Pediatric School Psychology: Opportunities and Perspectives on Training and Practice

Pediatric School Pediatric School Psychology:Psychology:

Opportunities and Opportunities and Perspectives on Training Perspectives on Training

and Practiceand PracticeSusan M. Sheridan (Chair)Susan M. Sheridan (Chair)Thomas J. PowerThomas J. Power

Edward S. ShapiroEdward S. ShapiroGeorge DuPaulGeorge DuPaul

Kathy Bradley-KlugKathy Bradley-KlugCindy EllisCindy Ellis

Symposium Presented at the Annual ConferenceSymposium Presented at the Annual Conferenceof the National Association of School Psychologistsof the National Association of School Psychologists

March, 2006March, 2006Anaheim, CAAnaheim, CA

Comprehensive Care in Comprehensive Care in Pediatric School Pediatric School

Psychology: Programming Psychology: Programming across the Intervention-across the Intervention-Prevention ContinuumPrevention Continuum

Thomas J. Power, PhDThomas J. Power, PhDChildren’s Hospital of Children’s Hospital of

Philadelphia/University of PennsylvaniaPhiladelphia/University of Pennsylvania

Kathy L. Bradley-Klug, PhDKathy L. Bradley-Klug, PhDUniversity of South FloridaUniversity of South Florida

Historical Perspective – Historical Perspective –

Pediatric School Pediatric School PsychologyPsychology• 1995-2000 (Power, DuPaul, Shapiro, Parrish, 1995-2000 (Power, DuPaul, Shapiro, Parrish,

1995)1995)• Targeted children with chronic illnesses and disordersTargeted children with chronic illnesses and disorders• Primary focus on problem solving Primary focus on problem solving • Based in hospitals and schoolsBased in hospitals and schools

• 2000-present (Power, DuPaul, Shapiro, Kazak, 2000-present (Power, DuPaul, Shapiro, Kazak, 2003)2003)• Expansion to incorporate a public health model that Expansion to incorporate a public health model that

includes all childrenincludes all children• Emphasis on building resources and solving problems Emphasis on building resources and solving problems • Base in school, primary care, other community Base in school, primary care, other community

settingssettings

Expanded Model:Expanded Model:Address Continuum of Address Continuum of

NeedNeed• Intervention – problem solving approachIntervention – problem solving approach

• Crisis intervention – urgent needCrisis intervention – urgent need• Targeted intervention – moderate to severe Targeted intervention – moderate to severe

problemsproblems• Early intervention – emerging to mild problemsEarly intervention – emerging to mild problems

• Prevention – public health approachPrevention – public health approach• Indicated prevention – for at risk childrenIndicated prevention – for at risk children• Selective prevention – for children with Selective prevention – for children with

characteristics that may place them at riskcharacteristics that may place them at risk• Universal prevention – for all childrenUniversal prevention – for all children

Crisis Intervention

Intervention

Early Intervention

Universal Prevention

Selective Prevention

Indicated Prevention

Continuum of CareContinuum of Care

Targeted InterventionTargeted Intervention(Power, DuPaul, Shapiro, & Kazak, 2003)(Power, DuPaul, Shapiro, & Kazak, 2003)

• School Reintegration – children with cancer School Reintegration – children with cancer and traumatic brain injury (TBI)and traumatic brain injury (TBI)• Multisystemic interventionMultisystemic intervention

• FamilyFamily• Healthcare teamHealthcare team• School teamSchool team

• Emphasis on system preparationEmphasis on system preparation• Supporting familySupporting family• Assisting family and healthcare team to work Assisting family and healthcare team to work

collaborativelycollaboratively• Preparing family for school collaborationPreparing family for school collaboration• Preparing school for family collaborationPreparing school for family collaboration• Implementing conjoint behavioral consultation modelImplementing conjoint behavioral consultation model

Step 1:Step 1:

System PreparationSystem Preparation Family HealthCare

Family SchoolSteps 2 and 3:Steps 2 and 3:System Preparation/System Preparation/System IntegrationSystem Integration

Step 4:Step 4:IntegrationIntegration

Child

HealthCare

Child

Child

HealthCare

HealthCare

Family School

Process of School Reintegration

Targeted InterventionTargeted Intervention(Cohen, Bradley-Klug, Armstrong, Carey, & Dixon, (Cohen, Bradley-Klug, Armstrong, Carey, & Dixon,

2005)2005)• Sickle Cell “Hop To It” ProgramSickle Cell “Hop To It” Program

• Collected data on students with SCDCollected data on students with SCD• Reading & Math CBA Reading & Math CBA • Behavior rating scales and teacher interviewsBehavior rating scales and teacher interviews• AttendanceAttendance• Quality of life Quality of life • Focus groupsFocus groups

• OutcomesOutcomes• Revised community-based tutoring program for Revised community-based tutoring program for

students with SCD to include focus on mathstudents with SCD to include focus on math• Met with parent group of children with SCD – focus on Met with parent group of children with SCD – focus on

advocacyadvocacy• Presented research at local, regional, & state Presented research at local, regional, & state

conferences to increase knowledge of educational conferences to increase knowledge of educational personnel on SCDpersonnel on SCD

Indicated Level of Indicated Level of PreventionPrevention

(Luginbuehl, Batsche, & Bradley-Klug, 2004)(Luginbuehl, Batsche, & Bradley-Klug, 2004)• Sleep Disorders ScreeningSleep Disorders Screening• Sleep Disorders Inventory for Students (SDIS)Sleep Disorders Inventory for Students (SDIS)

