Journal of Pediatric Psychology, Vol. 27, No. 4, 2002, pp. 315-323
© 2002 Society of Pediatric Psychology
Expanding Pediatric Psychology Beyond Hospital Walls to Meet the Health Care Needs of Ethnic Minority Children
University of Florida
All correspondence should be sent to Carolyn M. Tucker, Department of Psychology, P.O. Box 112250, University of Florida, Gainesville, Florida 32611. E-mail: cmtucker{at}ufl.edu .
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Abstract |
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Objective: To discuss the need for an ecological model and new approaches for meeting the psychological and physical health care needs of minority children.
Method: I support approaches that are informal, empowerment oriented, and culturally sensitive and that address illness prevention and health promotion.
Discussion: Assessment, intervention, and research challenges involved in implementing these approaches are identified, and some strategies for overcoming these challenges are discussed.
Conclusions: Pediatric psychology can be expanded to embrace the advocated model and intervention approaches to better meet the health care needs of minority children.
Key words: minority; intervention; culturally sensitive model.
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Introduction |
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TopAbstractIntroductionThe Need for Expanded...Characteristics of Needed...Overcoming the Challenges to...Mechanisms for Expanding...A University-School-Community...ConclusionsReferences |
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The alarming state of affairs regarding the health of ethnic minority children in the United States clearly suggests that provision of appropriate and consistent health care to these children needs to be a national priority. High rates of hospitalization, disabilities, and missed school days among these children result in numerous negative consequences including interference with their psychosocial development (Canino & Spurlock, 2000
). Additionally, minority children experience
preventable diseases at a higher rate than their white peers.
In recent years the public has turned much needed attention to the
disparities in health care access and use between ethnic minority American
families and white American families. Economically disadvantaged ethnic
minority families typically lack good health maintenance and seek medical care
only during a medical crisis or after a disease has progressed
(Canino & Spurlock,
2000).
Clearly, new approaches to health care, illness prevention, and health
promotion among ethnic minorities in the United States are needed. Approaches
based on an ecological conceptual model
(McLeroy, Bibeau, Steckler, & Glanz,
1988) seem most appropriate, as this framework considers five
levels of influence on health behavior, all of which appear to be particularly
important in understanding and modifying the health behaviors of ethnic
minority groups:
- (1) the individual level, including beliefs, values, education level,
skills and other individual factors; (2) the interpersonal level, including
interpersonal relationships between individuals; (3) the organizational level,
which covers the way relevant institutions are organized and managed; (4) the
community level, including the communities that individuals operate in (e.g.,
professional networks, associations, neighborhoods), community attitudes and
the relationship among different institutions within communities; and (5) the
policy level, which refers to policies and regulations affecting intervention
participants and the institutions in which they function. (cited in
Newes-Adeyi, Helitzer, Caulfield, &
Bronner, 2000, p. 2)
Because pediatric psychologists have knowledge of and experience with multidimensional approaches (e.g., biopsychosocial intervention approaches) for understanding and modifying health-related behavior of children, pediatric psychologists are especially well suited for developing and implementing ecological model—based approaches for improving health care among ethnic minority children. To do so, however, will involve expanding pediatric psychology beyond hospital walls.
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The Need for Expanded Health Care Approaches |
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TopAbstractIntroductionThe Need for Expanded...Characteristics of Needed...Overcoming the Challenges to...Mechanisms for Expanding...A University-School-Community...ConclusionsReferences |
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There is strong evidence that the existing formal health care system in the United States, which includes health service delivery through hospitals, emergency clinics, public health clinics, and private physicians, psychiatrists and psychologists, is not meeting the health care, illness prevention, and health promotion needs of our children. This evidence includes reports that an estimated 50% of the approximately 40 million American youths between the ages of 10 and 19 years old engage in two or more of the four major categories of high-risk behaviors (i.e., drug and alcohol use and abuse; unsafe sex, teenage pregnancy, teenage parenting; delinquency and crime; and school underachievement, failure, and dropout), with approximately 10% of these youths engaging in at least one behavior within each of these four categories (Dryfoos, 1990
).
Additionally, it has been found that healthrisk behaviors, contagious
childhood diseases, tuberculosis, and rheumatoid fever continue to occur at
higher rates among ethnic minority youths than among other youths (Mitchell
& Heagarty, 1991).
The latter finding is especially alarming, given the prediction that by
2050 the current ethnic/racial minorities may be the majority population in
the United States (Chen, 1999).
