Clinical Practice in Pediatric Psychology

Objective: Black youth face numerous barriers to equitable mental health care that contribute to service underutilization. Some clinicians and researchers encourage matching Black youth with Black clinicians as a strategy to mitigate the effects of these barriers and improve treatment outcomes and engagement. Evidence in the adult therapy literature demonstrates that racial matching can improve treatment outcomes (i.e., symptom reduction) for Black adults; however, youth research is limited and largely restricted to traditional outpatient treatment models. Pediatric integrated primary care (IPC) aims to improve mental health access by embedding mental health services into primary care clinics; however, little is known about how racial match influences service utilization and delivery in pediatric IPC for Black youth. Method: We utilized retrospective chart review to examine associations between patient–psychology clinician racial match and service utilization and delivery in a pediatric IPC clinic serving predominately Black families (N = 234, 50% female, 100% Black). Our primary measures of interest were patient–provider racial match, psychology attendance rate, and first encounter diagnosis. Results: Black clinicians were grossly underrepresented in our dataset and families had limited opportunities to receive racially matched care. Black youth attendance rates were unrelated to working with a Black clinician, but youth were more likely to receive a developmental/learning/autism diagnosis during their first encounter when working with a Black clinician. Conclusions: Racially matched care in IPC remains a promising strategy to improve care and warrants further investigation, both in the literature and in clinical practice.

Pediatric integrated primary care aims to improve mental health access by embedding mental health services into primary care clinics; however, no research explores if racial match between Black mental health clinicians and Black youth influences care in this setting. Although Black clinicians were underrepresented in our clinic and families had limited opportunities to receive racially matched care, Black youth were more likely to receive a diagnosis related to development, learning, or autism when working with a Black clinician. Racially matched care in integrated primary care remains a promising strategy to address mental health inequity for Black youth and warrants further investigation.

Objective: Previous work has suggested disparities for survivors of pediatric cancer who live in rural or Appalachian areas relative to those in more well-resourced communities. Limited research exists for pediatric brain tumor survivors, who are at risk for poorer quality of life (QOL) due to the location of their tumor and treatments directed toward the central nervous system. We examined how geographic region related to QOL for survivors. Method: Survivors of pediatric brain tumor (N = 41; ages 10–25) and their caregivers recruited from the cancer registry and clinics in 2018 at a Midwest children’s hospital completed measures of QOL (Patient-Reported Outcomes Measurement Information System Profile). Demographic/treatment factors were extracted from medical records. Addresses were categorized as rural/nonrural using the Rural–Urban Commuting Area Codes and Appalachian/non-Appalachian with the Appalachian Regional Commission boundaries. Independent samples t tests compared geographic groups and to measure norms. Results: Rural and Appalachian survivors reported significantly lower social QOL compared to their nonrural/non-Appalachian counterparts and norms (ds = 1.25–1.33). Appalachian survivors reported lower physical mobility than norms (d = 0.81). Conclusions: Results suggest reduced social QOL for both Appalachian and rural survivors and lower physical mobility for Appalachian survivors. Future research should prioritize partnership with stakeholders to explore factors that may contribute to poorer QOL for Appalachian survivors and potential solutions for improving social engagement and physical functioning.

Findings suggest that rural and Appalachian survivors of pediatric brain tumor report largely equivalent quality of life to their nonrural and non-Appalachian counterparts, except for physical mobility and social engagement. Additional research should be dedicated to investigate underlying causes to improve survivor well-being.

Objective: Describe how menstruation affects the gender identity of gender-diverse adolescents and young adults who were assigned female at birth and now seek gender-affirming care. Method: Patients at a multidisciplinary pediatric gender program, ages 12–20 assigned female at birth and identified as gender diverse, and had reached menarche were recruited via purposive sampling. Thirty-six patients completed semistructured qualitative interviews about their experiences and attitudes toward menstruation. Open coding procedures, constant comparative method of ground theory, and inductive thematic analysis were used for analysis. Results: Four major themes were identified: (a) language, (b) first periods, (c) periods now, and (d) ways to cope. The association of menstruation with femininity was a source of discomfort. This was reinforced through language, menstrual products, and public bathrooms. Participants were uncomfortable with words related to menstruation but accepted their use with healthcare providers for menstrual management. Many participants noted that their discomfort with menstruation and its association with femininity confirmed their gender identity. A minority of participants expanded their definition of masculine to include people who menstruate. Participants coped with the discomfort of menstruation with distractions, avoidance, menstrual management, testosterone, mental reframing, gender-affirming clothing, and social support. Conclusions: Gender-diverse youth have a diversity of experiences and attitudes toward menstruation. Menstruation is not only a source of dysphoria; it can be a catalyst of exploration and confirmation of gender identity. Psychologists can help gender-diverse adolescents and young adults explore how menstruation influences their identity and identify strategies to cope with their discomfort.

