All interns regardless of track will complete three minor rotations. 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. Typically, one other minor rotation is assigned (Behavioral Pediatrics Treatment and Pain Management Clinic are most common), and one is an elective. Options vary somewhat from year to year and are not guaranteed. Anticipated minor rotation options for the upcoming training year are as follows:
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).
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 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.
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.
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.