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2016-10-12T23:21:57-07:00










Commentary: The Wright Ross Salk Award: Worker Bees and Benefits to the Hive: Service Contributions to the Profession and Society of Pediatric Psychology

2016-10-12T23:21:57-07:00

This article reflects on service contributions upon receiving the 2016 Society of Pediatric Psychology Wright Ross Salk Distinguished Service Award. As the title implies, worker bees make service contributions for the overall benefit of the hive and colony. So too, the scientific discipline, clinical profession, and the Society of Pediatric Psychology need the service contributions of multiple individuals to survive and thrive. Many people have made professional contributions to benefit the field and its organizational home; many more worker bees will volunteer in the future to fill important service roles and sustain the hive. The article discusses lessons learned about service.







Pioneers in Pediatric Psychology: Smashing Silos and Breaking Boundaries

2016-10-12T23:21:57-07:00

As part of the Pioneers in Pediatric Psychology series, this article provides a brief personal account of my career as a pediatric psychologist. Educational and professional experiences often involved confrontations with silos and boundaries set by traditions limiting understanding and impact on children’s healthy development. A pedigree in developmental psychology clashed with identity, guild, and loyalty dimensions of clinical psychology. A research emphasis challenged the emergent harmony of the scientist–practitioner models. The medical center and its silos collided with those of arts and sciences academia. Evolving as an applied developmental scientist specializing in pediatric psychology allowed for a gratifying and meaningful career with a range of scientific, pedagogical, and policy contributions. An abiding orientation toward human rights and social justice sustained progress and generativity.




Introduction to the Special Section: Psychology in Integrated Pediatric Primary Care

2016-10-12T23:21:57-07:00

Interest in providing integrated psychological and medical services in pediatric primary care is growing rapidly. Efforts to incorporate psychological services into primary care settings are leading to new models and innovative approaches to evaluation and treatment in a variety of settings. Presently, there is a need to expand the empirical base for such work and to critically evaluate what is being done. The introduction to this special section discusses some of the background for the development of integrated care, and provides some context for the articles that follow. These articles address issues related to screening in integrated pediatric primary care, the variety of services provided in the context of integrated primary care, and outline the competencies needed for providing high-quality care in such settings. Suggestions for future research directions are provided.




Screening for Mental Health Problems: Addressing the Base Rate Fallacy for a Sustainable Screening Program in Integrated Primary Care

2016-10-12T23:21:57-07:00

Objective The Affordable Care Act has stimulated interest in screening for psychological problems in primary care. Given the scale with which screening might occur, the implications of a problem known as the base rate fallacy need to be considered. Methods The concepts of sensitivity and specificity, positive and negative predictive value, and the base rate fallacy are discussed. The possibility that a screening program may not improve upon random selection is reviewed, as is the possibility that sequential screening might be useful. Results and Discussion Developing effective screening programs for pediatric mental health problems is highly desirable, and properly addressing the high rate of false positives may improve the likelihood that such programs can be sustained. Consideration needs to be given to the use of sequential screening, which has both advantages and disadvantages, depending upon the type of problem to be screened for and the availability of resources for follow-up evaluations.




Systematic Review: Classification Accuracy of Behavioral Screening Measures for Use in Integrated Primary Care Settings

2016-10-12T23:21:57-07:00

Objective To examine the classification accuracy of measures of overall psychopathology recommended for pediatric primary care screening. Method A systematic review identified relevant instruments described in the literature. Subsequent systematic reviews identified studies of sensitivity (SE) and specificity (SP) of each measure for various cutoffs and different criteria for disorder (e.g., caseness determined by structured interview, exceeding a cutoff score, referral for psychiatric evaluation). Results Measures include the Child Behavior Checklist (CBCL), Pediatric Symptom Checklist (PSC), Strengths and Difficulties Questionnaire (SDQ), Brief Infant-Toddler Social Emotional Assessment (BITSEA), and the Ages and Stages Questionnaire: Social-Emotional scale (ASQ:SE). For three measures (CBCL, PSC, and SDQ) studied extensively, achieving relatively high SE and SP values (≥ .70) simultaneously occurred in only 30–55% of the studies reviewed. There are relatively few studies of the ASQ:SE and BITSEA, or of relatively new measures. Discussion Documented utility of these measures as screening instruments is limited.




