Pediatricians and Pharmacologically Trained Psychologists (eBook)

George M. Kapalka earned his PhD in Clinical Psychology from Fairleigh Dickinson University, and holds board certifications in several areas of practice, including clinical psychology, psychopharmacology, child and adolescent psychology, learning disabilities, and forensic psychology. He is an associate professor (tenured, graduate faculty appointment) at Monmouth University where he currently serves as the Interim Chair of the Department of Psychological Counseling. Dr. Kapalka previously taught at several universities, including Fairleigh Dickinson University (within the PhD program in Clinical Psychology) and the New York Institute of Technology (where he served as the Director of Counselor Education).Dr. Kapalka is licensed to practice psychology in NJ, NY, PA and NM and has been in practice for over 20 years. He maintains a private practice that primarily focuses on the treatment of children and adolescents with learning and emotional disorders. Dr. Kapalka completed level 3 psychopharmacology training through the Prescribing Psychologists’ Register, and in his practice he frequently consults with pediatricians about the use of medications in the treatment of children and adolescents. For over a decade, he has been a member of medical staff at Meridian Health, Brick Hospital Division, a primary care hospital. In addition, Dr. Kapalka is school-certified in New Jersey and heads a state-accredited Independent Child Study Team.Dr. Kapalka’s research program has focused on the education and treatment of youth with disruptive disorders, as well as the use of nutritional and herbal supplements in the treatment of children and adolescents. He is an author of four books and dozens of professional publications and presentations. Dr. Kapalka is active in professional and community education and has held dozens of workshops for medical and mental health professionals, teachers, and parents. Dr. Kapalka has been interviewed in newspapers, Internet publications, and on television.

Pediatricians and Pharmacologically Trained Psychologists 3
Preface 5
About the Editor 13
Contents 15
Contributors 19
Part I Foundations of Collaborative Care 25
Chapter 1: Psychology, Psychopharmacotherapy, and Pediatrics: When to Treat and When to Refer 26
Conditions 27
Treatments 29
Integration of Medical Psychology with Pediatrics 31
Case Study Vignettes 34
Attention Deficit 34
Psychosis 35
Panic Disorder 35
Bipolar/Major Depression 35
Addictions 36
Conclusion 37
References 38
Chapter 2: Collaboration Between Pharmacologically Trained Psychologists and Pediatricians: History and Professional Issues 40
A Brief History of a Movement 41
The Case for PTPs in Pediatric Care 44
Professional Issues in Collaborating with Pediatricians 46
Case Example: Childhood Bipolar Disorder 53
Conclusions 55
References 55
Part II Collaboration with Pediatricians in Specific Settings 58
Chapter 3: The Clinical Experience of RxP-Trained Psychologists Working in Non-RxP States 59
RxP Training 59
The Importance of Training in Psychopharmacology 60
The Utility of Prescription Privileges 60
Viewpoints Opposed to RxP 61
General Consensus 61
Collaboration with Physicians 61
Building Relationships with Physicians 62
Case #1 62
Working Through 63
Case # 2 64
Case #3 65
Iatrogenic Problems 65
Case Study #4 65
On The Capacity to Bear Uncertainty 66
Who is the Patient? 67
Case # 5 67
Case #6 68
Summary 68
References 69
Chapter 4: The Practice of Medical Psychology in an RxP State: New Opportunities for Comprehensive Pediatric Care 71
Practice Settings 72
The Collaboration Process 73
The Medical Psychologist’s Perspective 73
The Pediatrician’s Perspective 75
A Metabolic Perspective 76
The Parent’s Perspective 76
When to Medicate 78
Family Dynamics 78
Unconscious Expectations 79
Comorbidities 79
