Addressing Structural and Institutional Barriers to Supporting Wellness for JEDI Warriors in Pediatric Psychology: A Trauma-Informed Call to Action
Amy Beck PhD - Children's Mercy Kansas City
Idia Thurston PhD - Texas A&M University
Christina Low Kapalu PhD - Children's Mercy Kansas City
Alexis Exum MPS MA - University of Kansas
Melissa Santos PhD - Connecticut Children's
Wendy Ward PhD ABPP FAPA FNAP - University of Arkansas for Medical Sciences
Lori Crosby PhD - Cincinnati Children's Hospital Medical Center
Pediatric psychologists exist within institutions where wellness is not always prioritized within the system; however, as psychologists, a key tenet of our training emphasizes wellness as an ethical imperative. When wellness is addressed within systems, it is infrequently tailored to the unique stressors/traumas that pediatric psychologists experience in the workplace. Equally overlooked are targeted wellness strategies for psychologists who experience racism at work, as well as psychologists who experience trauma from championing the dismantling of racist practices and systems. Pediatric psychologists are uniquely qualified to model innovative ways of embedding JEDI (Justice, Equity, Diversity, and Inclusion) principles into wellness strategies. Given that pediatric psychologists serve in diverse interdisciplinary and leadership roles, including clinical practice, training, research, and management, we are well positioned to advocate for these trauma-informed wellness strategies. To develop trauma-informed wellness programs that are tailored to persons of color and JEDI champions, it is important to identify the structural and institutional barriers to wellness that exist within systems and highlight the positive outcomes associated with removing these barriers(i.e., improving faculty and trainee wellbeing and retention, and improving patient outcomes). Further, institutional and personal wellness strategies are needed to promote the flourishing without re-traumatization of JEDI advocates. Our field is moving toward a more ethical, competent, and culturally humble practice, and thus it is necessary to advocate for the prioritization of trauma-informed wellness approaches at the institutional level. This process will create benefit for all institutional stakeholders. The proposed workshop will focus on increasing pediatric psychologists’ awareness of their own trauma related to racism and JEDI work, as well as support attendees in the creation of personalized wellness plans that increase capacity for thriving while disrupting and challenging barriers at the individual, interpersonal, and systemic levels. This workshop will focus on the following topics:
- Introduce a trauma-informed approach to wellness. (didactic)
- Identify the specific wellness needs of persons of color and JEDI advocates. (didactic)
- Facilitate a panel discussion with diverse (racial/ethnic; career development stages) pediatric psychologists regarding wellness in clinical practice, training, research, and management (panel discussion)
- Engage in a self-discovery activity with small groups (discussion and experiential)
- Create a personalized wellness plan (action)
- Practice mindfulness strategies tailored to JEDI work and advocacy (experiential)
This workshop is directly relevant to the conference theme given the focus on advocating for wellness, targeting strategies to enhance leadership, and promoting justice, equity, diversity and inclusion considerations.
Kelsey MacDougall PsyD - MetroHealth Medical Center
Laura Edwards-Leeper PhD - Pacific University
Diane Chen PhD - Northwestern University Feinberg School of Medicine/ Ann & Robert H. Lurie Children’s Hospital of Chicago
Amy Tishelman PhD - Department of Psychology and Neuroscience Boston College
Claire Coyne PhD - Northwestern University Feinberg School of Medicine/ Ann & Robert H. Lurie Children’s Hospital of Chicago
Terry Stancin PhD - MetroHealth Medical Center/ Case Western Reserve University
Demand for gender affirming psychological services for youth has grown, including requests for psychotherapy (Chen et al. 2018). General medical and guidelines for clinical practice with transgender and gender nonconforming (TGNC) individuals are available, but there is limited evidence for psychological treatments, specifically interventions to support gender exploration and co-occurring conditions among TGNC youth. The purpose of this workshop is to fill a gap in existing practices by exploring and teaching specific problem focused interventions a pediatric psychologist may consider for a range of concerns commonly presented in gender diverse youth.The proposed structure of our workshop is to first broadly level set the audience with basic language and elements of guidelines for standards of care. Five national experts in gender diverse youth will then each discuss application of problem focused interventions followed by participant practice with interventions via small break out groups. The proposed topic areas include: Interventions in gender exploration in pre- and post-pubescent children/adolescents, applying the transgender resilience intervention model to TGNC youth with a stable gender identity, interventions and adaptations to trauma focused work, and practice in integrating various interventions into treatment planning for complex cases.Consistent with the theme of the conference, this workshop aims to advance practice and advocacy in the field of psychology by providing clinicians with the tools needed to serve a diverse group of protected individuals. An important aspect of work with TGNC youth is providing advocacy across systems including medical, school, family, and broader social settings.
