Major Clinical Rotations (6 months) The fellow will select two of the following:
- 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 and attendance at multidisciplinary rounds are integral parts of this rotation. Supervisor: Dr. Berry.
- Hematology/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 who have received 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: Dr. Foster.
- Adherence: The focus of this rotation is improving adherence to medical regimens across a variety of different chronic illnesses, including Diabetes, Cystic Fibrosis, and Asthma. The fellow has the opportunity to see children and adolescents with these conditions during inpatient admissions for non-adherence and may follow up with outpatient psychological intervention to continue to address issues with adherence, adjustment to illness, problem solving skills, and coping. 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. SLCH has been dedicated to the treatment of patients with cystic fibrosis (CF) for almost a half century, the Cystic Fibrosis Center at Washington University Medical Center and St. Louis Children’s Hospital continues to thrive. The Cystic Fibrosis Clinical Center now follows 250 children and adolescents regularly. SLCH is also a national leader in treating childhood asthma. Supervisor: Dr. Juehring.
- Pain: In this rotation, the fellow will have the opportunity to work with children and adolescents with acute or chronic pain. The fellow will work closely with The Division of Pediatric Gastroenterology, Hepatology, and Nutrition for treatment of abdominal pain and Pediatric Neurology Services for treatment of headache pain. Additionally, the fellow will participate in treatment of complex pain issues through the St. Louis Children’s Hospital Multidisciplinary Pain Management Clinic. The fellow has access to and will utilize biofeedback in treatment of pain in addition to gaining experience with assessment techniques and cognitive behavioral pain interventions. Supervisors: Drs. Shelton & Thompson.
Minor Clinical Rotations (6-months) The fellow will participate in 2-3 minor rotations.
- Craniofacial/Cleft-Palate Clinic (required rotation): For half the year, fellows will participate in this weekly multidisciplinary clinic conducting brief psychosocial assessments with children with cleft palate and other craniofacial anomalies and providing anticipatory guidance. The multidisciplinary team consists of representatives from surgery, speech pathology, audiology, genetics, ENT, orthodontics, and dentistry. The fellow will participate in rounds at the end of clinic, reporting relevant findings and assisting in determining treatment recommendations. Fellows will also provide clinical supervision to graduate students who participate in this clinic. Fellows may follow children from this clinic in their outpatient psychotherapy clinic for assistance with presurgical preparation, behavioral/emotional adjustment, and peer issues. Supervisor: Dr. Cradock.
- Newborn Follow-Up Clinic: For half the year, fellows will participate in this weekly multidisciplinary clinic providing follow-up care to children who were cared for in the NICU. Fellows will become competent in the administration and interpretation of measures of young child development (i.e., BSID-III, WPPSI-IV, 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: Dr. Davis
- Research (required rotation): For 6 months, with an option to continue, fellows will have 4 hours of dedicated research time per week and a 10% reduction in billable requirements. They will identify a research supervisor with whom they will develop specific goals. Fellows will meet with supervisors at the beginning or the year to discuss potential research projects. While fellows are welcome to work on a previous dataset of their own or submit a manuscript of their dissertation, we also encourage collaboration with a faculty member on an ongoing project. Our entire faculty is involved in clinical research projects, largely in collaboration with medical colleagues at the hospital. Fellows will identify a research supervisor with whom they will meet regularly.