Evaluating outpatient pediatric psychology services in a primary care setting.

OBJECTIVE: To provide descriptive and outcome information of an outpatient pediatric psychology clinic based in a medical center in a major metropolitan area. METHODS: We coded the characteristics and outcomes of 100 patients prospectively on a number of dimensions. Surveys and interviews were used to gather follow-up information. RESULTS: The majority of patients were Caucasian boys (n = 56 out of 100) between 2 and 12 years of age. The most common reasons for initiating contact with the clinic were assessment of school problems, behavior problems, anger, attention problems, depression, and temper tantrums. Eighty-one percent of the patients saw a therapist for brief treatment, between one and five sessions, and behavioral treatments were administered for the majority. The children's behavior for which the parents sought treatment improved significantly from pre- to posttreatment, as rated by parents and therapists. CONCLUSIONS: Overall, parents were satisfied with the services received and indicated that the recommendations given during therapy were helpful and easy to implement. This study provides general evidence for the effectiveness of pediatric psychology services.

Outcomes of a nursing intervention for siblings of chronically ill children: a pilot study.

PURPOSE: To evaluate the outcomes of a structured, educational, and support group intervention (ISEE, Intervention for Siblings: Experience Enhancement) for siblings of children with chronic illness (cancer, cystic fibrosis, diabetes, and spina bifida), including a session with parents about sibling needs; and to describe sibling and parent perceptions of sibling experiences at home. DESIGN: One-group, pretest-posttest pilot study. PARTICIPANTS: A convenience sample of 22 siblings and parents. SETTING: A Midwestern university medical center. MAIN OUTCOME MEASURES: Knowledge of Illness Test, parent ratings on a global, single item, 10-point scale. RESULTS: Sibling test scores increased significantly after intervention, compared to baseline. Parents' average evaluation rating was 9 on a 10-point scale. Parents supported their positive ratings with verbatim descriptions. Sibling and parent perceptions of sibling experiences were congruent, suggesting the sources of potential adjustment problems in siblings, and were consistent with the literature. CONCLUSIONS: A randomized, clinical trial with a larger sample size is needed to evaluate the intervention further.

Psychometric properties and normative data for the parent version of the diabetes independence survey.

The parent version of the Diabetes Independence Survey measures parents' perceptions of their children's mastery of 38 diabetes self-care skills. The instrument was administered to 648 parents of 622 children with insulin-dependent diabetes mellitus, ages 3 and 18 years, at seven different pediatric medical centers. Data confirming the internal consistency, interrater reliability, construct validity, and concurrent validity of the instrument are presented in this paper. Age-adjusted normative data for total scores on the instrument as well as item-by-item data on the ages at which mastery of each skill was reported by 25%, 50%, and 75% of parents also are discussed. The Diabetes Independence Survey can be used as a reliable, valid, and efficient research tool for assessing the growth and development of diabetes knowledge and skills among children and adolescents, and as a screening instrument and program evaluation tool for clinical purposes.

Empirical selection of psychosocial treatment targets for children and adolescents with diabetes.

Used an empirical approach to determine psychosocial variables related to optimal metabolic control of diabetes in two samples (total n = 56) of children and their families. Children and adolescents classified as either in optimal or nonoptimal control of diabetes (based on glycosylated hemoglobin results) completed self-report measures on variables of anxiety, coping, family environment and health locus of control, and a structured interview. Parents completed parallel self-report measures and a child behavior checklist. Children in optimal control of diabetes had more structured and controlling family environments, and more frequently believed that "powerful others" were responsible for their health. There was a marginally significant difference in knowledge, with children in poorer metabolic control showing better knowledge about diabetes and its management than children in optimal control. The study illustrates an empirical approach to the selection of psychosocial treatment targets for children with diabetes, and underscores the importance of parental involvement with the diabetes regimen to ensure optimal control of diabetes in both children and adolescents.

Parental and professional estimates of self-care independence of children and adolescents with IDDM.

OBJECTIVE: To report the results of a survey of 490 parents of children with insulin-dependent diabetes mellitus (IDDM) regarding the children's mastery of 38 diabetes-care skills. Parental responses are contrasted with those of a previous survey in which 229 diabetes professionals estimated ages at which typical children with IDDM master the same skills. RESEARCH DESIGN AND METHODS: Parents were recruited at five pediatric endocrinology clinics with a response rate of 88.9%. RESULTS: For 33 of 38 skills, professionals' median mastery age estimates exceeded, by greater than or equal to 1 yr, the median ages that parents reported skill mastery by their estimates, children. Despite the parent-professional disagreement about mastery-age their survey responses yielded substantial agreement about the order of mastery of specific skills. The data also revealed two profiles of comparative results. For many items, parents reported earlier skill mastery, but parental and professional estimates eventually converged during adolescence. These skills consisted of rote, motoric acts, or more complex tasks for which errors yield relatively certain aversive consequences. For other skills, more professional estimated skill mastery among adolescents than did parents. These skills required substantial organization and self-regulation by the adolescent, involved treatment components for which the aversive consequences of errors are deferred and uncertain, or they were skills infrequently required of most patients with IDDM. CONCLUSIONS: The parent-professional discordance revealed by this survey illustrates the importance of clear specification of treatment responsibilities, careful monitoring of self-care competence, and periodic reeducation of children with IDDM.