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Abstract: Objective: Youth with high levels of needle fear are at risk for adverse health outcomes and poor compliance with general and specialty medical recommendations. With consideration of the COVID-19 pandemic and the increased availability of vaccines, recommendations for adapting and virtually delivering evidence-based interventions for youth with high levels of needle fear are of particular importance for pediatric psychologists. Thus, the purpose of this commentary is to provide an overview of evidence-based interventions and recommendations for pediatric psychologists seeking to adapt and virtually deliver evidence-based interventions to youth with high levels of needle fear. Conclusions: Although pediatric psychologists may face challenges when adapting and virtually delivering exposure-based interventions to youth and their families, the clinical benefits certainly outweigh the costs, particularly considering the increased availability of the COVID-19 vaccine for youth. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Thu, 04 Nov 2021 00:00:00 GMT
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Abstract: Objective: The COVID-19 pandemic presented many personal and professional challenges to pediatric psychology interns as they navigated new policies and provided clinical care via telehealth to patients and families during an unprecedented time. Method: This commentary explores the experiences of 4 pediatric psychology interns and their training director during the height of the pandemic with an emphasis on challenges, opportunities, and lessons learned relevant to internship training. Results: There were numerous challenges in adapting and completing training during the pandemic, such as the rapid transition to telehealth, loss of training opportunities, providing care to inpatient and high-risk patients, and increased personal stress and social isolation. Despite these challenges, there were unique opportunities that arose. Interns were given opportunities to learn a new modality of care (telehealth), expand their breadth of training, practice innovation, receive live supervision in unobtrusive ways, and actively support their medical colleagues. Conclusions: Looking toward the future of health care, interns will significantly benefit from the skills learned during this pandemic, particularly as skills in providing evidence-based care via telehealth will continue to benefit psychologists seeking to increase access to care for patients and families. Institutions providing pediatric psychology internship training may also benefit from incorporating these training opportunities and lessons learned into future internship training in order to best support interns’ professional and personal needs. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Thu, 29 Jul 2021 00:00:00 GMT
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Abstract: Objective: There are numerous psychosocial and ethical complexities in the medical and psychological care of an adolescent with cancer and a concurrent pregnancy. The article aims to discuss specific ethical dilemmas in a case, proposed frameworks for managing these complexities, and a summary of how the psychologist navigated these difficulties. It is notable that many states in the United States allow minors to legally consent for care related to their pregnancy but not their own psychological or oncological care. Methods: This article discusses a unique and complex case encountered by a pediatric psychologist specializing in psycho-oncology, including a discussion of the numerous challenges faced. Relevant cultural considerations are also discussed. Results: The case is further complicated when the patient experiences a spontaneous abortion and disagreements arise between the parents and the psychologist about how to acknowledge the loss. In addition, there is a lack of legal and ethical clarity related to an adolescent’s ability to consent to therapy addressing a pregnancy-related loss. Specific ethical issues that arose in this case pertain to beneficence, nonmaleficence, and respect for rights and dignity for both the patient and for her parents. Considerations for resolving ethical dilemmas are presented, including the use of an ethical framework. Conclusions: There is limited research and discussion in the literature about how to manage psychological goals of care disagreements. It would be beneficial to have additional research, case reports, and clearer laws and ethical guidelines related to the parameters of adolescent pregnancy consent. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Thu, 10 Jun 2021 00:00:00 GMT
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Abstract: Objective: Parental acceptance and support are associated with positive psychosocial outcomes among transgender and gender expansive (TGE) adolescents. Understanding the degree of parental acceptance and support of gender identity and expression is an important component of gender affirmative pediatric assessment and can inform intervention. Although there are reliable measures assessing general family support, there are no existing parent self-report measures assessing acceptance and support of their gender expansive children. The present study examines the factor structure of the Parental Attitudes of Gender Expansiveness Scale for Parents (PAGES-P). Methods: Participants included 739 parents who completed the PAGES-P as standard of care during their child’s gender health clinic visit within a children’s hospital in the midwestern United States. A principal component analysis was used to identify subscales reflected in the PAGES-P. Results: The principal component analysis yielded 4 subscales reflecting the following domains: (a) support and affirmation, (b) guilt and loss, (c) gender concealment, and (d) pride. Conclusions: This study provides preliminary evidence of the factor structure of the PAGES-P. The resulting subscales lend insight into the thoughts and behaviors of parents of TGE youth and can inform clinical practice to facilitate parental support and promote overall well-being in TGE youth. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Thu, 04 Mar 2021 00:00:00 GMT
