Commentary: Family Assessment in Pediatric Psychology

This issue of the Journal of Pediatric Psychology (JPP) includes articles submitted for a special issue on “Longitudinal Research in Pediatric Psychology.” In the Call for Papers, we sought empirically oriented manuscripts that employed longitudinal designs and theoretical, methodological, or statistical papers relevant to longitudinal research. Examples of potential topics were provided in the Call and included: (a) familial, peer, and/or other contextual predictors of subsequent change in health-compromising behaviors in typically developing children or change in health-related behaviors and processes in children with chronic illness, (b) the impact of chronic illness on normative development or the consequences of varying developmental trajectories for subsequent health-related behaviors and processes, (c) studies that isolate different health trajectories as well as predictors of such differential outcomes, (d) tests of prospective mediational or causal predictor models based on longitudinal data, and (e) prevention, health promotion, and intervention studies with multiple data collection points that identify intervening mechanisms of change in health outcome. In response to the Call for Papers, 15 manuscripts were submitted. This issue includes eight of these articles; the first focuses on statistical strategies that can be used with longitudinal data and the other seven papers are empirical studies. Longitudinal studies permit examination of changes in health-related behaviors and processes over time. Such designs can be retrospective or prospective, with the latter having clear advantages over the former (Loeber & Farrington, 1994). As will be argued in more detail below, prospective longitudinal investigations of children with chronic physical conditions may be particularly informative when change is examined during critical developmental periods or transition points (e.g., early childhood, the transition to school, the early adolescent transition, the transition to adulthood). Indeed, a chronic condition is “chronic”; the impact of the condition is likely to unfold over time. At the most complex level of analysis, the task for the researcher is to understand a chronic condition that is changing over time in an individual that is also changing, developing, and maturing over time. Despite the advantages of longitudinal designs in addressing such issues, most studies in the fields of clinical child psychology and pediatric psychology are not longitudinal. In an earlier special issue of the Journal of Consulting and Clinical Psychology (JCCP) on “The Role of Longitudinal Data with Child Psychopathology and Treatment,” Wierson and Forehand (1994) conducted a review of articles published on children and adolescents between 1983 and 1992 and found that only 4% were longitudinal (with 13% of those in JCCP being longitudinal). Of course, not all research questions require longitudinal designs, but Wierson and Forehand’s (1994) review suggests that such designs are more the exception than the rule. Within the field of pediatric psychology (and in JPP, in particular), most scholars suggest in their “future directions” sections that longitudinal data would be beneficial. Indeed, Wallander and Varni (1998) argued that developmentally oriented longitudinal studies in the field of pediatric psychology would be informative: “General developmental processes should become more salient features of the conceptualizations of adjustment in this special group. Longitudinal designs need to become the norm” (p. 42). In this introductory article, we first discuss advantages of longitudinal research in the study of children and adolescents with chronic conditions. Next, we provide an overview of several factors one may wish to consider when designing longitudinal studies with pediatric populations. Finally, we provide a brief overview of the articles included in this special issue.

In 1995, the associate editors of the Journal of Pediatric Psychology (JPP) published an article to encourage the submission of case reports, studies, and series (Drotar, LaGreca, Lemanek, & Kazak, 1995), which had been remarkably underrepresented in the portfolio of published articles. Apparently, this article did little to encourage submissions of case studies and series because the situation is unchanged. But being undaunted and persistent, I would like to revisit this issue in light of the continuing importance of case studies and series to the field of pediatric psychology. In its formative years, JPP published many case studies, series, and descriptions of programs (e.g., Bachara & Lamb, 1976; Davidson, Adams, Schroeder, & Tyler, 1978; O’Malley & Koocher, 1977). At that time, pediatric psychologists published such work in order to call attention to important and challenging clinical problems, as well as to share their experiences, ideas, and data concerning clinical practice. Given the state of the art of the science at that time, early case studies and series focused more on description of clinical problems and intervention methods than on empirical demonstrations of treatment efficacy, with some notable exceptions (e.g., Barnard, Christophersen, & Wolf, 1976; Linscheid, Copeland, Jacobstein, & Smith, 1981; Varni, 1980). What conclusion should we draw from the fact that recent submissions to and publications of case studies and series in JPP are so few and far between? Is it the case that the field of pediatric psychology has moved beyond the need for case studies and series to inform clinical practice and research? In fact, the standards for the evaluation of science in our field, including studies of intervention efficacy (Spirito & Kazak, 2006), are much higher now than they were in the early days of the field. Are case studies and series no longer relevant or competitive for publication in JPP? Another possibility is that pediatric psychologists have simply stopped trying to write up their case studies for JPP because they do not see it as a ready outlet for publication. Alternatively, they could be writing them, but submitting them to journals other than JPP. It’s hard to know. As the current editor of JPP, I believe that case studies and series have not outlived their usefulness and that the field of pediatric psychology will continue to benefit from their publication. To address this issue, this editorial has the following goals: (1) underscore the continuing need for the publication of case studies and series in JPP; (2) clarify issues that need to be considered in preparing and reviewing case studies and series; (3) suggest ways to enhance publishability; and (4) invite authors to submit manuscripts that focus on case studies and series.

