The goal of the pediatric psychology position is to enhance the psychologist’s skills in the assessment, consultation and treatment of children in medical inpatient and integrated primary care and specialty clinics.
The pediatric psychology position is filled for 2021-2022. We will next recruit for the position in Fall 2021 with a start date in September 2022. This fellowship would fit best for a psychologist who has previous pediatric psychology training, or who has solid general skills in assessment and psychotherapy, along with a background in child developmental and behavioral interventions with children. It is anticipated that psychologists completing this training program plan a career that includes working with children and adolescents with medical problems and providing psychological services in a medical setting.
The pediatric psychology fellow will participate in several areas specific to children with medical or medically related disorders. Children and their parents are treated as outpatients or medical inpatients. Training on these services is guided by the observable practice activities (OPAs).
The expected caseload is an average of 22-24 hours of direct patient contact per week. Very close supervision is provided in the early phase of the pediatric psychology fellowship training experience, tapering as the fellow demonstrates effective performance on the observable practice activities (OPAs) of each service. The attending psychologist assesses the fellows' performance on the OPAs and provides formative feedback. OPA performance contributes to the semiannual Clinical Competency Committee (CCC) summative evaluation of the fellow with respect to the core competencies and their essential components.
The focus is immediate intervention on a short-term basis. In addition to working with infants, children, adolescents and their families, the fellow will gain experience consulting with physicians, nurses and other medical team members on the consultation-liaison service. Fellows participate in the weekly fellowship seminar, the bi-weekly case consultation staffing, the monthly professionalism seminar, the monthly leadership seminar and quarterly patient safety/quality improvement forums.
While the pediatric psychology fellow will be exposed to and encouraged to explore different conceptual frameworks, the prevailing theoretical framework is behavioral and cognitive behavioral. The fellow must begin with a firm foundation in child development and the principles of behavior modification. Pediatric psychology focuses on normative behavior and stresses an educative approach.
Accordingly, the pediatric psychology fellow will become involved in professional in-services and presentations to the larger community. The specific training activities for the post-doctoral fellow in pediatric psychology will vary to some degree, based upon the training needs and interests of the fellow. Approximately 50 percent of the fellow's time will be spent doing inpatient consultation.
In our regional children's hospital, the fellow will consult to the Pediatrics Unit, Pediatric Intensive Care Unit (PICU), and the Neonatal Intensive Care Unit (NICU). The fellow will also work with patients on the Pediatric Rehabilitation Inpatient Team (PRIT). Through these practice settings you will be exposed to a broad range of patient ages and medical concerns. You will collaborate in patient care with physicians from endocrinology, hematology/oncology, respiratory diseases, surgery, orthopedics, neonatology, gastroenterology, nephrology, trauma and cardiology. Fellows are involved with the inpatient unit services throughout their fellowship.
Neonatal Intensive Care Unit (NICU)
The pediatric psychology fellow will provide assessment and therapeutic support for families who have a newborn infant in the intensive care unit. The fellow will assist families in coping with chronic illnesses, varying levels of compromised infants, and the care of a vulnerable child. Common issues include parental depression and anxiety regarding their baby, issues of death and dying, out of home placements, and ethical decisions regarding level of treatment interventions. Fellows will attend weekly rounds with the medical staff team members.
In this setting, pediatric psychologists work with children and their families who are hospitalized for medical reasons. The pediatric psychology fellow will learn to conduct assessments for suspected psycho-physiologic disorders, parenting capacity, child abuse, child and family coping capacity, assessment of pediatric patients following suicide attempts, adherence to medical regimen, pain management, and the degree to which family dysfunction may interfere with medical treatment. The fellow will obtain experience with a wide range of medical patients, including patients with cancer, diabetes, congenital handicapping conditions, kidney failure, feeding disorders, conversion disorders, cardiac problems, seizures and other neurological conditions, gastrointestinal disorders, respiratory conditions, and issues of death and dying.
Outpatient Specialty Clinics
The Marshfield Clinic Department of Pediatrics has several specialty services and clinics fellows train on with an attending psychologist. These include Integrated Pediatric Primary Care (IPPC), Cystic Fibrosis, Diabetes and Hematology-Oncology clinics. Training on these services is guided by the observable practice activities for each service (OPAs). Each clinic is described below.