This qualitative study demonstrates that menstruation causes distress for adolescents and young adults who were assigned female at birth and now identify as a different gender. Psychologists can encourage adolescents and young adults to find words for menstruation that they are comfortable with, talk to supportive family and friends about menstruation, and identify how they may affirm their gender identity when they menstruate.

Objective: Infancy is a critical period for preventing obesity and health disparities. This study reports on the acceptability of a responsive parenting obesity prevention intervention (Teaching Healthy Responsive parenting during Infancy to promote Vital growth and rEgulation [THRIVE]) delivered via integrated behavioral health in a pediatric primary care setting. Intervention participants were invited to participate in a focus group on the acceptability of THRIVE and suggestions for refinement with particular attention to cultural responsiveness and diversity, equity, inclusion, and accessibility (DEIA). Method: Eleven of 32 (34.4%) mothers participated in a 45–60-min focus group (three groups, three to five participants each). Sessions utilized a semi-structured interview guide, were transcribed verbatim, and analyzed according to a thematic analytic approach. Results: Four themes emerged: (a) lived experience (e.g., lived experience as a mother, navigating systemic and healthcare-related barriers, and context that shaped personal experiences with THRIVE); (b) therapeutic processes and cultural responsiveness (e.g., an appreciation of families’ strengths and values by the THRIVE interventionist that facilitated engagement with THRIVE); (c) tailored strategy implementation (e.g., implementation of THRIVE skills and strategies by families and how strategies were adapted or tailored to meet families’ needs); and (d) future improvements to THRIVE (e.g., proposed strategies for increased attention to DEIA and reducing participant burden). Conclusions: Conducting qualitative research prior to Phase 2–3 trials is vital to ensuring the interventions developed, implemented, and tested are not only empirically based but also culturally responsive, attentive to DEIA, acceptable, and relevant. Mothers provided valuable insights surrounding participation in THRIVE, highlighting important DEIA elements of THRIVE and suggesting ways to decrease the burden and increase access.

The present focus group study examined the acceptability and perceived effectiveness of a strengths-based obesity prevention intervention delivered in integrated primary care. Mothers identifying as Black or African American were also asked to provide feedback on cultural responsiveness or how the study team, intervention, and procedures valued diversity and cultural factors. This is an important but often overlooked step in intervention development; thus, this study demonstrates the importance of attending to the “voice of the customer,” particularly those with intersecting and diverse identities (i.e., Black mothers), in clinical research.

Objective: RASopathies are a group of genetic conditions that produce a wide range of manifestations including failure to thrive, congenital heart disease, an increased risk of cancer, and cognitive problems. Parents of children with medical conditions often experience stress; thus, interventions targeting parenting stress in this population are crucial. This internal pilot study investigated the feasibility and acceptability of a remote acceptance and commitment therapy (ACT) intervention for parents of children with RASopathies (e.g., neurofibromatosis Type 1, Noonan syndrome, Costello syndrome). Internal pilots enable researchers to garner participant feedback and conduct a small-scale intervention before transitioning into a randomized controlled trial (RCT) to determine efficacy. Method: This 8-week intervention included three individual ACT telehealth sessions and weekly videos delivered via a smartphone app. Participants received ecological momentary assessment surveys through the app that measured stress, self-compassion, and various ACT concepts (e.g., parenting values, present-moment awareness). Feasibility was determined by engagement with weekly videos and follow-up sessions. A red/amber/green benchmark system was used to determine whether to proceed to the RCT. Acceptability was measured through participant feedback. Results: The recruitment target (n = 8) was met within 4 months, and seven participants completed the intervention. Seven participants attended all sessions and viewed all videos. All participants who completed the intervention reported enjoying the study and provided qualitative feedback for improvement. Conclusion: Feasibility targets were met and acceptability was high, allowing continuation into an RCT to determine efficacy. Preliminary results suggest that the intervention may provide clinically meaningful effects.

This study examined the overall feasibility of conducting an intervention targeting stress in parents of children with genetic syndromes. Most parents completed the study and reported enjoying the intervention; self-care and connection with child increased and present-moment awareness did not. Thus, we are transitioning to the randomized controlled trial where we will examine efficacy.