The field of intervention research in pediatric psychology has evolved to the point that there are a sufficient number of controlled clinical trials, especially randomized controlled trials (RCTs), to warrant a special ongoing section of the Journal of Pediatric Psychology (JPP) that will be devoted to this topic. There will be a rolling deadline for this section so that manuscripts can be submitted at any time. We are optimistic that an ongoing section of this Journal will serve not only to highlight RCTs of psychological interventions but also to stimulate publication of the results of RCTs for psychological interventions, which are very much needed in the field of pediatric psychology (McGrath, Stinson, & Davidson, 2003). One reason to develop this special section of the Journal is that controlled intervention studies, especially RCTs, raise difficult methodological, practical, and ethical challenges that need to be considered by researchers, reviewers, and editors. To address this need, the purpose of this special section will be to publish original work in any of the following areas: (a) New data from RCTs of psychological interventions, including preventive interventions, conducted with a range of pediatric populations; (b) Key methodological and data analytic problems involved in RCTs and examples of approaches to their solution; (c) Relevant logistical problems in conducting RCTs in pediatric settings and examples of innovative approaches to their solution; (d) Critical ethical issues in conducting RCTs with pediatric populations and potential approaches to their solution; and finally, (e) Theoretical contributions that relate to development of RCTs with pediatric populations. Relevant manuscripts will include data concerning the results of RCTs, critical reviews, and descriptions, including brief reports concerning pilot and feasibility studies, innovative methodologies and statistical approaches that are applicable to RCTs. As recommended by McGrath et al., (2003) and Stinson, McGrath, & Yamada, (2003), empirical reports of data from RCTs that are submitted to this special section will be expected to conform to the CONSORT statement criteria developed to improve standards of reporting RCTs in medical journals (Altman et al., 2001) and with the five additional CONSORT items that have been proposed for review and reporting of psychosocial interventions (Davidson et al., in press; McGrath et al., 2003; Stinson et al., 2003). The CONSORT criteria were designed to accomplish the following: (a) Improve the quality of the conduct of clinical trials by guiding investigators’ attention to important details including the method of randomization, report of blinding status etc.; (b) Provide important details to be reported in a standard way for readers of journals such as JPP, and facilitate comprehension of these reports by readers; (c) help to make the published data from RCTs more easily retrievable, thus increasing the ease of conducting systematic reviews and meta analyses from articles that report RCTs. It is fitting that Stark and colleagues’ report of RCT designed to increase calcium (CA) intake in children with juvenile rheumatoid arthritis (JRA) is the publication that launches our special section. This study has a number of important features. First of all, it is a preventive intervention trial that was designed to enhance bone mass density in children with JRA who, similar to other children with chronic health conditions such as cystic fibrosis and Crohn’s disease are at greater risk of low bone mass density and hence onset of osteoporosis earlier in their development (Mackner, McGrath, & Stark, 2001). Despite its importance to the field, preventionfocused intervention research has not received sufficient attention in published work in JPP (Kazak, 2002; La Greca, 1997; Roberts, 1992). To address this need,

