G.I. Doc’s will rule out organic causes and refer to biofeedback Health Psychology Supervisor will provide group supervision to interns Senior Intern/Psych Asst will train and provide administrative support to Psych Supervisor and interns BCIA* certified interns will provide Biofeedback treatment *The Biofeedback Certification Institute of America (BCIA) was formed in January 1981 to establish and maintain professional standards for the provision of biofeedback services and to certify those who meet these standards.
Biofeedback clinic for functional abdominal pain
Biofeedback Clinic for Functional Abdominal Pain ProposalDivision of Pediatric Gastroenterology and NutritionChildren’s Specialists of San DiegoUniversity of California San Diego
Recurrent Abdominal Pain (RAP) Most common childhood G.I. Disorder Affects up to 34% of world’s children Three bouts of pain severe enough to disrupt activities in a three month period No organic cause
Recurrent Abdominal Pain (RAP)• Leading cause of childhood school absences• Increased medical utilization• Family disruption• In nearly 50%, the complaints persist overmany years of their life-span to adolescenceor adulthood.
Why Biofeedback treatment? Painless/Non-invasive techniques Research shows biofeedback is a successful treatment for functional abdominal conditions Engaging and fun treatment modality for children
What is Biofeedback? Electronic biofeedback instruments connected to sensors on the body Real-time physiological information (feedback) is displayed to patient on computer monitor A certified biofeedback professional provides instruction and interpretation
How does biofeedback treatFunctional Abdominal Pain? Autonomic nervous system (ANS) imbalance exacerbates abdominal dysfunction. ANS feedback (i.e. heart rate, respiration, skin conductance) educates patients about effects of stress on their symptoms. The therapist guides the patient through techniques to balance ANS. Home practice assignments reinforce techniques for better results
Pre/Post Assessment: VivoMetrics, Inc. LifeShirt,tm• 12 hour continuous Ambulatory Monitoring (Heartrate/Respiration/Personal Diary Entries of Pain/PsychosocialStress)
J&J Engineering, Inc. Biofeedback Equipment I-330-C2 Plus Clinical System $3,170.00
Example of Currently Running Biofeedback Program #1 Department of Preventive Medicine Biofeedback Program In continuous service past 7 years. Little to no advertising Patients self-referred and/or referred by Kaiser physicians.
Example of Currently Running Biofeedback Program #1: Cost Considerations Billing= $75 dollars in advance for 50 minute session. Average number of sessions per patient= 3 Approximate number of sessions in 2004 = 300 300 sessions X $75 = $22,500/annually This is with 1 to 2 part time employees.
Example of Currently Running Biofeedback Program #2 Kaiser Permanente Pediatric Gastroenterology Biofeedback Program Program has been in continuous service for past 4 years Biofeedback sessions held in GI clinic
Example of Currently Running Biofeedback Program #2: Cost Considerations Billing through Kaiser Permanente Insurance Average number of sessions per patient= 6 Program Director: Warren L. Shapiro, M.D. Staff: AIU/CSPP doctoral psychology interns AIU/CSPP supervisor: Richard Gevirtz, Ph.D.
Case Study (Sowder et al., 2004)From biofeedback program at Kaiser Permanente 36 kids with RAP/IBS Significantly lowered ratings of pain intensity and frequency post-treatment 56% pain-free at follow up (3mo, to 2yrs)
AIU Case Study Conclusions Effective, non-invasive, and timely treatment option Potential to reduce costs/ further distress (avoiding unnecessary & uncomfortable GI testing) Findings support autonomic dysfunction as a precipitating factor in RAP AIU Case Study (Sowder et al., 2004) Recently presented in Princeton, NJ at the 2004 International Society for the Advancement of Respiratory and Psychophysiology (ISARP) Conference
Children’s Hospital Physician Management Group, Inc.Gastroenterology New Patients (Outpatient only)in one year: 8-1-03 through 8-31-04 All DX ABD PAIN ABD ABD DX1 PAIN PAIN DX2 DX3 PATIENTS 1,813 392 59 18 % 23% 3% 1%
ProposalBiofeedback Treatment Center CSSD and UCSD GI physicians from Children’s and community will refer patients Patients will meet with Biofeedback therapist in medical setting at Children’s Hospital Patients will be seen for all 6-8 sessions.
Proposed CSSD/UCSDBiofeedback Center ProtocolPrior to 1st session – Provide instructional DVD with demo of what to expect in biofeedback sessions – Collect payment ($100/session for all 8 sessions) – Complete paperwork (intake, demographics, consent)
Proposed CSSD/UCSDBiofeedback Center Protocol Continued 1st Session: – Collect paperwork / Answer questions – Connect VivoMetrics LifeShirt (wear at least 8 hours) 2nd - 7th Sessions: – Biofeedback Training – Cognitive Therapy – Home practice assignments 8th Session: – Connect VivoMetrics LifeShirt (8 hours)
Typical Home Biofeedback Practice Regimen Daily Homework Assignments (Reviewed in weekly sessions) – Takes 20 minutes/day – Daily pain/stress diary – Psychophysiological self-monitoring practice tools: Hand temperature biofeedback device ($20) Paced breathing compact disc ($15) Freeze-framer heart rate/breathing training device (optional) www.bio-medical.com & www.beingart.com
Proposed CSSD/UCSDBiofeedback Center Protocol Continued Staff: Certified Biofeedback Technician Clinical Psychologist Supervisor -(1 day per week) Doctoral Interns – Alliant International University (AIU) California School of Professional Psychology (CSPP)
Biofeedback CenterOther: Use pre-existing secretarial staff for reception Biofeedback office Use of underutilized, pre-existing MOB space under G.I. Dept.
Potential Financial Considerations One time costs:2 Biofeedback clinical systems $6,000VivoMetrics LifeShirt equipment $25,000 $31,000
Future Directions Expand Biofeedback Clinic to other locations within San Diego County. Open clinics that treat other diagnoses such as migraines, chronic pain, fibromyalgia, and other stress related disorders