458 Child Health Psychology
secondary infection, and effects of long-term use of immuno-
suppressive agents (Sormanti, Dungan, & Rieker, 1994).
Moreover, limitations on quality of life remain due to contin-
ued medical complications (Zamberlan, 1992), and concerns
about prognosis, parental adjustment, and “nances continue
(Sormanti et al., 1994). Future directions for research in
transplantation include the prospective assessment of stress
and adjustment in children and their parents. This information
may be used in the development and systematic evaluation of
interventions particularly focused on implementation early in
the transplant process (Streisand et al., 2000).
CONCLUSIONS
We have integrated the literature on interventions in child
health psychology developing four assumptions and within
the framework of levels of intervention, universal, selective,
and indicated. Although a number of well-established inter-
ventions have been identi“ed, systematic intervention re-
search to establish the effectiveness of interventions for the
broad range of child health issues is in its beginning stages.
Re”ecting on the surprising lack of published intervention
studies in pediatric psychology, Drotar (1997) discusses sev-
eral barriers that have limited this literature. The inherent
dif“culties in conducting intervention trials, combined with
increasing pressures for pediatric psychologists to focus on
provision of direct services to patients and families, can be
signi“cant impediments. At the same time, as Drotar notes,
there are several avenues by which research on child health
interventions can partner with, and enhance, the overall qual-
ity of care provided to children and families. For example,
there is increased acknowledgment of the importance of psy-
chosocial well-being and function as an outcome of pediatric
treatments. While research and clinical practice have often
been viewed as separate activities by child health psycholo-
gists, more attention to the acceptability (social validity) of
psychological interventions, to patients, families, and staff,
may lead to increased interest and support for our efforts to
provide treatments with empirically supported outcomes.
Future directions for intervention research in child health
psychology have been delineated throughout this chapter.
We focus on three goals here. First is the integration of psy-
chological and pediatric interventions and outcomes. In
procedural pain, for example, evaluation of approaches com-
bining pharmacological and psychological interventions
(e.g., sedative, anxiolytic, or pain medication plus CBT) has
proven helpful. Work related to treatment adherence must
consider medical variables to maximize resolution of these
problems.
Second, some of the most effective treatments in
Table 19.1 rely on combined approaches; therefore, it will be
important to understand what elements of the intervention are
contributing to its effectiveness. This may allow for greater
precision in the development of interventions and for re“ne-
ment of interventions that may facilitate their acceptability to
patients, families, and health care providers. Alternatively,
it allows us to step back and view the “eld of child health
intervention more broadly. For example, what general charac-
teristics of interventions are important and how can we maxi-
mize these more generic contributors? It is critical that we be
able to say that an intervention was delivered in the manner
that it was intended, or that the interventionist was adherent to
the treatment manual or protocol and competent in the imple-
mentation. Establishing this type of validation for the deliv-
ery of interventions is crucial (Moncher & Prinz, 1991).
Finally, research on issues that cut across disease groups
may be facilitated using family systems theory and interven-
tion. The child health psychology literature is generally orga-
nized by medical disease groups, attendant to the National
Institutes of Health•s organization by disease-de“ned Insti-
tutes. Yet, as Table 19.1 indicates, the generally effective
methods are highly consistent across diseases. It appears that
there are commonalities to the types of experiences that chil-
dren with various chronic illnesses and their families have
(e.g., disruption, fear, ongoing needs for care, worries about
other children) although there are speci“c aspects of particu-
lar diseases and treatments that may be common to some but
not all illnesses (e.g., dietary requirements, cognitive impair-
ments, restrictions in mobility).
In conclusion, child health psychology is a growing “eld
in which psychological knowledge is applied to address the
concerns of pediatric health and illness. A broad, contextual
orientation provides a framework for integrating research and
clinical practice to support children, families, and health care
providers as they confront challenges related to children•s
well-being. The “eld is diverse; the current primary chal-
lenge of child health psychology is the development and
evaluation of effective interventions with suf“cient ”exibility
to address the entire range of diseases, treatments, and related
child and family adjustment.REFERENCESAnderson, C., Zeltzer, L., & Fanurik, D. (1993). Procedural pain. In
N. L. Schechter, C. B. Berde, & M. Yaster (Eds.), Pain in infants,
children and adolescents(pp. 435...458). Baltimore: Williams &
Wilkins.
Barakat, L. P., Kazak, A. E., Meadows, A. T., Casey, R., Meeske,
K., & Stuber, M. L. (1997). Families surviving childhood