The integration of research and practice in the field of pediatric psychology remains an important but elusive goal, despite early precedents (Wright, 1967; Wright, Nunnery, Eichel, & Scott, 1968) and more recent developments in dissemination of empirically supported interventions (Spirito & Kazak, 2006) and evidence-based assessments (Cohen et al., 2008). Despite these developments, published research in pediatric psychology still does not emphasize intervention, clinical significance, or dissemination of valid interventions (Brown, 2007; Drotar, 2002; Kazak, 2000; LaGreca, 1997; Roberts, 1992). Moreover, published research on psychological interventions generally does not focus on clinical populations that are seen in pediatric practice-based settings (Drotar, 2002, 2006, 2009). Moreover, most practicing pediatric psychologists are not engaged in research that evaluates the effectiveness of their clinical practices. The net effect of these patterns is continuing isolation of research and practice in pediatric psychology that is also reflected in published work in the Journal of Pediatric Psychology (JPP). Powerful forces have sustained less than optimal integration of research and practice in pediatric psychology. For example, even in the most academically oriented medical settings, fiscal incentives for practitioners focus primarily on clinical care, especially billable hours, rather than on developing practice-based research. Moreover, research funded by the National Institutes of Health (NIH) is generally not conducted in clinical populations because of sampling (e.g., presence of comorbid conditions) and study design considerations as well as the considerable pragmatic obstacles involved in conducting research in practice settings (Drotar et al., 2000). For example, it is very difficult to conduct and sustain research in practice settings given limitations in space, time, and resources (e.g., research assistants, data analytic support, etc.). Heterogeneous clinical practice patterns also make it difficult to achieve the level of experimental control and treatment fidelity that are required for intervention studies. Moreover, NIH review places a premium on testing new intervention models rather than dissemination or clinical application of evidence-based interventions into practice. Based on the above constraints, and to the point of this editorial, research that is published in the JPP focuses on empirical descriptive or explicative research (Roberts, 1992) and randomized trials of intervention rather than case series and clinical effectiveness studies that evaluate the application of interventions conducted in clinical care settings. Such publication patterns reflect the content of manuscripts that are submitted to JPP. In order to shift these publication patterns, I am very interested in encouraging authors to submit clinically relevant research, case reports and series, and studies of clinical effectiveness to JPP. Such research can have important scientific and clinical impact on the field of pediatric psychology. For example, single subject designs and clinical case reports have heuristic value and scientific utility in suggesting new directions for research or clinical care by documenting success or failures of empirically supported interventions in clinical settings, describing the generalizability of research to practice, and evaluating new practice-based interventions (Drotar, 2009; Drotar, LaGreca, Lemanek, & Kazak, 1995). Studies designed to test psychological interventions that improve the power and effectiveness of those conducted in clinical settings will enhance the psychological and health outcomes of children who are seen by practicing pediatric psychologists. Moreover, studies of the comparative effectiveness of alternative interventions should have increased priority under Health Care Reform and for work funded by the Agency of Healthcare Research and Quality. Finally, it is also important to note that the need for greater clinical

