Virtual reality (VR) is an innovative technology with the potential to enhance treatment for children with chronic pain and functional symptoms. Currently, little is known about patients' experiences of VR in the setting of intensive interdisciplinary pain treatment (IIPT). This study aimed to better understand how patients engage with and benefit from VR. This case report focuses on a 12-year-old female with amplified musculoskeletal pain syndrome and comorbid functional neurological disorder receiving treatment in inpatient IIPT. VR was incorporated into physical/occupational and recreational therapy sessions. A semi-structured interview was completed one-month post-discharge. Qualitative analysis revealed three major themes: Process of Change (VR was unique/immersive, reduced pain focus, challenged skepticism, and changed pain perception), Efficacy (VR increased movement, supported transitioning from a wheelchair to walking independently, and increased confidence, excitement, and surprise), and Engagement (VR aided in acknowledging progress, increased camaraderie, was fun, and challenged patient to extend treatment goals made in VR to real life). Therapist observations of the benefits and barriers to using VR in treatment are described. Overall, this report indicates that VR may be a helpful tool to use with existing IIPT interventions to enhance patient engagement in treatment and improve functionaloutcomes.

The present study gathered information about the characteristics of individuals and dogs in Emotional Support Animal (ESA) partnerships, instances of service-animal misrepresentation, animal welfare and behavior, dimensions of bond quality, and health professional involvement. Seventy-seven adults (53 female, 24 male) with a canine ESA were surveyed via Qualtrics panel services. Data were analyzed for descriptive data, as well as correlational analyses among variables. Participants reported high frequencies of misrepresentation of emotional support animals, access law violations, and problematic instances including ESAs with a history of aggression and times when participants were unable to care for their dog. The majority of participants reported mental illness diagnoses, seeking ESA documentation from mental health providers; however, levels of health professional involvement in the ESA-procuring process were varied. Several dimensions of bond quality between participants and their ESA were reported to be consistently high across participants. Correlational data brought forth questions about the roles that health professionals and animal welfare could play in preventing harm to clients, animals, and communities, discouraging unlawful and problematic behavior, and strengthening the human-animal bond between their clients and ESAs. For example, welfare concerns were correlated with problematic animal behaviors and perceived costs to the participants. Additionally, as professional involvement increased, so too did rates of misrepresentation of ESAs as service animals and access law violations. These data provide a first picture of ESA partnerships and can be a springboard for future research toward protecting individuals with disabilities, their animals, and communities.

During intensive interdisciplinary pain treatment (IIPT) for pediatric chronic pain, multiple methods are used to assess pain-related function and physical impairment/improvement. Outside of the Functional Disability Inventory (FDI), few studies have examined which assessments best capture functional improvements as a result of IIPT. The aim of the current study was to investigate the psychometric properties of commonly used physical rehabilitation measures in a sample of pediatric patients with chronic pain receiving IIPT. Participants included 140 pediatric patients (M age=14.71, SD=2.39; female=74%) with primary diagnoses of musculoskeletal pain, abdominal pain, and headache. Investigation of the psychometric properties of the Functional Independence Measure for Children (WeeFIM), the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2 upper and lower subtests), the Canadian Occupational Performance Measure (COMP performance and satisfaction assessment domains), 6-minute walk test, 30-second step test, and grip strength included descriptive statistics assessed at admission and discharge. The shape of the distributions was a focus with skewness and kurtosis of greater than |1| used to identify non-normal distributions. At admission, WeeFIM (-3.4), COPM-S (1.3), and BOT-2 UL (-1.8) demonstrated significant skew. At discharge, WeeFIM (-5.4), BOT-2 BL (1.7), and 6-minute walk test (-1.2) showed increased skew. Several variables showed kurtosis (1-4) including COPM-S, BOT-2 BL, BOT-2 UL at admission and BOT-2 BL, 6-minute walk test, and grip strength at discharge. The WeeFIM demonstrated significant kurtosis (admission=15.5; discharge=36.5). All measures were moderately correlated with the FDI at admission with the strongest relationships between the 6-minute walk test (-.39) and 30-second step test (-.34). The WeeFIM, seems particularly problematic for use within this population. The overwhelming majority of patients score at the top of the distribution at admission prohibiting demonstration of treatment gains. The BOT-2 and COPM performed somewhat better although caution should still be used. Recommendations for assessment in pain treatment are provided. During intensive interdisciplinary pain treatment (IIPT) for pediatric chronic pain, multiple methods are used to assess pain-related function and physical impairment/improvement. Outside of the Functional Disability Inventory (FDI), few studies have examined which assessments best capture functional improvements as a result of IIPT. The aim of the current study was to investigate the psychometric properties of commonly used physical rehabilitation measures in a sample of pediatric patients with chronic pain receiving IIPT. Participants included 140 pediatric patients (M age=14.71, SD=2.39; female=74%) with primary diagnoses of musculoskeletal pain, abdominal pain, and headache. Investigation of the psychometric properties of the Functional Independence Measure for Children (WeeFIM), the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2 upper and lower subtests), the Canadian Occupational Performance Measure (COMP performance and satisfaction assessment domains), 6-minute walk test, 30-second step test, and grip strength included descriptive statistics assessed at admission and discharge. The shape of the distributions was a focus with skewness and kurtosis of greater than |1| used to identify non-normal distributions. At admission, WeeFIM (-3.4), COPM-S (1.3), and BOT-2 UL (-1.8) demonstrated significant skew. At discharge, WeeFIM (-5.4), BOT-2 BL (1.7), and 6-minute walk test (-1.2) showed increased skew. Several variables showed kurtosis (1-4) including COPM-S, BOT-2 BL, BOT-2 UL at admission and BOT-2 BL, 6-minute walk test, and grip strength at discharge. The WeeFIM demonstrated significant kurtosis (admission=15.5; discharge=36.5). All measures were moderately correlated with the FDI at admission with the strongest relationships between the 6-minute walk test (-.39) and 30-second step test (-.34). The WeeFIM, seems particularly problematic for use within this population. The overwhelming majority of patients score at the top of the distribution at admission prohibiting demonstration of treatment gains. The BOT-2 and COPM performed somewhat better although caution should still be used. Recommendations for assessment in pain treatment are provided.

