Medical College of Wisconsin Pediatric Psychology and Developmental Medicine (PPDM) Postdoctoral Fellowship Program

Fellows spend approximately 70% of their time engaged in clinical activities and the remainder on administrative and academic activities, including time to attend didactics and engage in other educational and professional development activities. Didactics occur on Friday mornings and cover professional development topics, supervision, ethics, and DEI topics. Fellows receive a minimum of two hours of individual supervision per week from a licensed psychologist on faculty. Supervision is focused on clinical care, scholarly work, and career development. Additionally, fellows participate in peer supervision monthly facilitated by a faculty psychologist. The purpose of this group supervision is to spend time discussing a variety of issues, while also fostering a sense of community, building relationships, and increasing socialization across the cohort. The focus is often on emergent interprofessional issues and relevant case discussions.

Fellows must participate in the following scholarly activities:

• MBH rotation for medical residents: Medical residents are mandated to complete four weeks observing mental health experts during their residency, with a goal of increasing understanding of the role of mental health providers in a hospital setting. Fellows will be asked to provide shadowing opportunities throughout the year.
• Fellows must give at least two unique academic presentations focused on the dissemination of research or information. This requirement can be met through an oralor poster presentation at a local or national conference, practicum or residency didactic, or teaching opportunity within your training track.
• Fellows must complete a mentored peer review of a journal submission. Specialty Leads will assist in identifying a faculty mentor who will provide guidance and oversight.

Fellows must have their EPPP date scheduled by March 1 and successfully passed prior to the end of the fellowship year.

Clinical Experiences

Inpatient consultation/liaison (C/L) service
The fellow will complete new consults and follow-ups for medically hospitalized children, adolescents, and their families at Children’s Wisconsin. Fellows will conduct psychiatric diagnostic assessments at the bedside and follow patients who remain hospitalized for ongoing intervention throughout the work week. Most commonly, consults are for patients with presumed eating disorder symptoms who require the inpatient structured eating disorder guideline. On occasion, a consult will be placed for a patient in need of diagnostic clarity and outside resources or referrals for those patients with eating disorder symptoms but who do not require medical stabilization.

Multidisciplinary specialty clinics

• Eating Disorder Treatment Clinic: Patients with disordered eating and associated medical complications or risks are seen within the multidisciplinary adolescent medicine clinic. Specialists include adolescent medicine, clinical nutrition, social work, and psychology.

Outpatient therapy clinic
The fellow will work with pediatric outpatients and their families who present with adolescent health related concerns, including disordered eating and the exploration of gender identity and sexuality. Caseload can be tailored based on the fellow’s interest.

The Autism Clinic is a multidisciplinary team housed at the Center for Child Development (CCD). This facility offers comprehensive and multidisciplinary care for children and families, addressing a variety of developmental concerns. Within the Autism Clinic, fellows play an integral role in expanding access to comprehensive evaluation and intervention services for children and adolescents with Autism Spectrum Disorder (ASD).

Clinical Experiences

• ASD New Patient Evaluations: Conduct comprehensive diagnostic evaluations for children ages 0–18 referred for concerns related to autism.
• Fast Track Program: Provide brief consultations, psychoeducation, and individualized recommendations to families of children recently diagnosed with autism by Children’s Wisconsin pediatricians.
• Individual Psychotherapy: Deliver evidence-based psychotherapy to children with autism and co-occurring mental health conditions.
• Group Therapy: Facilitate therapeutic groups for children and adolescents with autism targeting social skills and emotion regulation.
• Parent-Child Interaction Therapy (PCIT): Fellows have the option to receive training and pursue certification in PCIT under supervision of a PCIT certified trainer. Fellows may be eligible for PCIT certification if all training requirements are met during their fellowship year.
• Parent Education: Develop and lead educational workshops for caregivers of children with autism and related developmental conditions.

Clinical Experiences

Inpatient consultation/liaison (C/L) service
The fellow serves as a member of the Psychology C/L service by completing new consults for medically hospitalized children, adolescents and their families at Children’s Wisconsin. The Psychology C/L service is currently staffed by 5 psychologists and psychology trainees. Fellows conduct health and behavior assessments at the bedside and follow patients who remain hospitalized for ongoing intervention throughout the work week. Fellows communicate recommendations and liaise with multidisciplinary medical teams. Opportunities will be available to participate in psychosocial rounds throughout the week. Common referral questions include assessment and intervention around acute trauma symptoms, difficulties coping with hospital setting, adherence to treatment regimen, and adjustment to new diagnosis.