The clinical and validation studies published in this issue are very timely, as they continue to refine theoretical models and evidence-based family assessment measures for vulnerable pediatric chronic populations. The studies in this issue individually and collectively advance our understanding of what predicts and informs parental and family outcomes across a number of pediatric chronic illness groups. These findings will also be critical to advancing family-based clinical practice and treatments for children with chronic illnesses (Alderfer et al., 2008; Kazak et al., 2007). In total, the articles increase the potential to include nontraditional families, use multi-method and validated assessment tools, and to integrate family measures with other assessment tools so that we can take a comprehensive approach to assessment in our work as pediatric psychologists. While this special issue of JPP advances our understanding of family assessment and processes related to pediatric conditions, it also reveals the continued need to improve cultural sensitivity in pediatric and family assessment (Alderfer et al., 2008; Shudy et al., 2006). This editorial will discuss the challenges and opportunities for enhancing diversity in pediatric psychology family assessment research, as well as the implications for how culturally sensitive family assessment informs clinical practice and research for culturally diverse populations (Clay, Mordhorst, & Lehn, 2002; Ochieng, 2003; Wood, 2005). Trends in publications confirm that the general pediatric family psychology and family assessment literature has increased over the past 25 years, most notably in the past 10 years when publication rates have more than doubled. Using JPP as the example to illustrate growth in trends over time, there will be more articles published on the topic of ‘‘family’’ in this issue than there were published on the topic of ‘‘family’’ in the year 1980 when there were total eight articles (and these numbers remained below 30 in most of the years in the 1980s). Much of the journal’s space focused nearly exclusively on childfocused articles with a behaviorally focused assessment and/or intervention. In contrast, when using ‘‘family’’ as a keyword in 2009, 118 articles were published in the journal, and in 2010, 77 such articles were published through the third quarter. When the key words were narrowed to ‘‘family assessment,’’ the number of published articles was 105 since 1980 and half of these 52 (50%) were published since 2003, highlighting the emerging trend to better integrate family assessment tools in pediatric research. Finally, when examining the number of articles with a ‘‘family assessment’’ and a ‘‘cultural’’ or ‘‘diversity’’ focus, the number of articles was fewer than five. This rate held true even when looking for articles written on specific racial or ethnic subgroups (e.g., using ‘‘family assessment’’ as a search term with ‘‘African American’’ or ‘‘Hispanic/Latino’’). While JPP offers a great context for making the case for why attention should now be given to diversity issues in the field, trends are likely to be similar in other journals and in the broader literature. With the publication of this issue, it is fitting to celebrate the evolution and progress of family assessment research in the field of pediatric psychology, while also acknowledging the gap that still remains in the family assessment literature with respect to cultural diversity. We have to find sensitive and valid methods and models for applying and translating family assessment concepts and

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.

I feel grateful and privileged to receive the 2014 Society of Pediatric Psychology Wright Ross Salk Distinguished Service Award, named for three legendary pediatric psychologists who had the foresight to create the Society for Pediatric Psychology (SPP). It is my intent here to honor their contributions and highlight the gifts I have received through my membership in and affiliation with colleagues, friends, students, and trainees of Division 54. Logan Wright, Dorothea Ross, and Lee Salk are luminaries in the field of pediatric psychology. In fact, Dr. Ross received the SPP Distinguished Contributions Award in 1979, before I was even aware of pediatric psychology and before I had begun graduate school. As noted at that time, ‘‘She was one of the three who founded the Society in 1968, putting her great and sustained energy into this task’’ (Award Announcement, News and Notes, 1979). Dr. Ross was not able to attend the award presentation, but her remarks were read to the members of the Society in attendance, and her acceptance speech was reprinted in the Journal of Pediatric Psychology (1979), in which she noted: ‘‘I feel that the great strides made by the Society in a little over a decade should be numbered among the advances in pediatrics cited in connection with the International Year of the Child.’’ She went on to describe the ‘‘air of vigor and resiliency about the fledgling Society that foretold success, productivity, and longevity’’ and ‘‘our jubilation when the membership roster reached 100’’ (now at 1,600 members). Logan Wright was a pioneering founder of SPP and served as the Society’s first President in 1969. These organizational contributions occurred while he was a faculty member in pediatric psychology at the University of Oklahoma Health Sciences Center. Dr. Wright wrote the first seminal article about pediatric psychology, published in the American Psychologist in 1967: ‘‘Pediatric Psychology: A Role Model.’’ His writing about training for pediatricians paved the way for the pediatric subspecialty of developmental and behavioral pediatrics, physicians who continue to be primary collaborators with pediatric psychologists across the country. Following the American Psychologist article, Wright chaired the Committee on Pediatric Psychology as a subgroup of Division 12’s Section of Clinical Child Psychology, with both Dorothea Ross and Lee Salk as members of that committee. It is noteworthy that the founder of pediatric psychology also served as the President of the American Psychological Association (APA) in 1986. Dr. Lee Salk, brother ofNobel Prize recipient (for the polio vaccine), Jonas Salk, served as the Director of Pediatric Psychology at Cornell University Medical Center. In a 1974 interview with People Magazine, he was described as ‘‘. . .one of America’s most admired practitioners in the contentious field of child psychology.’’ He was one of the founders and President of the Division of Child, Youth, and Family Services (Division 37) and awarded the first Distinguished Contributions Award from SPP. Dr. Salk was well known for televisionand print media interviewsduring the1960’s, which provided publicity for pediatric psychology and facilitated funding resources. The first meeting of the Society was held at the1968SanFranciscoAPAConvention,with theorganization initially referred to as the Society FOR Pediatric Psychology, eventually becoming the Society OF Pediatric Psychology. Each of these individuals played a leadership role in the establishment, promotion, and growth of SPP, now a thriving independent division of APA. This legacy of ‘‘distinguished service’’ is exemplified through the spirit of the SPP’s Wright Ross Salk Award, with this history being carried forward by other pediatric psychologists who continue to serve the Society and its members. A review of dictionaries highlighted various definitions of ‘‘distinguished service’’ including ‘‘characterized by excellence or distinction; noble or dignified in conduct or