• Rule-out sleep disordersRule-out sleep disorders• Correlations between behavior problems, academic Correlations between behavior problems, academic

skills deficits, and sleep concernsskills deficits, and sleep concerns• OutcomesOutcomes

• School district use of SDISSchool district use of SDIS• Referrals to sleep specialists for further assessmentReferrals to sleep specialists for further assessment• Improvement in school performanceImprovement in school performance• Open discussion at county school district level to Open discussion at county school district level to

change start times of elementary, middle, and high change start times of elementary, middle, and high schoolsschools

• Added strand in Regional Sleep Disorders Convention Added strand in Regional Sleep Disorders Convention specifically for psychologists and educatorsspecifically for psychologists and educators

Indicated Level of Indicated Level of PreventionPrevention• Mental health screening in primary care Mental health screening in primary care

• Focus groups - PCPs, support staff, parentsFocus groups - PCPs, support staff, parents• Mental health screening during well-child visits acceptable Mental health screening during well-child visits acceptable

and feasible for parents and support staffand feasible for parents and support staff• MH screening acceptable to PCPs only with guidelines for MH screening acceptable to PCPs only with guidelines for

children who screen positivechildren who screen positive• Pediatric Symptom Checklist – 17 item Pediatric Symptom Checklist – 17 item

• Inattention (ADHD symptoms) Inattention (ADHD symptoms) • Internalizing (anxiety, depression)Internalizing (anxiety, depression)• Externalizing (defiance, conduct problems)Externalizing (defiance, conduct problems)

• Nurse administers PSC-17 in exam room before PCP arrivesNurse administers PSC-17 in exam room before PCP arrives• Children screening positive (at risk) receive follow-up Children screening positive (at risk) receive follow-up

from PCPfrom PCP• Evaluation using ADHD Toolkit (Am. Academy of Pediatrics)Evaluation using ADHD Toolkit (Am. Academy of Pediatrics)• Education Education • ReferralReferral

Universal Level of Universal Level of PreventionPrevention

(Leff, Costigan, & Power, 2004)(Leff, Costigan, & Power, 2004)• Violence Prevention – Playground-basedViolence Prevention – Playground-based

• Collaborate with playground aidesCollaborate with playground aides• Plan organized activitiesPlan organized activities• Provide active supervision throughout playgroundProvide active supervision throughout playground

• Monitor progressMonitor progress• Observe children’s behavior (cooperative play, rough-and-Observe children’s behavior (cooperative play, rough-and-

tumble play)tumble play)• Observe playground context (presence of organized games, Observe playground context (presence of organized games,

presence of active supervision)presence of active supervision)• OutcomesOutcomes

• Cooperative play observed during 78% of intervals in which Cooperative play observed during 78% of intervals in which there were organized games (26% without games)there were organized games (26% without games)

• Rough-and-tumble play observed during 26% of intervals in Rough-and-tumble play observed during 26% of intervals in which there were NOT organized games (13% with games) which there were NOT organized games (13% with games)

Universal Level of Universal Level of PreventionPrevention

• Steps to A Healthier Hillsborough County Steps to A Healthier Hillsborough County InitiativeInitiative• Collected data on high school studentsCollected data on high school students

• BMIBMI• Food and Activity ChoicesFood and Activity Choices

• OutcomesOutcomes• School added healthy choices to lunch menuSchool added healthy choices to lunch menu• Eliminated fryer machines in school cafeteriaEliminated fryer machines in school cafeteria• Added fresh cheese & crackers and fruit cups to Added fresh cheese & crackers and fruit cups to

vending machinesvending machines• School district requested follow up research; School district requested follow up research;

mandated all PE and Health teachers to participate in mandated all PE and Health teachers to participate in data collectiondata collection

Implications for School Implications for School PsychologistsPsychologists

• Collaboration across systemsCollaboration across systems• Applications in a range of settingsApplications in a range of settings• Impact on the communityImpact on the community• Feasibility of training Feasibility of training • Opportunities for researchOpportunities for research

Interdisciplinary, Interdisciplinary, Intersystemic Intersystemic

Collaboration in Pediatric Collaboration in Pediatric School PsychologySchool Psychology

Susan M. Sheridan, PhDSusan M. Sheridan, PhDUniversity of Nebraska-LincolnUniversity of Nebraska-Lincoln

Cindy Ellis, MDCindy Ellis, MDUniversity of Nebraska Medical University of Nebraska Medical

CenterCenter

Purpose/RationalePurpose/Rationale• A child’s development and learning is influenced A child’s development and learning is influenced

by many interacting systems. Collaboration by many interacting systems. Collaboration among the major spheres of influence (e.g., among the major spheres of influence (e.g., families, schools, health care systems) may families, schools, health care systems) may optimize outcomes. optimize outcomes.

• An interdisciplinary, cross-system collaborative An interdisciplinary, cross-system collaborative

model involves families, schools and health care model involves families, schools and health care providers "working with one another, providers "working with one another, establishing shared goals, mutually developing establishing shared goals, mutually developing intervention plans, sharing responsibility for the intervention plans, sharing responsibility for the implementation of those plans, and collaborating implementation of those plans, and collaborating on assessing outcomes" on assessing outcomes" (Paavola et al., 1994, p. 23). (Paavola et al., 1994, p. 23).

