All interns regardless of Major Rotation Track will complete three minor rotations (4 months each). These clinical training experiences supplement training that occurs through major rotations and are designed to offer opportunities for develop fluency in application of knowledge and skills in diverse clinical settings and/or with diverse populations. All interns will complete a minor rotation on the Inpatient Consult Service and through the Pain Team/Coping Clinic. The third minor rotation is Behavioral Pediatrics Treatment for the Special Health Needs Track and Grand Ronde Primary Care Consultation for the two Specialty Tracks.
Peds Psychology faculty participate in a wide variety of clinical activities, and intermittent observation or participation in these activities may also be possible, pending permission and scheduling restraints. A representative list appears here:
The Pediatric Pain Management Clinic is a multidisciplinary clinic providing comprehensive assessment and on-going care to children and adolescents presenting with acute or chronic pain conditions such as pain associated with chronic medical conditions, chronic abdominal pain, and neuropathic pain. The team consists of pain physicians, a pediatric psychologist, a physical therapist, and advanced practice nurses. All patients undergo a thorough initial assessment by the pain management team including evaluation of pain history, complete physical exam, functional/physical therapy evaluation, behavioral assessment, and psychological evaluation. Interns will conduct psychological interviews with caregivers and children to assess pain history and comorbid emotional and behavioral disturbances, will conduct functional analysis of contingencies maintaining pain behaviors, and will administer standardized assessments of anxiety, depression, and sleep disturbance. Some interns will also participate in the Coping Clinic, a follow up psychology treatment clinics for youth with chronic pain. Much of this aspect of the rotation will involve virtual care in order to access patients who live in rural, underserved areas, have transportation difficulties, or experience other barriers to in-person care.
Faculty members of the Division of Psychology provide consultation to children and adolescents receiving inpatient care at Doernbecher Children's Hospital. Focus of consultation is typically on evaluating psychosocial status, providing specific treatment recommendations regarding strategies to address acute (e.g., coping with painful medical procedures) or chronic (e.g., nonadherence to regimen) issues, offering recommendations for specific types of outpatient services that appear warranted, and consulting with medical providers regarding how to address psychosocial needs of youth. Inpatient intervention may be offered to youth hospitalized for extended periods of time. Requests for consultation come from many inpatient services, including Hematology/Oncology, the Pain Service, endocrinology, gastroenterology, and the general floors, to name a few.
The Behavioral Pediatrics Treatment Program is a subspecialty behavioral health program, and designed to respond to the needs of pediatricians and other pediatric health care workers to assist their patients with specific presenting concerns. Behavioral Pediatrics as a field involves short-term, focused treatment of emotional and behavioral difficulties from the perspective of normalcy, by avoiding over-pathologizing presenting concerns.
Patient concerns treated via this program, emphasize, but are not limited to, elimination problems (e.g., delayed toilet training, enuresis, encopresis), tic and habit disorders, bedtime and sleep problems, and other child rearing challenges often first presenting in pediatric care (e.g., mealtime behavior/feeding problems, tantrums, noncompliance).
The Telehealth Consultation Clinic is designed to respond to the growing need for accessible behavioral health services by primary care providers and children and their families. The Grand Ronde Health and Wellness Center (GRHWC) Primary Care Clinic offers medical and behavioral health services to the children, adults, and families of The Confederated Tribes of Grand Ronde. A minor rotation in the Telehealth Consultation Clinic is intended to add value to the intern’s overall training experience through opportunities to participate in clinic development, research development, and program outcomes. Activities may include providing behavioral health consultation within the GRHWC Primary Care Clinic via telecommunication from Oregon Health & Science University (OHSU).
Members of The Confederated Tribes of Grand Ronde have the right to culturally responsive health care and evidence-based services to improve health outcomes and promote health equity. Therefore, this rotation is essential to meeting the health care needs of the Tribe, while respecting self-governance and creating community-driven solutions toward optimal health and well-being of children and families within the community.
Telehealth Consultation takes a culturally responsive approach to psychosocial formulation, medical and non-medical treatment recommendations, and referrals to outside resources and specialty clinics. Telehealth Consultation will consist of a blend of brief interviews with children and their family, psychometric instruments, a review of medical records, and consultation with the GRHWC primary care providers.
The Doernbecher Healthy Lifestyles Clinic provides multidisciplinary evaluation and education to youth who are overweight or obese and their families. The clinic is staffed by a pediatrician specializing in weight issues and medical co-morbidities, a pediatric dietician, a pediatric physical therapist, and a pediatric psychologist. Psychology focuses on assessment psychosocial health and familial functioning as well as offering assistance with goal setting, problem-solving, and self-monitoring and reward programs.
The Doernbecher Survivor's Clinic is sponsored by the Division of Pediatric Oncology and provides interdisciplinary assessment of youth who have survived cancer. The clinic is staffed by a pediatric oncologist, pediatric nurse practitioner, medical social worker, educator, and pediatric psychologist. Psychology assesses patient's current psychosocial status, educational and/or work functioning, and supports in place. Recommendations regarding behavioral health issues are communicated to patients, families, and other members of the medical team; recommendations for additional evaluations and/or services are provided.
