Medical College of Wisconsin Pediatric Psychology and Developmental Medicine (PPDM) Post-Doctoral Fellowship Program

The Adolescent Health Fellowship Track includes provision of health psychology services to the pediatric eating disorder population across inpatient and outpatient settings, and to the gender diverse population in an outpatient setting. Clinical experiences include providing services within an adolescent medicine clinic, gender health clinic, outpatient therapy clinic, and an inpatient pediatric hospital setting. The fellow will have the opportunity to provide services for pediatric patients with various comorbid medical and mental health conditions such as GI and functional presentations, anxiety, depression, autism, and OCD. Within the ambulatory adolescent medicine clinic and inpatient medical stabilization unit, services are primarily consultative and targeted. The fellow will have the opportunity to provide longer-term therapy with evidence-based approaches (i.e., family-based treatment, enhanced cognitive behavioral therapy, cognitive behavior therapy for ARFID). The fellow will work closely with interdisciplinary teams across these settings.

Clinical Experiences

Inpatient consultation/liaison (C/L) service
The fellow will spend two days per week completing 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

• Adolescent Medicine Clinic – Patients with disordered eating and associated medical complications or risks are seen within the multidisciplinary adolescent medicine clinic. Specialists include a nurse practitioner, dietitian, social worker, and psychology.
• Gender Health Clinic is one of only two programs in the state of Wisconsin to provide hormonal medical interventions for gender diverse youth. The fellow will participate in one multidisciplinary clinic a month, where they will see new patients for initial assessment. They will also have opportunities to provide ongoing therapy to gender diverse youth who may be exploring gender identity, discussing readiness for medical interventions, or stabilizing co-morbid behavioral health diagnoses such as depression and anxiety using empirically supported interventions. The fellow can expect to gain a deeper understanding of gender diverse populations through their work with patients, families, and collaborating disciplines.

Outpatient therapy clinic
The fellow will work with pediatric outpatients and their families who present with adolescent health related concerns, including the need for gender affirming care or eating disorder treatment. Caseload can be tailored based on the fellow’s interest.

The Autism Clinic is a multidisciplinary team housed within the Division of Pediatric Psychology and Developmental Medicine at the Center for Child Development (CCD). This facility offers comprehensive and multidisciplinary care for children and families, addressing a variety of developmental concerns. The clinics within the CCD include the Multidisciplinary Evaluation Team (MET), Selective Mutism Program, School Performance Program, Autism Clinic and International Adoption Clinic. These clinics offer a combination of assessment and therapy services. The CCD also includes developmental pediatricians, speech-language pathologists, advanced practice nurse practitioners, nurses, occupational therapists, and physical therapists.

Clinical Experiences

Autism Clinic
The Autism Clinic provides autism spectrum disorder diagnostic evaluations, as well as therapy services for children and adolescents on the autism spectrum. Treatment modalities currently offered by providers within the Autism Clinic include behavioral parent training (e.g., Parent-Child Interaction Therapy), cognitive behavioral therapy, and group-based social skills training (e.g., PEERS). Fellows in this clinic provide diagnostic evaluations for children and adolescents referred for possible autism spectrum disorder.

Individual and Group Therapy
Fellows will also provide individual and/or group therapy for autistic children, adolescents, and their family members for a variety of presenting concerns, including anxiety, depression, and challenging behaviors. Opportunities exist for fellows to work with children from ages 0 to 18 depending on their area 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 (e.g., challenging behaviors).

The Consultation & Liaison/Adherence Fellowship Track is a 1-year pediatric psychology postdoctoral training experience, which will include provision of health psychology services to pediatric populations in a variety of settings. Anticipated clinical experiences include providing services within an outpatient health psychology clinic, multidisciplinary specialty clinics, and an inpatient pediatric hospital setting. It is expected that the fellow will have opportunities to provide services for pediatric patients with various medical conditions, including those followed by pulmonary, endocrine, cardiac, renal, and nephrology medical services. Focus on interventions is anticipated to be related to challenges adhering to medical regimens and coping with medical conditions, though may include questions about general emotional and behavioral concerns as well. The fellow will work closely with interdisciplinary teams across these settings. Supervision will be provided by licensed psychologists who are on faculty at Medical College of Wisconsin. Opportunities may be available for program development and/or to engage in teaching/supervision.

Clinical Experiences

Inpatient consultation/liaison (C/L) service
The fellow will spend one day per week completing new consults for medically hospitalized children, adolescents and their families at Children’s Wisconsin. Fellows will conduct health and behavior assessments at the bedside and follow patients who remain hospitalized for ongoing intervention throughout the work 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 will gain experience working as a part of a multidisciplinary team in at least one of the following clinics:

• 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).
• REACH Clinic – Patients with difficulty managing their diabetes regimen are seen in multidisciplinary clinic by endocrine provider, psychology provider, diabetes nurse clinician, medical social worker, and dietician.

