Objective Behavioral intervention technologies (BITs) stand as a promising delivery mechanism that overcomes multiple condition-specific and access barriers for self-management interventions for adolescents and young adults with spina bifida (AYA-SB). The purpose of the current review was to synthesize the behavioral and self-management intervention literature in conditions that have overlapping symptoms with youth with SB and to develop a model of likely user needs for AYA-SB that promotes self-management. Method The search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) databases. The review was based on a systematic narrative synthesis framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092342). Results In total, 18 articles were included in the current BIT review. The majority of included studies (1) targeted the management of chronic health conditions, (2) were informed by evidence-based approaches, (3) relied on content delivery, (4) were Web-based, (5) used linear or user-driven workflows, (6) included professional human support, and (7) included a control condition. Conclusions Many of the evaluated BITs resulted in acceptable usage and maintained or improved targeted symptoms. A user needs model for AYA-SB is proposed with the intention that future research will promote further refinement and ultimate deployment of a BIT for AYA-SB to promote self-management.

Purpose This article focuses on the transition to adult health care in youth with spina bifida (SB) from the perspective of theory, measurement, and interventions. Methods The purpose of this article is to discuss (a) a theory of linkages between the transfer of medical responsibility from parent to child and the transition from pediatric to adult health care, as mediated by transition readiness; (b) measurement issues in the study of self‐management and the transition to adult health care; and (c) U.S.‐based and international interventions focused on the transition to adult health care in young adults with SB. Findings Individuals with SB must adhere to a complex multicomponent treatment regimen while at the same time managing a unique array of cognitive and psychosocial challenges and comorbidities that hinder self‐management, medical adherence, and the transition to adult health care. Moreover, such youth endure multiple transitions to adult health care (e.g., in the areas of urology, orthopedics, neurosurgery, and primary care) that may unfold across different time frames. Finally, three transition‐related constructs need to be assessed, namely, transition readiness, transition completion, and transition success. Conclusions SB provides an important exemplar that highlights the complexities of conducting research on the transition to adult health care in youth with chronic health conditions. Many transition trajectories are possible, depending on the functioning level of the child and a host of other factors. Also, no single transition pathway is optimal for all patients with SB. Clinical Relevance The success of the process by which a child with SB transitions from pediatric to adult health care can have life‐sustaining implications for the patient.

Attention to child protective factors can enhance understanding of adjustment to type 1 diabetes and may have implications for intervention.

Objective To determine if there are distinct developmental trajectories of medical responsibility in youth with spina bifida (SB) across ages 8–17 years and to identify condition-related, parental, and family systems predictors of membership in these trajectory groups. Methods Participants were 140 youth with SB and their parents who participated in four waves of a longitudinal study across 6 years (ages 8–15 years at Time 1). Multi-method (questionnaires and observed family interactions) and multi-respondent assessments were conducted during home visits. Results Findings revealed that there were two distinct developmental trajectories that characterized this sample, with one being labeled “high increasing” (two thirds of the sample) and one labeled “low increasing” (one third of the sample). Most predictor variables were significantly associated with trajectory group membership, with the exception of ethnicity, SES, and measures of conflict. When all significant univariate predictors were included in the same model, only intelligence quotient (IQ), family stress, and gender were retained as significant. Conclusions Most youth exhibited relatively rapid increases in responsibility over the course of late childhood and adolescence, but there was a smaller portion of the sample that did not exhibit this type of developmental trajectory. The magnitude of the IQ effect on group differentiation appeared to attenuate the effects of most other predictors. It will be important for clinicians working with youth with SB to recognize that the transfer of medical responsibility from parent to child cannot be expected to unfold in the same manner for all families of youth with SB.

One way in which neurocognitive dysfunction may hinder the development of medical autonomy in youth with SB is through an increased risk for depressive symptoms.

For parents of youth with SB, personal distress, and parenting stress are related to parental perceptions of child vulnerability, and child age may moderate this relationship. Parental personal distress and parenting stress are important targets for future interventions.

Twelve trainees (3 men and 9 women) who had recently completed predoctoral internships at a university counseling center were interviewed about what they had learned from clients. Data were analyzed using a consensual qualitative research method. Participants reported learning things about doing therapy, themselves, client dynamics, human nature, the therapy relationship, and the usefulness of supervision. In addition, participants highlighted the importance of consultation and self-reflection to help them recognize what they learned. Implications for practice and research are discussed.

The aims of this study are to: (1) examine the preliminary utility of the Self-Management and Research Technology (SMART) pilot project, (2) identify which adolescents were most likely to benefit from participation, and (3) examine interview feedback to inform future program iterations. Twenty-three adolescents ( M = 15.13 years) were enrolled in the six-week text message pilot program consisting of daily interactive blood glucose (BG) prompts and type 1 diabetes-related educational text messages. Medical charts were reviewed for hemoglobin A1c and to corroborate medical record and demographic data. Glucometer data were downloaded to calculate an average monthly BG level and daily BG monitoring frequency. No statistically significant improvements were observed pre-intervention to post-intervention in glycemic outcomes. Participants with a high text message response rate were more likely to demonstrate improvement in average monthly BG levels and daily BG monitoring frequency than those with a low text message response rate. Participants reported satisfaction with the text message program. The text message-based SMART pilot project demonstrated preliminary efficacy for a targeted subset of adolescents who were engaged with the program. Continued research with a larger sample and longer trial duration is warranted to evaluate the potential utility of text message-based interventions.