Starting with the first issue of 2008, the Journal of Pediatric Psychology, (JPP) will have a new editorial board with a 3-year term. This change was accomplished to recognize the work of ad hoc reviewers and to involve a diverse editorial board with respect to age, sex, ethnicity, content area of expertize, professional discipline, and country. Congratulations to the new and remaining board members! They are joined by a reviewer panel, which is a new position that was developed to provide interested and promising reviewers with additional experience in reviewers for JPP. We anticipate that the combination of the new editorial board and the reviewer panel will facilitate our abilities to sustain the high level of expertize, quality, and timeliness for JPP. In making this change, it is very important to acknowledge the extraordinary efforts of the editorial board of JPP, most especially those who are rotating off the board. Without naming individuals, some of these board members have held their position for more than 30 years: Now that’s dedication! Editorial board members are truly the unsung heroes and heroines of the community of scholars in the field of pediatric psychology. They spend an extraordinary amount of time on manuscript reviews, all of which is unrecompensed in dollars, in order to enhance the science of the field of pediatric psychology and provide mentorship to authors and other reviewers. The currency that sustains the editorial board’s contributions involves caring, concern, and dedication. They care deeply about the quality of the scholarship and research in the field of pediatric psychology and about providing feedback to scientists about their work. Countless authors have benefited from their work (see my editorial in this issue). On behalf of authors and the field of pediatric psychology, we thank you for your extraordinary dedication and hard work.

Research regarding family adaption and resilience in children with chronic health conditions has resulted in the development of a number of theoretical models and data‐driven psychosocial interventions in the field of pediatric psychology, some of which may not be well known in the field of family science. These models incorporate family systems theory and multiple resiliency factors within their framework to better describe the complex process of adaptation and subsequent adjustment outcomes. In this article, three contemporary resilience models within pediatric psychology are briefly reviewed and discussed. The development of a psychosocial intervention targeting uncertainty management for caregivers of children with cancer and the preliminary results are also presented as an exemplar of how such models may utilized to build interventions. Finally, the implications of the authors' findings and future research directions involving psychosocial interventions for families of children with chronic health conditions are discussed.

The most personally and professionally gratifying of my activities in the field of pediatric psychology has involved training of undergraduate, graduate, and postdoctoral fellows (Drotar, 2003). I continue to be impressed by the intellectual curiosity, values, and compassion, and raw talent that are demonstrated by the remarkable cadre of graduate and fellowship level trainees who are attracted to pediatric psychology. The future of our field will be theirs. To ensure their and our future, we need to be the best possible stewards of the extraordinary promise of these careers in the making by creating the most optimal training opportunities, experiences, and career paths for our future practitioners, teachers, and researchers. This special issue on training in pediatric psychology was conceived to address this continuing need. Training in pediatric psychology has evolved in important ways since the founding of our field (LaGreca, Stone, Drotar, & Maddux, 1988; Roberts et al., 1998; Spirito et al., 2003). The Society of Pediatric Psychology Task Force Report (2003): Recommendations for the Training of Pediatric Psychologists considered issues related to breadth and depth of training, scope of practice, training paths, primary care, interdisciplinary training, and mentors (Spirito et al., 2003). Topic areas identified as most important for obtaining knowledge and expertise in pediatric psychology included life span development, developmental psychology and developmental psychopathology, child, adolescent, and family assessment, intervention strategies, research methods and systems, evaluation, professional ethical and legal issues, diversity, roles of multiple disciplines in service delivery, prevention, family support, and health promotion, social issues affecting children, adolescents, and families, consultant and liaison roles, and disease process and medical management. This report was an important milestone in the development of training in our field as it expanded on the prior survey results and recommendations for pediatric psychology (LaGreca et al., 1988) and clinical child psychology. Since the Task Force report (Spirito et al., 2003), training programs that focus on pediatric psychology or offer pediatric training as part of another program at graduate, internship, and postdoctoral levels have expanded significantly. However, training programs in pediatric psychology face a number of significant challenges: Recruiting graduate students and facilitating development of their core competencies in both specialized training and an increasing breadth of content areas, training students to meet the challenges of research careers, and promoting the development of mentors in our field. The manuscripts in this special section respond to these challenges of pediatric psychology training.

