50% of people with chronic health conditions discontinue their medication within six months. adherence to behavioral treatments is also poor. for example, no more than 30% of patients quit smoking at their provider's request, even those with lung conditions. at the same rate, the leading causes of death (heart disease, cancer, stroke and chronic lower respiratory diseases- see https://www.cdc.gov/nchs/fastats/lcod.htm) contain behavioral related causes and treatments. therefore, adherence is a lifelong, mortality risk. additionally, higher rates of adherence result in economic benefits. for example, direct savings may be accrued by reduced use of expensive and sophisticated health services needed in cases of crises, relapse, and worsening disease outcomes due to non-adherence. research suggests that when self-management and adherence program are combined with regular treatment, there is an increase in health-promoting behaviors and a cost to savings ratio of approximately 1:10 in some cases and results persisted over 3 years (see holman et al., 1997; tuldra et al., 2000 access to medical care is vitally important, but if people do not comply with their professional recommendations, then mere access will not lead to better health outcomes. thus, generating innovative methods to enhance childhood adherence has become increasingly more important because effective preventive efforts must begin at an early age, starting with healthy lifestyle behaviors and increased adherence. for example, "a pediatric psychologist may work with a young child who has cystic fibrosis and who refuses to complete all his daily medical treatments that are essential to his health. the psychologist might work with the child's caregivers on how to interact with the child when he refuses his medical treatments and how to implement a reward system to reinforce his adherence to treatments." http://www.nextgenmd.org/archives/808. also, challenging family interaction styles can play a role in adherence. in particular, families with divorced parents may struggle with communication concerning a child's illness and treatment. pediatric psychologists may intervene by working with the parents to find a way to communicate more effective so that barriers to adherence are removed. craniofacial special interest group the craniofacial special interest groups consists of members of the society of pediatric psychology who share an interest in craniofacial conditions. complementary and alternative medicine special interest group the complementary and integrative medicine special interest group is a forum for communication and discussion about the role of cim as it relates to advancing the health and well-being of pediatric populations. consultation and liaison special interest group the mission of the consultation and liaison special interest group is to promote discussion, education, research, and networking among pediatric psychologists who provided consultation and liaison services to pediatric patients and their families. pediatric consultation-liaison is a subspecialty practice of pediatric psychology and represents the most active collaboration between pediatricians and pediatric psychologists. according to the 2003 society of pediatric psychology task force report: recommendations for the training of pediatric psychologists, consultation-liaison roles are one of the types of experience most important to developing competencies in pediatric psychology. pediatric psychologists often consult with pediatricians and providers from other disciplines in a variety of inpatient and outpatient settings. they have a working understanding of various consultation models and often consult with and educate patients, their families, physicians, other health-care providers school psychologists, counselors, teachers, and other professionals regarding pediatric illness and accompanying psychosocial issues. pediatric psychologists also act as liaisons with medical subspecialties and provide support to other professionals for issues related to the management of difficult families, stressful physician and family interactions, professional burnout, bereavement, and negotiating stressful situations. consultation vs. liaison emphasis often considered synonymous, the terms "consultation" and "liaison" have important distinctions. while many psychologists provide both services, pediatric psychologists acting in a consultant role are directly involved in patient care only at the request of a referring physician or service. in a consultation arrangement, the relationship between the consultant and physicians is often time-limited—when consultation services are terminated, the relationship often ends. pediatric psychologists in a liaison role are often involved in the day-to-day workings of a particular hospital service or unit and are formally embedded within a department or working service. psychologists in a liaison role are often involved in all of the systemic and mental health concerns of the unit, not just the concerns of referred patients. patient-centered vs. systems-centered focus consultation-liaison models are sometimes differentiated based on whether the focus of the services are primarily on the patient ("patient-centered") or on the larger system the patient and family must rely on for medical care ("systems-centered"). in patient-centered services, the primary goal is to evaluate the patient in order to provide direct treatment. in systems-centered services, the focus of the services are on creating change in the professionals requesting the services to make them more effective in the intervention with the case in question, as well as in other similar cases. inpatient pediatric consultation-liaison as an inpatient pediatric consultation—liaison, the pediatric psychologist advises physicians or other medical professionals or provides direct services to medically hospitalized children regarding behavioral, emotional, or familial aspects of the child's illness and symptoms. the consultation-liaison psychologist's primary role includes evaluating children and their families for mental health concerns; recommending and providing treatments; and educating families, staff, and referring physicians on a wide array of factors associated with adjustment to medical illness and injury. patient interventions include teaching coping skills, evaluating side effects of medication, helping manage physical pain, and addressing physical pain, among others. defined narrowly, inpatient pediatric consultation-liaison involves a pediatric psychologist providing assessment and guidance to a pediatrician colleague regarding the care of a specific patient. broadly defined, the pediatric consultation-liaison psychologist is a systems-level catalyst—in educating and empowering multiple interacting components of the health care system, fostering a responsive environment that maximizes the overall quality of life and psychological adjustment of patients and their families. research on inpatient pediatric consultation-liaison services there are few studies illustrating the breadth of services provided by pediatric consultation-liaison psychologists. in a survey of 144 children's hospital-based child psychiatry consultation-liaison services, shaw and colleagues reported that returned surveys (33%) indicated that the most common referral concerns for consultation-liaison services included patient depression, anxiety, suicide risk assessment, and medication evaluation. in the only case-controlled study of pediatric consultation-liaison services, carter and colleagues (2003) matched 104 referrals with controls for age, gender, and illness type or severity and completed parent- and self-report behavioral rating scales to assess for adjustment. nurses completed in-hospital ratings of behavioral or adjustment difficulties. goal attainment and satisfaction ratings were obtained from referring physicians, parents, and the consultant. results indicated that referrals exhibited more behavior, adjustment, or coping difficulties than nonreferrals by parent-, nurse- and self-report. referring physician and consultant ratings of goal attainment were high, as were physician ratings of satisfaction and parent or guardian ratings of overall helpfulness of the consultation-liaison services. referral sources included equal distributions from hematology/oncology, surgery/trauma, pulmonology, and other sources. reasons for referral included assisting children in coping with physical illness/injury, improving treatment adherence, assessing and treating depression and anxiety, teaching pain management techniques, assisting with parent coping, helping with adjustment to medical diagnoses, and resolving family conflicts. in a review of clinical reports and treatment outcome studies on pediatric consultation-liaison services, knapp and harris surveyed illness-specific and general investigations into the psychiatric care of children with medical illnesses. they concluded that pediatric consultation–liaison services are playing an increasing role in addressing the emotional and behavioral needs of pediatric inpatients by helping patients and their families adapt to stressors associated with chronic illness. olson and colleagues reviewed the records of 749 inpatient referrals seen by pediatric psychologists at oklahoma children's hospital over a 5-year period. in order of greatest frequency, referrals were for depression or suicide attempt, adjustment problems to chronic illness, and behavior problems. consultations were most frequently requested by general pediatrics followed by surgery and adolescent medicine. nearly a third of the referrals were also seen for outpatient follow-up. health care providers making referrals were generally very satisfied with the services of the pediatric consultation-liaison team and reported a high likelihood of making future referrals. in another study, rodrigue and colleagues reviewed 1,467 records of referrals (448 inpatient, 1,019 outpatient) to a health sciences center-based pediatric psychology service at the university of florida health sciences center. the majority of inpatient referrals were from general pediatrics (40%), pediatric hematology or oncology (31%), adolescent psychiatry (15%), pediatric intensive care (5%), and the burn unit (4%). the most common reason for referral (inpatient and outpatient) was assessment of cognitive or neuropsychological functioning. next were externalizing behavior problems, comprehensive psychological evaluation, pre-surgery or transplant evaluation, and adjustment problems to chronic illness. they also reported that retrospective survey results suggested high overall satisfaction with service quality. in an early study of referral problems for pediatric consultation-liaison services, drotar reported that referral questions included evaluation of developmental delay, adaptation and adjustment to chronic illness or physical disability, concerns regarding the psychological factors in physical symptom presentation, behavior problems, and managing psychological crises. five c's of pediatric consultation-liaison services using an alliterative pneumonic device called the "five c's of consultation: crisis, coping, compliance (adherence), communication and collaboration," carter and von weiss characterize the activities of pediatric-liaison services according to overlapping arenas of intervention and practice under which the majority of referrals can be categorized. crisis following diagnosis of a potentially serious illness or injury, patients and their families are often in a state of shock and disbelief. at this time, the details and decisions of medical evaluation and treatment may be overwhelming and bewildering. very focused interventions are often needed to help them achieve some sense of basic understanding and control of the situation. consultation-liaison skills that enable psychologists to act in crisis situations include crisis intervention, needs assessment, providing direction, mobilization of social supports, identifying areas for parental or child control, and interpreting and reframing child or family reactions to staff. a medical crisis counseling model that lends itself particularly well to pediatric crisis situations has been developed by pollin. in this model, the consultant focuses on the patient's medical condition, and directs interventions toward normalizing the patient's and the family's state of emotional distress while helping the patient and family identify concrete actions they can take in order to cope successfully. coping children are exposed to many stressors associated with acute and chronic illness and injury during the course of evaluation and treatment. acute stressors include short and lengthy medical procedures such as venipunctures, injections, hospitalizations, surgeries and chemotherapy, among others. other stressors accompanying chronic illnesses may impact the child and family for months, years, or even a lifetime, often with an uncertain prognosis. pediatric consultation-liaison psychologists need to be aware of individual and developmental factors when designing interventions to help children adapt to the stressors of illness or injury and treatment; for example, limited linguistic and cognitive abilities limit the knowledge and understanding of health concepts of younger children, thus limiting their ability to use internal coping resources and reach out to external supports when compared to older children or adolescents. children's coping styles also differ; for example, some children attempt to gather information and familiarize themselves with upcoming procedures, whereas others avoid discussing stressors and refuse to look at or distract themselves from stressful stimuli. differences in coping styles have been shown to be associated with the child's adaptation to surgery and hospitalization, lower physiological stress response, and child cooperation pre- and post-surgery. there is evidence suggesting that primary control, strategies whereby a child modifies the objective situation, are most effective when employed to cope with stressors over which the child has control, whereas secondary control strategies, strategies involving the child modifying emotional and behavioral reactions to the stressor, are most effective with uncontrollable stressors. interventions to facilitate child and family coping often begin with providing basic information and education about their illness and treatment procedures, often using videotaped or in vivo models to demonstrate the use of positive coping strategies and teach mastery skills. other coping interventions include cognitive-behavioral and strength-building interventions, operant reward programs, integrating parent participation, evaluation and mobilization of family and social supports, assisting patient and family in understanding and navigating the medical system, directive and expressive medical play therapy, pain and anxiety management skills training, sensitizing medical staff to patient needs and perceptions, and psychopharmacological interventions. compliance (adherence) adherence to medical treatment regimens is a major