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
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