Youth with chronic medical conditions are at risk for adverse psychosocial outcomes. The Children's Health and Illness Recovery Program (CHIRP), a roughly 12-week manualized cognitive behavioral therapeutic (CBT) intervention for youth with chronic medical conditions, has demonstrated efficacy as an individually delivered treatment for improving functioning and reducing psychosocial problems. The present study investigated outcomes of CHIRP delivered in a group format, which may offer additional benefits for access, efficiency, and social support. Participants were recruited from pediatric healthcare provider referrals of youth who had a chronic illness, no developmental disability, spoke English, and were aged 12-18 years. Participants included 37 adolescents and their parents across ten separate groups. Paired t-tests were used to compare pre- and post-treatment results of measures assessing functional disability, health-related quality of life, and impairment. Adolescents and parents reported significantly reduced impairment, disability, and improved health-related quality of life from pre- to post-treatment. Clinically significant differences in health-related quality of life were reported for 24 out of 37 parents from pre- to post-treatment. Findings suggest that the CHIRP group intervention is an effective treatment for improving functioning and quality of life in pediatric patients with chronic illness. Future research should explore long-term follow-up of these findings.

Social competence is crucial to functioning in youth with chronic medical conditions. Developmentally sensitive measures of social functioning in this population can aid clinicians in identifying skill deficits and informing treatment interventions that improve social competence. The study explored the psychometric properties of a proposed social functioning measure utilizing data obtained from a clinical sample of chronically ill adolescents enrolled in an evidence-based manualized psychosocial treatment program. Initial exploratory findings support the potential for the SDI to be a valid, reliable, and clinically sensitive measure of adolescent social functioning in teens experiencing functional disability associated with their chronic health conditions.

Objective: The novel coronavirus 2019 (COVID-19) pandemic has led to a rapid shift in the health care landscape To meet the psychological needs of children/adolescents in the medical setting, pediatric consultation-liaison (CL) psychologists have had to radically adapt their traditional forms of practice Method: To understand this adaptation, a questionnaire was sent to members of the consultation-liaison and related special interest groups of the Society of Pediatric Psychology (American Psychological Association Division 54) Questions included: participant background;practice setting;prepandemic/peri-pandemic psychological service delivery methodology;speed/level of support for service transition;and open-ended questions on challenges and benefits of providing CL services during the pandemic Responses to open-ended questions were coded using content analysis Results: Between April 6 and April 20, 2020, 51 individuals (88 2% female;86 3% psychologists;72 5% in free-standing children's hospitals) participated Findings showed service methodology shifted from predominantly face-to-face prepandemic (100%) with a small group (3 2%) also providing telemedicine services to a small percentage of their patients to primarily telemedicine during the initial stage of the pandemic (82 4%) During this time some (37 37%) used only telemedicine;several (9 8%) provided only face-to-face;a few (3 9%) completely paused services;and some (47 1%) used a mix of modalities Conclusion: Given the predominant use of telemedicine, these findings are initial evidence of the feasibility of transitioning pediatric CL psychology services to meet pandemic-specific needs Benefits of telemedicine include continuity of care, flexibility and efficiency, and organizational benefits There were also reported challenges that provide important areas for improvement in the continued climate of uncertainty during the COVID-19 pandemic as well as future similar public health crises (PsycInfo Database Record (c) 2020 APA, all rights reserved) Impact Statement Implications for Impact Statement -Pediatric consultation-liaison (CL) psychologists are effective in providing brief, focused interventions across pediatric patients and their families Considering pediatric CL psychology services during the coronavirus 2019 pandemic, it was important to collect information on how pediatric CL psychologists provided mental health services during this the initial stage of the pandemic in the United States Findings indicated that service delivery shifted from face-to-face to telemedicine to address the patient needs and institutional guidelines, suggesting the feasibility of transitioning pediatric CL psychology services to respond to dynamic public health crises (PsycInfo Database Record (c) 2020 APA, all rights reserved)

During the remaining Sessions 10–12 of the Children’s Health and Illness Recovery Program (CHIRP) no new skills or strategies are introduced. Rather these sessions focus on continuing to practice and consolidate the skills introduced in Sessions 1–9 and problem solve those areas where the teen and parent(s) continue to struggle.

For teens with a chronic illness, setting reasonable and reachable personal expectations while titrating their activities in response to their disease/symptoms is often a major stressor. In Session 5 the teen is taught specific strategies to distinguish between desired (want to) and required (have to) activities and to create (and revise) personal schedules that address problems they may have with over- and/or underscheduling physical and social activities in their daily life. These issues are particularly important in working with teens who are on home-hospital/home-bound schooling or who are home-schooled and thus more likely to have less structure and peer social contact.

