Clinical Practice in Pediatric Psychology

The primary outcome in many treatment studies for pediatric chronic pain has been reduced pain intensity, but it is well documented that several facets of chronic pain, including poor coping and functional disability, negatively impact daily functioning and mood. Given recent attention to defining and collecting evidence-based clinical outcomes, it is important to develop feasible methods of measuring these behavioral outcomes in clinical settings. This article describes the process of translating empirically derived measures of pain intensity, pain coping efficacy, and functional disability into clinical practice and provides a first step toward developing an indicator for classifying “positive treatment response” for patients completing a course of cognitive–behavioral therapy (CBT) for pain management. Patients (n = 100, ages 8–18 years) completed outcome measures of disability, coping, and pain intensity during every CBT treatment session. A treatment response indicator was created to represent a positive treatment response to CBT appropriate for clinical settings: 25% decrease in disability OR 40% increase in pain coping efficacy OR 30% decrease in pain intensity at the end of active treatment. Results showed that 75% of patients met criteria for a positive treatment response. Specifically, 60% achieved a 25% reduction in FDI, 34% ended active treatment with a 40% or greater increase in pain coping efficacy, and 44% achieved a 30% reduction in average pain intensity. This study describes the process of using outcome measures to measure positive treatment response in pediatric behavioral pain management.

Millions of children are affected by acute medical events annually, creating a need for resources to promote recovery. Although web-based interventions promise wide reach and low cost for users, development can be time- and cost-intensive. A systematic approach to intervention development can help to minimize costs and increase the likelihood of effectiveness. Using a systematic approach, our team integrated evidence on the etiology of traumatic stress, an explicit program theory, and a user-centered design process to intervention development. This study describes evidence and the program theory model applied to the Coping Coach intervention and presents pilot data evaluating intervention feasibility and acceptability. Informed by empirical evidence on traumatic stress prevention, an overarching program theory model was articulated to delineate pathways from specific intervention content to program targets and proximal outcomes to key longer-term health outcomes. Systematic user-testing with children ages 8–12 years (N = 42) exposed to an acute medical event and their parents was conducted throughout intervention development. Functionality challenges in early prototypes necessitated revisions. Child engagement was positive throughout revisions to the Coping Coach intervention. Final pilot-testing demonstrated promising feasibility and high user-engagement and satisfaction. In conclusion, applying a systematic approach to the development of Coping Coach led to the creation of a functional intervention that is accepted by children and parents. Development of new e-health interventions may benefit from a similar approach. Future research should evaluate the efficacy of Coping Coach in achieving targeted outcomes of reduced trauma symptoms and improved health-related quality of life.

Shared decision making (SDM), which accommodates patient preferences and values in making decisions about their care, has been used extensively in adult health care, but less so in pediatrics. SDM in pediatrics differs since parents’ involvement in decision making changes as children mature and become increasingly capable of informed decision making. This pilot and feasibility study evaluated an SDM approach to 2 pediatric treatment decisions: allergen immunotherapy for children with environmental allergies and spinal fusion surgery for children with scoliosis (curved spine) as a result of severe neuromuscular conditions. Fifteen patients with environmental allergies and 11 with neuromuscular scoliosis participated along with their parents. Families reviewed carefully constructed decision aids for the respective conditions, which were designed to enhance the quality of their decision making, provide information about the options and outcomes, and help clarify their personal values and preferences. Pre–post comparisons indicated significant increases in parental knowledge of treatment information for their child’s condition. Additional measures indicated high satisfaction with the SDM intervention and better decision quality (alignment of values and choice) for both conditions. Clinicians were also highly satisfied with the intervention. Exploratory findings suggested better engagement with allergen immunotherapy for children who experienced SDM relative to similar patients who did not. Completion of follow-up measures was poor, especially among those who decided against the treatment option under consideration. The results support the feasibility, acceptability, and effectiveness of SDM in pediatrics. Future approaches to increasing retention and maximizing effectiveness of SDM interventions in pediatrics are discussed.

The specialty of pediatric psychology inpatient consultation-liaison (CL) continues to grow despite limited research examining practice and training approaches. With increasing need to justify services, the current study surveyed pediatric inpatient CL psychologists on their institutional, practice, and training characteristics to highlight areas of strength and growth needed to advance inpatient CL practice. One hundred eighteen members of SPP completed an anonymous online survey assessing institution characteristics, service activity and practice characteristics, training, billing and funding issues, research activity, and perceptions of inpatient CL practice. Respondents represented diversity in years of practice, institution type, institution size, and department. There was significant variability in the nature of inpatient CL coverage, number of CL psychologists, and professional composition of the CL team. Psychology trainees play a significant role on many CL services. Treatment protocols are used infrequently, and few inpatient CL psychologists are systematically tracking clinical outcomes or conducting formal research. Most inpatient CL services are fiscally dependent on a combination of funding sources. Despite frustrations with limited protected time for research and teaching, most inpatient CL psychologists are satisfied in their roles and deny significant burnout. Diversity of setting and practice characteristics presents challenges in providing global recommendations for pediatric inpatient CL psychological practice. Rapid changes in the American health care system demand that, for survival and growth, increased research efforts are needed to demonstrate outcomes of consultation activities and the added benefit of service provision. Recommendations are given for inpatient CL practice and research.

