Toolkit for PCBH in Pediatric Primary Care Lesley Manson, Psy.D., Assistant Chair of Integrated Initiatives, Clinical Assistant Professor, Arizona State University, Phoenix, AZ Tawnya Meadows, Ph.D., BCBA-D, Co-Chief of Behavioral Health in Primary Care-Pediatrics, Geisinger, Danville, PA Matthew Tolliver, PhD, Assistant Professor/Psychologist, Eastern Tennesee State University Pediatrics, Johnson City, TN Allison Allmon Dixson, Ph.D., Pediatric Psychologist, Gundersen Health System, La Crosse, WI Cody Hostutler, Ph.D., Psychologist, Nationwide Children's Hospital, OH Sarah Trane, PhD, Assistant Professor, Division of Integrated Behavioral Health (Pediatrics), Mayo Clinic Health System, La Crosse, WI Brian DeSantis, Psy.D., ABPP, VP, Behavioral Health, Peak Vista Community Health Centers, Colorado Springs, CO Session # PC 3 CFHA 20 th Annual Conference October 18-20, 2018 • Rochester, New York
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Toolkit for PCBH in Pediatric Primary Care
Lesley Manson, Psy.D., Assistant Chair of Integrated Initiatives, Clinical Assistant Professor, Arizona State University, Phoenix, AZ
Tawnya Meadows, Ph.D., BCBA-D, Co-Chief of Behavioral Health in Primary Care-Pediatrics, Geisinger, Danville, PA
Matthew Tolliver, PhD, Assistant Professor/Psychologist, Eastern Tennesee State University Pediatrics, Johnson City, TN
Allison Allmon Dixson, Ph.D., Pediatric Psychologist, Gundersen Health System, La Crosse, WI
Sarah Trane, PhD, Assistant Professor, Division of Integrated Behavioral Health (Pediatrics), Mayo Clinic Health System, La Crosse, WI
Brian DeSantis, Psy.D., ABPP, VP, Behavioral Health, Peak Vista Community Health Centers, Colorado Springs, CO
Session # PC 3
CFHA 20th Annual ConferenceOctober 18-20, 2018 • Rochester, New York
Toilet Talk• Cody Hostutler, PhD
• Pediatric Primary Care Psychologist at Nationwide Children’s Hospital• Assistant Professor at The Ohio State University
• Tawnya Meadows, PhD, BCBA-D• Co-Chief of Behavioral Health in Primary Care - Pediatrics at Geisinger• Assistant Professor at Temple University
Hayley Quinn, PsyD• Psychologist at West Seattle Pediatrics part of Swedish Pediatrics
CFHA 20th Annual ConferenceOctober 18-20, 2018 • Rochester, New York
Faculty Disclosure
The presenters of this session have NOT had any relevant
financial relationships during the past 12 months.
Potty TrainingANTICIPATORY GUIDANCE
Typical Potty Training• Start anticipatory guidance at 18 mos
• Average training period is 6 months• Earlier start -> longer training period• Starting before 27 months does not result in earlier completion
• 85% of 30 month olds are continent during the day, Bowel Control usually occurs by 36 months
• Nighttime control occurs months to years later and is expected at 5-7 years old
Fun Facts• Girls complete toilet training 2-3 mos earlier than boys
• First born usually takes longer
• Racial Differences• 50% of AA parents reported that it was important to have child toilet
trained by age 2 compared to 4% of Caucasian Families• AA parents start toilet training at 18 mos, Caucasian families start
around 25 mos
• Digo People in East Africa teach their children to urinate and stool on command by 4-5 months of age
Potty training readiness is based on development of readiness, not age
• Ability to stay dry for 2 hours or more
• Understand “wet” “dry” “pants” and able to tell parents when they are wet/dirty
• Showing interest: Asking for “big girl/boy” underwear; Asking about toilet
• Follows simple directions
• Able to recognize, express, and delay urge to use bathroom
• Regular BM schedule
• Able to pull down diapers/training pants/underwear
Potty Training Readiness
Two ApproachesParent led
•“Potty Party”
•Increase fluids
•Regular sit times
•Rewards for compliance• Sticker chart/M&Ms
•Over-correction for accidents
Child led
•Build vocabulary
•Presentation of the potty chair
•Shaping with positive reinforcement
•Transition to underwear
•Most consistent with AAP
Notes:- No head to head comparison trials - Independent trials show little difference in outcome- AAP approach most closely resembles child-led approach