Interdisciplinary Interdisciplinary Collaboration in Pediatric Collaboration in Pediatric

ContextsContexts• Systematic mechanisms are necessary by which Systematic mechanisms are necessary by which

pediatric service providers (e.g., pediatric psychologists, pediatric service providers (e.g., pediatric psychologists, pediatricians), school personnel, and families can pediatricians), school personnel, and families can exchange meaningful information, create effective and exchange meaningful information, create effective and responsive interventions, and sustain positive outcomes responsive interventions, and sustain positive outcomes for children.for children.

• Skills in consultation, data-based decision making, Skills in consultation, data-based decision making, evidence-based interventions, children’s health and evidence-based interventions, children’s health and mental health, family systems, and school-based mental health, family systems, and school-based services are necessary.services are necessary.

• School psychologists are in ideal positions to orchestrate School psychologists are in ideal positions to orchestrate and activate interdisciplinary, intersystemic and activate interdisciplinary, intersystemic collaboration.collaboration.

Interdisciplinary Interdisciplinary Collaboration in Pediatric Collaboration in Pediatric

ContextsContexts• Conjoint Behavioral Consultation (CBC)Conjoint Behavioral Consultation (CBC)

• Links school psychologists, medical specialists, Links school psychologists, medical specialists, teachers and families in collaborative and joint teachers and families in collaborative and joint decision making within and across systems decision making within and across systems (interdisciplinary)(interdisciplinary)

• Focuses on integrated, versus parallel, Focuses on integrated, versus parallel, services across home, school, and health care services across home, school, and health care systems (intersystemic)systems (intersystemic)

• Role of school psychology consultant is to Role of school psychology consultant is to create a bridge across systems to support create a bridge across systems to support coordinated services for a child with medical coordinated services for a child with medical needsneeds

CBC in a Pediatric CBC in a Pediatric ContextContext

• Provides a framework for multi-Provides a framework for multi-directional communication and educationdirectional communication and education• Collaboration rather than simple information Collaboration rather than simple information

sharing sharing • Bidirectional influences across home, school, Bidirectional influences across home, school,

and medical center and medical center • School-linked consultants can educateSchool-linked consultants can educate

• health care providers about realities of schoolshealth care providers about realities of schools• school personnel about medical issuesschool personnel about medical issues• family members about ways to work with schools, family members about ways to work with schools,

medical specialistsmedical specialists

School Psychology Leadership School Psychology Leadership Specialization in Family-Centered Specialization in Family-Centered

Interdisciplinary CollaborationInterdisciplinary Collaboration• 4-year doctoral training tract to develop 4-year doctoral training tract to develop

students in school psychology into leaders students in school psychology into leaders in interdisciplinary collaboration across in interdisciplinary collaboration across medical, educational, and family systemsmedical, educational, and family systems

• Collaborative project:Collaborative project:University of Nebraska – LincolnUniversity of Nebraska – Lincoln

• Department of Educational PsychologyDepartment of Educational PsychologyUniversity of Nebraska Medical CenterUniversity of Nebraska Medical Center

• Developmental Medicine, Munroe-Meyer Institute for Developmental Medicine, Munroe-Meyer Institute for Genetics and RehabilitationGenetics and Rehabilitation

• Funded by the U.S. Department of Funded by the U.S. Department of Education, OSERSEducation, OSERS

School Psychology Leadership School Psychology Leadership Specialization in Family-Centered Specialization in Family-Centered

Interdisciplinary CollaborationInterdisciplinary CollaborationFour Year Training ProgramFour Year Training Program

Year 1 - UNLYear 1 - UNL• CBC Training – Didactic course/Practicum within school CBC Training – Didactic course/Practicum within school

psychology doctoral curriculumpsychology doctoral curriculumYear 2 - MMIYear 2 - MMI

• Interdisciplinary Leadership Training Curriculum in Interdisciplinary Leadership Training Curriculum in conjunction with the MMI Interdisciplinary Leadership Training conjunction with the MMI Interdisciplinary Leadership Training ProgramProgram

Year 3 - MMIYear 3 - MMI• Field-Based Interdisciplinary Consultation Practicum based in Field-Based Interdisciplinary Consultation Practicum based in

the MMI Developmental Pediatrics clinicsthe MMI Developmental Pediatrics clinicsYear 4 – MMI/UNLYear 4 – MMI/UNL

• Advanced Supervision PracticumAdvanced Supervision Practicum

Project FacultyProject FacultyUNL – Department of EducationalUNL – Department of Educational

PsychologyPsychologySue Sheridan, Ph.D.Sue Sheridan, Ph.D.• Willa Cather Professor and Professor of Educational Psychology with Willa Cather Professor and Professor of Educational Psychology with

an extensive resume of teaching, research and publishing in CBCan extensive resume of teaching, research and publishing in CBC• Director, Nebraska Center for Research on Children, Youth, Families Director, Nebraska Center for Research on Children, Youth, Families

and Schoolsand Schools

MMI – Nebraska Center onMMI – Nebraska Center onDisabilitiesDisabilities

Mark Smith, M.S.Mark Smith, M.S.• Consumer/Family Coordinator serving in a networking, mentoring Consumer/Family Coordinator serving in a networking, mentoring

and training/informational support role to consumers and families and training/informational support role to consumers and families across Nebraskaacross Nebraska

• 21 years prior experience as a Behavior Management Specialist at 21 years prior experience as a Behavior Management Specialist at the Eastern Nebraska Office on Developmental Disabilities; the Eastern Nebraska Office on Developmental Disabilities; background in school psychologybackground in school psychology

