Clinical Practice in Pediatric Psychology

The Society of Pediatric Psychology (SPP) is a growing, vibrant organization that works to meet the needs of pediatric psychologists around the country and the world. Because the field of pediatric psychology encompasses diverse patient populations, there have always been scholarly and clinical groups that form within the SPP around more specific areas. The current article describes the years leading up to and including the formation of special interest groups (SIGs) within the SPP. Current procedures, ongoing work, and future challenges to the health and productivity of SIGs, as well as discussion on how SIGs are beneficial to students and to early career psychologists, are covered.

This article describes our shared expertise and collaborative efforts to develop guidelines and recommendations for subspecialized training in pediatric pain psychology. First, we review the competency goals and standards relevant to subspecialized training in pediatric pain psychology. Next, we detail our shared understanding of competencies in pediatric pain psychology and the training experiences to foster their development. Third, we highlight collaborative activities of our subspecialized training programs in order to demonstrate ways each program can optimize training curriculum. We conclude with a reflection of the current state of subspecialized training, directions for further development, and implications for other subspecialty programs.

The integration of mental health services in primary care settings has expanded rapidly in recent years with psychologists being at the forefront of efforts to promote healthy behaviors, reduce disease, and care for behavioral, emotional, and developmental needs to promote overall health and well-being for children and families (Asarnow, Kolko, Miranda, & Kazak, 2017; Stancin & Perrin, 2014). While there are many psychologists working in pediatric primary care (PPC), little is known about the specific activities that these psychologists engage in, the training they receive, or funding mechanisms that support their work. This study sought to address this gap in the literature through a survey of psychologists working in PPC. An anonymous online survey was disseminated to members of professional organizations and listservs who were identified as having interest in PPC. Psychologists (N = 65) currently practicing in PPC completed the survey by reporting on clinical roles and practices, professional training, practice settings, and funding supports in PPC settings. Results indicate that psychologists assume a number of roles in PPC including providing individual and family therapy, conducting screenings for child mental health concerns, and providing consultation to medical colleagues. Many psychologists also provide supervision and offer educational opportunities for those in related fields, such as medicine and social work. Engagement in research activities was identified as a secondary activity. It was reported that a number of clinical activities were not billed for on a regular basis. Additional areas of research will be discussed along with implications for clinical services in PPC.

Bariatric surgery is becoming an increasingly used tool for the management of severe obesity in youth; however, outcomes after surgery are variable. Keeping adolescents engaged in treatment postsurgery is critical, yet little research has focused on this area. A review of the literature using Pubmed, Ebscohost, and PsycINFO and terms “bariatric surgery,” “gastric bypass,” “gastric band,” “sleeve gastrectomy,” “retention,” “attrition,” “engagement,” and “participation” was conducted. In addition, a survey to the psychologists working with adolescent bariatric surgery programs was conducted. Only 3 manuscripts met the inclusion criteria, demonstrating a significant lack of literature in this area. Age, baseline mood and eating symptoms, Body Mass Index (BMI) and parental history of bariatric surgery were some factors identified as being related to attrition. From the survey, members identified the following as the most common strategies to keep families within treatment: access to providers in between appointments, appointment reminders, and in person support groups. Little work exists focusing on retention, and follow-up for adolescent bariatric surgery patients. This is concerning given that these patients may be at high risk for negative consequences without follow up. This is a critical issue that adolescent bariatric surgery programs should commit to understand better, report findings, and systematically address.

Cleft lip and/or palate (CL/P) are among the most common of all birth defects. Habilitation requires multiple surgeries and other therapies throughout childhood and adolescence. While multidisciplinary care is recommended, there is a great deal of variation in treatment protocols for this condition. There is ample evidence that children with CL/P are at risk for psychosocial problems. However, to date, few studies have systematically investigated parent and patient self-reported psychosocial and quality of life (QOL) outcomes for children with CL/P as they relate to variations in treatment protocols. The Americleft Outcomes project was initiated to demonstrate and document outcomes to be expected with team care, and to define the key features or characteristics of various team treatment protocols and procedures that are associated with more or less favorable/desirable outcomes. This article will describe the psychosocial component of the Americleft Outcomes project that is aimed at developing a protocol that will allow cross team assessment of psychosocial outcomes for children with CL/P in relationship to the treatments they received. The protocol will be detailed along with a description of the process and considerations that were instrumental in the development of the project. Stakeholder input about the project’s perceived relevance to families of children with CL/P will be reported. The paper concludes with a discussion of the challenges encountered with this project, clinical implications, and future directions.

