Introduction to the special interest issue on parent/guardian interventions in pediatric psychology: The role of the pediatric psychologist working with caregivers as the target of intervention.

Abstract

Objective: There is a complex and bidirectional relationship between parent/guardian wellbeing and child physical and mental health. The role of a pediatric psychologist in this relationship has historically emphasized working with the parent as an agent of change to disseminate evidence-based skills and techniques toward improving child functioning. Increasingly, the role a pediatric psychologist can play in directly impacting the health and wellbeing of the parent/guardian of the identified patient is being explored, especially with expanded integration of behavioral health into primary care and medical home models that approach child health through a holistic, preventative lens. Furthermore, parents of children with acute/chronic illness are at increased risk of mental health concerns themselves; thus, considering parent functioning as its own outcome when working with pediatric patients may confer additional benefits in optimizing family adjustment. Method: Articles inclusive of topics on screening, early intervention, treatment, and program development targeting the parent/guardian of pediatric patients were considered for this issue. Results: This Special Issue includes 10 articles highlighting novel interventions targeting parent well-being in primary care and medical subspecialty settings using a range of service delivery modalities. Additionally, this issue explores the ethical, logistical, and systems considerations that can pose challenges to responding to parent mental health needs within the pediatric health care system, which pediatric psychology as a field is still learning to negotiate. Conclusions: This issue highlights clinical practice approaches and novel research in which the primary target of intervention is the caregiver of a pediatric patient. Implications for Impact StatementThe aim of this Special Issue is to contribute to the research base for pediatric psychology providers with regards to models and methodology for parent/guardian specific screening and intervention in the pediatric health care system. Ethical issues in addressing caregivers as the primary point of intervention also are explored while promoting a holistic family care model.

But parents need help! Pathways to caregiver mental health care in pediatric hospital settings

“…The effect of caregiver functioning is pervasive and affects each family member, including the ill child. Thus, interventions developed for caregivers have often prioritized potential benefits to the ill child and their treatment course (Kahhan and Junger 2021).…”

“…Caregivers routinely receive psychosocial support, but it is generally incorporated within the child's care and is designed to address basic needs (e.g., housing) or provide supportive psychotherapy narrowly focused on adjusting to the child's health condition rather than treatment targeting caregiver mental health disorders (Kahhan and Junger 2021). For example, caregivers may engage with pediatric medical social workers or their child's mental health provider (e.g., pediatric psychologist or psychiatrist) who can provide recommendations for their own self-care, help them problem-solve acute issues (e.g., communication with their child's medical team), or address common needs and reactions to caregiving.…”

Incorporating DEI informed-frameworks and increasing access to parent-focused interventions in pediatric psychology.

“…As the pediatric heath system has evolved from paternalistic to collaborative, and from patient-centered to family-centered care, there have been increased opportunities to fully engage parents as important members of the treatment team and integrate enhanced support of parent needs in the context of child wellness (Kahhan & Junger, 2021). While there is increased recognition of the need for parent-focused support, ethical, legal, and logistical barriers must be navigated in order to assess parent psychosocial functioning and respond to needs in the pediatric environment (Maragakis et al, 2021).…”

“…To further address and minimize disparities in behavioral health care we need to reconsider standard modes of treatment delivery outside of pediatric medical home and other models of integrated care. Electronic health (eHealth) and telehealth interventions have been identified as an area of important growth to increase access to evidence-based treatments (Fairburn & Patel, 2014) and during the COVID-19 pandemic behavioral health practice and research rapidly shifted to telehealth delivery services, as was discussed in our previous issue (Kahhan & Junger, 2021). Three articles in the current issue present eHealth and telehealth applications with additional consideration for health equity variables.…”

“…This has been highlighted not only across published interventions targeting child health and behaviors via parent training (e.g., Kichler & Kaugars, 2021), but also in services provided for parents which can indirectly impact child health through improved parent wellbeing (e.g., mindfulness training, depression screening; Harris et al, 2021; Lovejoy et al, 2000). This was explored in our previous special issue “Parent/Guardian Targeted Interventions in Pediatric Psychology” (Kahhan & Junger, 2021) where ethical, logistical, and service development considerations for parent screening and interventions were explored under best practice guidelines from the American Psychological Association (APA;, e.g., Maragakis et al, 2021). The recognition of the need to consider parents in pediatric services has been further highlighted with the recent addition of the Caregiver Wellbeing Special Interest group within the Society of Pediatric Psychology, the incorporation of a breakout session at the 2022 Society of Pediatric Psychology Annual Conference on the inclusion of parents and caregivers in program development and quality improvement projects, and the upcoming scheduled programming at the 2022 American Psychological Association conference (e.g., a workshop specific to Acceptance and Commitment Therapy with parents).…”