Clinical Practice in Pediatric Psychology - Vol 5, Iss 2

Pediatric psychologists’ role in faculty development.

Ward, Wendy L. — 2017-05-01

Faculty development is a process by which faculty are provided with learning opportunities to systematically improve their skills. Faculty development programs offer learning activities which target the development of (a) clinical skills, (b) educational skills, (c) research skills, (d) mentoring/strategic career planning, (e) leadership skills, and (f) personal and professional wellness. Psychologists possess a diverse range of skills that effectively prepare them for faculty development roles as speakers/facilitators, program directors, and program evaluators. This article reviews these diverse skills as well as key steps psychologists can take that highlight the value in faculty development programming and the skill set psychologists possess which fosters career development in this area. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

A longitudinal study of hardiness as a buffer for posttraumatic stress symptoms in mothers of children with cancer.

Stoppelbein, Laura; McRae, Elizabeth; Greening, Leilani — 2017-01-23

Mothers of children diagnosed with cancer have been found to be at a heightened risk for posttraumatic stress symptoms (PTSS). In an effort to identify a potential buffer, hardiness was examined as a protective factor for PTSS among mothers of children that were diagnosed with cancer in the past 2 weeks. Using a prospective design, mothers completed measures of PTSS and hardiness at the time of their child’s cancer diagnosis and then again at 6 and 12 months postdiagnosis. Random effects regression analyses revealed that mothers who scored high on hardiness were less likely to experience PTSS after controlling for the effect of time. PTSS cluster-specific relations with hardiness were also examined, which revealed that mothers who scored high on hardiness experienced fewer avoidance/numbing symptoms at the time of their child’s diagnosis of cancer and across 12 months, but mothers who scored low on hardiness tended to experience more avoidance/numbing symptoms at the time of their child’s diagnosis. However, these symptoms declined gradually over the course of 12 months. The present findings support examining hardiness further as a buffer against specific PTSS clusters and exploring options for identifying and treating mothers of children with cancer that may be at risk for PTSS. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Narrative exposure therapy with parents who have been traumatized in pediatric settings: A case series.

Colville, Gillian A. — 2017-03-16

There is increasing evidence that a significant number of parents are affected by symptoms of posttraumatic stress and anxiety for many months after their children’s serious illnesses or accidents. It is important, therefore, that psychological treatments for use with this population are tried and evaluated for effectiveness with this population. The application of a new brief treatment, narrative exposure therapy (NET), is described here in relation to a case series of 4 parents who met criteria for posttraumatic stress disorder following their children’s intensive care treatment. This approach, which has shown promise with other samples of people who have suffered repeated traumas, was associated with significant symptom relief (Cohen’s ds = 1.01–2.37). The main themes that emerged in therapy are discussed, along with other treatment considerations. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Adaptive intervention designs in pediatric psychology: The promise of sequential multiple assignment randomized trials of pediatric interventions.

2017-04-06

This article summarizes the utility of multiphase optimization strategy (MOST) and sequential multiple assignment randomized trial (SMART) processes in the development of empirically derived adaptive interventions (AIs). Recent empirical evidence suggests that SMART designs conducted within the context of a MOST framework can be used for building and optimizing AIs and may lead to better clinical care. SMART designs help optimize AIs by determining the best sequencing of decision rules. However, despite their growing relevance, MOSTs and SMARTs are relatively underutilized in the development of pediatric interventions. MOST and SMART designs can be used for developing efficient and cost-effective AIs. Intervention research within the field of pediatric psychology may benefit from incorporating these designs. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Effectiveness of the Comprehensive Behavioral Intervention for Tics (CBIT) in a pediatric psychiatry clinic: A retrospective chart review.

Dreison, Kimberly C.; Lagges, Ann M. — 2017-04-06

The Comprehensive Behavioral Intervention for Tics (CBIT) is endorsed as a first-line treatment for tic disorders, but it is not widely available. This is partially due to an enduring misconception that behavior therapy results in tic worsening, as well as the perception that treatment manuals are too inflexible for use in clinical settings. In an effort to address these concerns, the present study was conducted with two primary goals: (1) use existing clinical data to assess the effectiveness of CBIT in a pediatric clinic and (2) systematically examine similarities and differences between the CBIT protocol and clinic-based treatment in a subset of patients identified as treatment successes. We conducted a chart review of pediatric outpatients who received the CBIT intervention. Clinical characteristics, clinician symptom severity ratings, and session content data were extracted. A repeated-measures t test was used to determine whether the change in symptom severity was significant, and one-sample t tests were used to compare clinic-based treatment against the manual. Clinic-based CBIT treatment significantly reduced tic symptom severity, t(9) = 5.08, p = .001, d = 1.68. Moreover, this significant reduction was found with flexible use of the CBIT manual. While it is unclear if CBIT or other components of treatment were responsible for the treatment effects, the results suggest that for at least some pediatric patients with tic disorders, positive treatment outcomes can be achieved when CBIT is flexibly applied in a clinical setting. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

“Stop my pain, but don’t send me to school!” A pediatric case of irritable bowel syndrome and school absenteeism.

