Journal of Clinical Psychology in Medical Settings最新文献

Informed consent laws allow patients to decide what happens to their bodies within a medical setting, but medical practices within academic teaching hospitals do not always live up to ethical standards or align with the values and wishes of clinicians, patients, and families. Bioethics often helps to resolve these conflicts through collaboration and dialogue. However, when conflicts persist and are resistant to change, it may be necessary to pursue regulatory or legislative solutions. This paper discusses the role of bioethics in strengthening federal regulations on explicit consent for sensitive (pelvic, prostate, rectal, and breast) exams. Since psychologists within academic health centers may also wish to influence policy, this paper concludes with practical, achievable guidance for psychologists to gain an understanding of the public policymaking process, develop relationships with policymakers, and take steps to exert influence on the policymaking process.

While psychologists possess unique and valuable skills that can contribute to leadership within academic health centers (AHCs), there are common barriers within these institutions that impede psychologists' engagement in leadership. As a result, significant educational efforts and challenges to entrenched norms are often required to advocate for the field of psychology, particularly when working outside of centralized psychology departments. In the following article, four psychologist colleagues working in a centralized department of psychiatry at a single AHC share their recent experiences facing barriers to leadership roles. The authors describe the impact of historical context on the challenges they face, as well as the actions they have taken to support the advancement of psychologists. These actions include leveraging interdisciplinary support, learning from other fields, and developing a curriculum to enhance financial and business acumen in psychology trainees. The authors also review the importance of staying informed about state and federal policy changes that impact healthcare systems, so that psychologists can help lead in responding to these changes in value-consistent ways. By advocating for the unique contributions psychologists offer and addressing the structural barriers in many AHCs, psychologists can more effectively navigate and shape leadership pathways.

Infancy and toddlerhood are periods of rapid development which could be significantly compromised by the diagnosis of cancer and its treatment. The aim of this study was to describe health-related quality of life (HRQOL) in infants/toddlers diagnosed with cancer and their caregivers over time and identify whether treatment variables and caregiver HRQOL are associated with infant/toddler HRQOL. HRQOL was assessed by parent-proxy reports among infants/toddlers (N = 39) and their caregivers (N = 39) at three timepoints (baseline, 6 months, 12 months). Linear mixed models were used to investigate whether demographic and treatment variables, caregiver HRQOL, and caregiver distress was associated with infant/toddler and caregiver HRQOL over time. No statistically significant variables were found to be associated with caregiver HRQOL, including infant/toddler HRQOL, time since diagnosis, income, and intensity of treatment. However, caregiver distress and infant/toddler HRQOL were bidirectionally related to each other over time, whereby higher infant/toddler HRQOL was associated with lower caregiver distress, and vice versa. Infants/toddlers with cancer and their caregivers experience psychosocial challenges. Interventions targeting caregivers that emphasize the importance of the caregiver-child relationship, and self-care are important. Health care providers should screen caregivers to assess their well-being and provide appropriate supports when needed.

Psychologists working in medical and academic health settings bring unique skills that make them well-suited for policy advocacy. Their training in trust-building, translating evidence, and understanding context can be applied to influence policies that impact access, quality, and equity in healthcare. This article explains how clinical and counseling skills align with policy engagement and shows their relevance through examples such as Medicaid reform, telehealth parity, and racial equity impact assessments. It introduces conceptual frameworks and practical strategies to demonstrate how psychologists can participate in coalition building, communication, and policy evaluation. Training recommendations emphasize the importance of incorporating advocacy skills into graduate programs, offering mentorship, and providing ongoing professional development to equip psychologists for leadership in evolving healthcare systems. Advocacy is presented not just as a supplement to practice, but as a natural part of psychologists' professional identity. By embedding advocacy into education and practice, psychologists can promote health equity and help ensure policies are based on both scientific evidence and lived experience.

Academic health center (AHC) psychologists finding novel leadership pathways, both within and outside their AHCs, can provide valuable opportunities for professional enrichment and growth. In this manuscript, we describe how psychologists' training, experiences, and skills contribute to leadership success in traditionally medically-led organizations (MLOs). We also describe how four ACH pediatric psychologists, all at different career stages, found unique leadership roles within traditionally medically-led organizations (MLOs). For each leadership role example, we describe (1) how career stage, expertise, and values intersect with the leadership opportunity, (2) the psychologist's organizational context and leadership role structure, and (3) the psychologist's leadership contributions and collaborative strategies. We also provide concrete recommendations to other ACH psychologists who wish to explore leadership roles throughout their careers.