Topical Review: Mind Your Language--Translation Matters (A Narrative Review of Translation Challenges)

2016-10-12T23:21:57-07:00

Objective Translation of developmental-behavioral screening tools for use worldwide can be daunting. We summarize issues in translating these tools. Methods Instead of a theoretical framework of "equivalence" by Pena and International Test Commission guidelines, we decided upon a practical approach used by the American Association of Orthopedic Surgeons (AAOS). We derived vignettes from the Parents’ Evaluation of Developmental Status manual and published literature and mapped them to AAOS. Results We found that a systematic approach to planning and translating developmental-behavioral screeners is essential to ensure "equivalence" and encourage wide consultation with experts. Conclusion Our narrative highlights how translations can result in many challenges and needed revisions to achieve "equivalence" such that the items remain consistent, valid, and meaningful in the new language for use in different cultures. Information sharing across the community of researchers is encouraged. This narrative may be helpful to novice researchers.




The Scope of Behavioral Health Integration in a Pediatric Primary Care Setting

2016-10-12T23:21:57-07:00

Objective: The current study examines the scope of integrated behavioral health services provided by behavioral health clinicians in pediatric primary care. Methods: A cross-sectional electronic health record review was conducted to characterize integrated behavioral health services including consultation types, recommendations, and medical diagnoses. Services were provided over a 6-year period in an urban, residency-training clinic serving a primarily publicly insured population. Results: Of the 4,440 patients seen by behavioral health clinicians (BHCs), 2,829 (63.7%) were seen during well-child checks to address a wide array of presenting problems. The five consultation types "Healthy Steps (6%), pregnancy-related depression (17.7%), developmental (19.2%), mental health (53.2%), and psychopharmacology (5%)" were characterized by differences in demographics, presenting problems, recommendations, and medical diagnoses. Conclusions: Pediatric BHCs provide a wide range of services to pediatric populations in the context of integrated behavioral health programs. Implications for workforce capacity development, evaluation of outcomes and impact, and sustainability are discussed.




An Exploration of Behavioral Health Productivity and Billing Practices Within Pediatric Primary Care

2016-10-12T23:21:57-07:00

Objectives To provide descriptive information on behavioral health (BH) productivity and billing practices within a pediatric primary care setting. Methods This retrospective investigation reviewed 30 months of electronic medical records and financial data. Results The percent of BH provider time spent in direct patient care (productivity) was 35.28% overall, with a slightly higher quarterly average (M = 36.42%; SD = 6.46%). In the 646.75 hr BH providers spent in the primary care setting, $52,050.00 was charged for BH services delivered ($80.48 hourly average). Conclusions BH productivity and billing within pediatric primary care were suboptimal and likely multifactorially derived. To promote integrated primary care sustainability, the authors recommend three future aims: improve BH productivity, demonstrate the value-added contributions of BH services within primary care, and advocate for BH-supporting health care reform.




Topical Review: Building Competency: Professional Skills for Pediatric Psychologists in Integrated Primary Care Settings

2016-10-12T23:21:57-07:00

Objectives In the midst of large-scale changes across our nation’s health care system, including the Affordable Care Act and Patient-Centered Medical Home initiatives, integrated primary care models afford important opportunities for those in the field of pediatric psychology. Despite the extensive and growing attention, this subspecialty has received in recent years, a comprehensive set of core professional competencies has not been established. Methods A subset of an Integrated Primary Care Special Interest Group used two well-established sets of core competencies in integrated primary care and pediatric psychology as a basis to develop a set of integrated pediatric primary care-specific behavioral anchors. Conclusions The current manuscript describes these behavioral anchors and their development in the context of professional training as well as with regard to Triple Aim goals and securing psychology’s role in integrated pediatric primary care settings.




Commentary: Integrated Pediatric Primary Care: Moving From Why to How

2016-10-12T23:21:57-07:00

Whether to address behavioral health issues in pediatric primary care is no longer debated; instead, we are challenged to determine "how" and who can best deliver services in an effective and sustainable manner. This commentary explores how pediatric psychology can contribute to this discussion by developing and evaluating innovative clinical models (such as a hybrid Collaborative Care/Primary Care Behavioral Health model) and expanding workforce and teaching initiatives.