Clinical Practice in Pediatric Psychology

Objective: To highlight and disseminate research related to clinical applications of eHealth/mHealth technologies with children, youth, and families. Method: This special issue includes articles that reflect approaches to developing eHealth/mHealth interventions for children, youth, parents, and families; evaluations of feasibility, acceptability, and preliminary efficacy of digital health assessment tools and behavioral interventions for youth; and understanding adolescent privacy perceptions related to online collection of personal health-related information. Results: This collection of articles demonstrates various approaches to the development and evaluation of eHealth/mHealth technologies in clinical practice. Conclusions: eHealth/mHealth technologies have the potential to extend the reach of pediatric psychology services that can improve the health and well-being of children, youth, and their families. Further research is needed to support their efficacy, especially research that leverages methods and analyses responsive to the unique challenges and affordances of evaluating technologies with pediatric populations.

Objective: The objective of this study is to provide initial evaluation of the acceptability of a new eHealth system incorporating personalized self-report assessment of multiple health domains in school-age children and assess convergent validity of two brief measures presented via this system. Methods: Ill or injured children (N = 167) ages 6–14 recruited in two pediatric health care systems used the prototype eScreen interface on a mobile device to select an avatar and complete brief assessments of pain and posttraumatic stress symptoms (PTSS). Children rated technology acceptability and completed validated measures for pain and PTSS. Results: Children’s ratings indicated they found the eScreen interface easy to use (mean rating 4.4 on a 1–5 scale), potentially useful in helping them recover (M = 3.7), and would use/recommend it (M = 4.0). Among children ages 6–8, mean ratings were as follows: easy to use (3.7), usefulness (3.3), and would use/recommend (3.4). Acceptability was largely consistent across child gender, family income, or usual access to mobile devices. eScreen measures showed strong convergent validity with established measures. The eScreen Pain Screener was highly correlated (r = .86–.92) and evidenced strong agreement with two validated pain measures. eScreen PTSS scores were strongly correlated with a validated PTSS measure (r = .67); a positive PTSS screen was associated with significantly higher PTSS severity. Conclusions: Study results support the acceptability (ease of use, intention to use/recommend, perceived usefulness) of these tools for older school-age children and provide strong initial evidence for the validity of two brief measures presented in a novel digital modality.

Objective: A new diagnosis of type 1 diabetes mellitus (T1D) can be stressful for families as they are expected to learn a large amount of information regarding disease management and treatment in a short period of time. Currently, parents complete diabetes education at the time of diagnosis. However, this format may not be sustainable as rates of T1D climb. The current study aimed to develop an online platform to provide educational material in the form of video microlectures using an iterative, user-centered design process. Methods: In the first stage of development, parents of young children with T1D identified information they felt was most important to their child’s T1D care. In the second stage, health care providers contributed qualitative and quantitative feedback regarding the educational material and video mock-ups. The third stage involved parents of young children with T1D providing feedback on the completed video microlectures. Results: Providers and parents reported that the videos were highly useful, important to T1D care, and the majority would recommend them to other parents. Conclusions: The iterative design process used by the research team incorporated multiple perspectives and ultimately developed educational resources that were well-received by providers, researchers, and parents.

Objective: Methods for developing mobile health (mHealth) interventions are not well described. To guide the development of future mHealth interventions, we describe the application of the agile science framework to iteratively develop an mHealth intervention for adolescent and young adult (AYA) survivors of childhood cancer. Method: We created the AYA STEPS mobile app (AYA Self-management via Texting, Education, and Plans for Survivorship) by modifying and integrating 2 existing programs: an online survivorship care plan (SCP) generator and a text messaging self-management intervention for AYA off treatment. The iterative development process involved 3 stages of agile science: (1) formative work, (2) obtaining feedback about the first AYA STEPS prototype, and (3) pilot testing and finalization of a prototype. We determined preferences of AYA stakeholders as well as discovered and addressed technology problems prior to beginning a subsequent randomized controlled trial. Results: AYA survivors reported that the app and the embedded tailored messages related to their health and SCP were easy to use and generally satisfying and beneficial. Usage data supported that AYA were engaged in the app. Technology glitches were discovered in the pilot and addressed. Conclusion: The iterative development of AYA STEPS was essential for creating a consistent and acceptable end user experience. This study serves as one example of how behavioral scientists may apply agile science to their own mHealth research.

Objective: eHealth interventions may facilitate the dissemination of evidence-based psychosocial interventions to families of children with chronic illnesses, including cancer. This article describes a 4-phase, mixed-methods, user-centered approach to the design and evaluation of a novel psychosocial intervention for parents of children with cancer (Electronic Surviving Cancer Competently Intervention Program [eSCCIP]), adapted from an in-person intervention (Surviving Cancer Competently Intervention Program). Method: Development of eSCCIP involved a multidisciplinary design team of content and eHealth experts. Iterative Think Aloud testing and beta testing with parents of children with cancer was also completed. Results: An intensive, user-centered development and evaluation process was utilized to develop an eHealth intervention for parents of children with cancer. Initial testers rated eSCCIP favorably on questionnaires evaluating user experience and perceptions, and provided positive feedback and suggestions for additional improvement through qualitative interviews. Conclusions: Initial results suggest that eSCCIP may be an acceptable, feasible, and usable intervention for parents of children with cancer. eSCCIP is now ready for a larger pilot evaluation of usability, feasibility, and impact on target outcomes, including the reduction of anxiety and posttraumatic stress syndrome (PTSS) and improvements in family functioning.

