Primary Clinical Rotations (year-long)
o Inpatient Medical Consultation/Liaison: The fellow will provide inpatient consultation/liaison services 3 days per week. This service will include diagnostic interviews, ongoing inpatient psychotherapy, consultation with the medical team, attendance at care conferences, and multidisciplinary rounds. The variety of consults seen is typical of a pediatric psychology consultation/liaison service in a tertiary care center. We also are able to tailor assignment of cases to training needs and interests of the fellow. Many of these inpatient cases will transition to the fellow’s outpatient psychotherapy clinic. Supervisors: Nesin, Thompson, Davis & Fear.
o Newborn Follow-Up Clinic: One day per week. The fellow will participate in this multidisciplinary clinic providing follow-up care to children cared for in the NICU. The goal of this rotation is that the fellow will become competent in the administration and interpretation of measures of young child development (i.e., BSID-III, WPPSI-III, VMI, Bracken), have an understanding of typical young child development, and be knowledgeable of neurodevelopmental risks faced by children with significant neonatal histories. Fellows will conduct brief diagnostic interviews, administer, score, and interpret tests, and provide verbal and written feedback to the family and medical team. The fellow may follow children from this clinic in their outpatient psychotherapy clinic for behavioral or family issues identified during the evaluation. Supervisor: Davis
o Craniofacial/Cleft-Palate Clinic: One day per week. The fellow will participate in this multidisciplinary clinic consisting of representatives from surgery, speech pathology, audiology, genetics, ENT, orthodontics, and dentistry. The fellow will conduct brief diagnostic evaluations with children with cleft palate and other craniofacial anomalies and provide anticipatory guidance. The fellow will participate in rounds at the end of clinic, reporting relevant findings and assisting in determining treatment recommendations. The fellow may follow children from this clinic in their outpatient psychotherapy clinic for assistance with pre-surgical preparation, behavioral/emotional adjustment, and peer issues. Supervisor: Cradock.
o Sickle Cell Clinic: The fellow will be the primary consultant to the sickle cell team. Responsibilities include inpatient consultation/liaison, outpatient psychotherapy, and attendance at bi-monthly psychosocial rounds. The fellow will give a pain management presentation to youth attending Camp Crescent in July and will have the opportunity to conduct professional presentations and training to clinic staff and families throughout the year. Typical referral issues include adjustment to illness, pain management, and behavioral management. Supervisor: Nesin
o Outpatient Child Psychotherapy Clinic: Our goal for the fellow’s outpatient clinic is to continue to build a strong foundation of general child clinical diagnostic, interview, and intervention skills while allowing the fellow to focus on areas of clinical interest or need. The fellow’s outpatient psychotherapy clinic will consist of patients that have been referred from other medical rotations or from community pediatricians. Supervision is typically provided in cognitive-behavioral and family systems intervention strategies with special attention to evidence based techniques. Case supervisors are selected based on their area of expertise relative to the patient’s presenting problem. Supervisors: Cradock, Nesin, Thompson, Davis, & Fear.
Elective Rotations (6-month): The resident will select two of the following elective rotations.
o Solid organ transplant: St. Louis Children’s Hospital is one of the pioneers in pediatric organ transplantation and remains one of the most active transplant programs in the world. The goal of this rotation is to introduce the fellow to the unique issues facing families preparing for solid organ transplant. They will learn protective factors for transplant success and intervention strategies to address potential psychosocial risk factors for future graft failure. The fellow will conduct 2-4 pre-transplant evaluations per month with families whose children are preparing for lung, heart, liver, or kidney transplant. The fellow will have the opportunity to follow the family through the transplant process and address post-transplant adjustment and adherence issues as needed. Consultation with the transplant teams will be an integral part of this rotation as will attendance at multidisciplinary rounds. Supervisors: Thompson & Fear.
o Oncology: The pediatric hematology/oncology program at St. Louis Children’s Hospital is the largest comprehensive program for children with blood diseases or cancer in the region. The fellow will follow children following a cancer diagnosis through inpatient and outpatient evaluation and treatment. The fellow will play an active role in weekly psychosocial oncology rounds. There is an opportunity to do pre-bone marrow transplant (BMT) evaluations and follow families through the BMT process to address adherence and adjustment issues as needed. Typical issues addressed include coping with a new diagnosis, illness adjustment, behavioral concerns, anxiety, and palliative care. Supervisor: Nesin.
o Dialysis: The fellow will follow children on hemodialysis during their dialysis treatments and children on peritoneal dialysis during clinic visits addressing issues such as adjustment to dialysis, adherence, and preparation for transplant. They will work closely with the dialysis team to address strategies to manage behavioral and emotional issues of youth during their treatments. The fellow will have the opportunity to work with some families as they move from dialysis through kidney transplant. Supervisor: Fear
o Endocrine: The focus of this rotation is the treatment of youth with diabetes. St. Louis Children’s Hospital is the only pediatric hospital in St. Louis and one of two pediatric facilities in the state of Missouri recognized by the American Diabetes Association for excellence in diabetes education. The fellow attends the weekly new diagnosis follow-up clinic to introduce psychology services to the family, conduct a brief diagnostic interview, and provide anticipatory guidance regarding problem-solving skills, coping, and adherence. The fellow will also see children and adolescents in their outpatient psychotherapy clinic to address issues with adherence and adjustment to illness. There is the opportunity to provide inpatient consultation for youth admitted for diabetes complications or at diagnosis. Supervisor: Fear & Nesin.