The proliferation of marital and family practice and research has increased the recognition of the importance of reliable and valid assessments of family functioning. During the past two decades there have been significant developments that have facilitated the assessment of family relationships and functioning and have resulted in a rich cadre of family measures (Boughner, Hayes, Bubenzer, & West, 1994; Filsinger, 1983; Fredman & Sherman, 1987; Grotevant & Carlson, 1989; Halvorsen, 1991; Jacob & Tennenbaum, 1988; Touliatos, Perlmutter, & Straus, 1990). This article reviews and discusses applied issues and methods for evaluating families. The focus of this review is on the assessment of family relationships and functioning and will not specifically address the marital relationship, which is the topic of another article in this collection (see Bradbury article). Despite the development of good family measures, family oriented practitioners do not regularly make use of standardized or formal family assessments in their practices (Boughner et al., 1994; Floyd, Weinand, & Cimmarusti, 1989). There are several reasons for this. First, a major problem with family assessment is the lack of a unified theory of family functioning (Bray, 1995). There is no consensus about the definition of healthy or dysfunctional family relationships or even the key processes that need to be assessed. There is also no agreed upon diagnostic system, such as the Diagnostic and Statistical Manual (DSM-IV) or International Classification and Diagnostic (ICD-9) systems for individuals. Although there is work in progress on developing marital, family, and relational diagnoses and methods, there is not a consensus about the best measures or central factors for family assessment. Second, many family practitioners view family assessments as empirically-based, structured methods that do not have direct applicability or utility in clinical practice (Boughner et al., 1994; Floyd et al., 1989). This outlook may be due to a general lack of education and training in formal family assessment methods. Further, these methods are frequently viewed as static measures of family functioning that do not capture the dynamic processes and change within family systems. This perspective is promulgated by family clinicians who argue against an empirical, standardized approach, and instead value contextual, social constructivist, or qualitative views of family functioning (Anderson & Goolishian, 1988; Fraenkel, 1995). Third, most of the available family measures and methods have been developed for research contexts and have not been specifically applied to clinical practice. Therefore, many instruments do not provide either the instructions or clinically relevant norms and comparisons necessary for use in practice settings. These factors may explain the recent survey finding that most family practitioners do not necessarily view formal family assessment as an important part of clinical practice (Boughner et al., 1994). To overcome some of these problems, this article reviews the current status of family assessment, key family processes and constructs, and family assessment methods that have been consistently reported in the literature on family relationships and their impact on individual and family functioning. This review will hopefully encourage family clinicians to use more formal family assessment methods and facilitate the implementation of research on family process into practice settings. There are several reasons for clinicians to use formal, standardized methods for assessing families (Boughner et al., 1994; Floyd et al., 1989; Miller et al., 1994). Evaluations conducted prior to therapy or counseling can provide a rich source of information about the family and can be used to develop initial hypotheses about problem areas, causes of problems, and potential areas of strengths. Assessment also insures that a broad range of routine information is collected to make certain that important areas are not overlooked. …

Various scientists have underscored the critical need for replication of research findings in the development of science, including behavioral science (Cohen, 1994; Hedges, 1987; Robinson & Levin, 1997; Shaver & Norton, 1980). However, replication of research in behavioral science in general and pediatric psychology in particular has been limited (Kline, 2004, 2009). My review of articles in the Journal of Pediatric Psychology (JPP) for the past several years indicate that replications of research findings in our field are rare. There are several reasons for this: The editorial process for scholarly journals places a high premium on new and innovative research findings rather than replications. Grant review criteria used by the National Institutes of Health (NIH) that emphasize innovative research may also inhibit research replications. Although the reasons are understandable, the relative absence of replication limits the cumulative impact, generalizability, and ultimately the validity of science (Cohen, 1994; Robinson & Levin, 1997). To address the need for more frequent research replications in the field of pediatric psychology, the purpose of this editorial is to describe the importance of research replication, types and exemplars of study replication, issue a call for replication research, and provide guidance for authors in submitting replications to JPP.

