MUNROE-MEYER INSTITUTE

Munroe-Meyer Institute for Genetics and Rehabilitation

Match Code 141617

985450 Nebraska Medical Center

Omaha, Nebraska 68198-5450

402/ 559-6408

Fax 402/ 559-5737

Training Director:

Keith D. Allen, Ph.D.
kdallen@unmc.edu

Type of Facility:

The Munroe Meyer Institute is a federally designated University Center of Excellence for Disabilities Education, Research and Service.  MMI specializes in providing services and support for persons with behavioral, emotional, physical, health, cognitive, genetic and developmental disabilities.  Education, research, training, and clinical service programs are provided in an interdisciplinary and collaborative environment. MMI provides advanced interdisciplinary educational programs to students in over 15 disciplines and programs.  The Institute's mission includes a strong commitment to applied and basic research conducted by faculty and staff in all of MMI's disciplines and programs related to the prevention and treatment of disabilities.

Services are provided on-site, in the hospital, in schools and in community based primary clinics throughout Nebraska. MMI also provides state-wide technical assistance and consultation to public schools and other programs providing services to children, youth and adults with a wide variety of disabilities. Referrals are made by pediatricians, schools, and parents seeking treatment, second opinions, or interdisciplinary assessments for children and adolescents. A professional staff is organized within disciplines that include Psychology, Special Education, Human Genetics, Developmental Medicine, Occupational Therapy, Physical Therapy, Speech Pathology, Social Work, and Nutrition.

Internship Training Model:

Interns within the Nebraska Internship Consortium who are matched with MMI have the opportunity to receive training that is decidedly behavioral in orientation and focuses on evidence-based practice, including data-driven decision making and the implementation of empirically derived behavioral treatment technology. Clinical training and supervision is arranged sequentially. The intern starts by observing their supervisors, then progresses to participant observer, then co-therapist, and finally to primary therapist. Since training is designed to continuously move the intern toward independence, faculty work to move the interns into primary clinical positions as soon as possible. Assessment of competencies, completion of learning objectives and progression toward independence are reviewed every three months between the intern and their supervisor. Interns typically spend 60-70% of their time in clinical activities, approximately 15-20% of their time in research related activities and approximately 10% of their time in professional development. Faculty consider attendance at conferences to be an important part of professional development as well as a means of establishing important contacts for future employment. Thus, all interns are encouraged to attend educational workshops and professional conferences during the year. In addition, interns who have been invited to present clinical research findings at conferences or who are preparing presentations for job interviews are encouraged and financially supported by the department to use the Institute Media Center to develop professional quality presentations.

Additional resources are available to the intern include office space, an individual computer, access to the internet and online statistical packages as well as online library search engines, unlimited copying and phone services and media services. Interns receive a 12 month stipend of $19,800.

Program Rotations:

Interns within the Nebraska Internship Consortium who are matched with MMI have the opportunity to receive training in rotations within or across three different programs. Interns select two 6 month rotations and may elect to do the 2 rotations within one program (i.e., Behavioral Pediatrics, Outreach, or Autism) or across any two of the three programs.

Behavioral Pediatrics Program: Clinic-based rotations are available in which trainees learn outpatient behavioral assessment and treatment techniques for common developmental and behavioral problems encountered by children, adolescents and their families, including problems such as noncompliance, tantrums, ADHD, disruptive school behavior, adjustment disorders, anxiety, depression, habit disorders, etc. These rotations also provide "specialized" behavioral health training opportunities (depending upon the faculty supervisor) in areas such as: Childhood Sleep Disorders (Kuhn), Academic Disorders (Shriver), Chronic Pain Management and Stress Related Disorders (Allen), and Neuropsychology (Warzak). Services are also provided for behavioral and emotional adjustment problems related to children and families with developmental disabilities.

