William A. Rae

A School Reentry Program for Chronically Ill Children

Abstract Children with chronic illness face many challenges as they cope with the medical management of their disease. One of the best ways to promote a sense of normalcy for these children is to promote regular school attendance. A positive experience at school can help children achieve a sense of mastery and control, increase self-esteem, promote fulfilling peer relationships, and decrease emotional trauma resulting from the disease. Recent federal legislation regarding children with medical problems increases the likelihood that a positive school experience will be developed for chronically ill students. This article describes a school reintegration program aimed at overcoming the numerous psychological, physical, environmental, and family-based deterrents to school reentry for chronically ill children. The program uses a systems approach to children’s mental health, with an emphasis on multiple aspects of the child’s environment (i.e., family, medical personnel, peers, and teachers).

Effects of Workshop Training for Providers Under Mandated Use of an Evidence-Based Practice

Workshops are a common strategy for fostering the adoption of evidence-based practices (EBP), but workshops alone may not change provider behavior. This study investigates the impact of a two-day training combined with an existing mandate for EBP use. Providers attending regional workshops showed improved attitudes toward the behavioral parent training model, but not EBPs in general. Participants were more accepting of behavioral techniques shortly after training, but the effect was not maintained. Examination of youth served prior to and after the training showed that providers increased their use of the EBP but overall outcomes were not improved.

Factors contributing to breaking confidentiality with adolescent clients: A survey of pediatric psychologists

A common ethical dilemma experienced by professional psychologists involves deciding whether to break confidentiality with risk-taking adolescent clients. However, our understanding of the factors that contribute to this decision-making process is limited. The present study surveyed 200 pediatric psychologists (resulting in 74 usable surveys) and identified several items that are perceived to be important to clinicians when they consider the decision to break confidentiality in order to report potentially dangerous behaviors to the parents of adolescent clients. The present study also used exploratory factor analysis to identify 2 underlying factors—Negative Nature of the Behavior and Maintaining the Therapeutic Process—as crucial to the decision-making process. How do psychologists decide whether to break confidentiality in order to inform the parents of risk-taking adolescent clients about the potential harm that may result from the adolescent’s behavior? In order to encourage open communication and trust during treatment, psychologists often assure adolescent clients that confidentiality will be maintained, although there is no legal basis for doing so (Rae, 2001). Parents have the legal privilege to all information about their adolescent, yet in practice this privilege is usually voluntarily waived in order to facilitate the therapy process. Rather than being based on law, this decision is based on the psychologist’s desire to build and maintain an honest therapeutic relationship with the adolescent, in which the client feels safe in revealing sensitive information (Gustafson & McNamara, 1987). However, it is clear that psychologists have an ethical and legal responsibility to break confidentiality when a client’s behavior is deemed dan

Breaking Confidentiality to Report Adolescent Risk-Taking Behavior by School Psychologists

School psychologists often break confidentiality if confronted with risky adolescent behavior. Members of the National Association of School Psychologists (N = 78) responded to a survey containing a vignette describing an adolescent engaging in risky behaviors and rated the degree to which it is ethical to break confidentiality for behaviors of varying frequency, intensity, and duration. Respondents generally found it ethical to break confidentiality when risky adolescent behaviors became more dangerous or potentially harmful, although there was considerable variability between respondents. Significant gender effects were found between male and female respondents for alcohol use, and a significant Form Type (i.e., male or female vignette) × Frequency/Duration interaction was observed for antisocial behaviors. School psychologists could benefit from further training in ethical decision making because these ethical dilemmas are not always clear-cut.

Ethical and Legal Issues in the Treatment of Children and Families

The ethical and legal treatment of children and families engaged in psychotherapy is the greatest responsibility of any psychotherapist. In many ways, therapy with children and families requires the highest standard of ethical behavior because of the special vulnerabilities of children and the complexities involved with interacting with multiple family members. Ethical guidelines are most often written for adult patients and, as a result, they may be difficult to apply to children and families. Special considerations are needed to understand the child’s capacity to make treatment decisions, conflicting legal and ethical standards involved in the treatment of children, differing needs of children and their family members, and the special vulnerabilities of children. In addition, most child and family therapists believe that it is an ethical duty to be an advocate for the child and family. In fact, (Koocher (1976)) has stated that child therapists are morally bound to serve as an advocate for their child clients. This advocacy also adds complexities to the treatment process, as disagreements can occur between the child, therapist, and/or parent(s) with regard to the best interests of the child or family. The therapist must constantly strive to maintain the highest ethical and legal practices, yet in doing so, will face dilemmas that challenge the therapist’s thinking and behavior.

Hospitalized latency-age children: implications for psychosocial care.

Hospitalized latency-age children (ages 5-12) are often forced to deal with emotional feelings surrounding their illness or hospitalization that can be psychologically damaging. Factors which interfere with a latency-age childs psychological growth are enumerated. Potential benefits of hospitalization and guidelines for working with this age child are provided.

Mind-Body Approaches and Chronic Illness: Status of Research.

