Pediatric Rehabilitation Psychology

I am pleased to have the opportunity to announce an exciting development in Division 22 -- the formation of Section 1, Pediatric Rehabilitation Psychology. Based on strong support from the entire Division, and desire (if not longing) from the pediatric practitioners, Section 1 was formed to provide organization and structure for Pediatric Rehabilitation Psychologists who have constituted a small but significant portion of Division 22 members. Pediatric Rehabilitation Psychologists have organized in this way to:

* Promote healthy child development in children with disabilities through direct psychological services, consultation, advocacy, education and research;
* Provide a prominent voice for the rights of children with disabilities;
* Identify and address key factors in the disablement of children.

By forming a Section, Pediatric Rehabilitation Psychologists obtain a more prominent forum, representation on the Division 22 Executive Board, and greater input into APA Annual Meeting programming. In addition, the Section status provides a platform for developing collaborative activities with groups within other divisions including Divisions 40 and 54. Recent pediatric rehabilitation-related developments have included:

* Increasing focus on issues of inclusion in education and the community:
1. At this point, there is a significant literature that documents the stigma of disability in children but also the malleability of children's perceptions based on experience with peers with disability.
2. There has been increasing involvement of consumers in developing community resource and advocacy services and Family-centered Care has become a leading movement in health services for children.
3. Inclusion issues also were highlighted in the recent Supreme Court milestone decision regarding provision of school-based services to a child with long-term mechanical ventilation (Cedar Rapids Community School District v. Garret F., 1999). The Supreme Court ruled that students with disabilities are entitled to necessary "non-medical" services, irrespective of cost, under IDEA.
* Advances in rehabilitation-related research:
1. Generally increased rigor in the study of neuropsychological recovery from TBI;
2. The importance of family context on behavioral and cognitive outcomes from brain injury;1
3. Burgeoning interest in pharmacological treatment of cognitive impairments associated with TBI with recent focus on pediatric TBI;2 ,3
4. Increasingly effective pharmacological and other types of intervention for spasticity that appear to have significant effects on aspects of cognition and functional communication. 4 ,5
* Health care news (not all bad): There is recent precedent in Tucson, Arizona for neuropsychological evaluations being covered under the medical benefits portion of health care insurance. CIGNA and United HealthCare in collaboration with rehabilitation psychologists, neuropsychologists and legal consultation have developed a local contract in which no pre-authorization is required. Pediatricians and other physicians (including neurologists) can directly refer for neuropsychological evaluations without going through the mental health gate-keeping system. Billing is done using CPT codes 96115 (Neurobehavioral Status Exam) and 96117 (Neuropsychological Testing). Clients pay the service provider the MEDICAL co-pay, and the insurer pays the rest on an hourly basis at Medicare rates.

References

1. Yeates, K. O., Taylor, H. G., Drotar, D., Wade, S. L., Klein, S., Stancin, T., & Schatschneider, C. (1997). Preinjury family environment as a determinant of recovery from traumatic brain injuries in school-age children. Journal of the International Neuropsychological Society, 3, 617-630.
2. Whyte, J., Hart, T., Schuster, K., Fleming, M., Polansky, M., & Coslett, H. B. (1997). Effects of methylphenidate on attentional function after traumatic brain injury: A randomized, placebo-controlled trial. American Journal of Physical Medicine and Rehabilitation, 76, 440-450.
3. Williams, S. E., Ris, D., Ayyangar, R. et al. (1998). Recovery in pediatric brain injury: Is psychostimulant medication beneficial? Journal of Head Trauma Rehabilitation, 13 (3), 73-81.
4. Albright, A. L., Cervi, A., & Singletary, J. (1991). Intrathecal baclofen for spasticity in cerebral palsy. Journal of the American Medical Association, 265 (11), 1418-1422.
Craft, S., Park, T. S., White, D. A., Schatz, J., Noetzel, M., & Arnold, S. (1995). Changes in cognitive performance in children with spastic diplegic cerebral palsy following selective dorsal rhizotomy. Pediatric Neurosurgery, 23 (2), 68-74.