Project FacultyProject FacultyMMI - Developmental MedicineMMI - Developmental Medicine

Cindy Ellis, M.D.Cindy Ellis, M.D.• Associate Professor of Pediatrics and Psychiatry with 15 years Associate Professor of Pediatrics and Psychiatry with 15 years

experience in Developmental Pediatricsexperience in Developmental Pediatrics• Board Certified in Developmental/Behavioral Pediatrics and Board Certified in Developmental/Behavioral Pediatrics and

Neurodevelopmental DisabilitiesNeurodevelopmental DisabilitiesHowie Needelman, M.D.Howie Needelman, M.D.• Assistant Professor of Pediatrics with 24 years experience in Assistant Professor of Pediatrics with 24 years experience in

Neonatology and 10 years Developmental PediatricsNeonatology and 10 years Developmental Pediatrics• Board Certified in Neonatal Medicine and Board Certified in Neonatal Medicine and

Developmental/Behavioral PediatricsDevelopmental/Behavioral PediatricsBrigette Vaughan, MSN, APRNBrigette Vaughan, MSN, APRN• Masters of Science in NursingMasters of Science in Nursing• 10 years experience in Mental Health Field10 years experience in Mental Health Field

Munroe-Meyer InstituteMunroe-Meyer InstituteTraining SiteTraining Site

• MMI is an interdisciplinary program with over 150 MMI is an interdisciplinary program with over 150 professional staff in health and rehabilitation related fields:professional staff in health and rehabilitation related fields:NursingNursing Developmental pediatricsDevelopmental pediatrics Physical therapyPhysical therapyNutritionNutrition Endocrinology/diabetesEndocrinology/diabetes AudiologyAudiologyPsychologyPsychology Pediatric dentistryPediatric dentistry Recreation therapyRecreation therapyPublic healthPublic health Molecular genetics Molecular genetics Health policyHealth policySocial workSocial work Occupational therapyOccupational therapy Health administrationHealth administrationGenetics Genetics Speech-language pathologySpeech-language pathology

• MMI is the major interdisciplinary diagnostic and MMI is the major interdisciplinary diagnostic and evaluation center for children with neurodevelopmental evaluation center for children with neurodevelopmental disabilities in Nebraska and the surrounding regiondisabilities in Nebraska and the surrounding region

• For over 30 years MMI has received federal funding for its For over 30 years MMI has received federal funding for its core interdisciplinary training program. Over the past 10 core interdisciplinary training program. Over the past 10 years, over 2000 long-term students received training at years, over 2000 long-term students received training at MMIMMI

MMI - Developmental MMI - Developmental MedicineMedicine

Training SiteTraining SiteClinical ServicesClinical Services• Assessment, diagnosis, and treatment planning for Assessment, diagnosis, and treatment planning for

infants, children and youth with developmental, infants, children and youth with developmental, behavioral, and emotional disorders in Developmental behavioral, and emotional disorders in Developmental Pediatrics and Interdisciplinary ClinicsPediatrics and Interdisciplinary Clinics

• Ongoing follow-up/medical management for patients with Ongoing follow-up/medical management for patients with complexcomplex neurodevelopmental and psychiatric disorders neurodevelopmental and psychiatric disorders

• ADHD, Autism Spectrum Disorders, Developmental Delay, ADHD, Autism Spectrum Disorders, Developmental Delay, Mental Retardation, Cerebral Palsy, Anxiety, OCD, Mental Retardation, Cerebral Palsy, Anxiety, OCD, Disruptive Behavior DisordersDisruptive Behavior Disorders

Interdisciplinary Leadership Interdisciplinary Leadership Training CurriculumTraining Curriculum

The 2nd year of training is focused on The 2nd year of training is focused on interdisciplinaryinterdisciplinary and and leadershipleadership education: education:

1.1. OrientationOrientation2.2. Didactic and Self-Study CurriculumDidactic and Self-Study Curriculum3.3. Leadership Development ActivitiesLeadership Development Activities4.4. Service Coordination and Family Services Service Coordination and Family Services

ActivitiesActivities5.5. Cultural Competency TrainingCultural Competency Training6.6. ResearchResearch7.7. Developmental Medicine Practicum Developmental Medicine Practicum

ExperienceExperience


• Developmental PediatricsDevelopmental Pediatrics• NursingNursing• Speech/Language PathologySpeech/Language Pathology• Occupational TherapyOccupational Therapy• Physical TherapyPhysical Therapy• PsychologyPsychology• NutritionNutrition• Social WorkSocial Work

• AdministrationAdministration• Family ServicesFamily Services• Business ServicesBusiness Services• Genetics LabsGenetics Labs• Recreation TherapyRecreation Therapy• Pediatric DentistryPediatric Dentistry• AudiologyAudiology• Education/Child Education/Child

DevelopmentDevelopment

OrientationOrientation• 2-year interdisciplinary advisement program2-year interdisciplinary advisement program• Development of an Individualized Study PlanDevelopment of an Individualized Study Plan• Interdisciplinary ObservationsInterdisciplinary Observations


Weekly Student Weekly Student SeminarsSeminars

• family-centered family-centered interdisciplinary careinterdisciplinary care

• cultural competencycultural competency• advocacyadvocacy• leadership skillsleadership skills• teamworkteamwork• public healthpublic health• policy developmentpolicy development• researchresearch