The purpose of this study was to pilot the implementation of the Novel Interventions in Children’s Healthcare (NICH) program for youth with chronic pain who used a disproportionate amount of health care. Three youth (2 males and 1 female, aged 11 to 15 years) participated. The intervention consisted of a combination of family based problem-solving, care coordination, and case management, with the inclusion of technology-assisted treatment delivery (e.g., text messages, video chat) to reduce costs. Both objective (i.e., hospitalization records) and subjective (e.g., interventionist reports) outcomes were examined to assess changes over the course of treatment. Two of the three youth demonstrated reductions in the number of days hospitalized and associated costs. In addition, interventionist reports indicated improved quality of life for family and youth served. Although further research is needed, NICH appears to be a promising intervention for youth with chronic pain and high health care utilization and shows the potential to result in improved youth health and reduced monetary costs for families, providers, and the health care system.

Self-monitoring of food intake is a core strategy in cognitive–behavioral therapy (CBT) for weight management, but some concerns have been raised about the use of food monitoring (FM), particularly with youth. Appetite monitoring (AM), a form of self-monitoring in which participants track their appetite cues, has shown promise as a potentially acceptable and equally useful alternative. This pilot study implemented AM at a residential camp for overweight and obese youth (ages 9–14) that promotes family based healthy lifestyle habits. Campers and their families were taught to rate their appetite (using a form called the “Hunger Scale”) at family weekends in the spring, and were encouraged to use the scale at home. During the children’s 5-day summertime overnight camp, they were prompted to attend to their appetite cues before all meals. At the end of the camp week, counselor and camper ratings indicated that the AM intervention was feasible, acceptable, helpful, and utilized. At the fall reunion weekends, campers and parents reported remembering the Hunger Scale and continued to rate the intervention positively. On average, campers reported improved awareness of their appetite cues at the end of camper week, which was maintained at the fall reunion weekend. The most improvement was reported by campers identified by parents at baseline as having objective overeating episodes (i.e., eating clearly large amounts). These results are preliminary and warrant further investigation, but suggest that AM could be a promising alternative or additional self-monitoring strategy within camps and other interventions for overweight and obese youth.

The treatment of pediatric obesity is a recognized challenge, with mounting evidence that significant long-term weight loss maintenance is especially difficult. Additionally, obese youth display elevated rates of depression, anxiety, and binge eating, further complicating efforts to maximize and maintain weight loss. Thus, as bariatric surgery has become a more commonly used procedure for adolescents, psychological assessment has been incorporated into routine presurgical evaluations. However, no studies to date have examined the impact of psychological assessment and intervention on weight loss and psychosocial outcomes in adolescents presenting for bariatric surgery. In this case report, we sought to demonstrate the clinical effectiveness of an integrative and comprehensive empirically supported intervention addressing depression, anxiety, and binge eating with an obese adolescent female undergoing bariatric surgery. Psychosocial data were collected prior to and at discharge from therapy as well as 14 months postsurgery, while anthropometric data were collected at multidisciplinary outpatient appointments throughout the study period. After 11 months of weekly outpatient sessions, results indicated improvements across several areas of psychosocial functioning, including mood, anxiety, eating disorder symptoms, body esteem, and weight-related quality of life. Significant changes were also observed in health-related behaviors and overall weight loss. The current case highlights the importance of the presurgical identification of comorbid anxiety and depression, and the utility of treating these conditions prior to surgery in order to maximize initial and sustained weight loss.

Quality improvement (QI) is an iterative process designed to make controlled changes within the health care delivery system to provide patients with high-quality care that meets both their expectations and needs. Clinical Practice in Pediatric Psychology (CPPP) is actively soliciting QI studies to further its mission to promote and support the evidence-based clinical work of pediatric psychologists. This article (a) provides a basic introduction to what QI is and how it fits within ethical health care practice, (b) briefly describes the historical context of QI in health care, (c) discusses how QI serves as a complement to routine evidence-based care, and (d) gives guidance for writing up and publishing QI work. The overarching aim of this article is to promote the submission and acceptance of high-quality QI studies to Clinical Practice in Pediatric Psychology.