This population growth projection suggests that without new health care
approaches, the prevalence of health problems will be higher among future
generations of American youths. The additional findings that many ethnic
minorities underutilize formal mental health services and that cultural groups
differ in their helpseeking behavior
(Giordano & Giordano, 1977;
Tseng & McDermott, 1981)
suggest the need for pediatric psychology in settings where ethnic minorities
tend to seek other services and social and emotional support (e.g., churches,
schools, and community centers).
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Characteristics of Needed Expanded Health Care Approaches |
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TopAbstractIntroductionThe Need for Expanded...Characteristics of Needed...Overcoming the Challenges to...Mechanisms for Expanding...A University-School-Community...ConclusionsReferences |
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There is growing attention to identifying the descriptive characteristics of health care approaches or interventions that will likely better meet the psychological and physical health needs of ethnic minority children. Given the available health care literature and the five levels of influence on health behavior enunciated by the ecological model, these health care approaches should be informal, empowerment-oriented, culturally sensitive, and should address illness prevention and health promotion.
Informal Care Approaches
Informal care has been defined as the practice of alleviating physiological
and psychological problems through eliciting the involvement of diverse groups
(e.g., traditional healers and family members), using measures that do not
require a prescription from or intervention by a physician (e.g., lifestyle
modifications), and utilizing mechanisms or settings outside of formal,
institutional settings such as hospitals and physicians' offices
(Chen, 1999). In contrast,
formal care is the practice of alleviating physiological and psychological
problems by Western-trained allopathic and osteopathic medical practitioners
and associated health professionals through institutionally based settings
such as hospitals and clinics.
The settings for informal care include schools, community centers,
churches, and the homes or offices of unconventional health care providers
such as traditional healers. Informal care often incorporates alternative and
complementary medicine. Specific types of informal care include (1)
traditional Chinese or Oriental medicine (including acupuncture and
moxibustion); (2) Ayurvedic medicine; (3) body/mind medicine (including
biofeedback, imagery, and yoga); (4) chiropractic; (5) exercise; (6) herbal
medicine, Native Hawaiian La'au Lapa'au; (7) self-care; and (8) prayer
(Chen, 1999).
Informal care seems acceptable to many ethnic minorities, given the
estimation that as many as half of the racial/ethnic populations in the United
States use informal care (Chen,
1999). This estimation and research indicating the effectiveness
of informal care with ethnic minority pediatric patients support the expansion
of pediatric psychology beyond the walls of hospitals. An example of such
research is a study investigating pain among ethnic minority children with
sickle cell disease that concluded that the integration of assessment
strategies into home-based pain management programs may improve the health
outcomes of these children (Graumlich et
al., 2001).
The appeal by researchers at the Centers for Disease Control and Prevention
to psychologists to join with schools to improve the health of children and
adolescents further evidences the growing recognition of the potential value
of informal health care (Kolbe, Collins,
& Cortese, 1997). Pediatric psychologists can work in schools
and in communities (e.g., in churches and community centers) to help implement
and evaluate the effects of interventions to modify and prevent health-risk
behaviors among ethnic minority youths and to help analyze the associations
between educational outcomes and health behaviors/status among these youths.
Consistent with an ecological model, these psychologists would involve the
target ethnic minority children and their parents, as well as leaders and
unconventional health practitioners in the community in the development,
implementation, and evaluation of investigated interventions.
Empowerment Approaches
Empowerment connotes enabling or allowing people power and control for
self-determination of life direction and experiences. When this term is used
in the context of health care, it refers to having active control over the
identification of needed health care, health care delivery, health promotion
policies, and health-related resources. Such control and participation in the
United States typically come with high socioeconomic and educational status
and with physicians, hospital administrators, health insurance company owners,
and legislators with the legal authority to control the dissemination of
health resources or medications and to set health policies.
Due in part to historical events such as disenfranchisement (e.g., movement
of Native Americans and Japanese from their lands), economic exploitation
(e.g, slavery of African Americans and their African ancestors), and medical
abuse (e.g., the Tuskegee Study) of many ethnic minorities by majority groups,
ethnic minority children and their families are overrepresented in the low
socioeconomic classes in the United States and thus have little control over
or power to change the quality, quantity, or source of health care delivery to
them. Given the indication from the 1990 census that each of the racial/ethnic
minority populations in the United States grew faster than the majority
population (U.S. Department of Commerce
News, 1991), empowerment of ethnic minorities for illness
prevention, treatment of mental and physical health problems, and health
promotion among their children is an investment in the future health and life
of our nation (Chen, 1999).