Clinical Topics SeminarClinical Topics Seminar• prematurityprematurity• chromosomal/genetic disorderschromosomal/genetic disorders• metabolic & nutritional metabolic & nutritional

disordersdisorders• CNS disordersCNS disorders• sensory defectssensory defects• sleep problemssleep problems• feeding and eating problemsfeeding and eating problems• elimination disorderselimination disorders• interdisciplinary rolesinterdisciplinary roles• therapeutic interventionstherapeutic interventions

Didactic Curriculum and Self Study Didactic Curriculum and Self Study CurriculumCurriculum


ResearchResearch• Didactic curriculumDidactic curriculum

• Student research Student research projectproject

• Oral project Oral project presentationpresentation

• Presentation in Presentation in MMI Poster SessionMMI Poster Session


Developmental Medicine Clinic Developmental Medicine Clinic Practicum ExperiencePracticum Experience• Students initially observe new patient Students initially observe new patient

evaluations and follow-up visits in a variety of evaluations and follow-up visits in a variety of medical clinicsmedical clinics

• With experience, students participate as a With experience, students participate as a resource for patients, parents, and physicians resource for patients, parents, and physicians regarding issues such as:regarding issues such as:

• school and/or home behavior problemsschool and/or home behavior problems• IEP questionsIEP questions• interpreting psychoeducational testinginterpreting psychoeducational testing

• 33rdrd year of training program year of training program• Provides opportunities for students to Provides opportunities for students to

integrate knowledge gained in pediatric integrate knowledge gained in pediatric clinics, observations, and seminars with clinics, observations, and seminars with CBC experienceCBC experience

• Consultation services are provided for Consultation services are provided for children referred by a physician through children referred by a physician through the developmental pediatric (or related) the developmental pediatric (or related) clinicclinic

• Services take place in schools, with Services take place in schools, with parents, teachers, and other specialists and parents, teachers, and other specialists and school personnel working collaboratively to school personnel working collaboratively to address a child’s unique needsaddress a child’s unique needs

Field-Based Field-Based Interdisciplinary Interdisciplinary

Consultation PracticumConsultation Practicum

Field-Based Interdisciplinary Field-Based Interdisciplinary Consultation PracticumConsultation Practicum

Graduate student obtains parental consent and contacts school/schedules school visit

Introductory meeting with parent(s) and teacher(s)

CBC process initiated involving school personnel and family

CBC continues: treatment plan developed and coordinated with medical intervention

Supervision with:

CBC supervisor Interdisciplinary advisor - M.D. Family advisor - SmithCBC continues: treatment

implemented at home and school settings; student supports families and teachers

CBC process concluded: data collection and evaluation

MD identifies case and assigns to the graduate student

Key Elements of Key Elements of Interdisciplinary CBCInterdisciplinary CBC

• Referral:Referral:• Typically made by physician; consultant can Typically made by physician; consultant can

attend family visits with physicianattend family visits with physician• Referrals are often based on challenges Referrals are often based on challenges

presented over time due to complex medical presented over time due to complex medical issues with misunderstandings between families issues with misunderstandings between families and educational personneland educational personnel

• General information gathering is part of this General information gathering is part of this stagestage

• Rapport building with families, and with school Rapport building with families, and with school personnel is criticalpersonnel is critical

• Cross-system “bridge building” often becomes Cross-system “bridge building” often becomes paramount in order to address presenting needsparamount in order to address presenting needs

• Needs Identification:Needs Identification:• Assessment (including consultation interviews Assessment (including consultation interviews

and observations) across multiple contexts is and observations) across multiple contexts is facilitated by consultant facilitated by consultant

• Beyond assessing perspectives of parents and Beyond assessing perspectives of parents and teachers, consultant shares information and teachers, consultant shares information and educates consultees about relevant health educates consultees about relevant health issuesissues

• Needs Analysis:Needs Analysis:• Observations and relevant medical information Observations and relevant medical information

are integrated to formulate case hypotheses are integrated to formulate case hypotheses • Consultant shares assessment and observation Consultant shares assessment and observation

information with physician to guide medical information with physician to guide medical management of casemanagement of case


• Plan Development and Implementation:Plan Development and Implementation:• Intervention plans are co-constructed from a Intervention plans are co-constructed from a

broader, integrated knowledge basebroader, integrated knowledge base• Consultant coordinates intervention plan based Consultant coordinates intervention plan based

on cross-systems data, that is implemented on cross-systems data, that is implemented across natural home and school contexts across natural home and school contexts

• Evaluation:Evaluation:• Outcomes include degree to which child Outcomes include degree to which child

concerns are addressed; relevance and utility of concerns are addressed; relevance and utility of information shared across settings; long-term information shared across settings; long-term communication and relationships across systemscommunication and relationships across systems

• Decisions related to child outcomes are data-Decisions related to child outcomes are data-based based

• Physician apprised of intervention outcomes as Physician apprised of intervention outcomes as necessarynecessary


Case StudyCase StudyAmandaAmanda

• 13-year-old Caucasian female seen in 13-year-old Caucasian female seen in developmental pediatric clinicdevelopmental pediatric clinic

• Diagnoses: Tourette’s Syndrome, ADHD-Diagnoses: Tourette’s Syndrome, ADHD-Inattentive type, and Learning DisabilityInattentive type, and Learning Disability

• Medication: Tenex and Clonodine to manage Medication: Tenex and Clonodine to manage symptoms of ADHD and motor ticssymptoms of ADHD and motor tics