Objectives: This case study explores the application of a brief Integrated Behavioral Health-Prevention (IBH-P) model in a pediatric primary care setting that provides care to families experiencing complex psychosocial stressors. The model focuses on promoting social–emotional health and well-being while addressing structural and systemic inequities that hinder access to mental health care for families living in poverty and underresourced communities. The IBH-P visits use a universal, standardized approach, emphasizing trauma-informed care and recognizing the impact of caregiver well-being on the child. Method: This case study demonstrates the feasibility and impact of the IBH-P model through a case example of a Black family living below the federal poverty line. Results: The case study illustrates results previously documented in the literature regarding the impact of this IBH-P model. These include adherence to well child visits (WCVs), achieving developmental milestones on target, enhanced family distress tolerance and socioemotional well-being, reduced unnecessary emergency department visits, and sustained progress despite psychosocial risk factors. Conclusions: This case example highlights how IBH-P effectively supports families facing multiple challenges and promotes health equity for underresourced populations. It underscores the importance of culturally responsive care, standardization, and flexibility in building scalable and sustainable IBH programs.

This article shares how pediatric psychologists working in primary care can support the health and development of young children and their families, especially those facing poverty and other stressors. We illustrate how brief visits with a baby and her mother at their pediatrician’s office were important in helping the baby stay up to date with her healthcare needs and reach her milestones, while also helping her mother overcome stress/challenges in caring for her baby. This article serves as a roadmap for other clinics wanting to provide similar types of care and highlights how psychologists can use the strategies we know to work while meeting families where they are and respecting their points of view.

Clean intermittent catheterization (CIC) is widely accepted for managing bladder dysfunction, preserving kidney function, and achieving continence. While CIC is frequently used in children, its impact on family and social relationships is not well understood. This study aims to explore the experience of children and adolescents needing CIC along with their families regarding the impact of CIC on their family and social life. This qualitative interview-based study used a phenomenological approach to gather information from patients and families between Aug 2018 and Oct 2019. Interviews were audio recorded, transcribed, and coded, focusing on CIC’s impact on relationships with caregivers, siblings, friends, and intimate partners, and the use of or desire for peer-to-peer connection with individuals with similar medical conditions. A total of 52 interviews among 40 families were conducted. Common themes central to patient and family experiences were identified, including (1) navigation of CIC in relationships between patients and their caregivers, siblings, friends, and intimate partners; (2) communication and collaboration between caregivers when approaching CIC; and (3) relationship building with individuals with similar medical needs and members of their interprofessional team. These findings underscore the importance of collaborative family dynamics and the interprofessional team’s role in facilitating supportive relationships. Pediatric psychologists are uniquely positioned to provide interventions that can help patients and families encourage open communication, identify coping strategies, manage disclosure about CIC to peers and intimate partners, facilitate peer-to-peer mentorship, and provide education on sexual health to patients, families, and other members of the interprofessional team.

Interviews with 40 families (52 patients and caregivers) in a pediatric urology clinic about their experience with clean intermittent catheterization (CIC) uncovered a new understanding of how CIC impacts relationships with family members, friends, intimate partners, and peers with similar medical needs. Pediatric psychologists can provide intervention that (1) promotes communication within families and fosters gradual independence with CIC, (2) strengthens confidence and resilience when navigating CIC in social relationships, (3) promotes early discussion about sexual health as part of pediatric urologic care and supports patients in navigating disclosure about CIC needs to intimate partners, and (4) facilitates opportunities for peer support from individuals with similar medical needs.

Objective: This article aims to share the lessons we have learned during 25 years of development, research, and implementation related to a psychosocial group intervention for children with chronic illness and their families called Op Koers (“On Track” in English). Method: Using the National Institutes of Health Stage Model for Behavioral Intervention Development and the Consolidated Framework for Implementation Research, we critically appraise the different stages of our activities. Over the years, we used basic research to create and modify intervention modules for different populations. Op Koers was pilot-tested several times, and larger efficacy studies revealed that it was effective in improving coping skills and emotional functioning. It has become a part of usual care at the authors’ institutions and has been disseminated throughout the Netherlands. Results: We derived important lessons regarding the intervention’s characteristics, the inner and outer settings, individual characteristics, the implementation processes, and related research. Future efforts may be directed toward continuous improvement of the intervention and its successful lasting implementation. Conclusions: Op Koers is one of the few psychosocial interventions that has been both extensively studied and implemented. The main factor in this achievement is the close collaboration between, and the perseverance of, clinical care and research departments.

This article describes insights gained from over 25 years of research on psychosocial intervention development, evaluation, and implementation. We present important lessons we have learned regarding the characteristics of the intervention, the inner and outer settings, individual characteristics, implementation processes, and research.

