Advanced Practice Clinician Section

What is an Advanced Practice Clinician?

Advanced Practice Clinician (APC) is an umbrella term that typically includes physician assistants (PA) and advanced practice registered nurses (APRN). In some facilities, APCs are referred to as Advanced Practice Providers (APP).

APRNs have a master’s or doctoral degree in nursing while PAs complete a course of study that provides a master’s degree. Education and training may vary between APRNs and PAs, but they often serve a similar role in the Developmental and Behavioral clinic. They can diagnose, prescribe medications, and offer continued treatment. They are considered a vital part of the Developmental Behavioral Pediatric workforce.

The scope of practice of APCs is determined by the state in which they work. In certain states, APCs may be limited in their ability to prescribe controlled medications or certain therapeutic interventions. They may be required to have a collaborative or supervisory agreement with a physician. It is recommended to consult with each state’s Board of Nursing (for APRNs) or Medicine (for PAs) and relevant state laws to determine exact scope of practice.

Developmental & Behavioral Pediatric-specific Training and Education for APCs

It is important to note that there are few formal training programs in Developmental Behavioral Pediatrics for advanced practice clinicians. An appropriate training for APCs should include didactic information, clinical experience (shadowing of DBP providers), and any specialized training to conduct assessments (such as ADOS-2).  The length of this training will vary depending on the APC’s experience and comfort. After the initial training period, it is helpful to have a physician or experienced APC available for the new APC to go to when questions arise regarding complex patients or challenging situations. The most successful physician-APC relationships have been found to have an ongoing mentoring component with open bi-directional communication.

Our APC Section has been deeply engaged in conversations about how we can best contribute to advancing the Strategic plan’s three central pillars: Access, Quality, and Growth. Specifically, our Section has been recognized as one of several key priorities in this work, particularly through our initiative to develop an APC DBP Core Competency document.

A dedicated APC Section task force has been collaborating to clarify the scope of this project, identify essential content, and build partnerships to strengthen its development. We are now focused on creating clear, concise, and observable learning objectives across relevant content areas – laying the groundwork for a resource that will support the learning, professional development, and onboarding of Advanced Practice Clinicians in the field of Developmental and Behavioral Pediatrics. This is an important step toward equipping APCs with the tools, skills, and knowledge to deliver high-quality, equitable care in our discipline.

Training Programs

There are limited formal training programs for APCs looking to specialize in DBP. The majority of APCs gain experience and expertise on the job and working with physician and APC mentors. However, there are a few programs that may be helpful in your professional development. There are also new programs with more formal training in development across the country.

• APRN Scholars Program (in partnership with University of Chicago DBP Fellowship Program) offers a 12-month program for APCs which can be completed in person or virtually. Time commitment includes 15-20 hours per week.  With advanced training, APRN’s will be better able to diagnose, manage, co-manage, and refer as needed, children for developmental disabilities (including cerebral palsy, autism, and learning disabilities), medical complexities (including epilepsy, genetic abnormalities, neurological impairment, feeding and respiratory problems), and behavioral issues (including ADHD, anxiety, depression, and incontinence).

• Children’s Hospital of Philadelphia (CHOP) Developmental and Behavioral Pediatrics Advanced Practice Provider (APP) Fellowship Program is a 12-month intensive program designed for nurse practitioners and physician assistants seeking to subspecialize in developmental-behavioral pediatrics. The program provides APPs with the skills needed to prepare them to become competent clinicians. The fellow will be considered a full-time salaried employee of CHOP. The program runs from July to July of the following year.

• KySS Online Mental Health Fellowship is a continuing education program offered through Ohio State University.  The program objectives are to provide clinicians with tools to effectively screen, assess, and manage common mental and behavioral health problems in general pediatric population.

• Leadership Education in Neurodevelopmental and Related Disabilities (LEND) programs provide long-term, graduate level interdisciplinary training as well as interdisciplinary services and care. The purpose of the LEND training Program is to improve the health of infants, children, and adolescents with disabilities. They accomplish this by preparing trainees from diverse professional disciplines to assume leadership roles in their respective fields and by ensuring high levels of interdisciplinary clinical competence. There are 60 programs throughout the nation.

• REACH Institute's Patient-Centered Mental Health in Pediatric Primary Care Program offers training for primary care clinicians to diagnose and manage mental health concerns in pediatric population. Program includes a 3-day course and four-month follow-up program.  Participants join eight bimonthly, one-hour group conference calls with national primary care and child/adolescent psychiatry experts to solidify their learning.