• Reason for Referral:Reason for Referral:• Medication effects on behavioral/academic Medication effects on behavioral/academic

performanceperformance• Home-school relationship Home-school relationship

issues/communication problemsissues/communication problems• Systemic issues: Systemic issues:

• Difference in problem perception across Difference in problem perception across home and schoolhome and school

• Lack of communicationLack of communication

• Consultation ContentConsultation Content• Target behaviors: Help-seeking and following Target behaviors: Help-seeking and following

directions directions • Data collection: Event recording of help-Data collection: Event recording of help-

seeking in classroom and number of prompts seeking in classroom and number of prompts given per direction at homegiven per direction at home

• Intervention: Class-wide help indication Intervention: Class-wide help indication system, progress monitoring, parent training system, progress monitoring, parent training in delivering effective commandsin delivering effective commands

• Provided framework for identifying Provided framework for identifying misunderstandings, sharing information, misunderstandings, sharing information, involving parent, and building partnership involving parent, and building partnership between parent and teachersbetween parent and teachers

Case StudyCase Study

• Consultation ProcessConsultation Process• Achieved entry into school via preliminary Achieved entry into school via preliminary

meetings with educators and staff (i.e., meetings with educators and staff (i.e., principal and special education coordinator) to principal and special education coordinator) to explain CBC process and gain trustexplain CBC process and gain trust

• Shared behavioral observation data with Shared behavioral observation data with pediatrician to determine efficacy of combined pediatrician to determine efficacy of combined medical and behavioral treatmentsmedical and behavioral treatments

• Educated caregiver and teachers regarding Educated caregiver and teachers regarding differences between learned behaviors and differences between learned behaviors and disability related issues (e.g., side effects of disability related issues (e.g., side effects of medication, physiological responses)medication, physiological responses)

• Promoted collaborative partnership across Promoted collaborative partnership across systems by emphasizing shared perspectives systems by emphasizing shared perspectives and commonalities, as well as validating and commonalities, as well as validating differences in opinions to establish mutual differences in opinions to establish mutual respect respect

Case StudyCase Study

TeamTeam• Susan Sheridan, PhD, PISusan Sheridan, PhD, PI• Cindy Ellis, MD, Co-PICindy Ellis, MD, Co-PI• Jennifer Burt, MEdJennifer Burt, MEd• Brandy Clark, MABrandy Clark, MA• Ashley Rohlk, MAAshley Rohlk, MA• Michelle Swanger, MAMichelle Swanger, MA• Katie Woods, BAKatie Woods, BA• Carrie Blevins, BSCarrie Blevins, BS• Katie Magee, BAKatie Magee, BA

Pediatric School Pediatric School Psychology: Psychology:

8 Years of Experiences8 Years of ExperiencesEdward S. Shapiro, George J. Edward S. Shapiro, George J.

DuPaulDuPaulLehigh UniversityLehigh UniversityThomas Power, Thomas Power,

Children’s Hospital of PhiladelphiaChildren’s Hospital of Philadelphia

Program’s HistoryProgram’s History• 1997:1997: Instituted Curriculum Instituted Curriculum

Changes to provide Changes to provide subspecializationsubspecialization

• 1997 – 2002:1997 – 2002: Received grant from Received grant from U.S. Dept of Education – provided U.S. Dept of Education – provided endorsementendorsement

• 2002 – 2006:2002 – 2006: Received grant from Received grant from U.S. Dept of Education – provided U.S. Dept of Education – provided endorsementendorsement

Components of Components of Leadership Training Leadership Training

ProjectProject

• Specialized courseworkSpecialized coursework• Specialized practicaSpecialized practica• ResearchResearch• DisseminationDissemination

Specialized CourseworkSpecialized Coursework• Medical aspects of disabilitiesMedical aspects of disabilities• Comprehensive school health programsComprehensive school health programs• Prevention of health problems and health Prevention of health problems and health

promotionpromotion• Leadership development and systems changeLeadership development and systems change• Child developmentChild development• PharmacologyPharmacology• Working in culturally and linguistically Working in culturally and linguistically

diverse environmentsdiverse environments

Specialized PracticaSpecialized Practica• Provide typical school psychological Provide typical school psychological

services within school settingsservices within school settings• Collaborate with team of professionals Collaborate with team of professionals

to provide health care services in to provide health care services in medical and school settingsmedical and school settings

• Serve as liaison between schools and Serve as liaison between schools and health care settings to provide health care settings to provide integrated careintegrated care

Total HoursTotal HoursProject Project YearYear

School School SiteSite

Health Health Care SiteCare Site School School Health Health

CareCare11 2 day/ 2 day/

week, 10 week, 10 mos, no mos, no summersummer

1 day/ 1 day/ week, 10 week, 10 mos, mos, include include summersummer

640640 320320

22 1 day/ 1 day/ week, no week, no summerssummers

2 day/ 2 day/ week, 10 week, 10 mo, mo, include include summersummer

320320 640640

TotalTotal 960960 960960

Curriculum DetailsCurriculum Details• Joint program with Children’s Hospital of Joint program with Children’s Hospital of

PhiladelphiaPhiladelphia• Curriculum spans a student’s 3rd and 4th yrCurriculum spans a student’s 3rd and 4th yr• Coursework taken at both medical school Coursework taken at both medical school

and university settingsand university settings• Practicum requirements involve over 1900 Practicum requirements involve over 1900

clock hours across two year periodclock hours across two year period• Health care and educational sites have Health care and educational sites have

existing relationshipsexisting relationships

More Curriculum More Curriculum DetailsDetails

• Both full endorsement and Both full endorsement and subspecialization are offeredsubspecialization are offered

