Pediatric Psychology 

The Pediatric Psychology Clinic at the Mailman Center for Child Development provides outpatient therapy and behavioral evaluation services for children and adolescents in a confidential, family-centered environment. Clinics are held every Monday and Tuesday afternoon from 1-6 pm. In our Monday afternoon clinic, supervised by Dr. Delamater, we provide clinical services for behavioral and adjustment issues related to physical health conditions including toileting difficulties (enuresis, encopresis), pain (recurrent abdominal pain, migraine or tension headache), chronic health conditions such as asthma, diabetes, obesity, feeding disorders, GI disorders (Crohn’s disease, ulcerative colitis), spina bifida, as well as specific issues related to medical treatment such as pill swallowing difficulties. Psychological factors affecting physical conditions including adjustment and medical regimen adherence are addressed.

This rotation is a consultation-based, pediatric psychology experience in an outpatient pediatric diabetes clinic setting. Trainees have the opportunity to provide consultation services to children and adolescents and their families who present for routine outpatient diabetes care. When the psychology team is consulted for a patient, or when elevations on the mental health screener warrant consultation with psychology, the trainee joins the visit via Zoom directly from the electronic medical record system and completes the consult via telehealth. Documentation also occurs directly within the EMR and is routed to the referring physician. Common referrals include coping and adjustment to a new diagnosis, adherence issues, healthy lifestyle adjustments, transition of diabetes-related care from parent to child, transition to adult clinic, as well as other psychosocial, academic, and behavioral concerns that may or may not relate to a diabetes diagnosis. Patients include children and adolescents with Type 1 and Type 2 diabetes, as well as the occasional patient with metabolic syndrome (“pre-diabetic”) who needs to focus on healthy lifestyle changes. Additionally, trainees on this rotation run the mental health screening program. The screening program provides comprehensive behavioral health screening for youth ages 12 and older. In the coming months, this mental health screener will be integrated within the electronic medical record system and will be extended to include screening for children birth to 11 years via parent proxy.

This rotation focuses on mental health concerns in the pediatric cystic fibrosis pulmonary clinic. A study published by Quittner et al., 2014 in Thorax, indicated that adolescents and adults with CF are at higher risk for depression and anxiety. An international, multidisciplinary group of experts published guidelines for mental health screening beginning at age 12 for all individuals with CF and screening of all parent caregivers of children with CF from birth to age 17. These guidelines recommend annual screening using the PHQ-9 and GAD-7 with an algorithm for repeated screenings of those who are elevated. The guidelines have been incorporated into standard of care in the clinic and families are currently screened annually or each visit if elevated previously using an iPad application. Patients with elevated scores are interviewed to assess for any suicidal thinking if indicated. Evidence-based treatments (CBT, IPT) for those who score in the moderate or severe range are typically recommended. Parents who are elevated are given referrals to providers in the community or referred to appropriate Mailman programs (PM COPE, Behav Peds, PCIT) depending on nature of the concerns/presenting problems. Many individuals/families present with issues other than compliance or depression/anxiety that can impact adjustment. In addition to screening the patients, psychology conducts consultations with most patients during their regularly scheduled medical appointments. These consultations assess for adherence, depression, anxiety, sleep hygiene, appetite, and school problems among other relevant issues. Occasionally there are follow up contacts via phone or Zoom. There are opportunities within this rotation for conducting consultations with patients while they are inpatient at Holtz Children’s Hospital. Another main focus of this rotation is interdisciplinary collaboration. Psychology is a valued part of the CF team and physicians seek psychology’s input regularly.