Psihogios, Alexandra M.; Baber, Kari — 2017-04-24

The present case is an 11-year-old, Caucasian boy (“Leo”) with irritable bowel syndrome (IBS) who demonstrated significant functional impairment with school and was referred to behavioral health for stress management by his gastroenterologist. We conceptualized Leo’s IBS from a biopsychosocial perspective, in which biological (e.g., abdominal pain), psychological (e.g., fear of bowel incontinence), and environmental (e.g., inadvertent reinforcement of school absenteeism) factors interacted and resulted in symptoms and impairment. In conjunction with medical interventions, we aimed to improve his coping with IBS symptoms and increase his school attendance through the implementation of a family based cognitive–behavioral intervention involving coping skills training, contingency management, and exposure. Over the course of the intervention, Leo continued to demonstrate difficulties with school attendance and participation, as well as poor engagement with behavioral and cognitive coping strategies. His mother attempted to reduce reinforcement of school absenteeism but continued to acquiesce to his requests to stay home from school. The challenges of this case highlight potential areas of need that may have been inadequately addressed by our original case conceptualization and intervention plan, including consideration of an underlying anxiety disorder, maternal barriers to contingency management, time restraints–low dose of treatment, and strengthening our partnership with medical and school stakeholders. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Additional strategies for treatment barriers: Comment on Psihogios and Baber (2017).

Ernst, Michelle M. — 2017-06-05

Comments on the original article by Psihogios and Baber (see record 2017-18109-001) in which the authors present an interesting pediatric psychology case that highlights a number of challenges common to complex patient presentations. In this case, an 11-year-old boy with irritable bowel syndrome experiences physical symptoms (pain and bowel urgency) and refuses to attend school. The authors provide a robust conceptualization for the case and implement evidence-guided individual cognitive– behavioral therapy (CBT) and family-based behavioral interventions. However, the child showed minimal engagement, the parent did not follow-through with recommendations, little improvement was seen, the family terminated early, and the disposition remained guarded. Unfortunately, the reality is that some children simply (or not so simply!) do not benefit from cognitive–behavioral intervention. This commentary provides additional strategies for treatment barriers in cases such as this. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

"“Stop my pain, but don’t send me to school!” A pediatric case of irritable bowel syndrome and school absenteeism": Commentary on Psihogios and Baber (2017).

Carter, Bryan D.; Schultz, Kristie V. — 2017-06-05

Comments on the original article by Psihogios and Baber (see record 2017-18109-001) in which the authors present the case of Leo, an 11-year-old boy with irritable bowel syndrome. To pediatric psychologists working with chronic pain and somatization patients and their families, the case of Leo is all too familiar. The current authors suggest that in order to better motivate parents to adhere to a behavioral intervention for disabling somatic symptoms, such as seen in the case of Leo, it can be helpful to provide psychoeducation regarding the importance of mastery of critical developmental tasks associated with their child’s life stage. Negotiating healthy family role relationships is instrumental to accomplishing this task. (PsycINFO Database Record (c) 2017 APA, all rights reserved)

Ethical and legal issues in integrated care settings: Case examples from pediatric primary care.

2017-01-23

There is a growing recognition that integrated primary care (IPC) services can address longstanding sociodemographic disparities in access to and utilization of behavioral health services. At the same time, there has been increasing attention to the complex ethical and legal considerations that can emerge for psychologists working in these interdisciplinary settings. There are challenging ethical dilemmas that arise when providing services to youth and their caregivers involved in IPC services. Unfortunately, although some ethical guidelines and case illustrations relevant to IPC are available, very few focus on the pediatric IPC context. The purpose of this article is to examine salient ethical and legal dilemmas that may emerge in pediatric IPC practice. These issues are examined through the use of 4 case illustrations that collectively address issues related to consent for services among pediatric populations, confidentiality, scope of practice for the pediatric IPC psychologist, and multiple relationships. We apply an adapted ethical decision-making framework (Kanzler, Goodie, Hunter, Glotfelter, & Bodart, 2013) to highlight practice points drawn from each of these cases. Throughout this article, we reference the American Psychological Association’s 2010 ethics code and 2015 guidelines for primary care practice competencies, while highlighting clinical practice points and directions for future research. We also discuss similarities and differences between the American Psychological Association (APA, 2010) and American Medical Association (AMA, 2012) ethics codes and standards of care. (PsycINFO Database Record (c) 2017 APA, all rights reserved)