• Subspecialization is less intense Subspecialization is less intense practica (400 clock hours over two practica (400 clock hours over two year period) and includes some of year period) and includes some of the same courseworkthe same coursework

Hospital-Based Hospital-Based PracticumPracticum

• Students spend 2-3 months in rotationsStudents spend 2-3 months in rotations• Oncology ProgramsOncology Programs• Feeding and Swallowing Center Feeding and Swallowing Center • Center for Management of ADHDCenter for Management of ADHD• Neurorehabilitation ProgramNeurorehabilitation Program• Primary Care CentersPrimary Care Centers• Neuropsychology ProgramNeuropsychology Program• Behavioral Pediatrics ProgramBehavioral Pediatrics Program

• Students provided with experiences in Students provided with experiences in assessment, treatment, consultationassessment, treatment, consultation

ResearchResearch• HIV and drug abuseHIV and drug abuse• Medication complianceMedication compliance• Pain reductionPain reduction• Educational programs about health-related Educational programs about health-related

issues such as nutrition, exercise, lead exposureissues such as nutrition, exercise, lead exposure• Manuscript in submission about academic Manuscript in submission about academic

achievement and school performance of achievement and school performance of children with cancerchildren with cancer

• The effects of Bupropion Hydrochloride on the The effects of Bupropion Hydrochloride on the classroom performance of children with classroom performance of children with Attention Deficit Hyperactivity Disorder. Attention Deficit Hyperactivity Disorder.

Examples of Types of Examples of Types of Student Clinical Student Clinical

ExperiencesExperiences Consultation with pediatric psychologists regarding Consultation with pediatric psychologists regarding

children having academic difficulties following children having academic difficulties following cancer treatment cancer treatment

Creation of materials to provide to schools and Creation of materials to provide to schools and families about the school re-entry process following families about the school re-entry process following cancer treatmentcancer treatment

Presented inservice on Insulin Dependent Diabetes Presented inservice on Insulin Dependent Diabetes Melitus for school personnelMelitus for school personnel

Developed resources for families to assist them Developed resources for families to assist them with acquiring services for their children through with acquiring services for their children through the public schools.the public schools.

More ExamplesMore Examples• Effective asthma management in childrenEffective asthma management in children• Pharmacological treatment of seizure disordersPharmacological treatment of seizure disorders• School-based relaxation training for children and School-based relaxation training for children and

adolescents with chronic tension-type headache: Direct adolescents with chronic tension-type headache: Direct and collateral effects. and collateral effects.

• Inservice presentation for pediatric clinic staff at on Inservice presentation for pediatric clinic staff at on Pediatric School Psychology, a new direction for Pediatric School Psychology, a new direction for psychological servicespsychological services

• Grant to PA Dept. of Education, A Healthy Start: School Grant to PA Dept. of Education, A Healthy Start: School Breakfast Promotion. (Funded; will serve as Breakfast Promotion. (Funded; will serve as dissertation).dissertation).

Examples of Types of Examples of Types of Student ExperiencesStudent Experiences

• Developed standard protocol for Developed standard protocol for outpatient assessment of AD/HD at outpatient assessment of AD/HD at pediatric clinicpediatric clinic

• Developed adolescent weight control Developed adolescent weight control program in out-patient pediatric clinicprogram in out-patient pediatric clinic

• Implemented and participated in Implemented and participated in assessment, consultation, intervention assessment, consultation, intervention within schools as part of MDE teamwithin schools as part of MDE team

Examples of Types of Examples of Types of Student ExperiencesStudent Experiences

• Developing a research proposal Developing a research proposal focusing on delivering knowledge focusing on delivering knowledge to couples planning families or to couples planning families or expectant mothers on neonatal expectant mothers on neonatal lead poisoninglead poisoning

• Working with school and parent to Working with school and parent to advocate & education school staff advocate & education school staff about child with neurofibromatosisabout child with neurofibromatosis

Student OutcomesStudent Outcomes• 24 students enrolled in endorsement24 students enrolled in endorsement

• 18 completed endorsement18 completed endorsement• 4 still enrolled4 still enrolled• 2 left program for academic reasons2 left program for academic reasons

• Of 18 completed endorsementOf 18 completed endorsement• 9 graduated and employed9 graduated and employed• 1 currently on internship, will graduate in 1 currently on internship, will graduate in

May 07May 07• 3 completing dissertations3 completing dissertations• 2 leaving for internship in 06-072 leaving for internship in 06-07• 3 ABD, dissertation proposals pending3 ABD, dissertation proposals pending

Student Outcomes Student Outcomes (con’t)(con’t)

• 3 completed subspecialization & 3 completed subspecialization & 3 3 graduatedgraduated

• 3 completed subspecialization, 2 3 completed subspecialization, 2 graduatedgraduated

• 1 currently enrolled in 1 currently enrolled in subspecialization, 3 first or second year subspecialization, 3 first or second year students stated intent to enroll in students stated intent to enroll in subspecializationsubspecialization

Research in Pediatric Research in Pediatric School PsychologySchool Psychology

• Of 9 graduates:Of 9 graduates:• 5 dissertations in areas directly related to 5 dissertations in areas directly related to

