pediatric psychology pediatric psychology pediatric psychology is a multidisciplinary field of both scientific research and clinical practice which attempts to address the psychological aspects of illness, injury, and the promotion of health behaviors in children, adolescents, and families in a pediatric health setting. psychological issues are addressed in a developmental framework and emphasize the dynamic relationships which exist between children, their families, and the health delivery system as a whole. common areas of study include psychosocial development, environmental factors which contribute to the development of a disorder, outcomes of children with medical conditions, treating the comorbid behavioral and emotional components of illness and injury, and promoting proper health behaviors, developmental disabilities, educating psychologists and other health professionals on the psychological aspects of pediatric conditions, and advocating for public policy that promotes children's health. role of the pediatric psychologist the field of pediatric psychology developed to address unmet needs for psychological services in the pediatric setting and the field blends together several distinct areas in psychology (such as behavioral medicine, health psychology, developmental psychology, etc.) (roberts, maddux, wurtele, & wright, 1982 ). pediatric psychology is an integrated field of science and practice in which the principles of psychology are applied within the environment of pediatric health. the society of pediatric psychology (spp, division 54) resides under the american psychological association (apa), see http://www.apadivisions.org/division-54/index.aspx. spp aims to promote health and psychological well-being of children, adolescents, and their families through the promotion of evidence-based science and practice, education, training, and advocacy. the field was founded in 1969 and includes a broad interdisciplinary foundation, drawing on clinical, developmental, social, cognitive, behavioral, counseling, community and school psychology. pediatric psychologists work in a variety of settings and fulfill various roles such as (spirito, 2003 ): (1) providing psychosocial services for problems related to pediatric health conditions (2) psychological services for mental health problems appearing in medical settings—which involves mental issues related to medical conditions or the treatment of them, coping related to chronic and acute illnesses, adherence, quality of life, pain, traumatic medical stress, adjustment related issues on the psycho-social continuum, school reintegration, and behavioral problems (3) psychological services for mental health problems without concomitant health condition (4) programs for promotion of health/prevention and early intervention (5) provide assistance for those with intellectual and/or developmental disabilities (6) psychological training and consultation for physicians (7) public health and public policy. interventions are not just illness-related, but address behavioral problems as well. the settings that pediatric psychologists work in allows for brief interventions that are economical and time efficient. collaboration with the health care providers allows for more targeted assessment and interventions. pediatric healthcare providers seem to value the work of pediatric psychologists (stancin, perrin, and ramirez, 2009): "recently, a surge of interest by pediatricians on the identification and care of children with mental health problems has resulted from the recognition that: • precursors of mental health disorders in adulthood can often be identified in early childhood (e.g. anda et al., 2007) • at least 10% of children and adolescents have functional impairment due to a diagnosed mental health and/or substance abuse disorder (u.s. department of health and human services, 1999), and up to 25% have clinically significant problems that may not (yet) rise to the level of a diagnosable psychiatric disorder (briggs-gowan et al., 2003). • there is a shortage of qualified mental health clinicians, especially for children younger than 5, and for families in middle-and-low income groups and/or of minority background. • primary care settings provide the most accessible and least stigmatizing resources for many families who have concerns about their children's developmental and/or behavior." scope according to the work of a recent task force commissioned by the society of pediatric psychology, division 54 of the american psychological association, 12 topic areas adapted from roberts et al. (1998) were identified as important areas of expertise in pediatric psychology: lifespan development lifespan developmental psychopathology: the effects of one's disease and medical regimen on emotional, social, and behavioral development; additionally, normal developmental milestones may be used such that preventative efforts can be created and well-child visits can include a psychological-developmental perspective child, adolescent, and family assessment: experience with the assessment of health-related concerns such as health promotion, health risk, health outcome, and quality of life intervention strategies: exposure to and experience with empirically supported interventions specifically applicable in pediatric psychology and delivered in health care settings research methods and systems evaluation: exposure to research design issues especially pertinent to pediatric psychology such as health services research and clinical trials professional, ethical, and legal issues pertaining to children, adolescents, and families: knowledge and experience with issues such as health care delivery, practice of psychology in medical settings, and rights of caregivers vs. children when making decisions regarding medical care issues of diversity: experience with patients from diverse ethnic and cultural backgrounds, as well as sexual orientations, in health care settings and understanding of nonmainstream health practices influenced by a family's cultural or religious beliefs the role of multiple disciplines in service-delivering systems: experience on multidisciplinary teams delivering health care services prevention, family support, and health promotion: understanding the principles of behavior change as they relate to healthy development, health-risk behavior, and prevention of disease in adulthood social issues affecting children, adolescents, and families: exposure to and experience with advocacy in pediatric health care including social issues that affect health care delivery consultant and liaison roles in health care settings: exposure to different consultation-liaison models and supervised experience providing consultation disease process and medical management: a basic understanding of various diseases and their medical management. the field of pediatric psychology recognizes that pediatric conditions have emotional/psychological aspects, the presenting problems require integrated medical-psychological interventions, and traditional pediatric and/or clinical psychology could not meet the needs. future issues pediatric psychology is a growing field and several topics have been raised that need to be addressed within the field and were discussed in a delphic poll on the future of pediatric psychology: 1. pediatric psychologists must demonstrate viability through empirical support for treatment interventions, which requires continued efforts to demonstrate improvements in pediatric outcomes (health, quality of life, psychological functioning, development) due to pediatric psychologists' efforts. this also requires evidence of medical cost offset, evidence of the efficacy of the integration of clinical research and practice, and evidence of the effectiveness of psychological interventions in decreasing societal costs related to pediatric conditions. 