PROTOCOL: Education Support Services for Improving School Engagement and Academic Performance of Children and Adolescents with a Chronic Health Condition: A Systematic Review

External grant support has assumed increasing importance in the field of pediatric psychology. For example, during 2004, 41.5% of research articles published in the Journal of Pediatric Psychology contained author acknowledgments noting that the research was supported by the National Institutes of Health (NIH), and another 27.8% of the articles published acknowledged support from another federal agency or foundation. Thus, over two-thirds of research published in the Journal has endorsed support from external agencies. Although specific data are as of yet unavailable for 2005, it is suspected that external support for research articles published in 2005 will exceed that of 2004. Thus, investigator-initiated grants are driving research in pediatric psychology. In contrast, two decades ago little research

For children with chronic medical conditions, as with typically developing children, family is of central importance (Kazak, 2008; Schumm, 1982). Consistent with the Burmese proverb, ‘‘In times of test, family is best’’ (Hla Pe, 1985), numerous studies have demonstrated the role of the family as a potential protective factor in the adaptation of children with chronic medical conditions and as a key to successful disease management at home (see Alderfer & Stanley, in press, for a brief review). In turn, families are greatly impacted by childhood illness; they experience increased stress, must expand definitions of their roles (e.g., ‘‘parent’’), and learn to communicate and work together to meet medical demands (Kazak, 2001; Radcliffe, Barakat, & Boyd, 2006). Thus, reliable and valid family assessments are critical to pediatric psychology: (a) for research that aims to further outline the various aspects of family functioning that are impacted by medical conditions in childhood and influence child and family adaptation and quality of life over time, and (b) for clinical practice, to inform the direction of clinical interventions and serve as an evaluation of clinical outcomes (Cook & Kenny, 2004). The call for improved family assessment methods is a refrain in the broad family psychology literature. For example, Cook and Kenny (2004) argued that most family assessment tools do not provide a sufficient degree of detail, and Cook (2005) further noted the importance of developing assessment approaches that take into account reciprocal influences among individuals, dyads, and the family group. Echoing this call within the realm of pediatric psychology, Palermo and Chambers (2006) argued that family measures should better specify the pathways by which family factors play a role in children’s pain and disability. A path to achieving this goal is for family assessment to occur at multiple, integrated levels to identify how individual factors work in concert with dyadic and family factors to impact pain and functional outcomes. Efforts have been made to summarize the current literature regarding the use of family measures within pediatric psychology and to provide frameworks for categorizing these types of assessments for use in research and practice. Alderfer and colleagues (2008) reviewed the evidence base of family measures including self-reports, observer ratings, and interviews and delineated three broad assessment areas: (a) normative family processes (i.e., separation and individuation) assessed in families of children with chronic health conditions; (b) impact of childhood chronic health conditions on the family; and (c) family and/or parental coping with childhood illness or disability. While most reviewed measures were deemed ‘‘well-established’’ (reliable and valid) or ‘‘approaching well-established’’ (approaching reliability and validity), Alderfer and colleagues (2008) argued that more attention must be given to the psychometric properties of family measures when used in pediatric populations since many of the measures have been exclusively utilized within the general population. Further, recommendations were made to increase cultural sensitivity of measures so as to capture cultural definitions of family that extend beyond the traditional nuclear family dynamic, to use multiple family informants including fathers and siblings to account for how each family member perceives the family situation, and to determine whether family measures can be used to inform clinical interventions (i.e., are they predictive of treatment outcomes and sensitive to change?). Thus, while some general measures of family functioning are applicable in the pediatric context (e.g., Family Assessment Device; Epstein, Baldwin, & Bishop, 1983), and other pediatric-specific measures of family functioning