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 of this class • Goals • Use of class time • Expectations • Questions

3. Overview of today • Behavioral pediatrics • Definition • History • Models • The theory behind a behavioral approach • Definition • “Three essentials” for teaching behavioral skills • Assessment of function

4. What is Behavioral Pediatrics?

5. 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

6. 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.

7. What is Behavioral Pediatrics? • Clinical Psychology • First clinic in 1899. • First documented collaboration with pediatrics in 1930. • First call to collaboration in 1965.

8. 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

9. Collaboration with Primary Care

10. Collaboration withPrimary Care Why primary care? • Physicians are “de facto” mental health service providers (deGruy, 1997)

11. Collaboration withPrimary Care Why primary care? • Physicians are “de facto” mental health service providers (deGruy, 1997) • #1 presenting problem in PC: behavior problems

12. 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

13. 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

14. 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

15. Collaboration with Primary Care Models (Drotar, 1995) • Independent Functions

16. Collaboration with Primary Care Models (Drotar, 1995) • Independent Functions • Indirect Consultation

17. Collaboration with Primary Care Models (Drotar, 1995) • Independent Functions • Indirect Consultation • Collaborative Team

18. Collaboration with Primary Care Models of Collaboration (Drotar, 1995) • Independent Functions • Indirect Consultation • Collaborative Team • Systems Approach

19. The Theory Behind a Behavioral Approach • The Behavioral Approach Defined • “Three Essentials” for Teaching Behavioral Skills • Assessment of Problem Behavior: Looking at Function

20. The Behavioral Approach Defined

21. The Behavioral Approach Defined Three Important Underlying Concepts: • Behavior is driven by the environment in which it occurs.

22. 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.

23. 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.

24. Teaching Behavioral Skills

25. Teaching Behavioral Skills • What are behavioral skills? • Behaviors that society expects.

26. Teaching Behavioral Skills • What are behavioral skills? • Behaviors that society expects. • Behaviors that facilitate good relationships.

27. Teaching Behavioral Skills • What are behavioral skills? • Behaviors meeting societal expectations • Behaviors facilitating good relationships • Prerequisites for learning any other skill

28. Teaching Behavioral Skills • Birth through toddler years: • Independent sleep • Self-quieting • Independent play

29. 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

30. 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

31. Teaching Behavioral Skills • Adolescence • Persistence in working toward long-term objectives • Problem-solving • Increased emotional management • Negotiating

32. Teaching Behavioral Skills The Three Essentials: • Predictability

33. Teaching Behavioral Skills The Three Essentials: • Predictability • In your daily structure • In the consequences you provide

34. Teaching Behavioral Skills The Three Essentials: • Predictability • Practice

35. Teaching Behavioral Skills The Three Essentials: • Predictability • Practice • Break the new skill down • Give lots of opportunities to try it • Provide predictable feedback

36. Teaching Behavioral Skills The Three Essentials: • Predictability • Practice • “Big Difference”

37. 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.

38. Teaching Behavioral Skills HUGE! Mom’s Reaction none BABY LEARNS TO GAG

39. Teaching Behavioral Skills HUGE! Mom’s Reaction none IGNORING:BABY LEARNS NOTHING

40. Teaching Behavioral Skills HUGE! Mom’s Reaction none BABY LEARNS TO QUIET

41. Teaching Behavioral Skills • Generating an “effect” in the environment can be very reinforcing.

42. Teaching Behavioral Skills • Generating an “effect” in the environment can be very reinforcing. Touch, Talk, and Look are all effects.

43. Teaching Behavioral Skills • Problem #1: • Not enough of a reaction for using the skill appropriately.

44. Teaching Behavioral Skills • Problem #1: • Not enough of a reaction for using the skill appropriately.

45. Teaching Behavioral Skills NO LEARNING

46. Teaching Behavioral Skills Your Reaction WHAT ARE YOU DOING WHEN YOU SEE THE SKILL?

47. Teaching Behavioral Skills • Frequent, brief, “bursts” of attention for AVERAGE behavior.

48. Teaching Behavioral Skills • Frequent, brief, “bursts” of attention for AVERAGE behavior. • BIG REACTION for demonstrating the skill.

49. Teaching Behavioral Skills • Frequent, brief, “bursts” of attention for AVERAGE behavior. • BIG REACTION for demonstrating the skill. • Play the Child’s Game

50. Teaching Behavioral Skills • The Child’s Game: A relationship-building activity that makes children want to earn your POSITIVE attention.