Pediatric epilepsy is the most common neurologic condition and is linked to high rates of behavioral health comorbidities, which can compromise seizure control and quality of life. Despite these concerns, the behavioral health needs of youth with epilepsy are underserved. Given the climate of the Affordable Care Act, pediatric psychologists offer a unique skill set to address these comorbidities by developing and disseminating evidence-based behavioral health treatments that are efficient, increasingly cost-effective, and provided within an interprofessional framework. However, the training of pediatric psychologists within epilepsy care is limited outside of well-established neuropsychological assessment, which has stagnated the development of evidence-based behavioral health treatments for this population. The current aims of this project are multifaceted. The initial 2 aims include providing a brief overview of epilepsy and the associated behavioral health needs due to the high prevalence of psychological comorbidities, stigma, adjustment, and antiepileptic drug side effects, along with reviewing evidence-based treatments for externalizing and internalizing symptoms within pediatric epilepsy. The final aims are to offer directions for interprofessional care that contains health-care costs and improves outcomes, to highlight pediatric epilepsy as an optimal pediatric psychology training opportunity, and to provide next steps for the increased need for clinical intervention research. This effort increases awareness of epilepsy as a growing area of opportunity within pediatric psychology and strengthens the role of pediatric psychologists as an integral part of the comprehensive treatment of youth with epilepsy.

Pediatric gastroenterological disorders are frequently encountered by the practicing pediatric psychologist and can be challenging to treat due to the range of presenting symptoms and potentially high impact on patient’s functioning. In this article, the authors aim to (a) describe the brain–gut axis as a means to increase understanding among pediatric psychologists of the biological mechanisms implicated in pediatric GI disorders and how their interactions with psychological and contextual factors maintain GI symptoms and (b) provide practical ways for pediatric psychologists to incorporate the discussion of biological mechanisms and the brain–gut axis into patient education and psychological interventions. Biological mechanisms of the brain–gut axis including alterations in pain processing, the stress response system, and gut microbiome activity will be reviewed. Psychosocial factors that contribute to or maintain disturbances in the brain–gut axis are discussed with implications for clinical assessment and intervention. The authors assert that a mutual understanding by patients, families, and providers alike of the relevant brain–gut interactions and the biopsychosocial model, in general, will serve as a foundation for successful delivery of and adherence to psychological intervention.

Conducting comprehensive and culturally appropriate assessment in pediatric medical settings can be challenging. Previous systematic reviews of assessment measures have sought to develop criteria for considering a measure to be “evidence-based” (e.g., Cohen et al., 2008). These reviews have not, however, addressed the growing need for providers to integrate evidence-based assessment and cultural competency specifically when working with ethnic minority children and families. The present paper has the following aims: (a) to present a framework for conducting assessment with families from diverse cultural backgrounds, (b) to provide recommendations for the clinician who is selecting measures for use with cultural minority patients and families, and (c) to discuss the limitations of the existing literature in helping clinicians make these determinations and provide future directions for researchers and clinicians. Case examples are used to illustrate some of the challenges that clinicians face in this area.

The opportunity for psychology trainees to provide services on multidisciplinary teams in the pediatric medical setting offers unique opportunities and ethical challenges (e.g., deciding which information to disclose to medical team). The developmental process of integrating ethical principles learned from general ethics training in the classroom with ethical decision making for issues that present in the pediatric medical setting can be challenging for trainees. In this article the authors will highlight ethical issues related to working in a pediatric medical setting. In particular, ethical issues unique to the pediatric setting are highlighted, including (a) working with children with medical conditions and potentially life-threatening illnesses and (b) working on multidisciplinary teams. Case examples illustrate potential ethical concerns, and suggestions for both trainees and supervisors are discussed.