Outreach Integrated Behavioral Health Program: Interns may choose rotations in which they provide behavioral health services which are integrated into primary care clinics. In these clinics, interns learn to work alongside physicians and staff in the community in both rural and urban sites throughout Omaha and eastern Nebraska. Experiences include provision of assessment and treatment of common behavioral health problems (e.g., sleep, toileting, school behavior, ADHD), as well as for individuals and families with disabilities. Through these experiences, interns can expect to learn how best to integrate into the culture of primary care while providing evidence-based treatment. This program also has monthly team meetings to discuss pragmatic issues endemic to integration of behavioral health services and research into primary care.

Center for Autism Spectrum Disorder Program: Rotational opportunities are available in day treatment settings in which Interns learn to use techniques derived from applied behavior analysis to evaluate and treat severe problem behaviors.  Interns can choose from one of three programs. A major focus of the Severe Behavior Disorder Program (Fisher/Roane) is to provide highly specialized services to children with developmental disabilities who display destructive behaviors (e.g., aggression, self-injury, pica, property destruction).  A major focus of the Feeding Disorder Program (Piazza) is to provide highly specialized interdisciplinary services to children with developmental disabilities who display feeding problems (e.g., tantrums, food refusal, vomiting) in both day treatment and outpatient settings. Finally, a major focus of the Early Intervention Program (Kodak) is to provide highly specialized services to young children diagnosed with an autism spectrum disorder focusing on teaching language, academic and pre-academic skills, appropriate social behavior, and daily living skills. The program offers a continuum of services including evaluation, school consultation, clinic-based intervention, and home-based program development.

Interns are also typically involved in staffing many of the follow clinics at some time during their training experience, regardless of their program rotations:

• ADHD Diagnostic Clinic
• Ambulatory Pediatrics Clinic
• Autism Diagnostic Clinic
• Neurobehavioral Clinic
• Neonatal Follow up Clinic
• Cerebral Palsy Clinic
• Outreach Clinics
• Fetal Alcohol Syndrome Clinic
• Sleep Disorders Clinic

Professional Development Training:

Interns and Fellows attend monthly professional development activities that are provided through weekly research and professional development presentations, monthly interdisciplinary leadership seminars, regular case conferences and attendance at Pediatric Grand Rounds. A sample of recent topics from weekly professional development presentations include:

• Behavior Management of Sleep Disorders
• Cultural Sensitivity in Multidisciplinary Services for Individuals with Disabilities
• Setting up a Behavioral Health Services Private Practice in a Primary Care Setting
• Behavior Management of Medical Adherence
• Family-Centered Care
• Doing Clinical Research in a Medical Setting
• Management of Post-Traumatic Reactions to Terrorist Acts
• Family Adaptation to Diabetes
• Job Interviewing and Negotiating
• Grant Writing
• Behavioral Pain Management

Research Training:

All interns are expected to participate in ongoing interdisciplinary and clinical research. Interns regularly publish clinical research with their supervisors, a sample of which are listed below: (Intern in italics)

