Postdoctoral fellows’ developmental trajectories in becoming pediatric primary care psychologists.

Abstract

Pediatric primary care (PPC) settings provide optimal contexts for pediatric psychologists to deliver behavioral health services, including health promotion, prevention, early identification, and intervention. Policy statements and recommendations detail mental health competencies for PPC and delineate competencies for primary care psychology, providing a roadmap for training and preparing pediatric psychologists to work in primary care settings. This article focuses on the developmental progression of professionalism in postdoctoral fellowship training in PPC psychology. Using the Professionalism Cluster of the training competencies in pediatric psychology (Palermo et al., 2014), we apply the competencies to fellowship activities and provide examples of behavioral anchors that demonstrate readiness for independent practice. Project CLIMB (Consultation Liaison In Mental Health and Behavior) is an integrated behavioral health services program embedded in an urban, pediatric residency teaching clinic located at a regional children's hospital within a large university system. Postdoctoral fellows train in 1 of 2 tracks, general PPC or early childhood mental health in PPC. Fellows engage in clinical care, scholarly activities, training and education, and professional development efforts under the supervision of pediatric psychologists. Goal setting, continuous evaluation, and reflection facilitate fellows' preparation for independent practice. The Project CLIMB fellowship model illustrates the potential of training within PPC settings to cultivate competent and skilled pediatric psychologists.

Developmental trajectories of competency attainment amongst clinical psychology trainees across field placements

“…It is widely accepted that there is a developmental trajectory that students take in acquiring competencies in various domains (Talmi et al., ). However, it is not clear at what rate students develop these different competencies nor how they develop and gain competencies during field placements.…”

The Scope of Behavioral Health Integration in a Pediatric Primary Care Setting

“…Analysis of the types of consultations provided by BHCs supports the emerging literature around roles, responsibilities, and scope of work. BHCs can assist primary care providers with supporting children and their families, particularly in the first years of life, through screening protocols and processes (Kornfeld, Bair-Merritt, Frosch, & Solomon, 2012;Power et al, 2013;Radecki, Sand-Loud, O'Connor, Sharp, & Olson, 2011;Talmi et al 2014), Healthy Steps services (Barth, 2010), problemfocused consultation, health promotion and anticipatory guidance strategies (Golden & Fortuny, 2011;Talmi, Stafford, & Buchholz, 2009), system navigation/care coordination (Larson et al, 2013), and joint training efforts between pediatric psychologists/behavioral health professionals and pediatric medical professionals (Garfunkel et al, 2011;Talmi et al, 2015). BHC visits that are integrated into routine well-child care can include assessment of developmental difficulties interfering with a child's ability to optimally engage in age-appropriate activities, psychoeducation, anticipatory developmental guidance, and enhancing the relationship between pediatric primary care providers and the children and families they serve (Talmi & Fazio, 2012).…”

“…Workforce Capacity Development Attention must be paid to cultivating a workforce that is not only adept at providing integrated behavioral health services to pediatric populations, but also has considerable expertise and bandwidth to address early childhood, family, and environmental issues from a prevention and health promotion framework Talmi et al, 2015). Integrated BHCs working in pediatric settings require a strong foundation in typical development including infancy and early childhood for the prevention and health promotion consultation types, skills engaging family members and caregivers to understand and address environmental circumstances that impact development, knowledge of behavioral health issues in pediatric populations for the intervention consultation types, and a strong capacity to collaborate with pediatric health professionals from different disciplines to manage the care of patients seen in integrated health settings.…”

Pediatric consultation.

“…For example, internship training in integrated primary care is emphasized at MetroHealth Medical Center in Cleveland, Ohio (Nielsen, 2014), and integrated behavioral health tracks are offered at some internship sites, such as Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware (Novotney, 2014), and the Nebraska Internship Consortium in Professional Psychology at MunroeMeyer Institute, University of Nebraska Medical Center in Omaha (see Grus & Cope, 2016, for a directory of internship programs with training opportunities in primary care). Furthermore, Talmi et al (2015) described an integrated behavioral health services program, Project Consulta tion Liaison in Mental Health and Behavior, which provides postdoctoral fel lows training in primary care psychology.…”