Desiree N. Williford

Introduction: Mental and behavioral health (MBH) access varies in pediatric specialty medicine and rural healthcare. This study aimed to characterize healthcare professionals' perceptions and experience with MBH services and readiness for change. Methods: Thirty rural healthcare professionals completed validated questionnaires and semistructured interviews designed to meet study objectives. A convergent mixed methods design with a comparison method of interpretation was followed. Results: Thematic analysis yielded three major themes highlighting the prevalence of MBH concerns in practice, global perceptions of MBH care, and related barriers/facilitators to implementation. Current levels of MBH integration varied though overall readiness for change was high. Discussion: Findings highlight stakeholder perceptions about the role of MBH in pediatric specialty medicine. Key considerations for those who utilize or plan to adopt integrated MBH care at various levels are discussed, including readiness to change and other structural (e.g., organizational) or individual factors serving as facilitators and barriers to implementation.

Objective: The aim of this scoping review was to identify and describe the community-engaged research (CEnR) methods used in the development and evaluation of psychological interventions for pediatric sickle cell disease (SCD). Methods: We conducted a systematic search of three databases in April 2024 (PubMed, Scopus, and PsycINFO). The review was registered with Open Science Framework (DOI: 10.17605/OSF.IO/956AV). All titles, abstracts, and full texts for papers that appeared to meet criteria were independently reviewed by two members of the research team. Inclusion criteria were pediatric or young adult age and use of CEnR for a psychological SCD intervention. Data were extracted from articles meeting these criteria. Results: The search yielded 235 original articles, of which eight met the inclusion criteria. These articles showed that the involvement levels of community collaborators (patients, families, and community-based organizations) varied across research phases. Notable gaps in the literature were: (1) few studies reported utilizing CEnR methods, (2) variability in language/terms used to describe CEnR methods, (3) limited demographic data about community collaborators, and (4) a lack of description of CEnR frameworks guiding intervention development and evaluation. Conclusions: This scoping review found few studies describing the use of CEnR methods in a way that would facilitate reproducibility. Recommendations include using MeSH CEnR keywords, identifying CEnR methods and frameworks, and including specific information about community when possible (e.g., demographic information, meeting frequency, etc.).

Lay Summary: The PhenX Toolkit is an online resource that provides recommended measurement protocols to help with study design and data analysis. It lacked specific protocols for Sickle Cell Disease (SCD) related to psychosocial factors and social determinants of health (SDoH), which are important for improving SCD care. This paper outlines the process of selecting these protocols and presents final recommendations. A panel of experts in psychology, behavioral science, hematology, and nursing used a consensus method to identify and agree on the most important protocols. They initially developed 19 scope elements and reached consensus on 19 protocols, which were then shared for public comment. The final recommendations include 15 protocols that assess various indicators such as transition readiness, self-management, early aging impact, stigma, trust in medical care, resilience, spirituality, and stress responses. Additionally, 8 protocols were selected as supplemental information, and existing SDoH protocols in the Toolkit relevant to SCD were cross-listed. These new protocols enhance the SCD Research Collections and the SDoH Collections in the PhenX Toolkit, promoting the use of validated tools to study psychosocial factors and SDoH in SCD.

Purpose: Examining the influence of policy change and socio-political factors is paramount for contextualizing and addressing sexual violence. The purpose of this paper is to provide findings from a secondary qualitative analysis of the impacts of national and local high-profile events on the dialogue and actions surrounding violence prevention and response on college campuses. Methods: Data from mcBEE, a Centers for Disease Control and Prevention-funded project exploring the adoption and implementation of violence prevention programming on multiple college campuses in the United States were used for this analysis. Data include responses from 60-min telephone interviews with key informants (i.e., campus personnel in administrative roles or connected to violence prevention programming efforts) between 2017 and 2019. Results: Interviews ( n = 68) revealed that high-profile events (i.e., Title IX legislation, news coverage of sexual assault cases, and the #MeToo and It’s On Us movements) increased dialogue about violence prevention and response on some campuses, while others experienced activism and advocacy surrounding sexual assault, including greater accountability and response from campus leadership. Some participants connected national political discourse (i.e., the 2016 presidential election, Brett Kavanaugh nomination to the U.S. Supreme Court) to increases in violence perpetration and decreased reporting and help-seeking behaviors after sexual assault. Conclusions: Sociopolitical events and shifts in national dialogue surrounding violence affect perceptions and behaviors among students, faculty, staff, and overall college campus communities. Identifying potential impacts of national events can inform future prevention and response efforts and mobilize campus communities toward meaningful change.