When, for various reasons, the teen cannot alter the stressfulness of a challenging situation via active problem solving (“Solving the Problem”), such circumstances call for employing strategies to “Manage the Impact” of the stressor on their physical and emotional functioning. In Session 3 of the Children’s Health and Illness Recovery Program (CHIRP), the clinician instructs the teen in effective relaxation skills including diaphragmatic breathing and progressive muscle relaxation. These are introduced and practiced in the session, with homework practice assigned for skill development. Cognitive behavioral therapy skills are introduced to help the teen understand the bidirectional relationships between thoughts, emotional responses, and behavioral responses. Finally, thought-changing skills and activities are introduced from the CHIRP Workbook with the assignment of recoding stressful situations and their associated thoughts and feelings on a Thought Record sheet.

Ever since the establishment of the subspecialty of pediatric psychology, psychologists have been called upon to provide consultation to their pediatrician colleagues in ever-expanding roles and in a variety of medical settings. In response, a number of models have been created to address how psychologists fit into the overall health-care system in order to address those psychosocial factors that can have a major impact on prevention/early intervention in pediatric illness and injury and overall adjustment and quality of life. This chapter addresses both theoretical and pragmatic issues in establishing and maintaining a viable consultation-liaison service while avoiding personal and professional burnout.

Session 8 is again focused primarily on family communication and dynamics for the purposes of identifying and addressing parenting behaviors and parent–teen dynamics that may unwittingly undermining teen confidence in becoming more independent in managing their illness and lifestyle. The clinician engages the family in a discussion of parental and teen roles within the family system and an examination of the impact of the teen’s illness on family members’ roles. Behavioral family systems concepts of “misguided support” and “strong beliefs” that family members hold, but that inadvertently may be serving to maintain a dependent or even overprotective/enmeshed family dynamic, are introduced and applied to the family situation, along with strategies for moving these dynamics in a more independence-engendering direction.

Session 1 of the Children’s Health and Illness Recovery Program (CHIRP) addresses the impact of illness- and non–illness-related stressors on teens with chronic illness and coping strategies needed to reduce stress. This chapter provides the clinician with techniques for guiding the teen in developing methods for identifying stressors and assessing the impact they may have on their symptoms and functioning. The importance of sleep and developing healthy sleep hygiene practices are introduced, along with instructions for the teen in completing a Sleep Log to assess their own sleep patterns and practices. Graduated physical activity is also assessed and encouraged. These data will be collected over the course of several sessions in order to facilitate more effective coping, stress management, and sleep hygiene practices.

This chapter provides an explanation as to how having a chronic illness can start a cascading effect that results in the teen becoming more inactive and less involved in important life events experienced by healthy teens, and how this can actually worsen some of their symptoms and lead to more disability. The CHIRP interventions are introduced as a program specifically designed to provide teens, and their parents, with skills that can disrupt this process and allow the teen to more actively participate in life. A “Weekly Activity and Exercise Action Plan” Worksheet is provided to begin the process of gradually becoming more active at a level that is sensitive to the teen’s medical and health issues.

Session 6 is a family-focused session. In these family sessions you and your parent(s) will be seen together for all, or at least a major part, of the session. When a teen has a chronic medical problem it affects everyone in the family. The activities for these sessions are designed to begin the process of helping you and your family better understand the importance of helping put medical challenges in perspective while balancing these needs with the important experiences for teens to have to remain confident and competent in their lives. Workbook exercises and worksheets are used to identify how your lifestyle and activity schedule have been affected by your medical condition. This information is then used to help you and your parent(s) generate ways for increasing your activities and independence so important to this stage of your life.

In Session 7 you are introduced to the concept of avoidant coping. We all use avoidance at times in dealing with stressful, unpleasant and uncomfortable situations. However, if we use avoidance as the major way to cope with these challenges, it will have a negative impact on our ability to function physically, emotionally, and in school and social situations. In order to make sure we don’t fall into the trap of over-using avoidance in dealing with the challenges of a chronic medical problem, CHIRP uses activities that teach you strategies that can disrupt this cycle by improving your skills and confidence in dealing with stressful situations you may encounter socially and in your daily life. Key skills you will learn include improving interpersonal communication and assertive behaviors. Increasing your skills and comfort in communicating and asserting your wants and needs with others is a primary goal of this session.

