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 management of pediatric chronic illness, especially in the promotion of treatment adherence in children, adolescents, and their families.
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, the clinical benefits of medical treatment can be enhanced by more effective management, especially by an increased focus on treatment adherence promotion. 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 chronic illness management including 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 the management of pediatric chronic illness and 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 departments of psychology and lead research and/or clinical service progress in chronic illness management.
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. The fellowship program is housed in the new Center for Adherence Treatment Promotion 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 Center includes seven faculty who represent the disciplines of psychology and biostatistics, a coordinator, and administrative assistant. Based on a national search, faculty were recruited to the Center based on their interest and expertise in research and clinical care related to treatment adherence. Center faculty work closely with pediatric colleagues in a wide range of subspecialties at Cincinnati Children's and with faculty and graduate students from the University of Cincinnati, Xavier, and Northern Kentucky University.
Philosophy and Methods of Training
Fellows will be trained for potential careers in academic medical settings or departments of psychology. The training program is highly individualized. Based on dialogue with Center faculty, fellows' training programs are 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 of focus.
Fellows are expected to take initiative for their individual projects and training program in the context of close and collegial mentorship from faculty. Each fellow will have a primary mentor and a mentorship team comprised of Center faculty. Fellows will participate actively in a new series of didactic seminars.
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 and writers' workshop seminars that focus on preparation of manuscripts and research grants (see website for more information). The training program is enriched by visiting faculty lecturers who have included Barbara Fiese, Michael Rapoff, and Bruce Bender, and Michael Harris.
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, renal, liver, and stem cell transplantation, etc.
Content areas of faculty research include the following areas:
- Risk factors (e.g., impact of depression on treatment adherence)
- Measurement of treatment adherence based on multiple methods such as self- report, electronic monitoring, and serum assay
- Influences on the trajectory of self-management and adherence during early adolescence
- The relationship between nonadherence and health outcomes
- 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
Adherence Center Clinical Service: Fellowship Opportunities
The Adherence Center's clinical service is the first in the country to incorporate research with clinical care aimed at improving treatment adherence among patients and families coping with a pediatric illness. The use of a "real world" context for the delivery of care enables the Center to develop effectiveness-based research, thereby providing valuable information about the utility of evidence-based interventions across various pediatric conditions. Goals for the Center's service include not only improving patient biopsychosocial outcomes, but the dissemination of clinic-based data as a means of increasing synergy between medical and psychology professionals engaged in pediatric care.
Exciting opportunities for fellows are available to participate in the development of this service include the provision of evidence-based interventions to patients and families at-risk for, or having established difficulties with adherence to medical treatment. Fellows with work closely with the clinical service director, Dr. Sandra Cortina, as well as medical practitioners to develop appropriate clinical "action plans" for intervention. Patient referrals will represent a variety of pediatric conditions, including but not limited to: kidney disease, organ transplant, asthma, GI conditions, cancer, and cystic fibrosis. Referrals may also include needle phobia, pill swallowing phobia, and coping with a new diagnosis.
Fellows will learn individual and family based methods of empirically supported interventions (e.g. problem solving, motivational interviewing) for children and adolescents with problems with treatment adherence: they will also have the opportunity to learn methods of integrating clinical care and research including single subject design and case series, and to prepare and publish manuscripts based on this research.
Fellows in the Center of Adherence will participate in and facilitate a new clinical service has been developed to manage adherence problems that are referred from a range of specialties at Cincinnati Children's 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 are being 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.
Resources and Facilities
Fellows will have space and a computer in the Center's offices in the new research "S" building at Cincinnati Children's. 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 (2008-2009) NIH levels for the first year $37,368, and the second year $39,360. Healthcare benefits are available through Cincinnati Children's. 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.