Pediatric psychologists can help promote this health empowerment by collaborating and advocating with ethnic minority parents and with school and community leaders to obtain educational, counseling, and financial resources for use in their communities to promote health, prevent illness, and promote the use of formal and informal health care services. Additionally, pediatric psychologists can forge collaborative partnerships among community leaders, community businesses, and hospital administrators that enable each to provide financial and human resources to support the health delivery and health promotion mechanisms desired by the community.
Culturally Sensitive Approaches
Even though there is wide agreement that cultural sensitivity in health
care delivery is important, there is no universal agreement as to what is
meant by this term (Stewart et al.,
1999). I believe that cultural sensitivity is communicating or
displaying culture-related knowledge, skills, and awareness in ways that make
patients and others feel that their culture is respected and that make them
trust the health care that they receive. Cultural sensitivity includes being
aware of one's own culture and cultural biases, viewing cultural differences
as differences rather than as deficits or inadequacies, and recognizing the
roles of economic and cultural differences between the majority culture and
ethnic minority cultures in the disproportionately high incidence of
psychological and physical health problems among ethnic minority children and
their families.
Cultural sensitivity by pediatric psychologists in their actions to extend
their services beyond hospital walls to meet the psychological and physical
health needs of minority children can be demonstrated in several ways. These
psychologists can provide their services in ethnic minority neighborhoods
close to public transportation; provide some evening and night walk-in service
times; utilize the services of receptionists, co-therapists, and traditional
healers (e.g., curanderos) who share the cultural and linguistic
backgrounds of their patients; and create in their offices an ambience that
reflects the cultural heritage of the client population
(Rogler, Blumenthal, Malgady &
Costantino, 1985).
Illness Prevention Approaches
Because minority families in the United States are less able to pay for
medicines and hospitalization, illness prevention and health promotion should
be emphasized in needed approaches to extend health care beyond hospital
walls. Yet it has been estimated that the United States devotes less than 1%
of its budget to the prevention of mental health problems
(Nelson, Prilleltensky, Laurendeau, &
Powell, 1996) and spends very little on early intervention to
prevent physical health problems (McCain
& Mustard, 1999).
Prevention intervention approaches need to be directed toward all systems
that affect ethnic minority children, which include the following: (1) the
micro-system, which refers to the child's family and social network; (2) the
exosystem, which refers to the child and her or his family in relation to the
larger society (i.e., work settings, schools, religious settings,
neighborhoods); and (3) the macro-system, which refers to economic policies,
social norms, social class, and societal safety nets
(Belsky, 1993;
Prilleltensky & Nelson,
2000). This ecological systems approach recognizes that prevention
of illness among ethnic minority children cannot occur through individual,
family, group therapy, or consultation alone; interventions must take into
consideration the power structures (e.g., economic class structure) that
affect these children and their families.
Pediatric psychologists can promote prevention of psychological and physical health problems by forming coalitions among themselves and with children's advocacy groups to formulate and then advocate for ways that communities, schools, states, the federal government, private foundations, and businesses can promote the economic and educational advancement of ethnic minority families to reduce psychological and physical health risks among their children. Pediatric psychologists can also facilitate family-school-community-business-government partnership education and mentoring programs designed to help each partner identify and then implement strategies to prevent crime, school dropout, obesity, and other health-risk conditions in ethnic minority neighborhoods.
Health Promotion Approaches
In recent years, there has been growing support for the view that actions
must be taken to promote the physical and psychological health of all children
(Lerner, 2000;
Lerner, Sparks, & McCubbin,
1999).
Adoption of an ecological, social responsibility action approach to
promoting health and wellness is being advocated. This approach views health
and wellness of children as universal benefits, and thus everyone has a stake
in promoting them. Consequently, actions to promote health and wellness of all
children must be the responsibility of parents, communities, and governments
(Evans & Wekerle, 1997;
Griffin Cohen, 1997;
Kitchen, 1995).
To promote psychological and physical health and wellness among ethnic minority children, pediatric psychologists can assume advocacy, education, and partnership building roles. These professionals can also advocate for and help develop and evaluate community-based and school-based culturally sensitive health care and wellness promotion programs for ethnic minority children.
