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Journal of Pediatric Psychology, Vol. 28, No. 2, 2003, pp. 81-83
© 2003 Society of Pediatric Psychology
Introduction to the Special Issue: Training in Pediatric Psychology
Medical University of South Carolina
All correspondence should be sent to Ronald T. Brown, College of Health Professions, Medical University of South Carolina, 19 Hagood Avenue, Suite 910, P.O. Box 250822, Charleston, South Carolina 29452. E-mail: brownron{at}musc.edu.
When pediatric psychology began as a field of study nearly 35 years ago,
issues related to training clinical psychologists to practice dominated the
field (Tuma, 1975
,
1980,
1982;
Tuma & Grabert, 1983). At
inception, the field's constructs and terms needed to be explicated.
Investigation then proceeds, and the specialty becomes science. The Society of
Pediatric Psychology (SPP), formed in 1967, led to the Journal of
Pediatric Psychology, first published in 1975, which now showcases our
science as the prototype for scientific inquiry in pediatric psychology. The
Handbook of Pediatric Psychology defines the field as it was in the
late 1980s (Routh, 1988) and
in the mid-1990s (Roberts,
1995). In the early 1980s, information about the field of
pediatric psychology appeared in textbooks
(Drotar, Benjamin, Chwast, Litt, &
Vajner, 1982; Roberts &
Wright, 1982), with direction toward applied and research venues
in pediatric psychology. Models of collaboration with our pediatrician
colleagues were also developing.
Since the early 1980s, the field of pediatric psychology has changed
dramatically. The SPP has commissioned the third edition of the Handbook
of Pediatric Psychology, to be published later in 2003. We last fully
evaluated training in pediatric psychology in 1988
(La Greca, Stone, Drotar, & Maddux,
1988). Influences on the delivery of pediatric psychology also
influence training, and changes in health care systems influenced
opportunities for pediatric psychologists. We now work in many
settings—traditional academic departments, the applied environment of
the health sciences center, the primary care practice— and our
interventions and areas of expertise have multiplied. Nonetheless, regardless
of the service delivery venue, every practicing psychologist knows how the
associated changes with managed care over the past decade have clearly
influenced the practice of pediatric psychology
(Phelps, Eisman, & Kohout,
1998).
Significant increases in medical sciences, advances in pharmacotherapy, and
implementation of standard-of-care procedures have markedly changed the
delivery of health care (Brown &
Freeman, 2002; Brown,
Fuemmeler, & Forti, in press). Examples include the sedation
of children who undergo painful diagnostic procedures for cancer
(Tarnowski, Brown, Dingle, & Dreelin,
1998) and new chemotherapies that have significantly improved the
prognosis of children diagnosed with acute lymphocytic leukemia
(Brown et al., 1998;
Waber et al., 2001). As part
of our collaboration with the American Academy of Pediatrics, we have included
additional changes such as the reliance on clinical pathways and practice
guidelines developed by our pediatric colleagues
(Brown et al., 2001; Committee
on Quality Improvement, 2000,
2001).
Given the practice patterns and changes in delivery of care, an obvious and
important area to address is the state of the art of training in pediatric
psychology. Under the leadership of the SPP, a task force was commissioned to
evaluate graduate, internship, and postdoctoral programs in pediatric
psychology and make recommendations for improvements. Anthony Spirito, PhD,
chair of the Task Force on Training in Pediatric Psychology, led the effort
and organized two important conferences for committee members. A result of
these two conferences is an article in this issue that provides an overview of
the training experiences considered by the committee and the Board of
Directors of the SPP to be important in the development of competencies for a
pediatric psychologist. The recommendations provided by Spirito et al. (this
issue) build on the work of Roberts et al.
(1998), who include
recommendations from the 1992 National Institute of Mental Health work group
that defined clinical training guide-lines for children and adolescents.