Additional possible clinic experiences:

• Dual Provider Diabetes Clinic – REACH clinic patients in need of more intensive mental health intervention can be seen by psychology fellow and diabetes RN for coordinated care. Patients are offered a 12-session course of therapy.
• Cystic Fibrosis Clinic – Opportunities to participate in a multidisciplinary clinic for patients with cystic fibrosis may be available.
• Peritoneal Dialysis Clinic – Opportunities may be available to participate in a clinic for patients on peritoneal dialysis
• Opportunities to work with patients as part of multidisciplinary clinics for kidney, liver and heart transplant patients will also be available.

The Functional Disorders Fellowship Track is focused on providing specialized clinical and scholarly experiences in the Jane B. Pettit Pain and Headache Center and the Pediatric Gastroenterology, Liver and Nutrition Division at Children’s Wisconsin. Fellows provide outpatient clinical care to a diverse population of patients and families presenting with a range of functional disorders.

Clinical Experiences

Jane B. Pettit Pain and Headache Center
The Pain and Headache Center is an interdisciplinary team of physicians, psychologists, and nurse practitioners 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 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.

Gastroenterology, Liver and Nutrition Division
The Gastroenterology, Liver and Nutrition Division at Children’s Wisconsin provides clinical care to patients and families presenting with a range of gastrointestinal disorders and is among the top GI programs in the nation. Pediatric Gastroenterology experiences include the Functional GI Disorders clinic and the Elimination Disorders clinic, along with other experiences with common functional gastrointestinal disorders (e.g., recurrent abdominal pain, rumination, and cyclic vomiting). Fellows involved in the gastroenterology clinics will conduct bio-psychosocial evaluations, develop collaborative treatment plans, implement evidence-based interventions, and communicate and collaborate with multiple health care professionals within a health care team.

The Hematology/Oncology/BMT Fellowship Track provides an opportunity to receive specialized training in the care of children, adolescents, and young adults with hematological and oncologic disorders in a program where Psychology is a long-standing, highly respected, and embedded service. Fellows are exposed to a breadth of medical and mental health diagnoses and presenting problems, while also receiving the requisite training to develop an expertise in working with this population. Fellows are invited to function as a psychologist-in-training within the supportive and collaborative Pediatric Psychology team. This includes three faculty psychologists, a rotating psychology resident, and an advanced practicum student. The fellow also works closely with the psychosocial team embedded within hematology, oncology, and BMT.

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.

Clinical Experiences

Our fellowship provides extensive supervised clinical experience with pediatric, adolescent, and young adult hematology, oncology, and BMT patients and their families, including: 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. The fellow provides continuity of care to patients across inpatient and outpatient settings and collaborates closely within the broader multidisciplinary and psychosocial team. The fellow participates in the following multidisciplinary clinics:

Comprehensive Leukemia Clinic
This monthly clinic allows children diagnosed with leukemia to be evaluated by specialists at key points in their treatment. Common issues include parenting practices post-diagnosis, healthy sleep, and normative emotional reactions to treatment.

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.

The Orthopedics & Sports Medicine Fellowship Track provides extensive supervised clinical experience with multidisciplinary care of musculoskeletal conditions and problems, including but not limited to rehabilitation adherence, presurgical optimization, pain management, prolonged concussion recovery, treatment of behavioral health factors that undermine ACL surgical course, transition back to sports/activity following injury.

The fellow will provide continuity of care to patients across ambulatory clinics and collaborate with other relevant specialties/inpatient teams for care continuity. Common biopsychosocial concerns addressed include mood and behavioral symptoms prolonging recovery, suboptimal adherence to medical treatment (e.g., poor follow through with PT home exercise plan), lifestyle/health risk behavior undermining surgical course, and post-injury difficulty transitioning back to sports and other normal activities. The fellow will have opportunities to address lingering demand for sports-performance and sports-related mental health both within clinic and as part of established contractual Sports Medicine partnerships with area schools. Opportunities for supervision of practicum students and teaching of medical residents are also available.

The School Performance Program is a multidisciplinary team housed within the Division of Pediatric Psychology and Developmental Medicine at the Center for Child Development (CCD). This facility offers comprehensive and multidisciplinary care for children and families, addressing a variety of developmental concerns. The clinics within the CCD include the Multidisciplinary Evaluation Team (MET), Selective Mutism Program, School Performance Program, Autism Clinic and International Adoption Clinic. These clinics offer a combination of assessment and therapy services. The CCD also includes developmental pediatricians, speech-language pathologists, advanced practice nurse practitioners, nurses, occupational therapists, and physical therapists.

Clinical Experiences

School Performance Program
The School Performance Program provides comprehensive evaluations for a variety of presenting concerns that can affect a child’s school performance 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. Fellows in the School Performance Program will provide comprehensive evaluations for children and adolescents.

Individual and Group Therapy
Fellows will also provide 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 for fellows 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.