An emotional support animal (ESA) is a type of legally recognized assistance animal that purports to provide emotional support to individuals with mental and emotional disabilities. Due to their no-cost access to housing that is ordinarily not pet-friendly (and previously no-cost access to airline travel), ESAs have increased in popularity, reflected in media attention highlighting problems that occur when individuals obtain ESA verification fraudulently, or without critical thought and legal considerations. Given recent legal clarifications by the U.S. Department of Housing and Urban Development (HUD; 2020), ESAs should be considered an accommodation and adjunct to ongoing treatment for chronic mental health disorders. The present article approaches ESA decision issues from a human-animal bond research and positive ethics perspective and introduces an ESA Decision-Making Framework. The framework provides clinician-friendly overview of welfare, clinical, and legal aspects of ESA decisions and potential ESA selection. The framework can structure beneficial conversations about ESAs between providers and clients in order to facilitate collaborative treatment planning and to strengthen therapeutic alliances regardless of the outcome of the ESA decision. Public Significance Statement Emotional Support Animals (ESAs) should be considered an accommodation and adjunct to ongoing treatment for chronic mental health disorders. The present article provides a clinician-friendly overview of welfare, clinical, and legal aspects of ESA decisions and potential ESA selection from a human-animal bond research perspective.

The efficacy of family-based treatment (FBT) in outpatient settings has led to efforts to incorporate FBT principles into higher levels of care. The present study examined predictors of improvement in an FBT-based partial hospitalization program/intensive outpatient program (PHP/IOP) as measured by the Eating Disorder Examination-Questionnaire. Participants were 113 patients with anorexia nervosa (AN) or eating disorder not otherwise specified (EDNOS) consecutively participating in an FBT-based PHP/IOP. Multilevel modeling was used to investigate predictors for adolescents and young adults separately. Predictors considered included illness duration, previous hospitalization, hospitalization immediately prior to treatment, previous outpatient therapy, hospitalization during treatment, diagnosis, gaining 4 pounds in 4 weeks, and family status as time-invariant variables. Time-varying variables considered included depression symptoms and mothers'/fathers' ratings of parental self-efficacy and expressed emotion. For adolescents, depression by time and diagnosis by time interactions were statistically significant. At all levels of depression, adolescent patients with AN demonstrated greater reductions in eating disorder symptoms compared to patients with EDNOS. For young adults, depression and gaining 4 pounds in 4 weeks were significant predictors. The relationships for young adults were curvilinear such that, while lower eating disorder symptoms were found during treatment, these gains were not maintained at follow up.

As TEPP's new editorial team begins their term, the authors discuss their vision for the journal as a forum for thoughtful conceptual examination and sound empirical investigation of current issues in health service psychology (HSP) education and training. The editorial team articulates three primary goals for the journal, including (1) engaging the broad training community in sharing its best conceptual and empirical work relevant to the varied levels, settings, and areas of education and training in HSP; (2) advancing the science of education and training through strong empirical research; and (3) expanding our emphasis on the sociocultural context in which education and training occurs, to advance multicultural competence and humility within HSP and the profession's potential to make positive evidence-based impacts on societal issues. The editorial team invites TEPP readers to join in pursuit of these goals, as authors, reviewers, and readers. In addition to general submissions, TEPP welcomes submission to sections devoted to innovations and emerging practices, diversity and inclusion in education and training, and other high-impact topics. TEPP encourages readers to work collaboratively on manuscripts that will build the scientific foundations of education and training, to reach out and support new contributors and consumers of the journal, and to contact the editorial team with ideas that can help extend TEPP's reach and relevance to the training community, as well as to the policymakers, practitioners, and consumers of our profession.