2. we must also increasingly integrate psychologist into the pediatric primary care setting by providing mental health services directly to patients in primary care settings, provide consultation and collaborative relationships with pediatricians and allied staff, and conduct clinically based research on primary care barriers in care. 3. financial reimbursement policies need to be changed and the responsibility to makes these changes lies within several interacting disciplines—health policy-makers, health care institutions, and pediatric psychologists and their collaborators such as pediatricians. several factors should be addressed, such as: creating non-dsm categories of reimbursable services, eliminating behavioral health carve-outs, payment for multidisciplinary team services, and developing service systems that recognize the complexity of problems in children and families. currently, depending on the clinic and hospital that the psychologist is affiliated with, their services may or may not be covered by insurance or the institution's funds and reimbursement issues prevent pediatric psychologists from intervening in the most effective ways. pediatric psychologists are trained in data analysis and research and so efforts should be made to demonstrate the benefits of pediatric psychologists and pediatricians collaborating such that the necessary reimbursements are instituted (http://www.nextgenmd.org/archives/808). currently, research findings indicate that psychological interventions can decrease medical costs (chiles, lambert & hatch, 1999). future research should also target patient satisfaction. 4. collaboration between pediatricians and psychologists in clinical research and practice activities. 5. emphasize importance of prevention of problems in childhood and promotion of optimal physical and mental health here are a few examples concerning how pediatric psychologists have improved services: primary care example: there are an increasing number of empirically supported interventions available for the treatment of common childhood problems appropriate to treat in the primary care setting (i.e. disruptive behavior disorders, mood disorders, non-adherence to medical treatments, etc.). for example, lavigne and colleagues (2008) compared three interventions for oppositional defiant disorder (odd) in primary care. pediatric practices (n = 24) were randomly assigned to receive (1) nurse-led or (2) psychologist-led group manualized parent training treatment, or (3) minimum intervention in which the treatment book was used. sustained improvements occurred in all three conditions. however, there were better results for parents who attended more of the intervention sessions. this is evidence that primary care environments are an appropriate setting for delivering services. prevention/early intervention example: pediatric psychologists can take a lead both in developing interventions and test their effectiveness in promoting vaccine acceptance and knowledge such that children are more likely to be vaccinated (short, rosenthal, sturm, zimet, 2009). for example, education-based tutorials created by pediatric psychologists to improve providers' knowledge of and comfort with addressing parents' concerns related to childhood immunizations is one promising approach that has been researched and found to be effective (i.e. boom, nelson, laugman, kohrt, & kozinetz, 2007; levi, 2006). history of pediatric psychology the "official" history of pediatric psychology dates to 1968 when the society of pediatric psychology was established within the american psychological association. however, its origins date back to the early 1900s and lightner witmer. often considered the father of clinical psychology, witmer spent a good deal of his time working in tandem with physicians to improve children's behaviors. considering the roughly 70 years between witmer and the formation of the spp, this merging of medicine and psychology was a slow progression. in 1911, the apa conducted a survey of medical schools regarding their view of psychology within medicine. while responses were favorable to the benefit of psychology in the medical school setting, there was no action to implement such teachings. this action started following the second world war, when there was an increase in federal funding for clinical psychology and the employment of psychologists in medical schools. in fact, 80 percent of schools surveyed in 1951–1952 reported employing psychologists. however, it was thought that most were in psychiatric settings, not pediatric psychology positions specific to pediatric psychology, in 1930, anderson presented to the american medical association that he thought pediatrics and child psychology should work together on mutually important issues, but there was apparently limited response. the 1960s saw a growing number of pediatricians fielding questions regarding parent training. as a result, in 1964, the then president of the american pediatric society, julius richmond, suggested that pediatricians hire clinical psychologists to work with behavioral problems in children. the field was advanced when kagan identified a number of areas the psychologist could be of help in the "new marriage" of pediatrics and psychology. he addressed psychologists' role in early identification of disorders and interventions. much like a clinical-child psychologist, kagan believed this role included a wide range of psychopathology. wright, however, had a different idea of what a pediatric psychologists job should address. narrower in scope, he suggested pediatric psychologists take a more behavioral approach and deal with issues of parent training, child development, and short-term therapy. with the public and professional momentum for pediatric psychology forged by logan wright, the apa formed a committee to determine whether a formal organization was needed. the committee, consisting of logan wright, lee salk, and dorothea ross, discovered a need would be filled, and at the annual apa convention in 1968, formed the "society for pediatric psychology." the following year, spp was recognized as an affiliate of apa division 12 (clinical psychology), section 1 (clinical child psychology) . at the inaugural spp meeting in 1969, logan wright was elected the first president. medical schools employing psychologists in pediatric settings were also on the rise. this increase in demand resulted in federal funding for the establishment of the national institute of child health and human development in 1962. four years later it helped fund the first pediatric psychology training program at the university of iowa. over the next decade, spp would consider sectionhood with several divisions (12, 37, 38) before officially becoming section 5 of division 12 in 1980. ." here it would continue to grow until 2000 when it developed into division 54 of the apa . by 1984, spp had