1. Pediatric Psychology Training models and content
Palermo,
Sicily
January 2017
Michael C. Roberts, PhD, ABPP
Clinical Child Psychology Program
University of Kansas

2. Logan Wright’s “Role Model” Paper (1967)
1. Establish an identity through a formal organization 2. Construct new knowledge through applied research 3. Focus on professional training in the specialty

3. Logan Wright’s “Role Model” Paper (1967)
1. Establish an identity through a formal organization 2. Construct new knowledge through applied research 3. Focus on professional training in the specialty

4. SPP mission and vision statements
”SPP aims to promote the health and psychological well-being of children, youth and their families through science and an evidence-based approach to practice, education, training, advocacy, and consultation.”
(2012)
sani bambini, giovani e famiglie

5. pediatric psychologists provide:
Psychosocial services for issues related to pediatric health conditions
Psychological services for mental health problems appearing in medical settings along with a pediatric problem
Assessment and treatment for psychological problems presenting in a medical setting without a concomitant medical condition
Roberts, Aylward, & Wu (2014)

6. pediatric psychologists provide:
Programs for health promotion, disease, and injury prevention, and early intervention
Advocacy for public policy supporting children and families and promoting public health advancements
Roberts, Aylward, & Wu (2014)

7. Pediatric psychology Training
1987: “No single path to becoming a pediatric psychologist” (La Greca et al.)
2017: Training now more developed and formal
Didactic coursework
Research Experience
Clinical Practicum

8. Domains OF TRAINING In Pediatric psychology
Lifespan developmental psychology and psychopathology
Child, adolescent, and family assessment
Intervention strategies
Research methods and systems evaluations
Professional, ethical, and legal issues
Diversity considerations
Spirito et al. (2003)

9. Domains OF TRAINING In Pediatric psychology
Role of multiple disciplines in service delivery systems
Prevention, family support, and health promotion
Social issues affecting children, adolescents, and families
Consultation and liaison roles
Disease process and medical management
Spirito et al. (2003)

10. Competency initiatives in professional psychology

11. Competency initiatives in professional psychology

12. Competencies in pediatric psychology
Values and understands foundation underlying the practice of pediatric psychology
Builds on strong foundation in clinical child psychology
Has knowledge of biological, cognitive, social, affective, sociocultural, and lifespan developmental influences on children’s health and illness
Palermo et al. (2015)

13. Competencies in pediatric psychology
Understands pediatric acute and chronic illness, injury conditions, and medical management from the medical literature
Has knowledge of the role and effect of families on children’s health and of health, of illness, and medical management on family functioning
Has knowledge of the effect of socioeconomic factors on health and illness
Palermo et al. (2015)

14. Competencies in pediatric psychology
Understands how other systems affect pediatric health and illness and a child’s adaptation to illness
Understands the roles of other disciplines in health service delivery systems
Palermo et al. (2015)

15. Competencies in pediatric psychology
Appreciates the function of health information technology in children’s healthcare
Has knowledge of the transition of pediatric patients to adulthood and adult oriented health care
Palermo et al. (2015)

16. Common presenting concerns and settings

17. presenting problems Unintentional injury
Infants born prematurely or at biological risk
Pain from medical procedures
Pain from pediatric conditions
Sleep disorders
Juvenile idiopathic arthritis
Pediatric HIV
Asthma
Diabetes
Obesity
Cancer
Seizure disorders/epilepsy

18. presenting problems End of life issues Cystic fibrosis
Sickle cell disease
Pediatric organ Transplantation
Feeding disorders
Elimination disorders: enuresis and encopresis
Traumatic brain injury
Spina bifida
Cardiovascular disease
Pediatric burns
Gastrointestinal disorders
Autism spectrum disorder
Attention deficit/hyperactive disorder
Sexual development disorders and differences
End of life issues

19. Outpatient setting interventions: hospital-based clinics
Making broad and targeted assessments of functioning
Teaching and facilitating use of problem-solving strategies
Providing psychoeducation on relevant topics

20. Outpatient setting interventions: hospital-based clinics
Facilitating communication between medical team and patient and family
Implementing brief cognitive-behavioral or other therapeutic techniques to address referral question
Referring to more intensive services if needed

21. Outpatient setting interventions: specialized care
Providing psychoeducation on the rationale for recommended interventions
Teaching families behavioral strategies (e.g., reinforcement, planned ignoring) to address noncompliance and aggression
Using cognitive-behavioral or other therapeutic strategies to address mood or coping concerns

22. Outpatient setting interventions: Primary care
Making brief assessment of referral concern
Providing psychoeducation on child development and/or the referral problem
Using behavioral strategies, such as for toileting or to address behavior problems

23. Outpatient setting interventions: Primary care
Initiating problem-solving interventions
Serving as an advocate for children
Making referrals for extended evaluations or services

24. Outpatient setting interventions: Private practice
Using various assessment and intervention strategies
Treating more frequently in private practice than by primary care physicians or in hospital-based clinics
Implementing over a longer period of time, modifying treatments as patient’s needs change

25. inpatient setting interventions: consultation-liaison
Implementing cognitive-behavioral techniques (e.g., relaxation training)
Providing problem-solving strategies for coping with hospitalization and medical treatment
Using behavioral strategies for increasing adherence and/or meeting goals of hospitalization
Facilitating communication between medical team and patient and family