Primary Care Behavioral Health-Pediatrics
The fellow will have the opportunity to work within the Department of Pediatrics as part of an integrated primary care service. The fellow will work closely with pediatricians, pediatric residents, and support staff. It is expected that the fellow will be exposed to a broad range of presenting concerns from a diverse age range. Pediatrics provides care to newborns through early twenties. The fellow will provide: curbside consults to pediatricians regarding behavioral health questions; warm handoffs for patients identified as needing same-day, problem focused behavioral health interventions; short-term problem focused treatment for patients; annual screening of behavioral health concerns; assistance with referral to Department of Behavioral Health for higher level of care, and education regarding behavioral health issues for residents, staff, and providers. Some common consults and specific interventions include: problem-solving techniques; stress reduction skills, such as deep breathing and progressive muscle relaxation; parenting skills; coping strategies to assist with the diagnosis and subsequent treatment of a chronic medical condition; sleep hygiene skills; skills training to improve family/parent-child interactions; toilet training techniques; weight management; help with school related issues, including academics, behavioral issues, and social concerns; ADHD assessment and strategies; tips to prepare for medical procedures; behavior management strategies; brief cognitive-behavioral treatment for mild mood and behavioral issues; psychological and behavioral diagnostics; pain management.
Cystic Fibrosis Clinic
The fellow will have the opportunity to work on the cystic fibrosis multi-disciplinary treatment team, including providers from genetics, nutrition, social work, nursing, respiratory therapy, and pediatric pulmonology. Patients seen on this service are at every stage of their disease, from initial diagnosis to long term maintenance. Services that the fellow will provide include: (a) initial assessment of the patient and family's strengths and weaknesses, (b) family and individual treatment that focuses on coping and adjusting to a new diagnosis, adherence issues, and other disease-specific issues, (c) individual and family treatment related to general psychological difficulties, and (d) inpatient psychological consults with families and patients during hospitalizations.
The fellow will have the opportunity to work with providers from nutrition services, social work, and pediatric endocrinology. The fellow will provide services in the inpatient and outpatient settings to children and adolescents diagnosed with diabetes and their families. This includes patients newly diagnosed with diabetes to those who have been managing this chronic illness for quite some time. Services that the fellow will provide include: (a) initial assessment of the patient and family's strengths and weaknesses, (b) family and individual treatment that focuses on coping and adjusting to a new diagnosis, adherence issues, and other disease-specific issues, (c) individual and family treatment related to general psychological difficulties that may impact optimal diabetes management, and (d) inpatient psychological consults with families and patients.
Ketogenic Diet Clinic
The fellow will have the opportunity to work on the ketogenic diet multi-disciplinary treatment team with providers from neurology, nephrology, nutrition, pharmacy and social work. The fellow will provide services on the inpatient and outpatient setting to children and adolescents with epilepsy and their families. During outpatient clinics, they will participate in an arena-based assessment of each patient and follow-up with the patient and family as indicted. Services that the fellow will provide include: (a) initial assessment of the patient and family's strengths and weaknesses, (b) family and individual treatment that focuses on coping and adjusting to a new diagnosis, adherence issues and other disease-specific issues, (c) individual and family treatment related to general psychological difficulties, and (d) inpatient psychological consults with families and patients during hospitalizations.Pediatric Psychiatry and Behavioral Health ADHD Clinic
Through the Pediatric Psychiatry and Behavioral Health ADHD Clinic, the fellow will participate with child psychiatrists in the assessment of mood and behavioral concerns with special emphasis on ADHD. Fellows will become proficient at interpreting cognitive, academic, executive functioning, emotional/behavioral measures and personality measures related to this specialty service. They will learn to combine testing data and relevant background information into an integrative report. Fellows will become skilled at communicating the results to children and families, the child psychiatrist, medical professionals, school personnel, social service agencies, and other community agencies. Fellows are involved with the ADHD Clinic throughout their fellowship.
A Fellow's Perspective
Dr. Sarah Long was our pediatric psychology fellow from 2011-2013. Upon graduation she took a position at St. Jude Children's Research Hospital in Memphis. Here is her perspective on a day in the life of a Pediatric Psychology Fellow - YouTube video 9 minutes, 30 seconds