Leading change: Using Quality Improvement to Bring Evidence-Based Approaches into the Pediatric Healthcare Setting
Amanda D. Deacy PhD - Children's Mercy Kansas City
Jennifer Schurman PhD - Children's Mercy Kansas City
Improving quality within complex health care systems can be deceptively challenging. In other words, what may seem like a simple “fix” often is not. While research helps us to understand what should work under ideal circumstances, quality improvement (QI) supports the process of uptake in real life clinical practice. Specifically, QI provides pediatric psychologists with flexible and powerful tools to become leaders in bringing evidence-based treatments into the practice setting and to advocate for consistent implementation of highest-quality health care on behalf of the patients and families we serve.Despite the clear benefits of QI methodology for closing the research-practice gap, few psychologists have had adequate training in QI methods to effectively lead a QI project. This workshop will provide a practical grounding in QI methods, from development of a QI charter with SMART performance goals articulated, through to hand-off to a process owner at project end for sustainability monitoring. Conceptual, practical, and regulatory considerations will be discussed. To illustrate these concepts, we will use our experience in implementing the Comfort Promise, an evidence-based bundled approach to minimizing pain with needle procedures, across our institution in a variety of settings and with a range of stakeholders. Specific project examples from this effort will be used to highlight key concepts in QI project development, execution, and write up. Specific to the goals of this year’s SPPAC, we will discuss the role of marketing and other advocacy efforts in supporting uptake of the Comfort Promise interventions across PDSA cycles, identify ways in which stakeholder voices, including those of patients and families, can be used to prioritize and drive local change, and highlight ways in which QI methodology can level the playing field and ensure equal access to care for all patients. We further will touch on the ethical implications of this type of work, including specifically shifting the institutional culture from provision of evidence-based care (i.e., pain prevention for needle procedures) being a nice thing to the right thing to do.Attendees with interest in either further developing their QI skills and/or in strategies for adopting evidence-based comfort measures as standard of care across needle procedures at their own institution will benefit from this workshop.
Mariella M. Self PhD ABPP - Baylor College of Medicine/Texas Children's Hospital
Debra Lefkowitz PsyD - Children's Hospital of Philadelphia
Pediatric psychologists often lead multi-faceted careers with opportunities to influence patients, families, colleagues, institutions or systems, science, and even society at large. The proposed workshop will focus on ethical considerations of power and influence in the various roles in which pediatric psychologists may function, addressing two specific topics: (1) choice architecture in medical decision-making and (2) the psychologist as advocate. Choice Architecture in Medical Decision-Making: Pediatric psychologists routinely work with patients and families navigating complex medical decision-making, frequently in a multidisciplinary context. Physicians and psychologists, either intentionally or unknowingly, can exert significant influence on treatment decisions through choice architecture, or the manner in which a choice is presented. This presentation will offer an overview of choice architecture and one of its prime concepts, nudging, with a focus on the attendant ethical considerations of its use in clinical practice. Specifically, nudging refers to strategic presentation of information or alternatives in a manner intended to alter behavior or steer health decisions. Types of nudges (e.g., framing, saliency, defaults, norms, messenger effects) will be illustrated, and evidence for their influence on medical decision-making will be reviewed. Ethical considerations in the strategic use of choice architecture will be addressed, and ethical claims made to justify or oppose nudging to shape decision-making (e.g., beneficence/best interest, autonomy/parental authority) will be discussed. Consideration will also be given to use of nudging in the context of culturally competent care. The Psychologist as Advocate: Pediatric psychologists can function as advocates at multiple levels, including advocating directly for a specific patient or advocating for policy at the institutional, local, state or federal levels. Likewise, psychologists’ skills in communication, relationship-building, strategic analysis and research can lend well to advocacy roles. This presentation examines different potential advocacy roles for psychologists, with consideration of the attendant ethical considerations, including patient confidentiality, conflicts of interest, conflicting values, and multiple relationships. Participants will also explore the question, “are psychologists ethically obligated to serve in advocacy roles?” Factors influencing the psychologist’s own personal and collective power will be examined, as well as the ways in which that power can be used for both positive and negative outcomes, particularly in advocating for marginalized populations.