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Overcoming the Challenges to Expanding Pediatric Psychology |
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TopAbstractIntroductionThe Need for Expanded...Characteristics of Needed...Overcoming the Challenges to...Mechanisms for Expanding...A University-School-Community...ConclusionsReferences |
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There are noteworthy challenges to successfully expanding pediatric psychology beyond hospital walls using an ecological health care model. These challenges relate to (1) conducting assessments to gather needed information for tailoring expansion approaches to the target population, (2) effectively implementing the decided upon expansion approaches, and (3) conducting research to evaluate the impact of the expansion approaches. Strategies for overcoming these challenges must be formulated in collaboration with all involved in implementing these approaches.
Assessment Challenges and Strategies for Overcoming Them
It is important to obtain multidimensional information on the family and
community of any potential beneficiaries of expanded pediatric psychology that
embraces an ecological health care model, including their culture,
socioeconomic status and related challenges, psychological and physical health
status and related beliefs, and interest in interventions to improve their
children's health-related quality of life. Pediatric psychologists will likely
encounter several challenges in efforts to collect this assessment data.
One challenge is that of gaining community acceptance so that assessment or
background information can be obtained and working partnerships can be formed.
Pediatric psychologists can meet this challenge by informing community leaders
(e.g., religious leaders, spiritual healers, political leaders, school
leaders, and teachers) of their motivations to identify and address the
psychological and physical health needs of the children in that community.
Additionally, pediatric psychologists can become aware of cultural biases in
existing psychological diagnostic instruments and criteria and in their own
worldview. Evaluators (e.g., pediatric psychologists) must be self-reflective
regarding their own cultural norms and practices versus those of their clients
and consider the influence of revealed differences when interpreting
assessment information obtained. Evaluators themselves are the most important
instruments in conducting culturally sensitive assessments
(Canino & Spurlock,
2000).
A second assessment challenge is implementing culturally appropriate multidimensional assessment methods. To meet this challenge, pediatric psychologists can obtain training in conducting culturally sensitive assessments and can involve assessment partners who know the native language of the target intervention family and community. Individuals culturally similar to the target family may be ideal members of an assessment team; however, training in culturally sensitive assessment is paramount.
A third assessment challenge is finding incentives for data collection participation, including a list of the specific benefits of participating and monetary incentives/payments. The latter will require mini-grants from hospitals, foundations, businesses, or government agencies (e.g., NIMH and NIH) interested in the health and wellness of minority children.
Intervention Challenges and Strategies for Overcoming Them
Pediatric psychologists will likely encounter three major intervention
challenges in their efforts to implement intervention approaches for expanding
pediatric psychology beyond hospital walls. One is finding adequate time and
resources for intervention approach planning and program development. Because
of large clinical loads, pediatric psychologists typically do not have the
time to develop the ecological model—based, multilevel intervention
programs needed to meet the health needs of minority children
(Canino & Spurlock, 2000).
Thus, pediatric psychologists need to negotiate with their employers for the
time and resources to plan and implement these needed programs, pointing out
in the process the long-term economic advantages of tangibly supporting such
program development.
A second major intervention challenge for pediatric psychologists is to
obtain training in organizational and program development adapted to ensure
that trainees will be culturally competent. Such adaptations are consistent
with the national call for cultural competence by the Child and Adolescent
Service System Minority Initiative issued in 1999 to improve services for
children who are members of racial and ethnic groups of color. As reported by
Williams (1999), cultural
competence is "the convergence of program structure and climate as well
as a congruent set of behaviors, policies, and practices that enable programs
and service providers to operate effectively with people from diverse
backgrounds."
The third major intervention challenge for pediatric psychologists is sustaining family participation in health care—related programs over time. Many minority families face multiple stressors (e.g., financial problems, unsatisfactory school performance by their children, racial discrimination, etc.) that distract them from consistent and long-term participation in intervention programs. To meet this challenge, these programs must be easily accessible, include some periodic monetary incentives for participating in each program phase, include any needed participation transportation and child-care services, and include some immediate family or child assistance (e.g., tutoring for children who are failing).
Research Challenges and Strategies for Overcoming Them
Pediatric psychologists must conduct research to evaluate the effectiveness
of the approaches and interventions that they implement outside of hospital
walls and further identify the contributors to illness prevention, illness
treatment, treatment adherence, and health promotion among minority children.