An increasing number of children experience chronic health issues that affect their academic and behavioral functioning, as well as psychological well-being. At the same time, psychological stress can exacerbate the chronic illness. The first line of treatment most often is medical (e.g., pharmacology, surgery, radiation). Even when the medical approach addresses the physical issues adequately, there may be residual effects on functioning. To better address overall well-being, as well as to potentially decrease reliance on medication, one approach has been to use mind-body or mindfulness interventions. Overall, results from existing studies suggest that mindfulness interventions may be beneficial for reducing symptoms and associated problems through relaxation for many chronic illnesses, including epilepsy, fibromyalgia, headaches or migraines, cancer, and asthma. While the research is promising, there is a need for additional, more controlled studies that integrate mind-body approaches with traditional medical approaches. Suggestions for future studies are provided.

Pioneers in Pediatric Psychology: Parsimonious Interventions, Serendipity, and Collaboration

When I graduated from high school in 1966, the field of pediatric psychology did not exist. In fact, the term “pediatric psychology” was not coined until 1967 when Logan Wright wrote his groundbreaking article in the American Psychologist (Wright, 1967). I began the University of California at Berkeley wanting to be a dentist, but after a conspicuous lack of passion for organic chemistry, I went to the UC Counseling Center for advice about a change of major. After taking a Strong Vocational Interest Blank, the counselor suggested “psychology.” After taking a myriad of psychology courses, I discovered my passion. In fact, the experience with the counseling center convinced me to get my PhD in Counseling Psychology so I could help college students discover their passion. While attending the Counseling Psychology doctoral program at the University of Texas, I took several practica at the University of Texas Counseling Center and discovered to my dismay that, at least in the early 1970s, the kinds of presenting problems confronting college students (e.g., what to major in, dealing with parents, dating concerns) were not particularly challenging. This motivated me to do a predoctoral internship in a medical setting. I anticipated that I would be working with adults because I had little child training, but serendipity provided an opportunity to work with children and families. Although I had still not heard of the field of pediatric psychology, I was fortunate in 1974–1975 to obtain an internship specializing in pediatric psychology at the University of Oklahoma Health Sciences Center (UOHSC). This was one of the few training programs in existence at that time. Pediatric psychology was a new field, but I had the “dream team” of Logan Wright, Diane Willis, and Gene Walker as my primary supervisors. Logan was one of the three original cofounders of the Society of Pediatric Psychology (SPP) in 1969, Diane was the first editor of the Journal of Pediatric Psychology published in 1976, and Gene, a consummate behavioral psychologist, directly influenced and led the pediatric psychology program at the UOHSC for >20 years. My internship jumpstarted my future as a professional psychologist, which included beginning primary care pediatric psychology programs at Henry Ford Hospital (1975–1980) and Scott and White Hospital (1980–1995), joining a tertiary care pediatric psychology program at St. Louis Children’s Hospital (1996–1998), and eventually working with doctoral training in a school psychology program at Texas A&M University (1998–present). I will always consider myself first and foremost a “pediatric psychologist.” The field of pediatric psychology is diverse and multifaceted. At the same time, my experiences in pediatric psychology were predominantly in primary care outpatient pediatric clinics doing evaluation and treatment that would not be dissimilar to those activities of a clinical child psychologist. Pediatricians often would refer patients to me for common psychological issues pertaining to development, behavior, or learning. Although I had the occasional chronic illness referral, inpatient consultation, or emergency room referral, most of my time was spent in an outpatient setting. I was doing integrated care and primary care long before it was commonly used term. As I continued my practice in pediatric psychology, I had no idea how it would evolve. For the past 16 years, I have been teaching in the school psychology program within the Educational Psychology Department at Texas A&M University, which is not a traditional pediatric psychology position. At the same time, there is a long-standing tradition of school psychologists interfacing with pediatric settings (Power, DuPaul, Shapiro, & Parrish, 1995). Half of my effort is as a faculty member in an APA-accredited School Psychology program teaching child psychotherapy, assessment, and psychopathology, while the other half of my effort is as Director of the Counseling and Assessment Clinic (CAC), the training clinic for the School Psychology and Counseling Psychology training programs at Texas A&M. What do these two positions have to do with pediatric psychology? As a faculty member, I mentor doctoral students who might want to pursue a pediatric psychology career and am the faculty advisor for outside practica at MD Anderson Cancer Center (Houston), Texas Children’s Hospital (Houston), Cook Children’s Hospital (Ft. Worth), and Dallas Children’s Hospital. As a result, during the past 10 years, the School Psychology program has placed 30% of its predoctoral interns in pediatric psychology placements (e.g., Children’s Hospital of Los Angeles, Boston Children’s Hospital, Stanford Children’s Hospital, Nationwide Children’s Hospital, Oregon Health Sciences University, University of Minnesota Medical Center, Children’s Hospital of Michigan). As Director of the CAC, our psychotherapy clinic is located off-campus in a federally qualified community health center. This setting provides the School Psychology students with the opportunity to consult with physicians and other personnel from the medical side of the clinic.