Multidisciplinary specialty clinics

The fellow works as a part of a multidisciplinary team in at least one of the following clinics. Clinic opportunities may vary based on supervisor availability. Additional clinic opportunities may arise throughout the year.

• Asthma Plus Clinic: Patients with difficulty controlling their asthma symptoms are seen in multidisciplinary clinic by asthma or allergy provider, psychology provider, nurse clinician, medical social worker, and respiratory therapist through CHAMP (Community Health Asthma Management Program).
• Solid Organ Transplant Clinics: Opportunities are available to work with patients as part of multidisciplinary clinics for kidney and liver transplant patients. Opportunities to participate in pre-transplant evaluations are also anticipated.
• Diabetes Prevention Clinic: Patients at risk for developing Type 2 diabetes are seen in multidisciplinary clinic staffed by endocrinology provider, psychology provider and registered dietician.
• Functional Neurological Symptom Disorder (FNSD) Clinic: Patients who have been diagnosed with FNSD are seen for follow-up in multidisciplinary clinic staffed by neurology and psychology providers.
• Cystic Fibrosis Clinic: Opportunities to participate in multidisciplinary clinic for patients with cystic fibrosis may be available.

Outpatient health psychology clinic
The fellow will provide outpatient therapy services for children and adolescents through the Health Psychology Clinic at Children’s Wisconsin. Common referral questions include addressing emotional functioning in the context of a chronic medical condition, treatment adherence, medical trauma and adjustment to new medical diagnosis. Referrals may also include concerns related to general emotional and behavioral concerns.

The fellow in in this specialty splits their time between two distinct clinics where children and adolescents present with functional disorders.

Pain and Headache
The Pain and Headache Center is an interdisciplinary team of medical providers and psychologists specializing in bio-psychosocial treatment of youth with chronic pain and headaches. Youth present with a range of pain experiences including headaches, abdominal pain, myofascial pain, post-concussion syndrome, rheumatologic pain, and autonomic disorders. Often, they also experience anxiety, depression, or significant school related stress/avoidance. Fellows conduct bio-psychosocial evaluations as part of our team, develop treatment plans, co-facilitate Comfort Ability Program workshops, and implement cognitive-behavioral and family systems interventions. Biofeedback training is also available. Fellows have the opportunity to collaborate with schools and will develop a sophisticated understanding of the interaction between the mind and the body.

Functional Neurological Symptom Disorder (FNSD)
The FNSD Program at the Neurosciences Center provides outpatient, interdisciplinary care for children and adolescents with FNSD using a biopsychosocial, functionally-oriented model. Patients often present with functional disability across various domains (school, physical activity, sleep, and social life), as well as other comorbidities. Fellows participate in interdisciplinary assessment, psychoeducation, treatment planning, and evidence-based intervention as a part of a multidisciplinary team. Fellows will develop expertise in functional restoration and family-centered intervention as they work to collaborate with neurology and rehabilitation providers, coordinate care across family, school, and medical systems, and provide outpatient care to patients and families.

Clinical Experiences

The fellow conducts outpatient health and behavior assessments, develops collaborative treatment plans, implements evidence-based interventions, and communicates and collaborates with multiple health care professionals within the GI team.

Multidisciplinary specialty clinics

• Elimination Disorders Clinic: This weekly clinic offers specialized assessment and intervention for patients with toileting concerns including constipation, encopresis, enuresis, and failure to toilet train normally. Fellows will have the opportunity to lead a 7-week group intervention (Poop Group) twice throughout the year and gain umbrella supervision experience with psychology residents and practicum students.
• Feeding, Swallowing & Nutrition Program: This internationally recognized program offers comprehensive assessment and intervention for pediatric feeding disorders within an interdisciplinary team of medical providers, psychologists, speech language pathologists, and registered dieticians. The role of psychology is to assess biopsychosocial concerns related to feeding and swallowing and provide behavioral intervention to improve feeding skills. Opportunities may exist to work with patients with Avoidant-Restrictive Food Intake Disorder (ARFID).
• Inflammatory Bowel Disease (IBD) Clinic: This clinic provides annual assessment of psychosocial functioning in patients with Inflammatory Bowel Disease in conjunction with gastroenterologists, nurses, registered dieticians, and a research coordinator. Common issues addressed include coping and adjustment to new diagnosis, medication adherence, pain management, school functioning, and transition readiness skills for adult care.