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Abstract: Objective: Median arcuate ligament syndrome (MALS) is a vascular condition that is treated surgically. MALS is a diagnosis of exclusion and therefore often requires that pediatric patients undergo an exhaustive number of tests and potential experiences with misdiagnosis before receiving an accurate diagnosis and treatment. The purpose of the current mixed-methods study was to assess the pediatric patient- and parent-reported experience of (a) coping with and managing symptoms associated with MALS and (b) the diagnostic, treatment, and recovery process for pediatric MALS. Methods: Nine postsurgical pediatric patients (M age = 20.11 ± 3.59; all PubDate: Mon, 01 Mar 2021 00:00:00 GMT
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Abstract: Objective: Individuals with sickle cell disease (SCD) are at increased risk for complications from their disease during their adolescent and young adult (AYA) years. The risk of morbidity in AYAs with SCD can be decreased with improved self-management. Existing self-management interventions typically focus on one aspect of self-management (e.g., adherence) and do not address factors that activate patients (knowledge, motivation, self-efficacy, and social support) to self-manage. Sickle Cell Thrive (SCThrive) is a mixed in-person/online, technology-enhanced (use of a mobile app), group self-management intervention that targets patient activation. To determine the most clinically significant intervention components, a qualitative study was conducted. Method: Participants were 19 AYAs (Mage = 17.05) with SCD who participated in individual semistructured phone interviews after completing SCThrive. Interview content was coded using a grounded-theory approach to generate themes related to SCThrive’s feasibility, acceptability, and motivation for and impact on self-management. Results: SCThrive was reported to be highly feasible due to the mixed in-person/online format and acceptable because they learned skills to manage SCD in a group of AYAs with SCD. Action planning and pain/mood tracking appeared to be key factors in motivating AYAs for self-management. Participants reported continuing to use self-management skills post-SCThrive (self-efficacy) including applying them to other domains of their lives (e.g., educational/vocational). Conclusions: Study results provide data that can be leveraged to enhance the feasibility, acceptability, and impact of SCThrive and other self-management interventions. Findings can also inform clinical and mobile health interventions to increase self-management in this population. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 01 Mar 2021 00:00:00 GMT
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Abstract: Objective: Our study aimed to adapt an evidence-based, brief intervention for use in an urban safety net adolescent primary care center with an existing integrated behavioral health team who have not previously treated posttraumatic stress disorder (PTSD) explicitly in the clinic. PTSD is routinely undertreated in adolescent primary care due in part to a lack of evidence-based interventions for PTSD that can be feasibly delivered in primary care. Sustainable PTSD interventions in adolescent medicine clinics must overcome patient-, provider-, and system-level barriers. Method: The Brief Relaxation, Education And Trauma Healing (BREATHE) was selected for adaptation based on a literature review of evidence-based target interventions. Purposeful sampling was used to recruit nine adolescent patients, two parents, and eight clinic staff (N = 19) for individual qualitative interviews focused on feasibility of implementation of a PTSD intervention delivered in an adolescent medicine primary care clinic that serves diverse patients with high trauma exposure. Audio recordings from these interviews were transcribed and analyzed using inductive and directed a priori approaches related to the central research questions. Results: Participants provided feedback on the format and content of the BREATHE intervention to adapt the existing treatment to be feasible and sustainable in a primary care setting. Overall, participants thought the intervention was helpful and feasible and provided specific feedback for adaptation. Conclusion: This study developed the Primary Care Intervention for PTSD (PCIP) as a resource for improving PTSD care for adolescents in a primary care setting. Further studies will evaluate PCIP efficacy on PTSD symptomology. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Thu, 28 Jan 2021 00:00:00 GMT
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Abstract: Objective: This study aimed to examine the efficacy of a psychological screening tool for hospitalized pediatric patients to identify those at high risk for adjustment difficulties and optimize referrals to pediatric behavioral health (BH) providers. Specifically, this study evaluated the PROMIS® Parent Proxy 25 to capture the psychosocial needs of the inpatient pediatric population admitted to the general medicine floor in a free standing children’s hospital. Methods: The PROMIS® Parent Proxy 25 was administered to parents of children ages 5 to 17 (N = 128). Chart review was used to group children into those who did or did not receive BH consultation during their admission. Results: Results indicate that the PROMIS® Parent Proxy Anxiety and Depression scales consistently differentiated between children’s consultation status while also indicating a notable level of unmet need in children who did not receive BH consultation. Examination of patterns of scale elevations also provides further information to guide consultations to BH services. Conclusions: Results suggest that the PROMIS® Parent Proxy 25 may be a useful screening tool to determine pediatric patients who need BH referrals. Parental responses to the screener may also be used by CL services to identify patients with BH needs, which would enhance medical provider assessment of patient needs and factors impacting patient functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 25 Jan 2021 00:00:00 GMT