Development Problems 80
Trauma 81
Concurrent Medical Conditions 82
Adverse Reactions 83
Practical Issues 83
Prescriptions 83
Settings 84
Conclusions 85
References 86
Chapter 5: Integrated Care in Rural Settings 88
Integrated Models of Treatment and Rural Communities 89
Tourette’s Disorder and Kyle 90
Barriers 91
Integrated Model 93
Collaborative Care 93
Charlie in the Fishing Village 94
Barriers 96
Colocated Treatment Models 97
Wally and Grandfather Jones 97
Barriers 100
Fully Integrated Collaborative Model 101
Grandmomma Fanny and Annie 101
Barriers 106
Consultation Models 106
Mary: Combined Diabetes with Eating Disorder 106
Barriers 109
Tertiary or Independent Private Practice 110
Matt, Sam, and Grace 110
Barriers 112
Summary Remarks 113
Lessons Learned 114
References 115
Chapter 6: Collaborative Practice with Pediatricians Within the Indian Health Service: Taking Care of Frontier Children* 116
Indian Health Service 117
IHS National Model for Innovative Health Care 118
Medical Psychology in IHS: Responding to the Grassroots Need for Access to Quality Mental Health Care 119
Scope of Practice of Federal Prescribing Psychologist 121
Preparing Psychologists for Prescribing in the Indian Health Service 121
History of RxP Within IHS 123
IHS Prescribing Medical Psychology Precedent: Dr. Floyd Jennings PhD 123
United States Public Health Service (USPHS) Commissioned Corps Disaster Mental Health Deployment: Rosebud Reservation 124
Aberdeen Area IHS Behavioral Health Strategic Initiative 125
IHS Headquarters Division of Behavioral Health: Interagency Collaboration 127
Common Psychiatric Childhood Disorders Among Native American Children 128
Attention-Deficit/Hyperactivity Disorder (ADHD) 128
Mood Disorders 130
Anxiety Disorders 131
Summary 131
Collaboration with Healthcare Providers: Challenges and Solutions – A Story from Standing Rock Reservation 132
How Medical/Prescribing Psychologists and IHS Can Improve Psychiatric Care for Native American Children 136
Credential More Psychologists 136
Primary Care Integration 137
Educate Pediatricians About Medical Psychology 138
References 138
Chapter 7: The Practice of Medical Psychology in a Pediatric Hospital Setting: A Personal Account from an RxP State 139
Evolution of Medical Psychology’s Role at Children’s Hospital 140
Inpatient Medical Psychology Consultation 142
Anxiety and Agitation 143
Pain 144
Sleep Disorders 145
Case Examples 147
Jenny: End-Stage Renal Disease 147
Joey: Atypical Neuroleptic Malignant Syndrome 148
Conclusion 149
References 150
Part III Collaboration with Pediatricians in Treatment of Specific Disorders 152
Chapter 8: Collaborative Treatment of Disruptive and Mood Disorders 153
Pediatrician/Psychologist Collaboration 154
Psychologists as Consultants: Models of Practice 155
Consultation in Primary Care Outpatient Settings 156
Collaborative Care in Treatment of Disruptive Disorders 158
ADHD 158
Tic Disorders 160
ODD and CD 162
Collaborative Care in Treatment of Mood Disorders 164
Depression 164
Bipolar Disorder 166
Outreach to Pediatricians 168
References 168
Chapter 9: Collaboration Between Pediatricians and Pharmacologically Trained Psychologists in the Treatment of Anxiety Disord 170
The Pediatrician’s Dilemma 172
Anxiety Disorders in Children 174
Trauma Disorders in Children 175
Pediatric Consultation 175
Psychopharmacological Interventions 176
Case Studies 177
Fred 177
Jennifer 178
Mary 179
Alice M 180
Ralph 181
Summary 182
References 183
Chapter 10: Collaborative Treatment of Eating Disorders 184
Advantages of Pediatrician–Psychologist Collaboration 187
Models of Collaboration 190
Colocated Clinics Model 191
Behavioral Health Consultant Model 191
Staff Adviser Model 192
Self-Medicating Reinforcement Cycles 192
References 195
Chapter 11: Collaborative Treatment of Medical Disorders: The Management of Diabetes 199