The 2025 Association of Psychologists in Academic Health Centers (APAHC) national biennial conference was held in Saint Petersburg, Florida, May 1-3, 2025. Our conference theme was "Impact of Psychology in Complex Healthcare Systems: Opportunities, Innovation, and Intentional Growth," with a goal of showcasing the meaningful work academic health center psychologists do around the United States to enhance care and care access for the communities in which they live and work. The conference included invited plenary speakers as well as concurrent speakers who were selected based on a competitive application process. This special issue includes invited manuscripts from plenary speakers and concurrent speakers. All manuscripts were peer reviewed by field experts. The conference co-chairs, Drs. Melissa A. Faith, Ph.D., ABPP, and Lisa Ramirez, Ph.D., ABPP, served as guest editors for this special issue, with editorial support from JCPMS Editor Dr. Andrea Bradford. This article provides a brief overview of the conference theme as well as a framework for this special issue.

Child-Adult Relationship Enhancement (CARE) is an evidence-informed approach to promote positive child-adult relationships in youth with behavior problems or traumatic stress. Implementing CARE in community settings may extend accessibility to evidence-based practices (EBP) for children in underserved areas. The present study examined health professionals' perceptions of CARE. Participants were 277 professionals from a statewide training initiative including early childhood educators (n = 178), allied health professionals (n = 48; speech, occupational, physical therapists), and behavioral health clinicians (n = 51) completing CARE training. Participants completed the Evidence-Based Practice Attitude Scale (Aarons (2004) Mental Health Services Research 6:61-74) (pre-training). Post-training, participants completed two scales created for this study which assessed participants perceptions of the training experience. Structural equation modeling evaluated differences in health professionals' perceptions of CARE and EBP. CARE was the most well received by allied health professionals, who reported greater favorability of EBP relative to behavioral health clinicians (0.12, 95% CI [.04, .24]). Additionally, results indicated greater favorability of EBP-mediated perceived usefulness (0.17, 95% CI [.07, .31]). CARE is a well-received training for professionals working with youth. Interprofessional training may enhance developmental and behavioral outcomes for youth, and our findings suggest particular receptivity to CARE by allied health professionals and implicate EBP favorability as a key driver.

Innovative behavioral health interventions in medical settings are often constrained by financial and structural barriers within the U.S. health insurance system. Providers are caught between two billing pathways: DSM-based codes, which do not reflect health-focused interventions, and health and behavior codes, which remain inconsistently recognized and poorly reimbursed. This disconnect makes it difficult to sustain innovative care despite clear clinical benefit. Moreover, it stifles clinical advancements and contributes to health inequity. The Comfort Ability^® Program (CAP) intervention, a family-based, group treatment for pediatric chronic pain, illustrates both the promise and the challenge of this landscape. The CAP intervention integrates CBT, ACT, MI, and behavior management strategies in a comprehensive one-day format. It has been adopted by more than 45 healthcare institutions worldwide and demonstrates improved outcomes and reduced barriers to care. However, despite clinical success and scalability, CAP faces many reimbursement obstacles in the U.S., reflecting broader systemic issues. This manuscript reviews psychology billing reforms, outlines system-level challenges working within medical settings, and discusses real-world implications for providers striving to deliver integrated, patient-centered care. We propose concrete steps to support clinicians in navigating current barriers while advocating for system-level reforms that can sustain innovation in behavioral health delivery.

The SARS-CoV-2 (COVID-19) pandemic strained healthcare systems and professionals. Psychologists were not immune from these effects. This study examined stressors, well-being, and the roles of psychologists in academic health centers during the second year of the pandemic. Members of the Association of Psychologists in Academic Health Centers (APAHC) completed a survey addressing burnout, work capacity, stress, career satisfaction, sources of professional stress, and changes in practices. Items were compared with the 2017 APAHC Membership Survey. Compared to 2017, the 2021 respondents reported increased stress and burnout, as well as diminished work capacity, without decreased career satisfaction. Additionally, the number of professional stressors endorsed by the majority of respondents increased from four stressors in 2017 and seven in 2021 when retrospectively reporting prior to March 2020, to thirteen stressors in post-March 2020 reporting. In 2021, burnout was associated with greater overall stress, perceived faculty stress, fewer hours for relaxation or to pursue enjoyable activities, more non-billable clinical hours, and time spent on non-clinical consultation. Higher stress levels and fewer hours for relaxation were associated with being overextended in one's work capacity. These findings may inform well-being initiatives for psychologists in academic health centers and highlight the imperative for well-being for psychologists.

The rapidly expanding international scope of pediatric psychology presents significant collaborative opportunities as well as ethical challenges. In a quest of common ethics terminology and primary ethical considerations across international borders, we conducted an online survey with open-ended questions focusing on procedures essential to obtaining ethical approval for research with pediatric patients. Participants from 14 countries responded. This report provides an overview of some key international differences and challenges while providing recommendations for addressing each aspect. Key factors include ensuring international collaborators begin ethical planning from inception of the project; identifying pediatric ethics thought and policy leaders in each country; and confirming pertinent policies and procedures in each location.