The field of pediatric psychology has been changing rapidly over the last decade with both researchers and practitioners working to keep up with the latest innovations. To address the latest evidence-based interventions and methodological improvements, the editors of the Journal of Pediatric Psychology and Clinical Practice in Pediatric Psychology decided to join efforts and publish special issues on evidence-based interventions in pediatric psychology. We sat down with guest editors Tonya M. Palermo, Ph.D. (Journal of Pediatric Psychology) and Bryan D. Carter, Ph.D. (Clinical Practice in Pediatric Psychology) to discuss the latest issue in the field and what was learned in this collaborative review of the field.
Why did you want to do a tandem issue on evidence-based interventions in pediatric psychology?
Tonya Palermo: I was interested in putting together the special issue for Journal of Pediatric Psychology (JPP) because the last comprehensive reviews of evidence-based interventions in pediatric psychology were published in JPP in 1999. In the past 15 years, so much movement has occurred in the field around development and evaluation of interventions that an updated review of the state of the science was long overdue. My goal in conducting the special issue was also to increase the quality of the reviews by using rigorous systematic review methods. In this way, the special issue best represents the state of the science of interventions that comprise the professional practice of pediatric psychology.
Bryan Carter: I wanted to see how this special issue topic could be used to provide examples of “real world” applications of evidence-based interventions. The editors of JPP and Clinical Practice in Pediatric Psychology (CPPP) had the wisdom to recognize that linking the topics in both journals could provide the perfect opportunity to showcase practitioner-level applications of those representative interventions chosen for the JPP special issue. My goal was to make the end product as useful as possible for the reader to have access to those proven efficacious psychological interventions representing the best science our profession has to offer, while also being able to learn from the applied clinical experiences of practitioners as to the challenges and barriers to employing evidence-based interventions with unique clinical conditions, patients, and populations.
Were there any major lessons learned that would inform future methodological improvements in research on pediatric psychological interventions?
Tonya Palermo: One of the lessons learned from the JPP special issue is that the quality of the intervention research (randomized controlled trials) needs to be improved upon in virtually all areas of pediatric psychology interventions. We need to design trials that test a priori hypotheses about intervention effects using well-validated outcomes. We need to use appropriate control conditions and rigorous methods of data collection including blinding where possible to mitigate against bias. We also need to follow established standards for trial reporting so that readers can have a full and transparent reporting of our results. By improving the quality of our intervention research we will enhance the ability to draw firm conclusions about pediatric psychology interventions and to impact decisions made about delivery of these interventions in health systems.
Bryan Carter: Pediatric psychology has grown over the decades to encompass an increasingly bigger tent. Pediatric psychologists can learn important lessons concerning intervention implementation from reports of the application of science-based empirical interventions in day-to-day clinical work. The rich detail that can be addressed from these formats will hopefully lead to replication and stimulate larger scale intervention studies that impact the practice of pediatric psychology, as well as the policies of organizations and governments responsible for optimizing health care for children and families.
What do you believe are the overall take-home findings from the tandem special issues?
Tonya Palermo: From my perspective I see the glass as half full. In many areas of pediatric psychology within cross-cutting areas such as health promotion, adherence, and pain interventions, the evidence base has grown tremendously. There is evidence for psychological interventions to have robust effects for behavior change and symptom reduction in pediatric populations. This type of evidence is needed to establish pediatric psychology interventions as firstline treatments for children and families in hospital and community settings. Researchers can build from the evidence base to address specific knowledge gaps and to design stronger research to better understand which children and families receive the most benefit from which specific interventions. Clinicians can use these systematic reviews as a starting point for guiding practice in the absence of current consensus statements and clinical practice guidelines in pediatric psychology.
Bryan Carter: Despite the breadth of topics covered in the tandem issues, they represent only a sampling of the wide range of areas in which pediatric psychological interventions have been developed. In most pediatric medical conditions (e.g. late neurocognitive effects of pediatric cancer treatment, acute and chronic pain) and clinical settings (e.g. integrated primary care, in-hospital, school-based, home intervention), pediatric psychologists have implemented interventions. Many of the evidence-based interventions that have proven effective for certain pediatric conditions have relevance to the study of other pediatric health problems, and other areas of investigation, e.g. adherence studies, stress management, family interventions. Researchers and clinicians can draw from the representative systematic analyses and clinical “real world” application reports represented in the tandem JPP and CPPP special issues to inform their own investigations and practice.
Are there implications and recommendations for training psychology students in evidence-based interventions in pediatric psychology?
Tonya Palermo: Core competencies for training in pediatric psychology have been recently published in JPP. The tandem special issues highlight the areas of evidence-based practice that are particularly relevant for pediatric psychology training both in terms of clinical applications as well as scientific training. The next generation of pediatric psychologists can effect major changes in the delivery of pediatric psychology services by building on the evidence base through the conduct of rigorous clinical trials that address cost effectiveness and cost offset of these interventions; advocating for evidence-based interventions for their patients; and teaching other health care professionals, hospital systems, and insurers about the value of evidence-based pediatric psychological interventions.
Bryan Carter: Pediatric psychologists have many challenges ahead in solidifying their role in a rapidly evolving health care system that places a high premium on efficiency, expediency, and technology. For pediatric psychological services to be truly integrated into developing health care models, we must continue to demonstrate how we contribute to better health and quality of life outcomes. The tandem special issue of CPPP demonstrates areas of evidence-based practice critical to students learning to intervene with these populations. It is our hope that this will serve to encourage others to submit their data-based studies, commentaries, reviews, clinical case reports/series, outcome studies, examples of program development, etc., as these serve a valuable role in informing the process of designing theory-based clinical trials that are responsive to the realities of everyday clinical settings and diverse populations.
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