Jessica Kruse
Communications Chair
Student Advisory Council
Alexandra Ross, PhD is lead psychologist in the University of California San Francisco (UCSF) Pediatric Brain Center, where she specializes in evaluating and treating children with chronic headaches and other neurological disorders. She is an Assistant Clinical Professor in the UCSF Department of Pediatrics.
Dr. Ross earned her PhD in Clinical Psychology, with a focus on child development, at the University of Southern California. She completed her clinical internship at the Institute on Development and Disability at Oregon Health & Science University, followed by a postdoctoral fellowship in pediatric pain psychology at Stanford University School of Medicine.
Dr. Ross is a member of the American Headache Society and serves as co-chair of its behavioral section.
What does a typical week look like for you?
My week involves a combination of clinical care of patients, collaboration with my medical colleagues, program development, and research. My clinical work is primarily outpatient, providing evaluations and therapy to children and adolescents with chronic headache disorders. I have learned I am most productive and engaged in what I am doing if I am able to create boundaries for myself. On my clinical days, I focus on patient care activities (evaluations, therapy, writing school letters, consultation calls with neurologists). I try to hold my non-clinical days to work on larger projects.
What challenges does your specialty currently face and how do you predict it will overcome them?
One major challenge currently facing pediatric headache psychologists is that there are relatively few of us. Most pediatric neurology clinics serving a high volume of youth with headaches do not have access to a mental health provider, and when positions do exist, there is often a lack of infrastructure for integrating a psychologist within the neurology program (i.e., obtaining authorization, billing, etc.). Although the American Headache Society (AHS) Consensus Statement now includes biobehavioral therapy as a preventive treatment for headache and the American Academy of Neurology (AAN) recommends Cognitive Behavioral Therapy as a first line preventive intervention for pediatric patients with headache, there are simply not enough mental health providers with the relevant training for this to be realistic in practice.
I am hopeful that given this guidance from AAN and AHS, this dynamic is shifting, and I do anticipate pediatric headache psychology will look quite different over the next two decades. I predict that there will be growth in funding for pediatric headache psychologist positions within neurology programs in the years to come. I am hopeful that as this happens, it will become standard practice to have integrated psychologists embedded in pediatric headache neurology practices, leading to more available positions and training opportunities to prepare early career psychologists for a career in this subspecialty.
How did you decide on your specialty?
I don’t think I ever had an “ah-ha” moment, but rather a series of experiences where I have shifted and refined my focus until I ended up where I am today. Although I had always planned to work with children in a hospital setting, my graduate school focus was in a completely different specialty, social development, and I was planning to pursue a career with an autism spectrum disorder (ASD) focus. I was first introduced to pediatric pain psychology while interviewing for my internship at Oregon Health and Science University and remember thinking it sounded important and fascinating. I signed up for a pediatric chronic pain rotation and was drawn to the work. I particularly enjoyed the process of educating families about evidence-based interventions for chronic pain and helping children (who often had been through a tremendous amount of difficult medical experiences and were understandably initially skeptical about meeting a psychologist) develop positive associations with the concept of pain psychology. I felt that during brief interactions, I could support the resilience of my patients who may have been unlikely to have access to necessary mental health support outside of this context. Therefore, although I had entered internship anticipating I would be an ASD specialist, through these rewarding clinical experiences, I made the decision to shift my focus and applied to Stanford’s Pediatric Pain Psychology program for postdoc.
My first year of postdoc in Stanford’s Pain Management Program was wonderful and reinforced my interest in a career in chronic pain. I was planning to complete a second year of fellowship with a more prominent research focus. I learned, however, of the creation of my current position in the UCSF Pediatric Brain Center primarily establishing a pediatric headache psychology program. Although a specific headache specialty would be new to me, I was excited about the prospect of designing and building a program for patients who did not yet have access to any psychology services, continuing to work with youth with chronic pain, and being involved in an interdisciplinary program for kids with a range of neurological and neurodevelopmental needs. My mentors at that time recognized my interest in program development and supported me in pursuing this shift in career. It was not until I had developed this program and observed the positive impact it had on patients’ symptoms and functioning that I recognized my passion for working with young people with headaches.
If you could go back and do it all again, what would you change, if anything?
I can honestly say I have no idea! It’s so hard to know what path I would be on now had I made different decisions in the past, and there were plenty of points where I was not 100% sure about the decision I was making at the time. I am fulfilled by and genuinely enjoy what I do and if you had asked me what I would specialize in when I was a graduate student, I could not have predicted my current career, particularly as at the time I had never even heard of a pediatric headache psychologist. Perhaps the primary shift I would make would be to place less pressure on myself to make the “correct decisions” earlier in my training and development to embrace learning from the process itself.
What is the most helpful career advice you’ve received?
I had a formative conversation with a supervisor in graduate school regarding the path she had followed to her position. Up until that point, much of the guidance I had received had been quite linear and goal-oriented. She, however, spoke of continuously moving in a direction that felt interesting to her and learning more about what she wanted from and valued in her career at each opportunity. As she refined her interests, she was able to be open to new opportunities and fit her career to who she wanted to be as a psychologist. I think it can be difficult to stray from an agenda for perceived success once you have started down a certain path and have paused to reflect on this guidance often throughout my career.
This interview was conducted by Jessi Kruse, the SAC Communications Chair. Please feel free to reach out to her at studentcommunicationsdiv38@
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The Student Advisory Council