Editorial: Integrating Research and Practice: The Role of the Journal of Pediatric Psychology

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 relevance and application in published work in JPP was often mentioned in a recent survey of the members of the Society of Pediatric Psychology. To address these needs, the purpose of this editorial is to summarize JPP’s current directions in publishing clinically relevant work including single subject designs, case studies and series, quality improvement, and clinical effectiveness studies and invite authors to submit such work. In recognition of the importance of case studies and series to the clinical impact of the field of pediatric psychology, JPP has begun two new ongoing sections: (1) a single subject designs (Rapoff & Stark, 2008); and (2) descriptive case studies and series (Drotar, 2009). Thus far, relatively few case studies and series have been submitted and published, but it is still relatively early along in this initiative. Readers might be interested in Bernard, Cohen, and Mofett’s single subject intervention to improve exercise adherence in cystic fibrosis and Letourneau, Ellis, Naar-King, Cunningham, & Fowler’s (2010) case study of an application of multisystemic therapy with an adolescents at risk for HIV transmission that is published in this volume. We invite authors to submit manuscripts that focus on single subject designs, case studies, and case series to JPP. Irrespective of study design or setting of data collection, the clinical significance of research is now a criterion that is considered in reviews of articles submitted to JPP in the ratings provided by reviewers. In the editorial following this one in this volume, Rapoff (2010) provides an excellent description of various strategies that authors can and should use to enhance the clinical significance and social validity of their research. These include using specific measures of treatment acceptability, measuring clinically relevant and socially valid outcomes, and using statistical analysis of reliable change and normative comparisons. One of the newest developments in integrating clinical care and research is quality improvement (QI) research, which was developed based on methods that have been used in industry in order to improve the process and cost-effectiveness of health care as well as the pace of dissemination and delivery of effective treatments to patients. The first issue of JPP in 2010 included a section on QI research edited by Stark (2010) that contains excellent examples of QI research. We look forward to increased submissions of QI research as authors come to appreciate the contribution of QI methodology and its potential to generate new clinically relevant knowledge for the field of pediatric psychology. Another clinically relevant content area that will be emphasized in JPP concerns evaluations of services provided by pediatric psychologists in clinical settings, that is, studies of clinical effectiveness. In such studies, clinical practice settings are laboratories in which to evaluate new, clinically relevant intervention models or to demonstrate generalizability of empirically supported interventions to various populations in a range of clinical setting (Kazdin, 1995; Weisz, 2000). A call for manuscripts on this topic in 2008 yielded only a handful of submissions, one of which is published in this volume (Maynard, Amari, Wieczorek, Christensen, & Slifer, 2010). However, in recognition of the importance of such research, clinical effectiveness research will also become an ongoing section in JPP. To summarize, JPP has developed several new venues to encourage manuscript submissions that enhance the clinical relevance of published research. I recognize that JPP’s emphases on clinically oriented research will not change the constraints on the integration of research and practice noted earlier. However, we hope to make it easier (though it will never be “real easy” given JPP’s high volume of submissions and standards) for authors to: (1) identify a suitable niche for their clinically relevant research; (2) obtain a balanced, constructive critique of their case studies, series, QI, and clinical effectiveness studies; and (3) depending on the gods of editorial review (or devils depending on your experience), publish their work. Increasing the representation of clinically relevant research in JPP will ultimately enhance the clinical significance, and impact of our research on children’s health. Having been trained as scientist practitioners, many pediatric psychologists have the knowledge and capacity to improve the clinical significance of published work in our field. I can promise authors a potential venue for manuscripts that focus on the clinical application and significance of research in practice settings, if they can somehow find the time, motivation, and energy to produce them. I have confidence that you (we) will.