Developmental-Behavioral Pediatrics Fellowship
Directed by Andrew J. Barnes, MD, MPH, the Developmental-Behavioral Pediatrics Fellowship, which is accredited by the ACGME Residency Review Committee for Pediatrics and includes the American Board of Pediatrics, is a citywide training program jointly sponsored by the University of Minnesota Medical School and collaborating community sites. Strengths of the program include its longevity as one of the longest-running DBP programs nationally; its outstanding ties both to the broad community and to allied disciplines within the University of Minnesota; and the breadth and depth of leadership, research, and teaching opportunities offered by these collaborations. Our fellows are highly sought-after, and go on to obtain excellent positions both within academia and the private sector.
- Applicants must have completed an ACGME accredited residency program by the fellowship start date.
- We accept only applicants who are U.S. citizens or permanent residents (green card holders), or those who have a J-1 Visa.
- The Developmental-Behavioral Pediatrics (DBP) Fellowship Program consists of a number of key clinical, research, and didactic components as outlined by the Program Requirements for Education developed by the American Board of Pediatrics (ABP) and ACGME Resident Review Committee (RRC) for DBP.
- Fellows are assigned to these components in an individually-tailored sequence over the usual 36 months of training. This sequence is dependent upon the fellow's competencies and professional trajectory, consistent with goals and objectives determined by each fellow and the Fellowship Director and delineated in fellows' Individual Learning Plans.
- The DBP Fellowship program, accredited by the ACGME Residency Review Committee for Pediatrics, which includes the American Board of Pediatrics, is a joint effort of the University of Minnesota (UMN — the primary training site), Children’s Hospitals and Clinics of Minnesota (CHCM), Park Nicollet Child & Family Behavioral Health (PN), and Gillette Children’s Speciality Healthcare (GCSH). The UMN DBP clinics are located near the University of Minnesota Masonic Children’s Hospital, and have ~4000 annual patient visits. Across all sites, 11 developmental-behavioral pediatricians supervise patient care and provide education. Trainees from the University of Minnesota Pediatric and Medicine-Pediatric Residency Programs have rotations in DBP and Neurodevelopmental Disabilities across these sites, as well. All of the affiliated training sites serve a wide multi-state region, with patients from all socioeconomic groups. A variety of conditions are seen at each site, with corresponding research and didactic activities occurring on a scheduled as-needed basis.
- UMN DBP Clinics and ASD/NDD Clinics specialize in helping children with developmental disabilities and autism spectrum disorders; adjustment and coping with chronic medical conditions; learning and attention disorders; enuresis and encopresis; pain, sleep, and psychophysiologic disorders; habit problems; anxiety and mood disorders; and stress management. Evaluations and assessments are conducted with inter-professional collaboration. Common treatment modalities include self-regulation (self hypnosis), computerized biofeedback, mindfulness-based-based stress reduction, and parent guidance in effective management strategies for a variety of psychophysiologic and behavioral problems. Treatment groups are held for children with autism spectrum disorders and related social communication problems, including groups focused on anxiety management, social skills, and transitioning to adulthood. Elective opportunities at UMN include NICU follow-up, adoption medicine and fetal alcohol spectrum disorders, child and adolescent psychiatry and psychopharmacology, and pediatric integrative medicine.
- PN DBP clinics specialize in multi-professional team evaluations and collaborative, integrated care focused on the whole child and family. Common conditions seen include mood and anxiety disorders, attention disorders, autism spectrum disorders, learning problems, communication disorders, and conduct problems. On-site therapies are provided by a number of disciplines and include cognitive-behavioral and interpersonal therapy, Parent-Child Interaction Therapy, and speech/language therapy.
- CHCM includes NICU follow-up, Cardiovascular Neurodevelopmental Follow-up, and general Developmental Pediatrics. Elective opportunities at CHCM include pediatric pain and palliative care, child psychology and psychiatry, child abuse pediatrics, sleep disorders and pediatric clinical genetics.
- GCSH includes elective rotations in Pediatric Rehabilitation Medicine; Child Neurology; Down Syndrome; and Sleep Disorders.
- The clinical experience is based on 1st-year fellows having extensive experiences in direct patient assessment, case formulation, and in-depth case discussions with faculty preceptors. Second- and 3rd-year fellows have graduated levels of responsibility for longitudinal patient evaluation and management; applying treatment strategies such as medication and counseling; case coordination and collaborative care; and involvement in systems of care and quality improvement.
- The core clinical curriculum for DBP fellowship years 1-3 consists of at least 4 half-day DBP continuity clinics per week across clinical sites, plus 1-2 rotating- or elective-clinic half-days per week across sites. Each fellow follows at least 60 patients longitudinally over the course of 3 years. Supervision includes co-evaluation and in-person review of clinical encounters, review and discussion of records, weekly face-to-face supervision time separate from clinical encounters, and periodic review and discussion of video recordings of clinical encounters.
- Formal training in developmental-behavioral assessment methodologies occurs during year 1 via workshops, didactics, and clinical observation (depending upon individualized interests, goals, and competencies): diagnostic classification systems such as DSM, DSM:PC, and DSM:0-3; structured observational measures such as ADOS; Functional Behavioral Assessment; standardized neuropsychological, psychoeducational, and clinical psychological scales of emotional function; executive function, cognitive and intellectual abilities, achievement, oral reading, speech and language, and sensory and motor abilities.
- Formal training in advocacy and policy related to developmental-behavioral and mental health, including early intervention and transitions to adulthood, occurs in Years 1, 2, and 3 via participation in LEND and LEAH activities.