Objective: Pediatric feeding disorder (PFD) is a common condition for young children and can cause stress among parents. However, there are no parent psychosocial interventions that have been tested for efficacy in this population. Acceptance and commitment therapy (ACT) holds great promise for addressing parent stress among parents of children with PFD. In the present case report, we describe the application of ACT with a parent of a child with PFD, with a focus on parent and child outcomes and parent-reported implementation barriers and facilitators. Method: The mother of a young child with PFD completed six sessions of ACT focused on the stress she was experiencing related to her child’s feeding issues. Treatment was offered in the context of her child’s PFD treatment setting, and sessions were held over telehealth. Results: This mother’s stress improved from high to average over the course of treatment, using the Parental Stress Scale. The majority of her improvements in stress were following the first two sessions. She also reported qualitative benefits related to her parenting, her child’s feeding, and her general well-being. She reported several facilitators of treatment, including the flexibility offered throughout treatment the use of telehealth, and acknowledgment of her experiences. She reported barriers including mental health stigma, time constraints, and childcare. Conclusions: Brief treatment of parental stress, offered in a pediatric treatment setting is feasible to implement and may have clinical utility in supporting families of children with PFD or other medical conditions.

We used acceptance and commitment therapy, which is a specific type of mental health talk therapy, with a parent of a child with pediatric feeding disorder who was experiencing stress. This parent found the therapy helpful, and her ratings of stress improved from before to after therapy. This type of therapy may be helpful for other parents of children with pediatric feeding disorder and high stress.

Objective: Understanding specific drivers of dietary behavior in adolescents can inform preventive models for disordered eating and psychosocial and physical health concerns. The present study examined how eating motives (hedonic appetite, palatable eating motives, controlled dietary motivation), relate to impulsivity and emotional eating to predict binge eating and calorie intake in adolescents. Method: 43 adolescents (M_age = 15.1 years, 72.1% female) self-reported all variables of interest via survey during a study lab visit. Calorie intake was assessed via dietary recall. Models were run in SPSS and post hoc probing was conducted for significant interactions. Results: Significant associations emerged between hedonic appetite and binge eating, emotional eating and binge eating, palatable eating motives and binge eating, and controlled dietary motivation and binge eating. There was a significant interaction of controlled dietary motivation and emotional eating predicting binge eating (β = .23, p < .05) with higher levels of controlled motivation positively associated with binge eating when emotional eating was high. There was a marginally significant interaction (β = .22, p = .05) for hedonic appetite and emotional eating predicting binge eating, with higher levels of emotional eating predicting binge eating when hedonic appetite was high. Conclusions: The present study identified potential risk factors for binge eating in adolescents, highlighting hedonic appetite and emotional eating as important factors to assess to inform preventive intervention. Future studies with larger and more diverse samples, conducted longitudinally in comparison to clinical samples will progress the application of this research.

This study suggests that specific eating motives and behaviors can be risk factors for binge eating in healthy adolescents. Screening for hedonic appetite, emotional eating, and eating motives can inform preventive strategies for disordered eating. Interventions that promote healthful relationships with food can be preventive to the development of disordered eating and related concerns for adolescents.

Objective: The boarding of psychiatric patients on pediatric medical units has increased since the start of the COVID-19 pandemic and the ensuing mental health crisis. Boarding poses many challenges for youth and the care teams tasked with appropriately managing their acute needs. Pediatric consultation-liaison (CL) psychologists are critical in the management of psychiatrically complex patients. Ethical challenges abound when systemic barriers exist to optimal patient care. Methods: We aim to identify common ethical dilemmas for CL psychologists working with pediatric patients boarding on medical units and provide practical recommendations to enhance patient care, help staff navigate burnout and moral distress, improve supervision of psychology trainees, and advocate for systematic change at the institutional, state, and national level. Results: Through a hypothetical case example, recommendations are provided for improving interventions, training, and advocacy efforts to better support pediatric boarders and those who care for them. Conclusion: CL psychologists are encouraged to leverage their expertise in evidence-based care, patient advocacy, and conflict management to promote practices that enhance the ethical treatment of youth while boarding.

With the current mental health crisis, pediatric psychologists are working with more youth who are boarding in medical settings as they await psychiatric placement. This paper offers several suggestions for addressing the numerous ethical dilemmas and challenges that arise when a health system is overtaxed, providers step outside their comfort zone, and children wait for appropriate services. Pediatric psychologists are well positioned to promote ethical and just treatment of these patients and to advocate for system change.