OBJECTIVE:To evaluate outcomes associated with an experiential leadership program (the Veterinary Leadership Experience [VLE]) among participants 1 year after program completion.SAMPLE:157 veterinary students and 61 veterinary professionals who participated in the 2015 or 2016 VLE.PROCEDURES:Participants completed various instruments to assess emotional intelligence, psychological flexibility, resilience, and client-communication skills prior to (pretest) and 1 year after (posttest) attending the VLE; pretest and posttest findings were compared for all but client-communication skills, for which only posttest responses were analyzed. An additional posttest instrument assessed the impact that the VLE had on key knowledge areas (ie, self-awareness, self-management, social awareness, relational competence, communication skills, and conflict management skills) and overall impact.RESULTS:1 year after completing the VLE, participants reported that the program had a high impact on all key knowledge areas; the impact on social awareness and overall impact was significantly higher for veterinary students than for veterinary professionals. Veterinary professionals reported a greater increase in emotional intelligence after program completion than did veterinary students. For each assessed client-communication skill, the percentage of veterinary professionals who reported increased confidence in that skill after program completion was lower than the corresponding percentage of veterinary students. Resilience and psychological flexibility scores did not increase after program completion.CONCLUSIONS AND CLINICAL RELEVANCE:Assessment of the effectiveness and long-term outcomes of experiential leadership programs is important to understanding whether such programs are having the intended effect. Veterinary students and veterinary professionals who were assessed 1 year after completing the VLE reported improvements in leadership skills foundational to the program.

OBJECTIVE:To examine the medical assessment and triage of pediatric patients with anorexia nervosa (AN) initially seen in primary care.METHODS:A retrospective cohort study was conducted for all pediatric patients with AN who had eating/weight concerns and initially identified symptoms in primary care in a single health care system between January 1, 2010, and December 31, 2016. Information on presenting concern, medical assessment/laboratory tests, clinical diagnoses, treatment recommendations, and referrals were abstracted from the medical record.RESULTS:Forty-one (mean age = 13.7 years; SD = 2.2) pediatric patients with AN had eating/weight concerns and initially identified symptoms in a primary care. Overall, only 5% (n = 2/41) of patients received an AN diagnosis during the index visit; a minority were assessed for electrolyte disturbance (n = 20), electrocardiogram abnormality (n = 18), hypothermia (n = 13), binge/purge behaviors (n = 13), orthostatic hypotension (n = 2), or dehydration (n = 1), and only 56% (n = 23) received triage consistent with practice recommendations. Although 61% (n = 25) met criteria for inpatient admission, inpatient hospitalization was recommended for only 2 patients. Patients who received triage consistent with practice recommendations received AN diagnosis and treatment significantly earlier than those who did not (p < 0.01 and p = 0.001, respectively).CONCLUSION:Findings suggest that pediatric patients with AN may not be receiving medical assessment and triage per practice recommendations in the primary care setting. Understanding barriers to evidence-based care for pediatric eating disorders may inform provider education and system-wide changes to enhance outcomes in these patients.

OBJECTIVES:Evidence for the effectiveness of intensive interdisciplinary pain treatment (IIPT) for pediatric chronic pain is growing; however, little research has considered factors that contribute to differences in patients' treatment response. The present study utilized multilevel modeling to examine trajectory of change over time in functional disability from clinic assessment to 6-month follow-up in pediatric patients participating in IIPT, considering spatial distribution of pain, coping efficacy, and pain intensity.MATERIALS AND METHODS:Participants included 110 pediatric patients (Mage=14.65, SD=2.37; localized pain, 27.3%; widespread pain, 72.7%) consecutively admitted into IIPT. Patients completed self-report measures of functional disability, pain intensity, and coping efficacy at pretreatment assessment, admission, weekly during IIPT, discharge, and several follow-ups.RESULTS:Analysis identified a model with 3 three-way interactions, including time, time squared, pain intensity, coping efficacy, and pain distribution, on functional disability. The spatial distribution of pain had the greatest impact on treatment trajectory in patients with widespread pain, high pain intensity, and poor coping efficacy; these patients demonstrated greater functional disability compared with patients with localized pain. In addition, patients with widespread pain and poor coping efficacy had the most functional disability across all levels of pain intensity. Patients with localized pain and poor coping efficacy demonstrated initial treatment gains, but evidenced an increase in functional disability at follow-up.DISCUSSION:Overall, spatial distribution of pain, coping efficacy, and pain intensity played an important role in patients' response to treatment. Better understanding of these variables could improve treatment response, particularly for the most severely disabled chronic pain patients.