• Cowan, R.J. & Allen, K.D. (2007).Using naturalistic procedures to enhance learning in individuals with autism: A focus on generalized teaching within the school setting. Psychology in the Schools, 44(7), 1-15.
• Allen, K.D. (2007) EMG biofeedback treatment of dysphonias and related voice disorders. Journal of Speech-Language and Applied Behavior Analysis, 2.2: 149-157.
• Moore, J. W., & Fisher, W. W. (2007).The effects of videotape modeling on staff acquisition of functional analysis methodology. Journal of Applied Behavior Analysis, 40, 197-202.
• Tiger, J. H., Bouxsein, K. J., & Fisher, W. W. (2007).Treating excessively slow responding of a young man with Asperger syndrome using differential reinforcement of short-response latencies. J Applied Behavior Analysis, 40, 559-563.
• Valleley, R., Kosse, S., Schemm, A., Foster, N., Evans, J., & Polaha, J. (2007). Integrated care for children in rural communities: Examination of patient attendance to behavioral health services. Families, Systems, & Health, 25, 323-332.
• Evans, J. H., Polaha, J., Valleley, R. J., Jones-Hazledine, C., & Foster, N. L. (2006). Behavioral health in rural pediatric primary care. Journal of Rural Mental Health, 31, 28-35.
• Kuhn, B. R. & Floress, M.T. (in press). Nonpharmacological interventions for sleep disorders in children. In A. Ivanenko (Ed.), Sleep and Psychiatric Disorders in Children and Adolescents.
• Schnoes, C.J., Kuhn, B.R., Workman, E., & Ellis, C. (2006) Pediatric prescribing practices of clonidine and other psychopharmacological agents for pediatric sleep disturbances. Clinical Pediatrics, 45, 229-238.
• Hupp, S. D. A., Reitman, D., Forde, D., Shriver, M., & Kelley, M. L. (in press). Advancing the assessment of parent-child interactions: Development of the Parent Instruction-Giving Game with Youngsters. Behavior Therapy.
• McCurdy, M., Skinner, C. H., Watson, T. S., & Shriver, M. D. (in press). Examining the effects of group contingencies on the writing performance of middle school students with learning disabilities in writing. School Psychology Quarterly.
• DuFrene, B.A. & Warzak, W.J. (2006) Extending Brief Experimental Analyses of Oral Reading Fluency to Spanish. Journal of Behavioral Education.
• Piazza, C. C., & Addison, L. R. (2007).Function-based assessment and treatment of pediatric feeding disorders. In P. Sturmey (Ed.), Functional Analysis in Clinical Treatment. Academic Press: Burlington, MA.
• Cohen, S. A., Piazza, C. C., & Navathe, A. (2006). Feeding and nutrition. In I. L. Rubin & A. C. Crocker (Eds.), Medical Care for Children and Adults with Developmental Disabilities. Baltimore, MD: Paul H. Brooks Publishing Co.

Past interns' positions in (selected sample):

The Munroe-Meyer Institute has trained interns with widely varying backgrounds, experiences, and professional aspirations. All have a common goal of pursing clinical, research, and/or teaching positions in the service of children, youth and families of children and youth with common adjustment/behavior problems as well as those with more severe handicapping conditions and developmental disabilities. Interns have gone on to meet these goals in a wide variety of clinical, school, academic, medical, and private practice settings:

Private Practice
Lincoln Pediatric Group, NE
Great Plains Clinic, ND
Heartspring Program, KS
Mankato Clinic, MN
Pediatric Associates, Iowa City, IA
Language Development Program, NY
Kearney Clinic, NE
Partners in Behavioral Milestones, KS
Columbus Pediatrics, NE

Medical/Hospital Settings
Children's Seashore House, PA
Beatrice State Hospital, NE
LSU Medical Center, LA
UNMC/Munroe-Meyer Institute, NE
Eastern State Hospital, VA
U of OK Health Sciences Center
Southeast Hospital, Mandeville, LA
U of South Dakota School of Medicine, SD

Public Schools
Gig Harbor Schools, WA
Biloxi Schools, MS
Phoenix Public Schools, AZ
Sarasota Schools, FL
LaGrange Schools, IL
Wamego Public Schools, KS

Academic Departments
Brock University, Canada
East Tennessee State University
Florida State University
Kent State University
Louisiana State University
Mississippi State University
North Carolina State University
Texas A&M University
University of Southern Mississippi
University of Cincinnati
University of Oregon
University of Nebraska
University of Oklahoma Health Sciences Center
Utah State University
West Virginia University

Behavior Pediatrics Program Faculty:

Keith D. Allen, Ph.D.
West Virginia University 1987

Pediatric pain management, health-related behavior in children, parent training, stress-related disorders, autism, child management during invasive medical and dental
procedures. Publications include articles in Journal of Applied Behavior Analysis, Behavior Therapy, Headache, Pediatric Dentistry, Child and Family Behavior Therapy.

Brett R. Kuhn, Ph.D.
Oklahoma State University, 1992

Sleep disorders, Parent-Child Interaction Therapy (PCIT), elimination disorders, Fetal Alcohol Syndrome. Publications include articles in the Journal of Pediatric Psychology, Clinical Child and Family Psychology Review, Psychological Bulletin, Child & Family Behavior Therapy, Sleep, and Clinical Pediatrics.