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Abstract: Objective: Pediatricians and pediatric residency program directors recognize that training on social-emotional and behavioral health in residency is not adequate preparation for future practice. Pediatric psychologists’ expertise in the behavioral dimensions of health and facilitating learners’ skill development can help meet these training gaps. We developed a novel resident training curriculum in pediatric primary care focused on knowledge and skill development in the key areas of behavioral health and effective communication. This study examined the curriculum’s feasibility, acceptability, and impact on residents’ skill development in addressing social-emotional and behavioral health concerns. Methods: Using a mixed-methods, quasi-experimental design, we explored the curriculum’s effectiveness by comparing subjective and objective measures completed by residents from the intervention clinic (n = 32) and matched control clinic residents (n = 32). Ten intervention clinic residents provided qualitative data about the curriculum’s impact. Results: Results indicated that the curriculum was feasible and acceptable. Intervention group residents reported greater knowledge and skills associated with behavioral health screening and surveillance than control group participants and demonstrated significant improvement in the communication skills. Conclusions: Our results highlight the role of pediatric psychologists as coleaders and collaborators within pediatric medical training programs to design and implement training curricula to improve the care and attention that behavioral health issues receive in the primary care setting. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Thu, 21 Jan 2021 00:00:00 GMT
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Abstract: Objective: Collaborative approaches to pediatric primary care are increasingly recognized as a way to improve access to mental health care, but certain collaborative care models are not well suited for smaller, independent pediatric practices. We describe the development of the Mood, Anxiety, ADHD Collaborative Care (MAACC) program, based on the Chronic Care Model (CCM) and a hub-and-spoke organization for collaborating with such practices. Method: MAACC’s clinical team (coordinator, psychologist, psychiatrist) trained and collaborated with 46 pediatricians in 13 independent practices. Key services included a diagnostic evaluation by the psychologist, treatment planning for both psychotherapy and pharmacotherapy, tailored referrals to evidence-based therapy, pediatrician access to a psychiatrist for medication consultation, and centralized measurement-based progress monitoring. Results: During the 15-month start-up period, 234 patients were referred; 149 patients received an evaluation, 83 received a new referral for therapy, and 88 received medication recommendations for combined psychotherapy and medication. Patients experienced significant improvement in attention deficit/hyperactivity disorder and anxiety disorder symptoms. Pediatrician attitudes and access to care substantially improved. Conclusion: MAACC demonstrates the feasibility of implementing a CCM-derived model for collaborative care with independent pediatric practices. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Mon, 18 Jan 2021 00:00:00 GMT
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Abstract: Objective: The purpose of this study was to (a) describe the development and implementation of Behavioral Health in Pediatric Populations:0–5 (BHIPP:0–5), an initiative designed to increase the capacity of primary care practices to deliver early childhood behavioral health (ECBH) integration activities; and (b) examine practice transformation changes in ECBH services for three types of primary care settings (federally qualified health care centers—FQHCs, private practices, nonprofit/community practices). Methods: BHIPP:0–5 pediatric psychologists and interdisciplinary TA professionals provided monthly technical assistance sessions and quarterly cohort learning collaboratives to nine diverse primary care practices. Changes in ECBH activity implementation were examined across and within three practice type groupings. Results: All BHIPP:0–5 practice types expanded their capacity to provide ECBH services from baseline to the end of Year 2. Prevention/health promotion activities evidenced the most growth (from 16% in baseline to 40% in Year 2). Practice types differed in implementation of ECBH services. FQHCs accounted for 75% of the total prevention/health promotion services, private practices provided the most case-based consultation/intervention (54%), and nonprofit/community practices accounted for 86% of the total care coordination/systems navigation services. Conclusions: Primary care settings are uniquely suited to address early childhood mental health in the context of routine care. The BHIPP:0–5 initiative supports practice transformation in early childhood behavioral health integration while simultaneously advancing systems-level policies and practices that promote high quality care, increase efficiency, improve utilization of preventive services, and decrease overall costs in alignment with health care systems goals. (PsycInfo Database Record (c) 2022 APA, all rights reserved) PubDate: Thu, 17 Dec 2020 00:00:00 GMT
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