Introduction to Behavioral PediatricsJodi Polaha, Ph.D.Assistant Professor, PediatricsMunroe-Meyer InstituteUniversity of Nebraska Medical Center

Overview Sleep disorders Troubleshooting other presenting

problemsHomeworkHabitsAnxiety

Behavioral Pediatrics as a Career

Sleep Problems DSM-IV Types

Insomnia/HypersomniaNightmare DisorderSleep Terror DisorderSleepwalking Disorder

Sleep Problems Most common: Bedtime

resistanceMorning wake-up problemsSleep-onset delays up to 1 hourNight awakening

Sleep Problems Most common: Bedtime

resistanceSleeping independently is a skill

Sleep Problems Most common: Bedtime

resistanceSleeping independently is a skillLaying in bed is “time-out”

Sleep Problems Bedtime resistance

1. Assess overall noncompliance.

Sleep Problems Bedtime resistance

1. Assess overall noncompliance.2. Take data.

Sleep Problems Bedtime resistance

1. Assess overall noncompliance.2. Take data.3. Address consistency of pre-bed

routine.

Sleep Problems Bedtime resistance

1. Assess overall noncompliance.2. Take data.3. Address consistency of pre-bed

routine.4. Move bedtime closer to sleep

onset.

Sleep Problems Bedtime resistance

1. Assess overall noncompliance.2. Take data.3. Address consistency of pre-bed

routine.4. Move bedtime closer to sleep

onset.5. Set “sleep window.”

Sleep Problems Bedtime resistance

1. Assess overall noncompliance.2. Take data.3. Address consistency of pre-bed

routine.4. Move bedtime closer to sleep onset.5. Set “sleep window.” 6. Use “differential attention” (or high

contrast).

Sleep Problems Bedtime resistance

1. Assess overall noncompliance.2. Take data.3. Address consistency of pre-bed

routine.4. Move bedtime closer to sleep onset.5. Set “sleep window.” 6. Use “differential attention.”7. Use reward program.

Sleep Problems Bedtime resistance

1. Assess overall noncompliance.2. Take data.3. Address consistency of pre-bed routine.4. Move bedtime closer to sleep onset.5. Set “sleep window.” 6. Use differential attention.7. Use reward program.8. 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/routineRepetition

• 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 trainingIncompatible responseSupport (with contingencies)

• Predictable• Repetition• High contrast

Troubleshooting other presenting problems Anxiety – Exposure and Response

PreventionIdentify feared stimuli (rank

order)Teach relaxation or strategyEngage in predictable practices

with high contrast, using shaping.

Behavioral Pediatrics as a Career Graduate training

Other programsOur program

Behavioral Pediatrics as a Career Doctoral vs. Masters?

IndependenceSalaryOther responsibilities

Behavioral Pediatrics as a Career At the Doctoral level (7-8 yrs. to

licensure)Practicum experience during

class/research1 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 classworkInternship experience (300 hrs.)1+year (3,000 hrs.) supervision

with Provisional License

Behavioral Pediatrics as a Career Accessing a Mental Health

Practitioner Licensewww.hhs.state.ne.us/crl/mhcs/

mental.htm

Behavioral Pediatrics as a CareerProcess:

1. Apply for a Provisional License (PLMHP)2. Apply for a Mental Health Practitioner License (LMHP)

Behavioral Pediatrics as a CareerTo apply for a Provisional License

(PLMHP), you must document1. A practicum or internship with min. of 300 hrs

direct client contact under supervision of LP or LMHP

2. 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

3. 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 ExamComplete application

Behavioral Pediatrics as a Career

Additional Credentialing for LMHP:

1. Counseling2. Marriage and Family Therapy3. 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