Spirito's team also based their recommendations on La Greca and Hughes
(1999), who defined critical
competencies for clinical child psychologists. The authors hope that the
recommendations Spirito et al. outlined will be used by pediatric psychology
graduate programs. Of course, the guidelines will be translated into curricula
and practical experiences differently by specific programs and will need to be
assessed in terms of feasibility and usefulness.
Experienced, established pediatric psychologists were surveyed to elucidate these complex issues. Experts were selected based on distinguished training programs at their sites (Drotar, Palermo, & Ievers-Landis, this issue; Madan-Swain & Wallander, this issue; Roberts & Steele, this issue). The three commentaries on the article by Spirito et al. presented here react to the guidelines and discuss how the guidelines might be incorporated in the standards of specific training programs. These programs have earned the reputation of training the "best" of pediatric psychologists. These commentaries, I believe, will provide impetus for discussions about the training of future pediatric psychologists and about our current training practices.
To determine support for change in the field, of both theoretical
orientation and adaptation to a family systems model, Mullins, Hartman,
Chaney, Balderson, and Hoff (this issue) surveyed members of SPP. They found
that a higher percentage of membership now endorses a cognitive-behavioral
orientation compared to figures in a report in the mid-1990s
(Mullins, Harbeck-Weber, Olson, &
Hartman, 1996). It is likely that this result mirrors the effect
of empirically supported treatments that are the standard of care among
pediatric psychologists. Reflecting changes in the delivery of health care,
fewer respondents of the survey reported employment in private practice.
Research and scholarly activities have always been part of the core identity of pediatric psychologists. Drotar, Palermo, and Ievers-Landis (this issue) have identified key challenges in the training of graduate students that will best assist them in assuming the role of pediatric psychologists. Peer support and the involvement of multiple investigators to serve as mentors will help to meet the challenges of training graduate students to become accomplished investigators. Peer support always has been a strong feature of our discipline, and careful mentoring of our junior colleagues clearly will strengthen pediatric psychology, especially as we strive to meet the challenges ahead.
For those being trained to provide clinical services over the next several decades, uncharted waters remain with regard to advances in medical science. Patenaude (this issue) convinces us of the importance of genetic knowledge over the next several years. The firm foundation of pediatric psychologists in developmental frame-work and developmental psychopathology, clinical interviewing, assessment, and empirically validated interventions provides us with the essential tools to collaborate with our genetics colleagues. We are unique in our broad knowledge of several fields. However, there is still much to learn, including specific concepts and methodologies, risk notification, genetic test disclosure, and ethical dilemmas.
Power, Shapiro, and DuPaul (this issue) provide us with unique opportunities and a new venue where we might practice the science and art of pediatric psychology. Clearly, changes in the delivery of health care have mandated that psychological services for children and adolescents be provided at points of service most accessible to children and their families. School health clinics as a means of offering primary pediatric health care to all children provide an important system from which pediatric psychologists may deliver appropriate and compassionate care. This innovation in service delivery also allows for greater collaboration among other child disciplines that will enable all of us to provide comprehensive services.
Drotar et al. (this issue) discuss mentoring pediatric psychology students in a postdoctoral setting. If I had one wish for an additional article for this series, it would be on the role of mentors. Clearly, good mentoring is important in teaching us how to be better pediatric psychologists. Although, for some, mentoring included honing clinical and research skills, for others, mentoring may have included instruction on managing professional responsibilities, balancing professional demands with family life, and not only being ethical and responsible psychologists but also better human beings.
I wish to acknowledge the important contributions of each of the articles in this issue and to express my sincere appreciation to the authors for their diligent efforts in preparing the articles, as well as their patience with the review process. I hope that the articles will stimulate additional thought, policy, and scholarship on the training of pediatric psychologists. The articles in the series should serve as a baseline from which to evaluate our progress in training over the next several years as we strive to enhance the quality of life for the children and families we serve by enhancing the training of pediatric psychologists.
Received December 21, 2001; accepted January 8, 2002
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