Pediatric School Psychology

Conceptualization, Applications, and Strategies for Leadership Development

Thomas J. Power, Kathy L. Bradley-Klug

• Publisher: Routledge
• Year: 2012
• eBook ISBN: 9781135197551
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

In today's schools, it is imperative that school-based mental health professionals be adequately trained in the knowledge and impact of pediatric health disorders on children's academic, social, and emotional progress and performance. This book will provide practitioners and researchers with the most relevant and up-to-date information concerning conceptual models and applications of intervention and prevention strategies in pediatric school psychology. Rather than making specific disorders the book's primary focus, the authors discuss practical topics such as improving adherence, promoting successful school reintegration, reducing stress and enhancing coping skills, improving pain management, and enhancing quality of life. Prevention strategies covered include developing multi-tiered programs, monitoring program effectiveness and quality of implementation, and programming for sustainability. A unique feature of this book is its emphasis on developing leaders in pediatric school psychology, with chapters devoted to important topics including program development and evaluation, grant writing, and manuscript reviewing and preparation. An accompanying CD contains PowerPoint presentations and guidelines for practice to assist with lectures and describes strategies for application in clinical and school settings.

One

Background and Overview of Pediatric School Psychology

Success in school is critical for healthy child development. School promotes the learning of concepts and skills, the development of strategies for interacting with others, and fosters the growth of independence and a sense of self-efficacy. Failure in school is a strong risk factor for poor outcomes in life; it initiates a process of disengagement that can result in school dropout, increased risk for unhealthy patterns of behavior and psychopathology, and enhanced likelihood of relationship problems in adolescence and adulthood.

Being successful in school depends upon multiple factors, which include but are not limited to the following. First, a strong parent–child attachment prepares the child to relate effectively with teachers and classmates and regulate behavior and emotions in school. Second, parent involvement in education helps the child to appreciate the value of education, take advantage of educational opportunities at home and school, come prepared to learn in school, and master skills introduced in the classroom setting. Third, the climate of the school can create a context within which teachers are valued, professional development is emphasized, effective teaching strategies are modeled and affirmed, and students engage in supportive relationships with their teachers. Fourth, an ongoing relationship with a primary health care provider can prevent the emergence of illnesses that can serve as barriers to learning and social development.

What is Pediatric School Psychology?

Pediatric school psychology is a subset of child-serving psychology that is focused on the promotion of children’s health and development through the coordination of efforts across systems, including family, school, health system, and community agencies, with a particular emphasis on fostering success in school. The essence of pediatric school psychology is to promote linkages among systems of care and interdisciplinary connections to enable children to be successful in school.

The domain of child-serving psychologists is quite diverse and includes professionals who place emphasis on varying aspects of child development. For example, clinical child and adolescent psychologists focus on mental health issues and they work to assess and treat problems, as well as to minimize and prevent risk. Clinical psychologists have an interest in resolving mental health problems or reducing risk so that children and youth can adjust well in the community, including school. Pediatric psychologists have a similar focus on assessment, intervention, and prevention but the targets of their efforts are health conditions, including acute and chronic illnesses. Pediatric psychologists, like clinical psychologists, focus on assisting children so that they can become integrated or reintegrated into normalized community environments. Community psychologists address the needs of children with a particular interest in how community-based agencies support the development of youth. They typically emphasize the importance of designing community organizations so that they are aligned with the cultural values and norms of the children and families served. School psychologists directly address the development of children in school. They have a principal focus on advancing the primary mission of schools to promote the cognitive and social development of students.

Child-serving psychologists often focus on a narrow range of systems in response to prevailing models of training or practice constraints, such as institutional priorities or billing policies. The term pediatric school psychology was coined to refer to the subset of child-serving psychologists who have a major focus on promoting child development within a wide range of systems (e.g., family, school, health system, mental health system, and other community systems), with a particular focus on the school, and facilitating the alignment of systems to promote school success (e.g., school–health system connection, school–mental health system connection, family-school connection; Power, DuPaul, Shapiro, & Parrish, 1995). The distinguishing feature of pediatric school psychologists is not the graduate program within which they receive their training (e.g., clinical vs. health vs. school), but the developmental/systems approach they use in understanding children and intervening to promote healthy and successful development especially in schools (Power, Shapiro, & DuPaul, 2003).