Ped School PsychPed School Psych• Examples:Examples:

• Self-concept of children with asthma: The impact Self-concept of children with asthma: The impact of reference groups of reference groups

• Monitoring the effects of medications for students Monitoring the effects of medications for students with attention deficit hyperactivity disorder: The with attention deficit hyperactivity disorder: The role of the school psychologist role of the school psychologist

• Understanding the peer relationships of children Understanding the peer relationships of children with asthma: An examination of sociometric with asthma: An examination of sociometric status, friendship, and social networks status, friendship, and social networks

Survey of Doctoral Training Survey of Doctoral Training FacultyFaculty

n= 70/230 (30.4%)n= 70/230 (30.4%)ItemItem Not at Not at all/Not all/Not very very muchmuch

SomSomewhewhatat

Pretty Pretty much/much/Very Very muchmuch

Do you believe training programs in school psychology do a good job training students about health problems?

60.0 37.1 2.9

Do you believe training programs in school psychology should offer more intensive training in providing services to children with health problems?

10.0 31.4 58.6

Are training programs in school psychology enhanced by collaboration with a hospital-based training program?

15.7 27.1 57.2

How interested is your program in offering How interested is your program in offering intensive training related to providing intensive training related to providing services for children with health problems?services for children with health problems?

21.421.4 35.735.7 42.942.9

How feasible within your program is it to How feasible within your program is it to offer intensive training related to providing offer intensive training related to providing services for children with health problems?services for children with health problems?

35.735.7 28.628.6 35.735.7

ItemItem Not at Not at all/Not all/Not very very muchmuch

SomSomewhewhatat

Pretty Pretty much/much/Very Very muchmuch

How interested are you in offering intensive training related to providing services for children with health problems?

17.1 38.6 44.3

Do you believe that training school psychologists in providing services to children with health problems enhances employment opportunities for graduates?

14.3 22.9 62.8

Do you believe training programs have increased their focus on health issues since 1995?

30.0 44.3 25.7

How IMPORTANT is it for training programs to provide training related to illness prevention and health promotion?

4.2 32.9 62.9

How FEASIBLE is it for training programs to How FEASIBLE is it for training programs to provide training related to illness prevention provide training related to illness prevention and health promotion?and health promotion?

22.922.9 38.638.6 38.538.5

Survey of Doctoral Training Survey of Doctoral Training FacultyFaculty

n= 70/230 (30.4%)n= 70/230 (30.4%)

Lessons Learned – Lessons Learned – The GoodThe Good

• A need exists for doctoral level graduates A need exists for doctoral level graduates trained in this area, national survey support thistrained in this area, national survey support this

• Skills of graduates are very well regarded by Skills of graduates are very well regarded by employees, whether schools, consulting, or employees, whether schools, consulting, or academiaacademia

• 3 graduates assumed post-doctoral positions, 1 3 graduates assumed post-doctoral positions, 1 in academic position, 1 in medical school setting, in academic position, 1 in medical school setting, 1 in post-doc1 in post-doc

• Core curriculum we started with has held up over Core curriculum we started with has held up over the years and will continue into the futurethe years and will continue into the future

• Student research has been more focused in the Student research has been more focused in the area of pediatric school psychology over the last area of pediatric school psychology over the last few yearsfew years

Lessons Learned-Lessons Learned-The GoodThe Good

• Addressing a real need in pediatric settings Addressing a real need in pediatric settings based on survey of local pediatriciansbased on survey of local pediatricians

• Has helped to recruit strong doctoral Has helped to recruit strong doctoral students from a variety of academic students from a variety of academic backgroundsbackgrounds

• Has assisted doctoral students in being Has assisted doctoral students in being competitive for APA-approved internshipscompetitive for APA-approved internships

• Has enhanced understanding of schools and Has enhanced understanding of schools and school psychology among medical school psychology among medical practitionerspractitioners

Lessons Learned-Lessons Learned-Training Challenges Training Challenges

• Course requirements are too heavyCourse requirements are too heavy• Need to embed research requirements within the Need to embed research requirements within the

projectproject• Students need to enter with initial research Students need to enter with initial research

requirement completedrequirement completed• Need to maintain 2-days per week in hospital as Need to maintain 2-days per week in hospital as

minimal practicum requirementminimal practicum requirement• Need to shave unneeded course requirementsNeed to shave unneeded course requirements• Need to provide on-site supervision in all settingsNeed to provide on-site supervision in all settings

• A challenge in hospital sites not equipped with A challenge in hospital sites not equipped with psychological servicespsychological services

Lessons Learned-Lessons Learned-Dissemination Dissemination

ChallengesChallenges• Recognition in Pediatric Psychology Recognition in Pediatric Psychology

is slow to developis slow to develop• Capacity to impact pediatric Capacity to impact pediatric

internship opportunities for studentsinternship opportunities for students• Need to develop better mechanism Need to develop better mechanism

for developing professional for developing professional recognition in related disciplinesrecognition in related disciplines

The FutureThe Future• Doctoral level specialization should Doctoral level specialization should

continuecontinue• Great option to enhance School Great option to enhance School

Psychology skillsPsychology skills• Need to continue disseminationNeed to continue dissemination• Need to network across training Need to network across training

institutions with similar interests institutions with similar interests and programsand programs

Questions andQuestions andPanel DiscussionPanel Discussion

AllAll

Documents

Pediatric School Psychology: Opportunities and Perspectives on Training and Practice