NICH serves children with chronic health conditions who experience repeated hospitalizations that are largely unavoidable (e.g., due to adherence challenges). The Program offers 24 hour, 7 day per week support to patients and families to reduce barriers to engagement in health care and regimens with the goal of reducing health care utilization and improving health and functioning. Service providers offer case management, care coordination, and evidence-based intervention. Interns partner with NICH interventionists rather than assume independent care and are afforded opportunities to develop skills in the care model, systems-approach to health care, and research approaches to comprehensive behavioral health interventions.
The Division of Psychology neuropsychology service provides initial neuropsychological assessment and follow-up of children with known neurological conditions (e.g., epilepsy, specific genetic conditions), acquired insult (e.g., traumatic brain injury), as well as those at risk for neurological insult (e.g., youth with cancer receiving treatment). Interns, along with their supervisor, conduct inpatient consultations for the OHSU Division of Pediatric Neurology. Training emphasizes fluency in neuropsychological assessment, development of comprehensive yet pragmatic recommendations, and consultation and communication with patients/families, physicians, and other health care professionals.
This clinical training experience emphasizes neuropsychological consultation with youth diagnosed with concussion/mTBI. Emphasis is on identifying post-concussion sequela in order to provide rehabilitation, educational, and lifestyle recommendations to promote recovery. Ongoing monitoring of progress also occurs, as needed.
As part of the Autism Program, five age-grouped diagnostic clinics serve children 1 to 18 years of age referred due to concern about Autism Spectrum Disorder (ASD). Interdisciplinary evaluations are provided, including psychology, developmental pediatrics, occupational therapy, and speech and language pathology. The primary focus of evaluation is on differential diagnosis of ASD. One clinic per week specifically emphasizes early screening and identification of toddlers, one to two clinics emphasize school aged children, and one to two emphasize older children and young adults. Trainees learn Autism-specific screening and in depth (e.g., Autism Diagnostic Observation Schedule) and general developmental (e.g., Mullen Scales of Early Learning) and intellectual (e.g., WISC-IV, SB5) assessment tools.
Children who are under active surveillance or have recently completed treatment for cancer or tumors impacting the central nervous system are seen by their interdisciplinary neuro-oncology team for regular follow-up visits (pediatric oncologist, pediatric nurse practitioner, social worker, educator and pediatric psychologist). This rotation involves health and behavioral screenings regarding mental health, behavior and neurocognitive function. Psychology also assesses the patient's current psychosocial status, educational and/or work functioning, and current supports that may be in place. Recommendations regarding behavioral health issues are communicated to patients, families, and other members of the medical team; recommendations for additional evaluations and/or services are provided.
The Diagnostic Intake Clinic involves conducting relatively brief intake assessments of pediatric patients presenting for services through the psychological treatment program. Patients seen through this service present with a variety of complex psychological and behavioral issues. Given the tertiary nature of our services and our association with a major medical center, we often seen patients with unusual or complex medical needs, developmental or physical differences, and/or other complicating or comorbid factors. The rotation provides an opportunity for intern/trainees to work with and supervise practicum students, and to evaluate results of screening measures, conduct complex differential diagnoses, provide families feedback and education, deliver brief treatment recommendations, and refer families for an appropriate course of treatment.
The Fear and Anxiety Disorders Treatment Clinic provides empirically supported treatment for pediatric fear and anxiety disorders. Training emphasizes experiential learning with a particular emphasis on understanding and applying the principles of Exposure and Response Prevention (ERP) delivered through a cognitive behavioral framework. Patients are varied in their presenting concerns and have recently has included Post-Traumatic Stress Disorder, Selective Mutism, anxiety-based Eating Disorders/refusal, Social Anxiety Disorder, Obsessive-Compulsive Disorder, Specific Phobia, Generalized Anxiety Disorder, Panic Disorder, Separation Anxiety Disorder and an assortment of fears related to medical procedures, hospitalization or other conditions. Given patients are varied in age from approximately 4-18 years, training includes learning and delivering developmentally effective treatment across a wide range of ages and diagnoses.
The Pediatric Critical Care and Neurotrauma Recovery Program (PCCNRP) exists to systematically identify and address critical issues related to post-intensive care syndrome in patients surviving a critical illness or injury at Doernbecher Children’s Hospital. Critical issues include traumatic brain injury/trauma (e.g., motor vehicle accident, fall, non-accidental trauma) and central nervous system related conditions that often lead to acquired brain injury, such as infectious and inflammatory conditions (e.g., meningitis, encephalitis), hypoxic ischemic injury (e.g., cardiac arrest, heart defects, strangulation, near drowning), stroke (e.g., hemorrhagic, ischemic), and other illnesses (e.g., sepsis, severe pneumonia).
This interdisciplinary (i.e., neuropsychologist, critical care physician, and neurologist) program offers inpatient consultation, early recovery assessment clinic, long-term recovery assessment clinic, specialty medical & psychological support clinics, community consultation services, and a monthly PICU survivor family support group. The PCCNRP regularly hosts medical and psychology trainees and it has an active clinical research lab.