Pediatric school psychologists understand that promoting student success in school depends upon a wide range of variables, including school factors (e.g., content and method of instruction, teacher–student relationships, peer relationships), family factors (e.g., quality of the parent–child relationship, parental regulation of child behavior, family involvement in education), health system factors (e.g., access to health system, trust in health provider, quality of care), and the connections among these systems. The focus is on promoting the development of the whole child, supporting the multiple systems in which children function, and facilitating relationships between the school and family, and other systems in the child’s life.

At its core, pediatric school psychology promotes interdisciplinary collaboration. In promoting connections among systems, professionals from multiple disciplines naturally intersect with one another. Strong intersystemic relationships require that professionals from various disciplines value one another’s contributions and work to establish and maintain mutual partnerships.

Theoretical Foundations of Pediatric School Psychology

Because pediatric school psychologists work across systems and disciplines, it is essential that they understand and incorporate multiple theoretical models into their work. The following is a description of some of the more prominent models involved in practice and research related to pediatric school psychology.

Medical Model

This model is the prevailing paradigm used by health providers in medical settings. It is used to determine the presence or absence of a medical or mental health disorder. The Diagnostic and Statistical Manual of Mental Disorders is a system based on the medical model that is used to classify psychiatric disorders. In order to meet criteria for a diagnosis, one or more clusters of symptoms must be present and there generally needs to be evidence of functional impairment. For example, to receive a diagnosis of posttraumatic stress disorder, the person must have experienced an event that involved actual or threatened harm to self or others; demonstrate persistent symptoms related to reexperiencing the traumatic event, avoiding stimuli associated with the trauma, and being hyper-aroused; and show evidence that the disturbance is causing significant functional impairment (American Psychiatric Association, 2000).

The medical model has numerous advantages in that it specifies useful guidelines for assessment, delineates conditions that have a somewhat predictable developmental course, and helps in identifying potentially effective interventions. Limitations of the model are that it identifies the person (child) as the source of the problem, may fail to identify varying levels of severity, and has limited utility in designing specific strategies for treatment (Power et al., 2003).

Psychometric Model

This model is based on decades of research demonstrating that individuals differ from one another on numerous dimensions of physical, cognitive, learning, behavioral, social, and emotional functioning. Measures based on a psychometric model provide an assessment of functioning along a continuum that does not clearly differentiate normal (adaptive) from abnormal (nonadaptive) functioning. As such, these methods afford an examination of the relative severity of a dimension of functioning (Achenbach & Rescorla, 2001). The psychometric model typically incorporates multiple methods and informants, including direct assessment of functioning (e.g., testing of a child), informant reports (e.g., parent and teacher ratings), self-reports, and direct observations of behavior. Decisions about severity are often determined based upon a comparison of an individual’s functioning to that of peers of similar age and gender, although some assessment methods examine functioning in relation to an established criterion as a basis for decision making (i.e., criterion-referenced measurement). Although the psychometric model historically has focused on assessing deficits, recently there has been increasing emphasis on strength-based assessment.

The psychometric model addresses a limitation of the medical model in that it provides an assessment of the relative severity of a problem. It is highly useful for multimethod assessment of baseline functioning, as well as for progress monitoring and outcome assessment. Disadvantages may include its failure to account for contextual and cultural factors and its limited efficacy in designing intervention strategies (Power & Eiraldi, 2000).

Neuropsychological Model

Advances in neuroscience have been occurring at a breathtaking pace. Progress in neuroscience is elucidating mechanisms of action to explain individuals’ learning and behavior and how educational, psychosocial, and pharmacological interventions have an effect on the developing brain. Neuropsychology provides a set of methods to understand linkages between structures and functions of the brain and processes of learning and execution (Levin & Hanten, 2005). Neuropsychology is especially useful with children who have disorders that are clearly linked to the central nervous system, including but not limited to traumatic brain injuries, brain tumors, and neurodevelopmental disorders, such as epilepsy, spina bifida, and cerebral palsy. Neuropsychological tests are applied to establish baseline levels of functioning, monitor progress over time, and evaluate responses to intervention.

