Fellows work alongside CL providers to field consult requests from the general pediatric hospital service and a wide range of pediatric subspecialties (gastroenterology, neurology, hematology/oncology, endocrinology, etc.), as well as surgery, critical care, physical medicine and rehabilitation, and palliative care. Consultations often focus on child and family adaptation to chronic illness or acute injuries, differential diagnosis within the context of medically unexplained symptoms, and development of behavioral plans to assist with treatment optimization. Fellows interact closely with our colleagues in pediatrics, nursing, social work, child life, and chaplain services. Opportunities exist for the fellow to participate in the intensive behavioral feeding program.

The PPRC is a three-week intensive outpatient interdisciplinary program for adolescents and young adults, ages 13 to 21 years, with chronic pain, autonomic dysfunction, and other chronic symptoms which negatively affect functioning. Treatment consists of psychoeducational and cognitive behavioral groups focused on pain and stress management skills, as well as physical, occupational, and recreational therapy. Parents attend parenting groups on how to support their child’s treatment plan. Fellows have the opportunity to conduct evaluations and brief psychoeducational assessments, lead both teen and parent groups, attend medical rounds, and see patients for individual and family consultations.

The PADC offers assessment services and both individual and group-based treatment either through a once-weekly or intensive outpatient format to families of youth who are struggling with significant anxiety. Through the PADC, fellows gain experience administering structured diagnostic interviews, integrating assessment information from multiple sources (clinical interview, parent and child report forms) into a treatment plan, and working in a multidisciplinary clinic. Fellows work alongside PADC providers to facilitate parent-coached exposure therapy through the weekly groups and intensive treatment program. Fellows are encouraged to participate in a weekly PADC Team Meeting during which the maintenance of the anxiety clinic practice, research projects, and case consultation is discussed.

In this multidisciplinary rotation, fellows gain experience conducting structured functional behavioral assessments of eating and physical activity habits, assessing for psychological comorbidities and obtaining psychosocial history via interview and standardized assessment battery, and developing treatment plans. Fellows also have the opportunity to follow patients for family-based behavioral weight management intervention, and to participate in psychological evaluations and behavioral interventions with adolescents interested in bariatric surgery. Opportunities also exist for fellows to observe participate in program development, evaluation, and research related to pediatric weight management and health promotion.

*Note: Activities on this rotation are typically less than the 16-20 hours/week allocated to rotations and are typically combined with other rotation experiences.

Patients often present to this consultation-based clinic with complex and sometimes rare medical issues, including autonomic dysfunction or unexplained pain, nausea, vomiting, diarrhea, and dizziness. Other frequent conditions include somatoform disorders and conversion disorders. Fellows develop proficiency in conducting diagnostic interviews to identify comorbidities in need of psychological intervention, as well as in formulating and delivering brief feedback to youth and their families. Fellows also build experience discussing the rehabilitative approach to managing symptoms, including connections among physical symptoms, thoughts, and feelings. Furthermore, fellows are able to shadow physicians and medical teams working with these complex patients.

Rotations in pediatric neuropsychology are tailored to the fellow’s level of experience and interests and thus range from primarily observation-based experiences to conducting clinical interviews and contributing to testing reports and feedback sessions. Opportunities exist to engage with the pediatric neuropsychology service through three main areas of practice: (1) assessment of current functioning in children with complex medical presentations (traumatic brain injury, seizure disorder, brain tumors, etc.) on referral from medical specialties, (2) evaluation for developmental concerns (autism spectrum disorder, intellectual disability, extreme prematurity, etc.) in young and school-aged children presenting to Developmental Behavioral Pediatrics (a multidisciplinary team comprised of pediatric neuropsychology, developmental-behavioral pediatrics, speech pathology, audiology, social work, and nursing), and (3) assessment of developmental disabilities, learning issues, and social-emotional functioning in children followed in the multidisciplinary Craniofacial Clinic.

Highlighted aspects of training opportunities geared towards a fellow interested in developing expertise in chronic pain could include:

• Rotations:
  • Pediatric Pain Rehabilitation Center to work with patients doing the intensive multidisciplinary program and to gain with curriculum development experience
  • Pediatric Behavior Medicine Clinic to provide consultation related to chronic symptom management
  • Briefer rotation in Consultation/Liaison to provide consultation to patients with chronic symptoms in the inpatient environment
  • Briefer rotation in Pediatric Anxiety Clinic and/or Pediatric Mood Clinic to round out skills in clinical child assessment and evidence-based treatments
• Outpatient caseload: Focus on referrals to therapy for chronic pain management and/or coping with illness or treatment demands
• Research:
  • Supervision and mentorship from Drs. Harbeck-Weber, Weiss, and Sim
  • Projects involving investigating parenting factors related to chronic pain presentation and response to treatment
  • Participation in quarterly meetings of an interdisciplinary workgroup focused on research to understand autonomic dysfunction in adolescents
• Observational/Exposure experiences: Shadowing medical providers in pediatric pain medicine, neurology, the Mayo Clinic autonomic dysfunction clinic, and Adult Pain Rehabilitation Program
• Educational experiences: Mentored experience teaching a course on chronic pain for medical students

For a fellow interested in childhood anxiety disorders and obsessive compulsive disorders, the training plan could include:

• Rotations:
  • Pediatric Anxiety Disorders Clinic to gain experience in evidence-based assessment of anxiety disorders and OCD and in parent-coached group-based exposure-focused therapy (weekly groups and 5-day intensive program)
  • Pediatric Mood Clinic and Pediatric Pain Rehabilitation Center to gain familiarity with assessment and intervention for conditions commonly comorbid with anxiety disorders
• Outpatient caseload: Focus on referrals for anxiety-related concerns for additional opportunities to provide exposure-focused therapy to individual youth and their families, with additional referrals for mood disorders including some with complex medical presentations, as well as some behavior management-focused cases to round out clinical child skills
• Research:
  • Supervision and mentorship from Drs. Whiteside and Biggs
  • Projects involving evaluating clinic outcomes and/or technology-facilitated delivery of exposure therapy
• Educational Experiences: Umbrella supervision of a psychiatry resident or fellow in the delivery of exposure therapy