Fellowship Opportunities
The primary goal of this postdoctoral training program is to train psychologists to assume leadership roles in research, clinical care, and training concerning the promotion of treatment adherence in children with chronic physical and behavioral conditions.
Meet our current fellows.
Need and Rationale
Advances in modern medical treatment have resulted in improved clinical outcomes and quality of life for children with a wide range of chronic physical and behavioral conditions. However, it is well established that the clinical benefits of medical treatment are limited by nonadherence to treatment. Treatment nonadherence occurs frequently and has a negative impact on symptom control, healthcare utilization, costs of care, the patient/physician relationship, and long-term health outcomes, including quality of life of children with chronic physical and mental conditions. Although the clinical significance of treatment nonadherence is well recognized, the science and practice related to treatment nonadherence are in early phases of development. There are important gaps in scientific knowledge in such critical areas as the etiology and processes that relate to nonadherence, factors that promote positive adherence and self-management, and interventions that are most effective in preventing nonadherence and/or containing the impact of clinically significant problems with treatment nonadherence. Moreover, little is known about the most effective strategies and/or psychological intervention to promote adherence to treatment in medical comprehensive care.
One important reason for the gap in scientific and clinical knowledge is the absence of training programs that have been designed to train psychologists to utilize state-of-the-art methods of research and clinical care that advance scientific understanding and clinical outcomes related to adherence to medical treatment. This fellowship has been designed to address this gap in training by providing systematic training in the specialized knowledge and skills related to pediatric treatment adherence in an interdisciplinary research context in a major medical center. Fellows will be trained to assume faculty positions in academic pediatric healthcare settings and lead research and/or clinical service progress.
Setting and Structure of the Program
This new postdoctoral fellowship is one of the fellowship programs of the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children's Hospital Medical Center (CCHMC). The fellowship program is housed in the new Center for the Promotion of Adherence to Treatment and Self-Management, that has been recently established (7/1/07) to address the unmet scientific, clinical, and training needs related to treatment adherence. The first of its kind in U.S., the Adherence Center includes six faculty who represent the disciplines of psychology and biostatistics, a coordinator, and administrative assistant. Based on a national search, faculty were recruited to the Adherence Center based on their interest and expertise in research and clinical care related to treatment adherence (see website http://www.cincinnatichildrens.org/research/project/adherence/default.htm).
Core Training Experiences of the Fellowship
The fellowship in pediatric treatment adherence includes four core training experiences: research, clinical care, program development, and teaching and consultation.
Research - Fellows participate in a range of adherence related research programs that reflect funded and unfunded research conducted by Center faculty. These research programs encompass a wide range of chronic conditions such as type 1 diabetes, pediatric cancer, inflammatory bowel disease, epilepsy, ADHD, sickle cell disease, etc. Content areas of faculty research include the following areas 1) risk factors (e.g., impact of depression on treatment adherence); 2) measurement of treatment adherence based on multiple methods such as self- report, electronic monitoring, and serum assay; 3) influences on the trajectory of self-management and adherence during early adolescence; 4) the relationship between nonadherence and health outcomes; and 5) intervention studies: (e.g., application family-centered problem solving, cognitive and behavioral therapy, and motivational interviewing to promote adherence among children and adolescents in a range of chronic conditions).
Fellows will participate actively in research using established data sets and help to facilitate and develop new research projects. Fellows will also have ample opportunities to learn new state-of-the-art methods of intervention to promote adherence, methods of measurement, and novel statistical techniques that will help expand current research knowledge. Based on their initiative and research experience, fellows will have opportunities to participate as first and collaborating authors in manuscripts.
Clinical Care - Fellows in the Center of Adherence will participate in and facilitate a new clinical service that is being developed to manage adherence problems that are referred from a range of specialties at CCHMC from inpatient and outpatient settings. Fellows will work under faculty supervision and learn specialized strategies concerning clinical assessment and interventions that facilitate the management of challenging problems of treatment nonadherence encountered in a wide range of conditions. The Center's clinical programs will be evaluated in the context of a new research program that will evaluate the clinical outcomes of interventions designed to managing challenging nonadherence problems. Fellows will obtain experience and manage evaluation of psychological interventions to manage treatment nonadherence in the context of clinical practice. They will have unique opportunities to learn how to integrate research and practice and participate in scholarly publications related to case studies and series. Fellows will also participate in comprehensive clinical care and research programs that have been established by Center faculty such as the New Onset Seizure Disorder clinic.
Program Development - The clinical, research, and teaching programs of the Center for Treatment Adherence are relatively new and still in the process of development. Consequently, fellows have an important opportunity to participate in planning and implementing of Center programs (e.g., new research programs and pediatric residency training initiatives) and make significant contributions to program development with their ideas and initiative.
Teaching and Consultation - Fellows will learn methods of providing consultation and educational sessions to medical and nursing staff that focus on the management of adherence problems and adherence promotion in clinical settings. In addition, fellows have opportunities to provide mentorship to psychology residents, graduate students and research assistants in the context of specific research and clinical care initiatives.
Philosophy and Methods of Training
Based on dialogue with Center faculty, fellows' training programs will be tailored to their individual interests' and career development needs with respect to the balance of research and clinical care as well as specific content areas. Fellows are expected to take initiative for their individual projects and training program in the context of close and collegial mentorship. Each fellow will have a primary research mentor and a mentorship team comprised of Center faculty. Fellows will participate actively in a new series of didactic seminars that are provided by Center faculty. These seminars include: presentations of ongoing research, a journal club that focuses on new scientific articles concerning treatment adherence, didactic presentations on key issues such as methods, measurement, and statistical analyses, preparation of research grants that focus on treatment adherence and writers' workshop seminars that focus on preparation of manuscripts and research grants (see website for more information).
Resources and Facilities
Fellows will have space and a computer in the Center's offices in the new research "S" building at CCHMC. Fellows will also have access to research assistant help and research supplies as needed to develop new research projects. Fellows' stipend will be at the current (2007-2008) NIH levels ($37,000). Healthcare benefits are available through CCHMC. Travel funds are available to present research findings at a scientific meeting.
Application Procedures
Please email a letter describing how your interests, experience, and potential fit with the fellowship program, your CV, and at least three letters of recommendation from research and clinical mentors to the Center Director, Dennis.Drotar@cchmc.org.