Scope of Practice of the Health and Medical Psychologist 199
Treatment Adherence and the Health Belief Model 200
The Task of the Health Psychologist 203
Assessment 204
Psychopharmacological Interventions with Medical Conditions 207
The Session with a Medical Patient 208
The Interface with the Medical Practice 210
The Training Needs in the Clinical Psychology Curriculum 212
The Endgame 212
References 213
Chapter 12: Collaborating with Pediatricians and Gastroenterologists: A Biopsychosocial Approach to Treatment of Gastrointesti 215
Biopsychosocial Management of Pediatric GI Disorders 216
Brain–Gut Interaction 221
Role of the Pediatric Psychologist in the GI Setting 222
Diagnostic Assessment 223
Coping and Adjustment 224
Pain Assessment and Management 225
Behavior Change 227
Role of Medical Psychology in Pediatric Gastroenterology 229
Treatment of Pain Related to Pediatric Functional GI Disorders with Psychotropic Medications 230
Treatment of Disordered Sleep in Pediatric Functional GI Disorders 231
Treatment of Comorbid Anxiety and Depressive Disorders in Pediatric Functional GI Disorders 232
Suggested Treatment of Common Pediatric Gastrointestinal Diagnoses 233
Cyclic Vomiting Syndrome 233
Chronic and Recurrent Functional Abdominal Pain 234
Functional Constipation and Encopresis 235
Inflammatory Bowel Disease 236
Pain-Associated Disability Syndrome 236
Rumination Syndrome 238
References 239
Part IV Future Directions in Pharmacological Collaboration 246
Chapter 13: Brain Markers: An Emerging Technology with Potential to Enhance Collaboration Between Pediatricians and Pharmacolo 247
Why Should Psychologists Consult with Pediatricians? 247
Brain Markers 248
The Emerging Model for Use of Brain Markers in Clinical Practice 248
Types of Brain Markers 251
Brain Resources 253
The Testing Process 255
References 258
Chapter 14: Internship and Fellowship Experiences: Preparing Psychology Trainees for Effective Collaboration with Primary Care 262
Establishing Goals for Psychology Training in Collaboration with Primary Care 264
Collaborative Training Experiences Within Academic Medical Centers, Hospitals, Residential Treatment Facilities, and Outpatien 265
Consultation-Liaison in Hospital Settings 266
Consultation-Liaison in Primary Care and Family Medicine Clinics 268
Collaborative Training on Inpatient Unit Teams 269
Multidisciplinary Group Supervision and Training in Outpatient Clinics 271
Joint Treatment Sessions 275
Multidisciplinary Didactics, Seminars, and Case Conferences 276
Conclusion 277
Recommendations for Psychology Training Directors 278
Recommendations for Interns and Postdoctoral Fellows 280
References 281
Chapter 15: The New Face of Psychology Predoctoral Training: Psychopharmacology and Collaborative Care 284
How Does This Impact Students? 285
Prescriptive Authority in Louisiana: A Successful Model 285
§403 Application for Certificate of Prescriptive Authority 286
Sample Curricula 288
§403 Application for Certificate of Prescriptive Authority [in Louisiana] 288
Consultation and Collaboration 289
Classroom Instruction and Supervised Training 291
Classroom Instruction and Supervised Training: Mentorship and Networking 293
Research 295
Development of Standards 295
Future Implications: The Importance of Integrated Care 296
References 297
Chapter 16: RxP Training Informs the Practice of Supervision of Nonpharmacologically Trained Mental Health Practitioners 298
A Guiding Framework for Pharmacological Treatment of Mental Health Disorders 302
Step 1: Determining the Need for Pharmacological Treatment 305
Step 2: Developing a Plan for Measurement and Administration of Pharmacological Treatment 306
Step 3: Implementing the Protocol 308
Step 4: Evaluating the Data and Making Iterative Decisions 308
Supervision of Nonpharmacologically Trained Mental Health Professionals 308
Summary 312
References 312
Index 314