As a part of this research, these psychologists can also respond to the need
for data on the efficacy of specific types of informal/unconventional health
care practices and interventions among ethnic minorities—data that have
proven difficult to obtain (Chen,
1999; Canino & Spurlock,
2000). This important research will provide the impetus and
support for funding of informal, empowerment-oriented, culturally sensitive,
illness prevention and health promotion approaches to meet the health care
needs of ethnic minority children and their families.
Conducting this important research is not without challenges. One challenge
is developing existing data collection instruments and culturally sensitive
methods. Some strategies for meeting this challenge include using at least
some qualitative data collection approaches, using written assessments in the
native language of and at the education level of the persons completing them,
and involving a multicultural research team in collecting and analyzing the
data to promote objectivity (Gil & Bob,
1999). It is also useful to pilot-test planned assessment
instruments and methods with individuals similar to those with whom they will
be used in the actual research.
Another research challenge is to develop a large pool of researchers who focus on minority health. To meet this challenge, universities and teaching hospital faculty and administrators should actively recruit, train, mentor, and fund minority graduate students to become culturally competent and culturally sensitive pediatric psychology researchers.
Given the underrepresentation of ethnic minorities in clinical trials, getting them to participate in research related to expanding pediatric psychology beyond hospital walls will also likely be a challenge. In addition to paying minority research participants for their time and travel for research participation, researchers should clearly specify in writing and in verbal form the reasons for the research, how the research data will be used, and what will be done to protect research participants' rights as human subjects. Recruitment of family members to serve as research participant recruiters is also recommended, given that their explanations of the research may be viewed as more credible than explanations by the professional researchers, especially when the professionals are not ethnic minorities.
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Mechanisms for Expanding Pediatric Psychology |
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TopAbstractIntroductionThe Need for Expanded...Characteristics of Needed...Overcoming the Challenges to...Mechanisms for Expanding...A University-School-Community...ConclusionsReferences |
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Consultation services, therapeutic communities, school-based programs, and community-based programs to modify and prevent health-risk behaviors or to promote health and wellness among ethnic minority children and their families are examples of mechanisms for expanding pediatric psychology beyond hospital walls. These mechanisms differ in their structure and breadth and thus in the level of human and physical resources needed to launch and sustain them.
Consultation Services
As consultants, pediatric psychologists can assume numerous roles within
schools. For example, they can educate minority parents and students as well
as school personnel and community members about the links between physical
health problems and psychological problems and the importance and availability
of resources for addressing both problems. These psychologists can also
consult with school health professionals on strategies for promoting
psychosocial adjustment of ethnic minority children with disabilities or who
are experiencing academic failure, evidencing behavior problems, or living
with a chronic illness. Culturally sensitive pediatric psychologists can help
identify the roles of ethnicity, race, and culture in psychological, academic,
and physical health problems of school-children. Additionally, these
psychologists can encourage the recognition of the culture-related strengths
of ethnic minority children and make sure that this information is considered
in assessments and interventions with these children and their families.
Therapeutic Communities
Given that ethnic minority children, like other children, are influenced to
do what they see others consistently around them do, it is no surprise that
ethnic minority children who live in communities where there is much drug and
alcohol abuse, delinquency, teen sex, and truancy are at high risk of engaging
in these health-risk behaviors. Thus, culturally sensitive community
interventions to treat, modify, or prevent these health-risk behaviors have
great potential for reducing them.
Pediatric psychologists can work with religious organizations (e.g., churches), youth organizations (e.g., girls and boys clubs), after-school tutoring programs, counseling centers at community-based colleges and universities, minority youth mentoring programs, and large health-focused organizations (e.g., hospitals and mental health centers) to develop community-wide prevention-oriented and treatment-oriented services and activities for promoting the physical and psychological health of minority children. These psychologists can also assume leadership in collecting needed empirical data on the effectiveness of these therapeutic communities.
School-Based Programs
Because schools offer an organizational structure for multidimensional
interventions to promote positive development in children, they are perfectly
suited for programs that expand pediatric psychology beyond hospital walls. An
example of a school-based intervention program for minority youths that can
serve as a model for integrating the work of pediatric psychologists into
schools is a school mental health program developed by the Family Academy in
Harlem (Canino, 1996). This
model program includes schoolchildren, families, and educators in extended day
and school year activities that include family education workshops on health,
parenting, and home management. This program emphasizes prevention of
health-risk behaviors and community involvement, provision of integrated
services, collaboration with private and public supporters, and inclusion of
an appreciation of ethnic history and culture in its curriculum. Thus, it is
consistent with an ecological intervention model.