- Formal training in advanced management strategies occurs during year 2 via workshops, didactics, and clinical observation (depending upon individualized interests, goals, and competencies): psychopharmacology; behavioral modification; clinical hypnosis, biofeedback, and/or mindfulness; cognitive-behavioral, interpersonal, family systems, and/or psychodynamic therapy; and parent guidance and/or parent-child-relations therapy.
- Required rotations in Years 1 and 2 (e.g., NICU follow-up, PMR, neurology, child psychiatry) include observational and didactic training in rehabilitative therapy methods (including occupational, physical, and speech-language therapies) and psychotherapeutic and behavioral methods (including clinical psychology, martial and family therapy, school psychology, and applied behavior analysis).
- Elective experiences in Years 2 and 3 include (but are not limited to) sleep disorders, genetics, pain and palliative care, child abuse, cardiac neurodevelopmental follow-up, global/international DBP, and inpatient consultation.
- During Years 2 and/or 3, fellows participate in at least one new or ongoing QI/QA project, led by the respective site's Medical Director and attended by medical staff and relevant stakeholders (as needed, e.g. head nurse), with a focus on Plan-Do-Study-Act and Lean process cycles. Fellows can also implement QI/QA projects of their own devising, guided by input from the Fellowship Director, such as: 1) measuring average numbers of visits for psychopharmacology management vs non-pharmacologic management for common clinical problems, 2) screening adherence, and 3) tracking referral follow-up rates.
- Across Years 1-3, DBP Fellows gain competence with cross-cultural communication through didactics, workshops, and case supervision. All sites draw from diverse socioeconomic strata and accept public-, private-, and uninsured/self- pay patients. Fellows work with allied disciplines, such as Social Work, to ensure that patients’ social contexts are adequately addressed as part of their comprehensive well-being. This often includes direct phone and in-person consultation with County Mental Health and/or Developmental Disability Case Workers, Child Protective Services, and assisting families as they navigate a variety of social services such as Medicaid/SCHIP, TEFRA and other waiver/grant programs, and advocate for their families and children in the community.
- The DBP Fellowship consists of 40-60% scholarly activity across 36 months, depending on trainees’ individual needs and career development. As per the ABP, “all fellows will be expected to engage in projects in which they develop hypotheses or in projects of substantive scholarly exploration and analysis that require critical thinking. Areas in which scholarly activity may be pursued include, but are not limited to: basic, clinical or translational biomedicine; health services; quality improvement; bioethics; education; and public policy.” Traditional clinical/basic research or other scholarly activities such policymaking within the broad fields of child development, public health, and developmental psychophysiology are facilitated by research mentors in DBP and related subspecialties and scientific disciplines. Research mentors supervise these studies and are instrumental in guiding the development of individual projects with appropriate specific curriculum (e.g., laboratory meetings, journal clubs, course work).
- Once an area of interest is identified, fellows work with the Fellowship Director, in addition to their specific mentor (or mentoring team) and Scholarship Oversight Committee, to refine the parts of the Individualized Learning Plan to address the specific area of scholarly investigation.
- Areas of investigation for our DBP and DBP-affiliated faculty include, but are not limited to:
- Psychosocial risk and protective factors as they relate to child and adolescent development and behavior
- Translational research on stress, resilience, and self-regulation in children
- Clinical research on pediatric behavioral, autism spectrum, and neurodevelopmental disorders
- Community-engaged research among children and youth who have experienced severe adversity
- Developmental studies that incorporate fMRI, ERP, executive function, attachment and parent-child interactions, body composition and nutritional status, and/or biomarkers of HPA activity, immune-inflammatory response, electrophysiology, and gene-environment interactions
- Educational and curricular research in DBP, primary care pediatrics, and child social-emotional health
- Policymaking regarding early childhood, bullying, vaccination, violence prevention, and parental incarceration
- Developing treatment guidelines for children with developmental-behavioral conditions
- Because of our program's strong affiliations with many collaborators, our DBP fellows enjoy outstanding leadership and research opportunities, both within the University and within the local and regional community.
- Within the University of Minnesota:
- Institute for Child Development, with internationally-renowned experts in developmental psychopathology and clinical psychology
- Center for Neurobehavioral Development, pioneering transdisciplinary approaches to investigate how early experiences shape the development of cognition, affect, and physiology
- Center for Spirituality and Healing, researching and applying methods for integrative health and well-being
- Institute for Translational Research in Children’s Mental Health and the Center for Personalized Prevention Research, using prevention and implementation science methods to design, adapt, tailor, and disseminate evidence-based treatment strategies that improve child and adolescent well-being
- Maternal and Child Health Bureau-sponsored Programs at the University of Minnesota:
- Leadership Education in Neurodevelopmental Disabilities (LEND) — all DBP fellows participate in this program for 1-2 years of their training
- Leadership Education in Adolescent Health (LEAH) — all DBP fellows participate in this program for 1-2 years of their training
- Interdisciplinary Research Training in Child and Adolescent Primary Care
- Within the Community:
Fellows have the opportunity to participate in graduate‐level coursework offered by UMN. Some fellows continue to take coursework to obtain (for example) a Masters of Clinical Research, Masters of Public Health, Masters in Health Informatics, Masters in Psychology or related fields, or Masters in Bioethics. Specific curricula for these programs are listed at their respective UMN websites. Fellows also have opportunities to obtain certificates of training in Quality Improvement, Pediatric Bioethics, Integrative Health, Disabilities, Diversity, and Prevention Science. The DBP Fellowship program is open to discussing options with each fellow for additional training according to goals and objectives in each fellows’ Individual Learning Plan. Participation and tuition payment is dependent upon variable departmental and divisional funding, so cannot be guaranteed in advance and preapproval must be obtained from the Fellowship Director.