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Department of Family Medicine

Behavioral Sleep Medicine


The Behavioral Sleep Medicine minor rotation provides interns the opportunity to gain knowledge of and skills in the diagnosis and treatment of both physiological and behavioral sleep disorders.  Interns will evaluate and treat patients predominantly ages 6 months to 21 years with a variety of presenting sleep complaints.  Patients seen in the Pediatric Behavioral Sleep Clinic also commonly have co-morbid medical (e.g., atopic dermatitis, asthma) or psychiatric (e.g., autism spectrum disorder, anxiety) disorders.  Interns are responsible interviewing patients, formulating diagnoses, creating treatment plans, and providing follow-up care.  In addition, interns will have the opportunity to participate in a professional project related to pediatric sleep.

 
Goals/Objectives of the Training Program

The Behavioral Sleep Medicine minor rotation is offered through the Department of Pediatrics and Division of Pediatric Behavioral Health at National Jewish Health. The primary objective of this program is to teach interns how to evaluate, diagnose, and treat pediatric sleep disorders. At the completion of this rotation, trainees will be able to:

  1. Conduct a developmentally appropriate sleep evaluation, focusing on a child’s sleep, medical, and developmental history
  2. Formulate differential diagnoses based on presenting concerns and history
  3. Develop and implement behavioral treatment plans for the most common presenting pediatric behavioral sleep issues (e.g., bedtime problems and night wakings, insomnia)
  4. Dictate clinical evaluations

Through this rotation trainees will also be exposed to:

  1. Professional pediatric psychosocial meetings and case presentations within the Division of Pediatric Behavioral Health
  2. Primary research literature demonstrating the validity and application of behavioral interventions for common pediatric sleep disorders
  3. Clinical research opportunities

Specific Training Activities

Required Activities
This rotation occurs on Wednesdays from 9 a.m. to 5 p.m. at National Jewish Health.

Pediatric Behavioral Sleep Clinic: Interns will attend the Pediatric Behavioral Sleep Clinic on Wednesdays from 12:30-4:30 p.m. On average, interns will see 3 new and 2 follow-up patients per week. After an initial training/observation period, interns will be responsible for conducting the clinical intake interview. Differential diagnoses and treatment recommendations will be determined together with the supervisor (who will be present during the clinic).

Professional Meetings: Interns will attend the weekly Division of Pediatric Behavioral Health meeting where professional issues (e.g., patient care, billing, scheduling) are discussed (Wednesdays 9-10 a.m.). As members of the division give regular case presentations, the intern will also be required to give one case presentation at the end of the rotation.

Professional Project: Interns will choose a clinically based project to work on each week while at National Jewish Health (Wednesdays 10 a.m. – 12 p.m.). Although the time spent on this project is limited to the training time at NJH, it is expected that the trainee will have a completed project at the end of the rotation (e.g., be prepared to present a poster at a professional meeting, or be an author on a case report, review chapter, or original research article).

Follow-Up Patient Care: Interns will be given an active confidential voice mail number where patients can call in with an update in between follow-up visits. Interns will be responsible for checking this voice mail daily and returning patient calls within 24 hours.

Documentation: Interns are expected to dictate their clinic notes prior to leaving NJH, as well as edit and return their clinic letters to the supervisor within 48 hours or receipt by email.

 

Optional Activities

Sleep Medicine Journal Club: This monthly journal club, sponsored by the Division of Sleep Medicine at National Jewish Health, meets on the first Tuesday of the month from 12:30-1:30 p.m. to review recently published articles in the field of sleep medicine. Interns have the option of attending and/or presenting at journal club.

Sleep Medicine Grand Rounds: This weekly didactic, sponsored by the Division of Sleep Medicine at National Jewish Health, covers clinical and research topics on physiological and behavioral sleep issues. Grand rounds are Tuesdays from 1:30-2:30 p.m.

Adult Behavioral Sleep Medicine Clinic: Interns may have the opportunity to observe this clinic which focuses on the diagnosis and treatment of primary and co-morbid insomnia in adults (clinic sessions on Mondays, Wednesdays, and Thursdays).

Parent Sleep Group: Interns have the opportunity to attend and co-lead a parent sleep support group (every other Thursday from 11 a.m. to 12 p.m.) for parents of children with severe asthma and atopic dermatitis participating in the day hospital program at NJH.

Theoretical Approaches

The primary theoretical treatment approach utilized in the Pediatric Behavioral Sleep Clinic is behavioral. There are a number of well-validated and efficacious behavioral interventions for pediatric sleep, in particular for bedtime problems and night wakings. Interventions are typically brief (1-2 follow-up visits with an additional 1-2 brief phone calls) and problem focused.

Evaluations are also approached from systemic perspective, as a significant portion of pediatric behavioral sleep issues are related to interactions with the child’s environment (e.g., parenting practices, school anxiety). Finally, because sleep changes significantly over development, a developmental framework is also applied to the presenting issues and treatment approaches.

Types of Clinical Approaches

Clinical activities include diagnostic interviews, as well as the development and implementation of brief interventions.

Population of Clients

Patients seen in the Pediatric Behavioral Sleep Clinic range in age from 6 months to 21 years. Patients are referred by community primary care providers and National Jewish pediatricians. A significant number of patients also self-refer. The majority of patients seen have private insurance, although Medicaid patients are also seen.

Supervision

Interns will receive regular supervision for at least one hour every week. This includes live supervision during patient evaluations, as well as before and after the clinic to help formulate clinical hypotheses and treatment plans for new patients, and discuss next steps for follow-up and ongoing patients. In additional, professional development and project supervision will be provided as needed.

 

Lisa J. Meltzer, Ph.D. is the supervisor for this rotation. Dr. Meltzer is an Assistant Professor of Pediatrics at National Jewish Health. She is board certified in Behavioral Sleep Medicine by the American Academy of Sleep Medicine. She received her B.A. from Pomona College, and her M.S. and Ph.D. from the University of Florida’s Clinical and Health Psychology program. She completed her internship in Pediatric Psychology and her fellowship in Pediatric Behavioral Sleep Medicine at the Children’s Hospital of Philadelphia.