Pediatric psychologists have the credibility, knowledge, and skills to provide interventions to promote health and to treat and prevent illness as part of a school curriculum or via school-community outreach activities and programs such as health fairs and parent training workshops. Pediatric psychologists can also train teachers and school counselors in strategies to modify behavior problems and other health-risk behaviors.
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A University-School-Community Research-Based Model Partnership Education Program |
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TopAbstractIntroductionThe Need for Expanded...Characteristics of Needed...Overcoming the Challenges to...Mechanisms for Expanding...A University-School-Community...ConclusionsReferences |
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The University-School-Community Research-Based Model Partnership Education Program (Tucker, 1999
;
Tucker et al., 1995), commonly
referred to as PEP, is an example of an ecological program established by a
psychologist. Thus, it provides a good example of the kind of program
development in which pediatric psychologists are especially capable of
engaging. PEP is an after-school community-based program to improve academic
achievement and adaptive skills (i.e., communication, socialization, daily
living, and future job skills), promote health, and reduce health-risk
behaviors of African American children in grades one through twelve from
socioeconomically disadvantaged neighborhoods. It is implemented by multiple
partners, including psychologists and psychology students at the University of
Florida, teachers at local schools, parent and community volunteers, and
business leaders. It has received funding from individual donors, foundations
(i.e., the Jessie Ball duPont Fund and the Hitachi Foundation) and Florida's
Department of Education. PEP is implemented in the education annex of a church
(Mt. Olive AME Church) located in the heart of a low-income minority community
in Gainesville, Florida, and is in its twelfth year of operation.
The theoretical underpinning of PEP is the self-empowerment theory of
achievement (Tucker, 1999).
This theory recognizes that the multiple external factors (e.g., economic,
social, and political factors) that often negatively affect the life course of
African American children typically cannot be eliminated in the school
lifetime of a child and thus advocates teaching these children self-empowering
knowledge, skills, and behaviors for achieving overall academic success and
good health.
Using a wait-list control group research paradigm to assess the
effectiveness of PEP, Tucker
(1999) and Tucker et al.
(1995) found that at 2-year
and 4-year follow-up periods, children in the PEP evidenced better grades than
the control children. Qualitative measures showed that participation in the
PEP improved adaptive skills and reduced behavior problems among participating
African American children (Tucker, 1995). Physical health outcomes were not
assessed.
Pediatric psychologists can establish a version of the PEP focused on physical health outcomes. Given their research training, pediatric psychologists are especially prepared to evaluate the impact on health and the cost-effectiveness of such a health-focused community-based program. Indeed, such program evaluation research is needed to justify and institutionalize the expansion of pediatric psychology beyond hospital walls.
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Conclusions |
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TopAbstractIntroductionThe Need for Expanded...Characteristics of Needed...Overcoming the Challenges to...Mechanisms for Expanding...A University-School-Community...ConclusionsReferences |
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The failure of the current health care delivery system to adequately meet the physical and psychological health care needs of ethnic minority children in the United States clearly indicates the need for new, innovative, culturally sensitive health approaches. Given the multiple ecological factors that affect the psychological and physical health of minority children, these approaches should be anchored in an ecological intervention framework; that is, these approaches ideally should be multi-level and collaborative. Specifically, approaches to promote health and prevent illness among minority children must involve the target children and their families, their communities, and their health care providers, as well as leaders of institutions and policy makers at the local, state, and national levels who control or influence economic or health care policies. Existing research and literature on needed intervention programs to address health-risk behaviors of minority children additionally indicate the need for these approaches to be informal, empowerment-oriented, and culturally sensitive.
Because of their health-related research skills and their knowledge of how physical, psychological, cultural, and social factors interact to influence physical and psychological health of children, pediatric psychologists are especially well trained to participate in and evaluate the effectiveness of new multilevel collaborative approaches to meet the health needs of minority children. To do so will require working beyond hospital walls and informing hospital administrators of the potential hospital cost-containment benefits of this expansion of pediatric psychology. This expansion of work roles by pediatric psychologists will also likely require these professionals to join other psychologists in acquiring additional training to enhance their skills in organizational development and their cultural competence.
Received July 9, 2001; revision received December 1, 2001; accepted December 15, 2001
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TopAbstractIntroductionThe Need for Expanded...Characteristics of Needed...Overcoming the Challenges to...Mechanisms for Expanding...A University-School-Community...ConclusionsReferences |
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