26. inpatient setting interventions: consultation-liaison
Assisting medical team in implementing interventions
Educating medical team about development, adherence barriers, behavioral strategies
Facilitating disposition planning and transitions

27. inpatient setting interventions: Emergency room
Using relaxation training and other cognitive-behavioral techniques for acute stabilization
Providing psychoeducation for families and staff on behavioral techniques to use with disruptive youth
Using problem-solving strategies to address presenting problem
Assisting medical team with disposition planning

28. inpatient setting interventions: Specialized care
Implementing cognitive-behavioral techniques to manage mood and anxiety concerns
Educating children about parental illness
Educating parents and family members on typical childhood reactions to parental illness

29. inpatient setting interventions: Specialized care
Using behavioral strategies in supporting children during a parent’s illness
Providing problem-solving and educational strategies to help parents transition to parenthood or to learn to care for a medically fragile infant and cope with a child’s hospitalization

30. Emerging & Cross-cutting issues

31. Pediatric medical home
“Medical care of infants, children, and adolescents ideally should be accessible, continuous, comprehensive, family-centered, coordinated, and compassionate”
--American Academy of Pediatrics
Integrated health care movement

32. Primary care
Historically, only a few pediatric psychologists have worked in primary care settings
Developed effective models for assessment, treatment, and consultation for behavioral concerns
Provide services in numerous areas including prevention, screening and early intervention, health promotion and prevention, developmental disorders, and family-centered treatments

33. Traumatic medical stress
“A set of psychological and physiological responses…to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences”
“These responses may include symptoms of arousal, re-experiencing, and/or avoidance”
--National Child Traumatic Stress Network

34. Traumatic medical stress
May include diagnosable disorders as well as stress symptoms
Preventive and therapeutic interventions to address

35. School and home reintegration
Reestablishing regular school attendance, maintaining school performance, and coping with effects of illness or medical treatment on academic and cognitive functioning
Potential psychosocial adjustment difficulties
Collaboration between pediatric psychologist, medical team, and school staff

36. Treatment regimen adherence
Adherence to treatment regimen---medication, health procedures (e.g., respiratory therapy, blood glucose monitoring), and lifestyle changes
Numerous factors related to nonadherence including
cognitive abilities,
adjustment and coping
values and attitudes toward regimen
family resources

37. Treatment regimen adherence
Variety of interventions for nonadherence
including:
problem-solving approaches educational
behavioral
motivational interviewing

38. Patient and family Diversity
Patients and families who are diverse in numerous ways, including:
cultural
ethnic
socioeconomic
geographic
sexual orientation

39. Patient and family Diversity
Incorporate unique diverse characteristics into case conceptualization and into choice of intervention
Fewer clinical strategies are validated for use with diverse populations

40. Adjustment to chronic illness
Impact of illness can be associated with
experience of illness itself
developmental period of the child,
psychosocial difficulties resulting from interaction between illness symptoms, the child, and the child’s immediate environment

41. Adjustment to chronic illness
Factors on an adjustment continuum—
some are protective
(e.g., family support)
others are potentially negative
(e.g., ignoring medical care as a way of coping with “bad” news)

42. Outcome measurement & Evaluation
Demonstrate effectiveness of clinical services using objective measures
Quality Improvement
Examine outcomes over time
Provide feedback at point of care and monitor treatment progress
Use scale-up methods to implement clinical improvements to other patients or settings
PLAN  DO  STUDY  ACT

43. Evidence-based Practice
Evidence-based practice (EBP):
“Integration of best available research
with clinical expertise
in context of patient characteristics, culture, and preferences”
American Psychological Association
2006

44. Collaboration and consultation
Conceptual models for collaboration and consultation:
Independent Function Model: services without extensive interaction with pediatrician
Indirect Consultation Model: provide information to referral but not interact directly with the patient
Collaborative Team Model: multiple disciplines work together with joint responsibility
Systems-Based Consultation: systematic change on medical units and consult on procedural/structural changes in health care
Roberts & Wright/Mullins

45. Collaboration and consultation
5 C’s of pediatric consultation-liaison services:
Crisis
Coping
Compliance (Adherence)
Communication
Collaboration
Carter et al. (2017)

46. Maturation of Pediatric Psychology
…growth of the field can be traced to the value attributed to the concepts and psychological applications in meeting the multiple needs of children in the medical setting with a set of complex problems requiring interdisciplinary collaborations.
Roberts, Aylward, & Wu (2014)

47. Maturation of Pediatric Psychology
…growth has been propelled by the well-received effectiveness of pediatric psychologists as individual practitioners interacting with patients and medical personnel and of pediatric psychology as an integrative field collectively demonstrating the worth of its practitioners’ knowledge and skills.
Roberts, Aylward, & Wu (2014)

48. Maturation of Pediatric Psychology
Development of:
Sophisticated scientific and professional scholarship
Specialized assessment & measurement approaches
Empirically supported treatments for a wide range of clinical problems
[now  evidence-based practice]
Drotar (2007)
Roberts (2017)

49. Maturation of Pediatric Psychology
Development of:
Informational resources for clinical care, research, and training
Professional roles and specialization in multiple settings
Pediatric psychology specialty training programs
Drotar (2007)
Roberts (2017)

50. Maturation of Pediatric Psychology
Development of:
Specialized research methodologies
Prospective research methods
Advanced statistical methods
Multisite studies to enhance sample size for generalizability
Drotar (2007)
Roberts (2017)

51. Grazie per l'ascolto!