Culture and diversity-related training is critical to the development of competent pediatric psychologists. Evaluation of training efforts have been conducted at the program level, yet evaluation of trainee experiences in culture and diversity-related training remains unassessed. This trainee-led study was the first formal assessment of pediatric psychology trainee experiences of culture and diversity-related training and the impact of training on their own cultural humility. Study overview and a survey link was distributed across 2 listservs associated with the American Psychological Association (Division 53, Division 54) and sent directly to directors of graduate, internship, and fellowship training programs with a request to share with trainees. Surveys assessing integration of cultural training and trainee cultural humility were completed. Trainees also provided qualitative feedback regarding their multicultural training and development. Pediatric psychology trainees (N = 90) reported inconsistent integration of culture and diversity topics into their training. Of the 34 training areas assessed, 10 were perceived as thoroughly integrated into formal training by at least half of the respondents. Trainees often sought independent cultural training outside of their programs, and no relationship was detected between perceived integration of cultural training and trainee cultural competence. Results indicate room for improvement regarding integration of cultural training and a need to better understand driving forces behind trainees independently seeking training outside of their formal training programs. Moreover, understanding the aspects of training that are most contributory to trainee development is needed given that no relationship between training and development emerged in the current study.

Infancy is a critical period for preventing obesity and health disparities. This study reports on the acceptability of a responsive parenting obesity prevention intervention (THRIVE) delivered via integrated behavioral health in a pediatric primary care setting. Intervention participants were invited to participate in a focus group on the acceptability of THRIVE and suggestions for refinement with particular attention to cultural responsiveness and diversity, equity, inclusion, and accessibility (DEIA). Eleven of 32 (34.4%) mothers participated in a 45-60 minute focus group (three groups, 3-5 participants each). Sessions utilized a semi-structured interview guide, were transcribed verbatim, and analyzed according to a thematic analytic approach. Four themes emerged: (1) Lived Experience (e.g., lived experience as a mother, navigating systemic and healthcare-related barriers, and context that shaped personal experiences with THRIVE); (2) Therapeutic Processes and Cultural Responsiveness (e.g., an appreciation of families' strengths and values by the THRIVE interventionist that facilitated engagement with THRIVE); (3) Tailored Strategy Implementation (e.g., implementation of THRIVE skills and strategies by families and how strategies were adapted or tailored to meet families' needs); (4) Future Improvements to THRIVE (e.g., proposed strategies for increased attention to DEIA and reducing participant burden). Conducting qualitative research prior to Phase 2-3 trials is vital to ensuring the interventions developed, implemented, and tested are not only empirically-based, but also culturally-responsive, attentive to DEIA, acceptable and relevant. Mothers provided valuable insights surrounding participation in THRIVE, highlighting important DEIA elements of THRIVE and suggested ways to decrease burden and increase access.

Psychosocial concerns are common among youth who sustained a burn injury. Detecting psychosocial distress early is essential to ensure appropriate treatment and referrals. Thus far, research has focused largely on the long-term outcomes of pediatric burn survivors. The current quality improvement initiative details the implementation and outcomes of brief, pragmatic screening to assess psychosocial concerns among pediatric burn survivors in an outpatient setting. A primary caregiver completed an age-appropriate psychosocial screener for youth aged 4-10 years (n = 69), while patients aged 11-17 years (n = 72) completed a self-report screener. Total scores were used to categorize patients as acute risk (i.e., emotional concerns requiring immediate attention), moderate risk (i.e., elevated symptoms, but no immediate safety concerns), or low risk (i.e., endorsing few to no symptoms). Patients with acute risk were evaluated by medical staff to determine the need for immediate psychiatric intervention or social services referrals. Patients with moderate risk met with the on-site psychology team during their clinic visit or were contacted by telephone within 1 week. Patients in the low-risk category warranted no additional follow-up post-screening. Most patients scored in the low-risk category (n = 120; 85%), while 11% (n = 16) and 4% (n = 5) endorsed symptoms consistent with moderate and acute risk, respectively. Results demonstrate the utility of implementing pediatric psychosocial screening in an outpatient burn clinic, the importance of detecting psychosocial concerns in this context, and usage of referrals to address concerns. Findings also shed light on key caveats of psychosocial screening, barriers to accessing psychosocial support, and the potential benefits of embedded psychological support during medical visits.