• Rutgers Health Children’s Specialized Hospital Advanced Practice Nursing Clinical Fellowships include Developmental and Behavioral and Physical Medicine and Rehabilitation (Physiatry). Both are intensive 12-month programs designed to provide advanced didactic education with focused clinical experience to prepare APNs to provide optimal care to children with developmental needs and neurobiological/developmental disabilities, respectively.

• University of Arizona Diagnosis and Management of Autism Spectrum Disorder (Post-Masters Certificate) prepares pediatric nurse practitioners, psychiatric/mental health nurse practitioners and general practice pediatricians to address the increasing health care challenge of autism. The goal of the interdisciplinary program is to prepare pediatric clinicians with the skills necessary to diagnose and manage autism in the pediatric population.

• University of Colorado DBP-APP Fellowship program will provide the trainee with varied clinical and educational opportunities to prepare them for autonomous practice in the primary care or specialty setting. This is a one-year fellowship (12 months) starting in August of each year and running until July the following year.

CME Opportunities

• Society for Developmental and Behavioral Pediatrics (SDBP) SDBP Educational Resources was created by SDBP members based on needs assessment and includes developmental-behavioral pediatric and psychology education resources and materials for parents, families and patients. Plus, “Invite a Lecturer” series are offered quarterly and are great resource for those in training and interested in furthering their DBP knowledge.
  • SDBP Annual Meeting and Winter Virtual Conference 

• American Academy of Child and Adolescent Psychiatry Pediatric Psychopharmacology Update Institute’s fully virtual program gives you the flexibility to watch ten expert lectures in your own time and then come together with a live virtual audience for speaker Q&A sessions and self-assessment review sessions to fully assess your knowledge on these topics and ability to improve patient care.

• American Academy of Pediatrics PREP® (Pediatrics Review and Education Program) is a self-assessment program and includes sets of 20 case-based self-assessment questions in a specific content area. Each block offers up to 4 AMA PRA Category 1 Credits™. PREP Blocks are designed for all pediatric professionals, including attending physicians, nurse practitioners*, physician assistants, residents, and fellowship trainees. *Select blocks are accredited for NAPNAP CE contact hours.

•  National Association of Pediatric Nurse Practitioners (NAPNAP) PedsCE^SM online offers expert developed, evidenced-based continuing education on a wide range of hot topics in infant, child and adolescent health. Courses are added to PedsCE^SM throughout the year so visit the online catalog regularly. NAPNAP Cares, more specifically, aims to prepare PNPs and pediatric-focused advanced practice registered nurses (APRNs) to meet the mental and behavioral health care needs of pediatric patients and their families.
  • NAPNAP Annual Conference with DBMH content, virtual symposium, certification review courses 

• Pediatric Nursing Certification Board (PNCB) offers continuing education Pediatric Updates Modules. A certain number of modules are required for PNPs who are certified through PNCB. However, the CE is available to everyone. Offerings change from time to time, and modules expire, so visit the online catalog regularly.
  • Pediatric Primary Care Mental Health Specialist (PMHS) certification is offered through the Pediatric Nursing Certification Board (PNCB) and validates the added knowledge, skills, and expertise of advanced practice registered nurses in the early identification, intervention, and collaboration of care for children and adolescents with mental and behavioral health concerns.
  • PNCB Comprehensive DBP/MH Reference/Text list  

• Spectrum of Developmental Disabilities Conference is hosted by Kennedy Krieger Institute and John Hopkins University annually. Topics vary but always have a focus on Developmental Disabilities. Typically, every other year is devoted to autism spectrum disorders.

• Steven J. Parker Memorial Developmental Behavioral Pediatric Conference: Clinical Problems in Primary Care. Boston University School of Medicine and Tufts University host an annual conference focused on Developmental Behavioral Pediatric topics. It is designed for practicing clinicians who have an interest, passion or emerging expertise in developmental and behavioral pediatrics and want to take their knowledge and skill to the next level. It is appropriate for primary care, as well as specialists in Developmental Behavioral Pediatrics.

• University of Washington Developmental and Behavioral Pediatrics created a robust educational repository that offers modules on common DBP content, clinical practice guidelines, and reading materials and resources. Information is organized by content type and then by specific disorder.

