. • 1968 Society of Pediatric Psychology • 1980s Society for Developmental and Behavioral Pediatrics
Collaboration withPrimary Care Why primary care? • Physicians are “de facto” mental health service providers (deGruy, 1997)
Collaboration withPrimary Care Why primary care? • Physicians are “de facto” mental health service providers (deGruy, 1997) • #1 presenting problem in PC: behavior problems
Collaboration withPrimary Care Why primary care? • Physicians are “de facto” mental health service providers (deGruy, 1997) • #1 presenting problem in PC: behavior problems • Increased continuity of care
Collaboration withPrimary Care Why primary care? • Physicians are “de facto” mental health service providers (deGruy, 1997) • #1 presenting problem in PC: behavior problems • Increased continuity of care • De-stigmatizes mental health services
Collaboration withPrimary Care Why primary care? • Physicians are “de facto” mental health service providers (deGruy, 1997) • #1 presenting problem in PC: behavior problems • Increased continuity of care • De-stigmatizes mental health services • Increased confidentiality
Collaboration with Primary Care Models (Drotar, 1995) • Independent Functions
Collaboration with Primary Care Models (Drotar, 1995) • Independent Functions • Indirect Consultation
Collaboration with Primary Care Models (Drotar, 1995) • Independent Functions • Indirect Consultation • Collaborative Team
Collaboration with Primary Care Models of Collaboration (Drotar, 1995) • Independent Functions • Indirect Consultation • Collaborative Team • Systems Approach
The Theory Behind a Behavioral Approach • The Behavioral Approach Defined • “Three Essentials” for Teaching Behavioral Skills • Assessment of Problem Behavior: Looking at Function
The Behavioral Approach Defined Three Important Underlying Concepts: • Behavior is driven by the environment in which it occurs.
The Behavioral Approach Defined Three Important Underlying Concepts: • Behavior is driven by the environment in which it occurs. • Increasing appropriate behavior is as important as decreasing problem behavior.
The Behavioral Approach Defined Three Important Underlying Concepts: • Behavior is driven by the environment in which it occurs. • Increasing appropriate behavior is as important as decreasing problem behavior. • Focus is on observable, measurable outcomes.
Teaching Behavioral Skills • What are behavioral skills? • Behaviors that society expects.
Teaching Behavioral Skills • What are behavioral skills? • Behaviors that society expects. • Behaviors that facilitate good relationships.
Teaching Behavioral Skills • What are behavioral skills? • Behaviors meeting societal expectations • Behaviors facilitating good relationships • Prerequisites for learning any other skill
Teaching Behavioral Skills • Birth through toddler years: • Independent sleep • Self-quieting • Independent play
Teaching Behavioral Skills • Preschool Years: • Beginning anger management • Following one-step instructions • Following simple long-term and short-term rules • Waiting one’s turn • Sharing and parallel play
Teaching Behavioral Skills • Elementary Years: • Advanced anger management • Following increasingly complex instructions • Following multiple and complex long-term and short-term rules • Cooperation in group activities
Teaching Behavioral Skills • Adolescence • Persistence in working toward long-term objectives • Problem-solving • Increased emotional management • Negotiating
Teaching Behavioral Skills The Three Essentials: • Predictability
Teaching Behavioral Skills The Three Essentials: • Predictability • In your daily structure • In the consequences you provide
Teaching Behavioral Skills The Three Essentials: • Predictability • Practice
Teaching Behavioral Skills The Three Essentials: • Predictability • Practice • Break the new skill down • Give lots of opportunities to try it • Provide predictable feedback
Teaching Behavioral Skills The Three Essentials: • Predictability • Practice • “Big Difference”
Teaching Behavioral Skills Creating a “Big Difference” Your consequence for demonstrating a skill appropriately should be VERY DIFFERENT than your consequence for demonstrating a problem behavior.
Teaching Behavioral Skills HUGE! Mom’s Reaction none BABY LEARNS TO GAG
Teaching Behavioral Skills HUGE! Mom’s Reaction none IGNORING:BABY LEARNS NOTHING
Teaching Behavioral Skills HUGE! Mom’s Reaction none BABY LEARNS TO QUIET
Teaching Behavioral Skills • Generating an “effect” in the environment can be very reinforcing.
Teaching Behavioral Skills • Generating an “effect” in the environment can be very reinforcing. Touch, Talk, and Look are all effects.
Teaching Behavioral Skills • Problem #1: • Not enough of a reaction for using the skill appropriately.
Teaching Behavioral Skills • Problem #1: • Not enough of a reaction for using the skill appropriately.
Teaching Behavioral Skills NO LEARNING
Teaching Behavioral Skills Your Reaction WHAT ARE YOU DOING WHEN YOU SEE THE SKILL?
Teaching Behavioral Skills • Frequent, brief, “bursts” of attention for AVERAGE behavior.
Teaching Behavioral Skills • Frequent, brief, “bursts” of attention for AVERAGE behavior. • BIG REACTION for demonstrating the skill.
Teaching Behavioral Skills • Frequent, brief, “bursts” of attention for AVERAGE behavior. • BIG REACTION for demonstrating the skill. • Play the Child’s Game
Teaching Behavioral Skills • The Child’s Game: A relationship-building activity that makes children want to earn your POSITIVE attention.