Judith R. Mathews, Ph.D.
University of Kansas, 1988

Medical adherence, chronic illness, feeding disorders anxiety disorders, transitional problems (including adoption and foster care), adolescent females, primary care, and international public health. Publications include articles in Journal of Applied Behavior
Analysis, Pediatrics, Journal of Developmental and Behavioral Pediatrics.

Mark D. Shriver, Ph.D.
University of Nebraska, 1994

Academic and behavioral assessment for children with disabilities and school related problems, parent training, child noncompliance. Publications include articles in School Psych Review, Journal of Evidence Based Practices for Schools, Journal of Applied Behavior Analysis, Behavior Therapy.

William J. Warzak, Ph.D.
Georgia State University, 1987

Pediatric neuropsychology, diabetes, elimination disorders, feeding and swallowing disorders, pediatric rehabilitation, social skills training. Publications include articles in Behavior Therapy and Experimental Psychiatry, Archives of Physical Medicine and Rehabilitation, Children's Health Care, Pediatrics.

Outreach Integrated Behavioral Health Program Faculty:

Joseph H. Evans, Ph.D
University of Kansas, 1974

Integrated behavioral health in primary care, rural pediatricbehavioral health, dissemination research, Attention Deficit Hyperactivity Disorder, adolescent behavior. Publications include articles in: Journal of Rural Mental Health, Pediatrics, Families
Systems and Health, Child and Family Behavior Therapy

Rachel Valleley, Ph.D.
University of Nebraska at Lincoln, 2001

Impact of behavioral health clinics in primary care settings, clinical case studies, treatment integrity, and parent training. Publications in Journal of Behavioral Education, Journal of Applied Behavior Analysis, Pediatrics, Families, Systems and Health, and Journal of Rural Mental Health.

Holly Roberts, PhD.
Illinois State University, 2006

Rural behavioral health, assessment and treatment of ADHD, treatment outcomes, satisfaction and effectiveness at follow-up. Publications include articles in Behavioral Pediatrics, Behavior Modification, Journal of Applied Behavior Analysis, Parenting: Science and Practice, Proven Practice.

Tawnya Meadows Ph.D.
Mississippi State University, 2003

Autism spectrum disorders, functional analysis, and preference assessment. Publications include articles in Journal of Applied Behavior Analysis, Behavior Modification, School PsychologyReview, Psychology in the Schools.

Nancy Foster, PhD.
Mississippi State University, 2005

Rural outreach, disruptive behavior disorders, ADHD, learning problems, developmental disability, feeding, toileting, and sleep problems. Publications include articles in Journal of Rural Mental Health and Family Systems and Health.

Center for Autism Spectrum Disorders Program Faculty:

Wayne Fisher , Ph.D
University of Texas, 1982

Assessment and treatment of autism and severe behavior disorders, preference, choice, and the creative use of concurrent schedules of reinforcement. Publications include articles in Journal of Applied Behavior Analysis, Pediatrics, Journal Developmental
and Behavioral Pediatrics, and The Lancet.

Cathleen Piazza, Ph.D.
Tulane University, 1987

Pediatric feeding problems, dangerous behaviors that lead to injury, pediatric sleep problems, brain-behavior relations. Publications include articles in Research in Developmental Disabilities, Journal of Applied Behavior Analysis, Disability
and Rehabilitation

Tiffany Kodak, Ph.D.
Louisiana State University, 2006

Early intensive behavioral intervention, choice, Reinforcer assessment. Publications
include articles in Journal of Applied Behavior Analysis, Development and Behavioral Pediatrics, Research in Developmental Disabilities.

Hank Roane, Ph.D.
Louisiana State University, 1999

Assessment and treatment of severe behavior disorders, reinforcer effectiveness, caregiver training, treatment acceptability. Publications include articles in Journal of Applied Behavior Analysis, Behavior Modification.