Resources

• DBMH Resource - This is an excellent website from the NAPNAP DBMH SIG that has a wealth of resources around DBMH topics. Everything on the website is free and in the public domain, so there is material you can use in your practice. Resources are organized by topic and by age. Resources include screening tools, practice guidelines, articles, and patient education handouts. There is so much great information here! http://www.dbmhresource.org/

• PNCB PMHS Exam Resources - On the Pediatric Nursing Certification Board (PNCB) website for the PMHS exam, there is a list of resources to help study for the exam. This includes textbooks, practice guidelines, articles, and websites that are helpful for clinicians and families. There is a lot of great information here that may be helpful to you, whether you intend to take the PMHS certification exam or not. https://www.pncb.org/pmhs-exam-resources

• UW DBP home page - This website was developed and is maintained by Dr. Sam Zinner, DBP at the University of Washington and Seattle Children's Hospital, for training residents and fellows. Information is organized by content type and then by specific disorder. There is so much information here and many helpful links and family resources.  https://depts.washington.edu/dbpeds/index.html

Information for Physicians and Practices Interested in hiring a DBPeds APC

It is important to note that there are very few formal training programs in Developmental Behavioral Pediatrics for advanced practice clinicians. However, this should not deter you from considering an APC for your DBPeds practice. APCs are often well suited to DBPeds practice, as many are trained in holistic family centered care. APCs maintain national certification through their certifying board, as well as a state license. Many APCs who end up in this specialty have previous experience or training in general pediatrics or family practice. The majority of APCs who practice in DBPeds have received on the job training and support from physician and APC mentors and colleagues.

The first thing to be aware of when hiring an APC is that each state has their own rules and regulations that dictate APC practice. What an APC can do in your practice will be determined by the scope of practice in your individual state. In some states, APCs may not be able to diagnose autism spectrum disorders, prescribe controlled substances, or order certain therapies, such as Applied Behavior Analysis or durable medical equipment. In other states, an APC may be considered an independently licensed provider and have full diagnostic and prescriptive priveleges.  It is important to be familiar with the requirements of APCs in your state as this will help guide you on what an APC can do in your practice, and the amount of supervision or collaboration required. The American Association of Nurse Practitioners (AANP) provides an easy to use interactive map on their website (https://www.aanp.org/advocacy/state/state-practice-environment) that allows you to see at a glance if your state has full, reduced, or restricted practice for nurse practitioners. It also provides further information regarding requirements for nurse practitioners to practice in each state, as well as the associated laws or practice acts. The American Academy of Physician Assistants (AAPA) provides a state by state breakdown of PA laws and regulations for members on their website https://www.aapa.org/advocacy-central/state-advocacy/state-laws-and-regulations/. A convenient guide for both NPs and PAs can be found at: http://scopeofpracticepolicy.org/practitioners/.

Many states require a collaborative practice agreement between the APC and the supervising or collaborating physician. If you are part of a larger institution or academic center, your employer may have a standard collaborative practice agreement that you can use. If not, there are templates of collaborative practice agreements available online. It is important that a collaborative practice agreement has been developed and approved by both the physician and the APC before the APC starts working in your practice. It should be reviewed annually.

If you are hiring an APC who does not have previous DBPeds experience, it will be necessary to develop a training plan that you are both comfortable with. This may include didactic information through books or continuing education courses, specialized training in formal assessments that they are expected to perform as part of their job (ADOS, Bayley, etc), and shadowing DBPeds providers in your practice. The length of this training will vary depending on the APC’s experience and comfort. The benefit of this approach is that you can train the APC to fit in with the standards and expectations of your existing practice. After the initial training period, it is helpful to have a physician or experienced APC available for the new APC to go to when questions arise regarding complex patients or challenging situations. The most successful physician-APC relationships have been found to have an ongoing mentoring component with open bi-directional communication.

Finding the right APC for your practice can be a long and difficult process. Consider advertising on national websites, such as the NAPNAP job center https://careerconnection.napnap.org/ or the SDBP job bank https://www.sdbp.org/resources/job-bank.cfm. You may also want to advertise locally through the newspaper or online employment sites. Some states have a monthly or quarterly nursing or medical journal that will post job opportunities. Talking to APCs in your local area may also lead to individuals interested in DBPeds who may already be living and working in your area. While it may take time to find and train the right APC for the job, the addition of an APC can positively impact your practice in many ways.