Clinical Practice in Pediatric Psychology最新文献

Objective: Autistic children have higher unintentional injury risk than typically developing children, but little is known about how parents struggle and succeed in keeping their autistic children safe from injury. Qualitative methods evaluated the concerns of unintentional injury prevention experienced by mothers of autistic children and the impact of these strategies on maternal quality of life.

Methods: Fifteen mothers (M _age = 37.80 years) of autistic children participated in a semi-structured interview addressing child characteristics, injury concerns and experiences, and injury prevention strategies and resources. Interviews were transcribed and coded in NVivo following a systematic, inductive approach.

Results: Mothers of autistic children have significant concerns regarding child injury prevention, leading to increased feelings of parental responsibility and need for constant supervision of their autistic child. The sustainability of safety strategies that encompass supervision, such as proximity and control, were concerning to mothers. The dominant role of supervision leads to reports of exhaustion and increased cognitive load. Despite this, the mothers reported these efforts were necessary to prevent injury in their child.

Conclusions: By evaluating the lived experiences of mothers with autistic children, this study identified maternal responsibility and supervision as the most critical and most demanding aspects of child injury prevention. Clinicians working with families who have autistic children should consider encouraging parents to proactively develop effective and practical safety interventions to reduce child injury risk as well as reducing caregiver stress.

Objective: Parents of children with medical complexity (CMC) experience stressors related to caregiving, navigating the healthcare system, and managing their own well-being. There is a dearth of research examining parental coping strategies used in response to these challenges. Informed by the revised Transactional Model of Coping, the current study aimed to characterize coping among a sample of parents of CMC.

Methods: Twenty parental caregivers of CMC served by the Complex Care Program at a large midwestern pediatric hospital participated in one-hour semi-structured qualitative interviews.

Results: Participants described a breadth of ways of coping with challenges in their lives, including problem-focused and emotion-focused coping strategies. They also described a range of meaning-making strategies, represented by themes celebration of child, maintaining a commitment to caregiving, striving to be a "good parent," and recognizing gains from caregiving experiences.

Conclusions: Parents of CMC described coping with their challenges in diverse ways, including using many meaning-making strategies. Future research should investigate coping strategies more systematically with representative samples to enable culturally informed intervention development to support parent and family well-being among those who care for CMC.

Objective: The American Psychological Association (APA) defines early career (EC) status as occurring in the 10 years following earning a doctorate. As EC pediatric and behavioral health psychologists (ECPP) who work with and conduct research with adolescents and young adults (AYA), we have noted that our own and our peers' experiences during this career phase have mirrored that of our AYA research participants and patients. Namely, no longer scaffolded by training milestones and supervision, yet still often viewed as green, EC psychologists may often feel and be treated like they are experiencing a career-based emerging adulthood. Despite the presence of some institutional support during this career phase, we and our peers have found difficulty in navigating this career phase-something compounded by concurrent life events (e.g., parenting, pandemic).

Method: Grounded in our own current and recent histories, this Commentary provides examples of common experiences across the EC--from fellowship to nearing mid-career.

Results: To improve the EC experience for pediatric psychologists and beyond, recommendations are made at the institutional, mentor, and ECPP-levels.

Conclusions: Given the risks for burnout during this phase of career, when workforce demands are at all-time high, this Commentary aims to draw attention to the developmental norms of EC and to improve the EC experience for pediatric psychologists and our peers. The hope is that in doing so, pediatric patients and their families may be better served via a well-supported EC workforce.

Objective: Asthma disproportionately afflicts U.S. urban children, particularly those of Black and Latino backgrounds, and is highly prevalent in Rhode Island (RI). We collaborated with community partners to conduct a multi-level, theoretically supported needs assessment and used its findings to inform the development of the Rhode Island Asthma Integrated Response (RI-AIR) Program.

Methods: To elucidate social, epidemiological, behavioral, environmental, educational, administrative, and policy-related factors contributing to gaps in asthma care in RI, we established the RI-AIR Collaborative with community partners; examined state- and hospital-level health care data; conducted in-depth interviews and focus groups with community partners; used geospatial mapping to identify high burden areas; and interpreted outcomes of our existing school- and home-based programs.

Results: The Collaborative reviewed quantitative and qualitative data from multiple sources and identified gaps to address, and resources and strengths to utilize in the RI-AIR program. Findings highlighted the need to provide tailored interventions based on asthma control, and improve communication between families, schools, and health care providers to promote integrated care. Existing strengths included our guidelines-based school and home interventions, longstanding community collaborations, and technological resources.

Conclusions: We developed RI-AIR, a coordinated system of asthma assessment and intervention, that provides school- and/or home-based interventions tailored to risk levels and facilitate communication across sectors of care. Our multi-method needs assessment and RI-AIR represent an innovative, community-engaged approach to building a program to address asthma disparities.