The neuropsychological model has proven to be useful in understanding learning and behavioral processes that are strongly rooted in neuroscience. Also, this model can be useful in developing hypotheses about learning deficits and behavior problems that may be helpful in intervention planning (Hale et al., 2009). Potential disadvantages are that the application of neuropsychological methods may be time consuming and costly and the model is limited with regard to planning specific strategies for educational and behavioral intervention.

Behavior Analytic Model

The behavior analytic model as it is described for the purposes of this book is more accurately referred to as functional behavioral assessment (FBA). This model refers to the broad class of methods used to assess how environmental events elicit and maintain target behaviors. Environmental events typically are differentiated into those that are antecedents to target behaviors and those that are consequences. Tracking sequences of antecedent events, target behaviors, and consequences can be highly useful in understanding how target behaviors occur and are maintained. Further, identifying the function of behavior is important in understanding and predicting the occurrence of problem behaviors (Steege & Watson, 2009). In general, behavior has two major functions: (a) positive reinforcement (e.g., obtain adult attention, peer attention, access to privileges, concrete rewards), and (b) negative reinforcement (i.e., escape an undesirable situation). A functional behavioral approach typically includes an assessment of these two functions as well as an examination of potential skill deficits (e.g., memory or attention deficits, motor skills deficits, reading deficits) that may be contributing to the problem (Halle, Bambara, & Reichle, 2005). In addition, contextual factors that are more distal to antecedent events (i.e., setting events) are important to consider in predicting the occurrence of target behaviors.

The behavior analytic model has many assets, in particular its utility for intervention planning, progress monitoring, and outcome evaluation. Limitations include the time and effort involved in assessment and the difficulty in applying this approach to assess nonobservable behaviors, such as internalizing symptoms.

Cognitive-Behavioral Model

This model refers to the broad range of approaches based on the premise that an individual’s perceptions and cognitions of environmental stimuli as well as the ways in which the person processes information, have an important impact on behavior. Included in this framework are approaches related to modeling (e.g., adult, peer, and self-modeling); self-instruction through internal self-talk and cognitive reframing; self-regulation including self-monitoring, self-evaluation, and self-reinforcement; coping and problem solving strategies (Mayer & Van Acker, 2009).

The cognitive-behavioral model has been highly useful in planning interventions for children with a range of health and mental health conditions, including aggression, anxiety and depression, posttraumatic stress, pain, and nonadherence (Power & Werba, 2006). Many of the established evidence-based treatments for health and mental health disorders can be classified as cognitive-behavioral interventions. Although many cognitive-behavioral interventions have been demonstrated to be effective and acceptable for use by providers and families, challenges remain with regard to disseminating these approaches for wide-scale use in the c...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• List of Tables
• List of Figures
• Series Editors’ Foreword
• Preface
• Acknowledgments
• About the Authors
• About the Contributors
• Chapter 1 Background and Overview of Pediatric School Psychology
• Chapter 2 A Conceptual Model for Understanding Health Problems and Developing Interventions With Emily Shaffer-Hudkins
• Chapter 3 Interventions in Pediatric School Psychology: Applications of a Multisystemic Model
• Chapter 4 Conceptual Model for Health Promotion and Illness Prevention
• Chapter 5 Research to Practice: Prevention Programs in Community Settings With Stephen S. Leff and Jessica A. Hoffman
• Chapter 6 Program Development and Evaluation
• Chapter 7 Measurement Development and Evaluation With Katherine Bevans and George DuPaul
• Chapter 8 Grant Writing Strategies
• Chapter 9 Critiquing Journal Articles and Preparing Manuscripts for Publication
• Chapter 10 Directions for Program Development, Research, and Training
• Index
• CD Contents