Chapter 11 provides supplemental material for teens whose chronic illness challenges involve major problems with chronic pain. While pain is a necessary protective mechanism of the body, chronic pain involves complex interactions between the nervous system, the brain, our emotions, and various situational factors that can actually make our experience of pain worse. The activities in this session are intended to help teens better understand these interactions and apply pain management strategies. Many of the coping strategies in the Children’s Health and Illness Recovery Program (CHIRP) have been shown to be effective in helping teens manage chronic pain more effectively so that they are able to more actively participate in the multiple areas so important to development.

Being a teenager with a chronic illness can be challenging. The symptoms of an illness, particularly pain and fatigue, can interfere with just being a normal teen. The Children’s Health and Illness Recovery Program, or CHIRP, was developed to teach teens and their family strategies to help them live as normal a life as possible while coping with the effects of their chronic illness. The skills acquired in the CHIRP intervention are life skills almost every teen can use, and these skills can be especially valuable for those working to overcome the negative effects of chronic illness. The CHIRP Teen and Family Workbook provides evidence-based activities shown to improve coping skills, stress management, communication skills, and functioning in teens with chronic medical conditions. In addition, family-based activities included in CHIRP assist teens and parents in developing more effective ways to communicate about their illness and increase teen confidence and independence in both managing their illness and their lifestyle. These skills are important building blocks to help teens move toward recovery and improve functioning and quality of life as they approach young adulthood. The skills acquired in the program also serve as a guide and motivation for continuing the gains that teens and their families make in CHIRP.

Session 9 involves a review with you and your parent(s) of the individual skills you have acquired in Children’s Health and Illness Recovery Program (CHIRP) and providing guidance aimed at avoiding a relapse in your improvement. Key components of CHIRP are emphasized as they apply to your “Working Toward a Normal Daily Schedule.” The benefits of improved sleep and activity level, increased social contacts with peers, and increased comfort in assertively communicating with others are reinforced as critical for continued progress. Your parents are encouraged to support and trust your efforts in becoming more independent in managing various aspects of your medical condition, as well as in your decision making in setting a personal schedule and making lifestyle choices. Family members are strongly encouraged to continue to follow family rules for communicating about symptoms and resolving conflicts as discussed in the CHIRP sessions.

This session introduces important information on understanding just what stress is and how it can affect our bodies. Learning to identify situations that can be stressful is the first step, followed by understanding how different stressors call for different stress management strategies. One particularly important issue in managing the stress that comes from having a chronic illness is sleep. The Children’s Health and Illness Recovery Program (CHIRP) introduces the importance of improving sleep by learning healthy sleep hygiene practices and monitoring this with the help of the Sleep Log. Improvement in sleep hygiene and physical activity are emphasized as important building blocks of CHIRP.

Session 4 builds on “Managing the Impact” coping skills by helping you learn to apply “Challenging Your Thoughts” skills to the stressful situations identified earlier and recorded on the “Thought-Changing Skills” Worksheet from the previous session. The goal of this session is to assist you in more accurately identifying those distortions in your assumptions, beliefs and thinking that underly distressful and uncomfortable emotions/feelings, which in turn can amplify unpleasant symptoms such as energy level and pain intensity. Common thinking errors such as hopelessness, catastrophic thinking, and mind reading are introduced and applied to your own identified automatic thoughts. This is followed by introducing strategies for challenging those often unsubstantiated and disabling thoughts that serve as barriers to setting goals, expectations, and motivation, which make it difficult to get your coping and lifestyle back on track.

During the remaining Sessions 10–12 of the Children’s Health and Illness Recovery Program (CHIRP) no new skills or strategies are introduced. Rather, these sessions focus on continuing to practice the skills introduced in Sessions 1–9 so that they become positive habits and routines in the your and your family’s coping with their chronic illness while becoming more confident and competent in their movement toward more independence.

Building on the stress and stress management information from the last session, Session 2 introduces two specific forms of coping with stress: “Solving the Problem,” which involves you engaging in actions that instrumentally reduce the stressors to which you are exposed (active problem-solving), and “Managing the Impact” coping, i.e., those skills that reduce the effects of stressors on you physically and emotionally (relaxation and cognitive-behavioral strategies). This session describes these two forms of coping and the “when” and “how” of applying each. In this session problem-solving skills are introduced as a strategy that can reduce stress by addressing and altering the situation, and specific steps in the problem-solving process are described and illustrated.