In light of conflicting research regarding eating disorder risk and sports participation, the current study examined the relationship between specific aspects of sports participation (i.e., level of competition, leanness requirements, and physical/cardiovascular intensity level), an individual's motivation for sports participation, and eating disorder symptomatology/risk. Participants included 319 female collegiate athletes (M age = 19.88; SD = 1.62) representing a variety of sports and competition levels. Multilevel modeling found that level of competition, receiving a scholarship, age, and years of collegiate sport played did not predict eating disorder risk. In the final model, there was a significant interaction between intrinsic motivation and sport intensity. For high intensity sports, higher levels of intrinsic motivation were associated with lower eating disorder risk. For low intensity sports, the level of intrinsic motivation did not impact eating disorder risk. For all sport intensities, extrinsic motivation was associated with a higher eating disorder risk. Results suggest that it is not the specific sport but athletes' motivation for those sports with high physical/cardiovascular intensity and leanness requirements that is associated with untoward consequences. The results clarify conflicting results previously reported in the literature that have primarily employed univariate analyses and have implications for athletic development programs.

The purpose of the present study was to evaluate the factor structure of the Children's Sleep Habits Questionnaire (CSHQ) when used with preschool and toddler age children. Mothers of 105 children ages 2-5 completed the CSHQ, the Child Behavior Checklist (CBCL), and a sleep diary. Internal consistency for the original subscales on the CSHQ ranged from .55 to .82 and factor analysis resulted in four factors that tap into critical aspects of sleep. The concurrent validity of the revised scales of the CSHQ was adequate. Overall the results from this study suggest a revised factor structure may be more appropriate for use with preschool and toddler age children.

This is a narrative journey of a Blackfeet woman as she learned to help ethnic minority students navigate graduate training. The talk reflects the holistic, contextual, and interdependent characteristics of Native American culture blended with the culture of the West. Insights from working with horses are included because they have much to teach people.Esta es la narración de la trayectoria de una mujer de la tribu Pies Negros que aprendió a ayudar a los estudiantes de minorías étnicas a desenvolverse en sus estudios universitarios. El discurso refleja las características holísticas, contextuales e interdependientes de la cultura de los Nativos Americanos mezclada con la cultura occidental. Se incluyen observaciones obtenidas a partir del trabajo con caballos, porque tienen mucho que enseñar a los humanos.

Current literature presents four primary parenting styles: authoritative, authoritarian, permissive, and neglectful. These styles provide an important shortcut for a constellation of parenting behaviors that have been characterized as consisting of warmth, demandingness, and autonomy granting. Empirically, only warmth and demandingness are typically measured. Research reporting on parenting styles in Latino samples has been equivocal leading to questions about conceptualization and measurement of parenting styles in this ethnic/cultural group. This lack of consensus may result from the chasm between concepts (e.g., authoritarian parenting) and observable parenting behaviors (e.g., warmth) in this ethnic group. The present research aimed to examine parenting styles and dimensions in a sample of Latino parents using the two usual dimensions (warmth, demandingness) and adding autonomy granting. Traditional parenting styles categories were examined, as well as additional categorizations that resulted from adding autonomy granting. Fifty first-generation Latino parents and their child (aged 4-9) participated. Parent-child interactions were coded with the Parenting Style Observation Rating Scale (P-SOS). In this sample, the four traditional parenting categories did not capture Latino families well. The combination of characteristics resulted in eight possible parenting styles. Our data showed the majority (61%) of Latino parents as "protective parents." Further, while mothers and fathers were similar in their parenting styles, expectations were different for male and female children. The additional dimensions and implications are discussed. The importance of considering the cultural context in understanding parenting in Latino families is emphasized, along with directions for future research.

Although new to many members of the psychological community, the notion of a "combined" model of training has been in existence for nearly 30 years (Beutler & Fisher, 1994). The present article is intended to outline the benefits and advantages of the Combined-Integrated (C-I) model. Following a brief discussion of the terms "combined" and "integrated," the advantages of C-I training are discussed across five key themes: (a) the high overlap across traditional practice area training, (b) the advantages of the breadth of training offered, (c) the advantages of C-I training for the professional of psychology, (d) the pragmatic advantages of C-I training to faculty and students, and (e) the benefits of C-I training for salient constituency groups.