Evaluation

All care begins with a careful assessment of why help is being sought. Sometimes patients/families come to us because they have questions about their child’s behaviors and wonder if there is a condition present or if they should be worried about what’s going on. For example, sometimes people come asking, “Does my child have a tic disorder?” Or, at other times, they come with questions like, “Should we be worried that my child is still wetting the bed?”

In these situations, we focus on helping parents learn more about the concern and informing them about:
whether a condition exists,
if treatment seems needed and if so,
good treatment options.

At other times, youth and families come to us already knowing that treatment is a good idea. In these situations, we start by learning about those concerns so that we can best develop a treatment plan to meet the patient and family’s needs.

Evidence-based care

We provide “evidence-based care.” This means we take what we know from the best research out there, what we have learned from working with kids and families, and a family’s expertise in their children and situation to come up with the best treatment plan. Our goal is to help within as few sessions as possible, spread out over time; however, we remain committed to care until treatment goals are met.

Treatment focuses on:

• Specialized behavioral intervention strategies
• Habit Reversal Therapy for habits
• Comprehensive Behavioral Intervention for Tics
• “Bio-behavioral” treatments for bedwetting and soiling
• Behavioral treatments for bedtime and sleep issues
• Anxiety management strategies for fears (e.g., of using the toilet, of needles)
• Ways that youth can self-monitor their own behavior, and use self-management strategies
• Motivation and consequence systems/programs
• Tracking progress to make sure we’re helping
• Focus on individual and family members, as needed

Consultation

To make sure we address all important issues, we are happy to regularly talk with pediatricians, pediatric health care providers, and/or clinical staff from referral sources, as needed and appropriate. For example, we may talk to pediatricians about dosages of laxatives for kids who are constipated, help the pediatrician figure out how to best monitor if medications are helping tics, and so on.

Referral

Children and families who need either a different or more intensive assessment or treatment plan will be given referrals, either within the CDRC Psychology Treatment Program, or beyond.

Training the Next Generation of Providers

We want to make sure that we prepare the next generation of providers to effectively address the kinds of concerns we see in this treatment program. Therefore, we have different trainees involved in our program.

• Psychology post-doctoral fellow: Trainee receiving specialized training in Behavioral Pediatrics after earning a doctoral degree in psychology. The fellow provides direct care to families under the supervision of one of the psychologists.
• Psychology doctoral interns: Advanced psychology trainees completing an intensive year of specialized training before obtaining their doctoral degrees in psychology. Interns provide care as co-therapists.
• Psychology practicum students: Students pursuing doctoral degrees in psychology provide care as co-therapists.
• Pediatric residents: Shadow clinic to learn more about how to address presenting issues within their own medical practice.

Our team values staying current in the latest evidence to help inform our care. We also strongly believe in engaging in research that informs our practice. Below are some current/recent research examples. If you are interested in learning more about our research, including possible research opportunities, please contact Dr. Kurt Freeman at freemaku@ohsu.edu

• Mental Health Services in Pediatric Primary Care: This study is funded by the Cambia Foundation. As part of this project we developed videos describing effective parenting approaches for common child behavior problems. We are testing how to best use these videos in primary care during well child visits.
  • As part of this project, we are also looking at how watching these videos help with parenting. We are having parents watch videos on how to give commands and offer praise and then seeing if this helps them do better in giving instructions and encouraging their children.
• Behavioral Health Consultation in Primary Care: Our team has worked closely with pediatricians to consult with patients during primary care visits. We have been looking at the most common things we consult about, who asks us to do this (e.g., families, pediatricians), and what the outcome of the consultation was.
• Survey of Parenting Practices: Parents use lots of different strategies, like time out. And, there are lots of "opinions" out there about the best way of doing time out. We are interested in learning more about when parents use time out, what they think it should be used for, and how they use it.
• Novel Method of Home-Based Monitoring for Kids who Had Kidney Transplants: This study is funded by Astellas. For this project, some people on are team are working with kidney doctors to see if we can use a home-based monitoring system of "blood levels" of medication. Right now, kids who had kidney transplants have to come to clinic very often to get their blood drawn to test these levels. We hope we can use a new way that the blood can be drawn at home and sent in.
• Sleep and behavior problems in Smith Lemli-Optiz Syndrome: This is part of a larger study funded by the National Institutes of Health to better understand sleep and behavior problems in kids with a rare condition that effects how your body "processes" cholesterol. Our team is looking at how the problem with cholesterol may cause sleep and behavior problems.
• Continence Outcomes in Spina Bifida: This is part of a larger project funded by the Centers for Disease Control and Prevention. Most kids with Spina Bifida have pee and poop accidents pretty frequently because their bowels and bladders work differently. With other Spina Bifida care centers, we are looking at how many kids with Spina Bifida are dry and clean during the day, and what kinds of treatments seem to help this happen.
• Training Pediatric Residents to Address Child Rearing Challenges: Pediatricians are usually the first providers to talk with families about child behavior concerns. We are working with our pediatric residency program to train residents on how to effectively talk with parents about child behavior concerns and figure out the best treatment options.