Objective: Adolescents with type 1 diabetes (T1D) have risk for elevated negative affect, and mindfulness-based interventions (MBI) may be effective interventions. The aim of this case series was to (1) highlight individual changes in negative affect (depression, anxiety, and stress), mindfulness, and diabetes outcomes (diabetes distress, diabetes self-management, and HbA1c) after participating in an MBI and (2) highlight the utility of MBI in historically marginalized populations.

Methods: Cases were chosen from a sample of adolescents with T1D and elevated negative affect who took part in a pilot randomized controlled trial of an MBI. Individuals were selected due to adherence to study protocol, similar baseline scores on target outcomes, and demographic similarities that indicate historical marginalization. The participants were two 12-14-year-old girls with T1D, one identifying as Black/African American, "Jayla," and one identifying as biracial Latinx/Hispanic, "Valerie" who participated in a 6-7 session virtual group MBI. Participants completed surveys at baseline, post-intervention, and three months post-intervention.

Results: Jayla and Valerie demonstrated improvements in multiple domains including depression, anxiety, stress, mindfulness, diabetes distress, and diabetes self-management. We observed small improvements in HbA1c and disordered eating in Valerie, but not in Jayla.

Conclusions: This case series demonstrates the potential utility of MBI in adolescents with T1D and negative affect, particularly those experiencing increased burden of SDOH.

Objective: To explore, by way of intentional, case-based reflection, the ways in which hospital-based chaplains and pediatric psychologists collaborate as key members of a patient/family's interdisciplinary care team to provide synergistic spiritual and psychosocial care.

Methods: Intentional reflection and dialogue amongst co-authors with backgrounds in chaplaincy/spiritual care, pediatric intensive care medicine, pediatric palliative care medicine, and pediatric psychology. Co-authors took notes on the content of conversations they observed at a midwestern hospital. They then reviewed the content of these conversations for themes which might be applicable to interdisciplinary psychosocial and spiritual care.

Results: While each case represents one specific situation, key concepts were identified and explored. These include: differences in timing of care and expertise among psychosocial team members can be leveraged to enhance the collective ability to support a family; spiritual and psychological distress can mirror one another, and even co-occur; a family's religious or cultural identity does not inherently predict the degree to which their distress has spiritual underpinnings; the collaborative nature of interdisciplinary team members can strengthen support to patients and families if they demonstrate partnership and consistent communication.

Conclusions: Interdisciplinary teamwork involving collaboration between hospital chaplains and pediatric psychologists, both serving critical roles within the care team, can lead to unique and effective partnerships which enhance psychosocial and spiritual care for patients and families. While these reflections represent collaboration at a single hospital, further work should be done to better understand the current state of such teamwork more broadly, and to identify best practices to maximize the impact of these collaborations across institutions.

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.

Methods: The mother of a young child with PFD completed 6 sessions of Acceptance and Commitment Therapy, 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 2 sessions. She also reported qualitative benefits related to her parenting, her child's feeding, and her general wellbeing. She reported several facilitators of treatment, including the flexibility offered throughout treatment the use of telehealth, and acknowledgement 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.

Objective: The COVID-19 pandemic presented unique stressors for parents of youth with chronic health conditions including type 1 diabetes (T1D), such as managing youths' diabetes self-management demands without usual routines, changes in interactions with health care system, and concerns about increased health risks related to COVID-19 exposure. While data have been published on how adolescents with T1D coped with pandemic-related stress, little is known about their parents' perspectives. To fill this gap, we explored parents' coping strategies.

Method: At the baseline of a multisite trial of a psychosocial intervention for adolescents with T1D, parents answered an open-ended question, "What is helping you through the pandemic?" A multidisciplinary qualitative research team used thematic analysis to code, analyze responses, and generate themes and explored patterns by gender, study site, race, ethnicity, and socioeconomic status indices.

Results: Eighty-nine parents (89% female, 18% Hispanic/Latinx, 7% non-Hispanic Black/African American, 70% non-Hispanic White) provided text responses to the qualitative question. We generated six themes: safety practices, social efforts, maintaining a positive perspective, efforts to distract, cognitive avoidance, and religious/spiritual coping. The spiritual/religious coping theme was more common among Black/African American and Hispanic/Latinx parents. There were no other demographic group patterns for the other themes.

Conclusions: Themes aligned with primary control, secondary control, and disengagement coping strategies of the control-based model of coping. Religious and spiritual coping represented an additional coping category that was especially common in marginalized groups. During stressful times, pediatric psychologists should attend to parental coping and consider cultural factors in relation to parental well-being.