Objective: Behavioral interventions for adolescent weight control are often difficult to access because they are rarely provided in primary health care. This study was designed to assess the feasibility, acceptability, and preliminary effectiveness of a motivational interviewing plus adaptive text messaging intervention for adolescent weight control delivered in primary care. Methods: Forty-seven overweight adolescents (aged 13–18 years) participated in a single, hour-long, in-person motivational interviewing session in their primary care pediatrician’s office with a clinical psychology doctoral student. All participants monitored diet, physical activity, and weight over 6 months and reported this information nightly via text message. Participants were selected randomly to receive computer-tailored adaptive text messages 3 times per day at mealtimes as an additional intervention component. Results: Participants found the intervention to be acceptable and beneficial for promoting weight-related behavior change. Adherence to self-monitoring was significantly higher in the adaptive text messaging group. Although body mass index z-score (zBMI) change was not significantly different across treatment groups, participants receiving the adaptive text message intervention demonstrated a reduction of .32 zBMI standard deviation units from before to after intervention, t(28) = −2.84, p < .01, d = .54, whereas zBMI did not change for individuals receiving the control intervention. Several domains of weight-related quality of life improved during the intervention period irrespective of treatment assignment. Conclusions: Study findings suggest that a behavioral weight control intervention delivered in a primary care is acceptable/feasible and may produce reductions in zBMI. Fully powered studies to further evaluate this intervention approach are warranted.

Objective: To describe the preliminary feasibility and acceptability of a web-based, problem-solving intervention for adolescent and young adult pediatric brain tumor survivors. Methods: With feedback from survivors and stakeholders, we created “A Survivor’s Journey” by modifying an existing problem-solving intervention for traumatic brain injury. Survivors (ages 13–25) were recruited from a pediatric survivorship clinic and were eligible if they had self or caregiver-reported psychosocial difficulties. A Survivor’s Journey has four core sessions (i.e., introduction, problem-solving, positive thinking, memory) and up to seven supplemental sessions. Each session involved web content and videoconferencing with a doctoral-level therapist. We analyzed postintervention data related to feasibility (i.e., enrollment and completion rates), as well as survivor’s ratings of satisfaction and usability of the intervention. Results: Nineteen survivors (M _age = 17.57), half of eligible participants, agreed to participate, and 95% of those enrolled completed at least the core sessions. Overall, survivors rated the intervention favorably on usability and satisfaction. Survivors who had borderline to impaired IQ or who were treated with cranial radiation reported higher satisfaction, suggesting that the intervention is appealing even for high-risk groups. Conclusions: Online problem-solving therapy could be a promising therapeutic approach for survivors of pediatric brain tumor, given the relatively high satisfaction and usability ratings. However, improving enrollment and examining treatment efficacy should be addressed in future work.

Objective: To assess feasibility and explore preliminary effectiveness of an online cognitive-behavioral group intervention (Op Koers Online) to prevent and/or reduce psychosocial problems by teaching use of active coping skills to adolescents (ages 12 to 18) with chronic illness. Method: Adolescents who signed up for the chat intervention were asked to complete online questionnaires at baseline and postintervention (after 8 weeks). Feasibility was evaluated based on attendance (missed sessions, dropout rate and homework completion), technological issues and with an evaluation questionnaire. Preliminary effectiveness was evaluated with standardized questionnaires: Op Koers Online Questionnaire (disease-related coping skills), Youth Self-Report (emotional and behavioral functioning), Pediatric Quality of Life Inventory (Health-Related Quality of Life [HRQoL]). Mean scale scores postintervention were compared with baseline with paired-samples t tests. Effect sizes were calculated. Results: In total, 33 adolescents participated in the intervention, 29 adolescents completed the questionnaires at baseline. Regarding postintervention questionnaires, 25 adolescents completed the evaluation questionnaires and 23 adolescents completed all questionnaires postintervention. Dropout rate was 6%. In 1 session (2%), there were technological issues that caused the session to stop. Participants’ overall satisfaction was high. Regarding effectiveness, participants improved significantly in the use of total coping skills and the coping skills “information seeking and giving” and “social competence” after the intervention compared with baseline. Participants also reported significantly fewer withdrawn/depressed behavior and scored significantly better on emotional and psychosocial HRQoL after following the intervention. Conclusions: This pilot study indicates that Op Koers Online is feasible and potentially effective. Further research (a randomized controlled trial) is needed to establish the effects of the intervention.

Objective: This exploratory study examines privacy perceptions and preferences among adolescent and young adult (AYA) and adult individuals with an emphasis on health-related information. Method: Participants (N = 112) completed surveys including measures of privacy concern, consumer control of information, online privacy concern and behavior, and sensitivity of personal information. Results: AYAs (n = 36) and adults (n = 76) showed similar levels of general privacy concern; specifically, their ratings of the sensitivity of non-health-related personal data did not differ. AYAs’ ratings of various health information sensitivities were lower than adults’ ratings, and AYAs reported less concern on subscales addressing online and consumer data collection. Conclusion: Discrepancies between AYA and adult responses to different privacy scales suggest contextual integrity at work. That is, AYAs’ and adults’ privacy perceptions differ based on the type of information being shared, and they draw on different norms to govern information flow. AYAs are more likely to feel they have control over their personal information and feel comfortable employing privacy protecting strategies. AYAs are less likely to see online information collection as a violation of an implied social contract. This study highlights differences in AYA and adult attitudes toward privacy and suggests that AYAs care about privacy but perceive certain types of information collection as less threatening than adults.