Additional opportunities for exposure with Disorders of Gut-Brain Interaction (DGBI; e.g., recurrent abdominal pain, rumination, and Cyclic Vomiting Syndrome) and Celiac Disease are available via individual outpatient therapy clinic.

The Hematology/Oncology/BMT service primarily operates within the MACC Fund Center, a 24-bed inpatient unit, day hospital, and outpatient clinic. Annually, the service provides care for approximately 200 newly diagnosed oncology patients, 400 patients with sickle cell disease, and 30 patients who undergo a BMT. The hospital routinely provides care to children from Wisconsin, Michigan, and Illinois.

Inpatient and outpatient care

The fellow provides continuity of care to patients across inpatient and outpatient settings and collaborates closely within the broader multidisciplinary and psychosocial team. Fellows are expected to conduct psychological assessment and psychotherapy, pre-BMT readiness evaluations, neurocognitive assessment for late effects of cancer treatment and to screen for neurocognitive functioning in the sickle cell population, and consultation/liaison with staff, schools, and community agencies.

Multidisciplinary specialty clinics

• Bridge to Next Steps: This 2-visit clinic with a medical provider and psychology occurs around the time of transition off active therapy with a goal to increase patient and family understanding of the plan of care as they enter survivorship. Psychological assessment focuses on socioemotional and academic/vocational functioning in survivorship, providing anticipatory guidance and recommendations for positive adjustment.
• Next Steps Survivorship Clinic: This biweekly clinic offers specialized care to monitor and manage possible late effects of treatment for survivors who are at least two years from pediatric cancer treatment or BMT. The role of psychology is to assess for and provide education around neurocognitive functioning and social and emotional health.
• Comprehensive Sickle Cell Disease Clinic: This clinic provides annual assessment of psychosocial functioning in patients with sickle cell disease in conjunction with hematologists and several other disciplines. Common issues addressed include pain management, medication adherence, and school performance. In addition, developmental and neurocognitive screeners are provided to assess for disease-related deficits in neurodevelopment.
• Comprehensive Hemophilia Clinic: This clinic follows pediatric, adolescent, and young adult patients with hemophilia and other bleeding disorders. The role of psychology is to broadly assess issues surrounding medication adherence, activity restrictions, social-emotional well-being, and transition of care. Collaborations include medical providers, social work, physical therapy, and genetic counseling.
• Cancer Predisposition Clinic: This weekly clinic offers specialized training in the management of cancer predisposition diagnoses in patients both with a personal history of cancer as well as those who are generally healthy. Patients generally undergo genetic testing and screening to monitor for an increased risk of developing cancer. The team consists of an attending physician, physician assistant, two genetic counselors, and a nurse coordinator. The role of psychology is to assess social and emotional health needs, readiness to undergo genetic testing, anticipatory guidance related to medical screening, and emotional support for patients and families, many of whom have had a personal or family history of cancer and loss.

School Assessment Team
The School Assessment Team provides comprehensive evaluations for a variety of presenting concerns that can affect a child’s school functioning including learning concerns, dyslexia, cognitive delay, autism, selective mutism, anxiety, attention concerns, and trauma. This multidisciplinary clinic is designed to meet the diagnostic and treatment needs of children with a variety of conditions that affect interpersonal, academic, social, emotional, behavioral and family well-being. Treatment components are multifaceted and designed to meet the needs of each child and family. Parent training and education, group therapy, individual therapy, and collaborative efforts with school/community agencies are available. Where appropriate, medication management of developmental and psychiatric conditions is also available. The fellow in the School Assessment Team provides comprehensive evaluations for children and adolescents.

Individual and Group Therapy
The fellow also provides individual and/or group therapy for children, adolescents, and their family members for a variety of presenting concerns with the opportunity to prioritize fellow training goals regarding patient populations. Opportunities exist to work with children from ages 4 to 18 depending on the fellow’s areas of interest. Flexibility also exists in determining the balance of assessment and therapy hours in the fellow’s caseload based on interest, as well as to specialize in specific presenting concerns. More specific group offerings available to the fellow includes an ADHD virtual parent group, DBT skills group, and Selective Mutism Building Bravery Camp.

The fellow will have the option to receive training in Parent-Child Interaction Therapy (PCIT) by a PCIT International certified Within Agency Trainer. Those participating in this training opportunity can expect to provide PCIT services to 2-4 families per week with youth with ADHD and/or disruptive behavior diagnoses. Fellows may be eligible for PCIT certification if all training requirements are met during their fellowship year. Adjustments in assessment or therapy expectations will be discussed if a fellow pursues this PCIT training experience.