Innovative behavioral health interventions in medical settings are often constrained by financial and structural barriers within the U.S. health insurance system. Providers are caught between two billing pathways: DSM-based codes, which do not reflect health-focused interventions, and health and behavior codes, which remain inconsistently recognized and poorly reimbursed. This disconnect makes it difficult to sustain innovative care despite clear clinical benefit. Moreover, it stifles clinical advancements and contributes to health inequity. The Comfort Ability Program (CAP) intervention, a family-based, group treatment for pediatric chronic pain, illustrates both the promise and the challenge of this landscape. The CAP intervention integrates CBT, ACT, MI, and behavior management strategies in a comprehensive one-day format. It has been adopted by more than 45 healthcare institutions worldwide and demonstrates improved outcomes and reduced barriers to care. However, despite clinical success and scalability, CAP faces many reimbursement obstacles in the U.S., reflecting broader systemic issues. This manuscript reviews psychology billing reforms, outlines system-level challenges working within medical settings, and discusses real-world implications for providers striving to deliver integrated, patient-centered care. We propose concrete steps to support clinicians in navigating current barriers while advocating for system-level reforms that can sustain innovation in behavioral health delivery.

Artificial Intelligence (AI) has been developed through interdisciplinary efforts since the 1940s, but generative AI and Large Language Models (LLMs) gained unprecedented attention with the launch of ChatGPT by OpenAI in late 2022. As these AI tools have become globally ubiquitous, significant implications arise for clinicians within and beyond healthcare settings. The simulation or emulation of human intelligence through coded heuristics now permeates clinical domains, creating new opportunities alongside ethical challenges that require careful exploration. For healthcare psychologists, regardless of specialty, it has become a priority to remain at the forefront of these technological advances. This includes developing literacy not only in psychological emulation software but also in the rapidly growing hardware that supports AI. Well-informed clinicians must act as responsible stewards of this advancing technology and its application in healthcare. These responsibilities must be approached through the lens of both existing and evolving ethical standards in human psychology. Although these tasks may seem daunting, the urgency, opportunities, and necessity for healthcare psychologists to engage thoughtfully with AI are clear. This engagement ensures that patient care benefits from innovation while upholding ethical principles. Said opportunities and the urgency for healthcare psychologists are discussed.

Informed consent laws allow patients to decide what happens to their bodies within a medical setting, but medical practices within academic teaching hospitals do not always live up to ethical standards or align with the values and wishes of clinicians, patients, and families. Bioethics often helps to resolve these conflicts through collaboration and dialogue. However, when conflicts persist and are resistant to change, it may be necessary to pursue regulatory or legislative solutions. This paper discusses the role of bioethics in strengthening federal regulations on explicit consent for sensitive (pelvic, prostate, rectal, and breast) exams. Since psychologists within academic health centers may also wish to influence policy, this paper concludes with practical, achievable guidance for psychologists to gain an understanding of the public policymaking process, develop relationships with policymakers, and take steps to exert influence on the policymaking process.

Infancy and toddlerhood are periods of rapid development which could be significantly compromised by the diagnosis of cancer and its treatment. The aim of this study was to describe health-related quality of life (HRQOL) in infants/toddlers diagnosed with cancer and their caregivers over time and identify whether treatment variables and caregiver HRQOL are associated with infant/toddler HRQOL. HRQOL was assessed by parent-proxy reports among infants/toddlers (N = 39) and their caregivers (N = 39) at three timepoints (baseline, 6 months, 12 months). Linear mixed models were used to investigate whether demographic and treatment variables, caregiver HRQOL, and caregiver distress was associated with infant/toddler and caregiver HRQOL over time. No statistically significant variables were found to be associated with caregiver HRQOL, including infant/toddler HRQOL, time since diagnosis, income, and intensity of treatment. However, caregiver distress and infant/toddler HRQOL were bidirectionally related to each other over time, whereby higher infant/toddler HRQOL was associated with lower caregiver distress, and vice versa. Infants/toddlers with cancer and their caregivers experience psychosocial challenges. Interventions targeting caregivers that emphasize the importance of the caregiver-child relationship, and self-care are important. Health care providers should screen caregivers to assess their well-being and provide appropriate supports when needed.

While psychologists possess unique and valuable skills that can contribute to leadership within academic health centers (AHCs), there are common barriers within these institutions that impede psychologists' engagement in leadership. As a result, significant educational efforts and challenges to entrenched norms are often required to advocate for the field of psychology, particularly when working outside of centralized psychology departments. In the following article, four psychologist colleagues working in a centralized department of psychiatry at a single AHC share their recent experiences facing barriers to leadership roles. The authors describe the impact of historical context on the challenges they face, as well as the actions they have taken to support the advancement of psychologists. These actions include leveraging interdisciplinary support, learning from other fields, and developing a curriculum to enhance financial and business acumen in psychology trainees. The authors also review the importance of staying informed about state and federal policy changes that impact healthcare systems, so that psychologists can help lead in responding to these changes in value-consistent ways. By advocating for the unique contributions psychologists offer and addressing the structural barriers in many AHCs, psychologists can more effectively navigate and shape leadership pathways.

This paper examines ethical challenges in clinical health psychology through a diversity-informed lens, drawing on insights gained from a 2025 panel discussion at the biannual meeting of the Association of Psychologists in Academic Health Centers (APAHC), held at Johns Hopkins All Children's Hospital in St. Petersburg, FL. The ethically relevant outcomes from the panel centered on four key domains: (1) ethical practice with diverse patients using organ transplantation as an exemplar, (2) ethical oversight in academic medicine and research, including the roles of Institutional Review Boards (IRBs), (3) the implications of grant terminations based on "gender identity" or diversity, equity, and inclusion (DEI) considerations, and (4) the implications of legal challenges to training a health care workforce that represents the populations they will serve. Across these domains, the panel emphasized the importance of advancing ethical practices that address persistent disparities affecting historically underserved communities.

The 2025 Association of Psychologists in Academic Health Centers (APAHC) national biennial conference was held in Saint Petersburg, Florida, May 1-3, 2025. Our conference theme was "Impact of Psychology in Complex Healthcare Systems: Opportunities, Innovation, and Intentional Growth," with a goal of showcasing the meaningful work academic health center psychologists do around the United States to enhance care and care access for the communities in which they live and work. The conference included invited plenary speakers as well as concurrent speakers who were selected based on a competitive application process. This special issue includes invited manuscripts from plenary speakers and concurrent speakers. All manuscripts were peer reviewed by field experts. The conference co-chairs, Drs. Melissa A. Faith, Ph.D., ABPP, and Lisa Ramirez, Ph.D., ABPP, served as guest editors for this special issue, with editorial support from JCPMS Editor Dr. Andrea Bradford. This article provides a brief overview of the conference theme as well as a framework for this special issue.

Psychologists working in medical and academic health settings bring unique skills that make them well-suited for policy advocacy. Their training in trust-building, translating evidence, and understanding context can be applied to influence policies that impact access, quality, and equity in healthcare. This article explains how clinical and counseling skills align with policy engagement and shows their relevance through examples such as Medicaid reform, telehealth parity, and racial equity impact assessments. It introduces conceptual frameworks and practical strategies to demonstrate how psychologists can participate in coalition building, communication, and policy evaluation. Training recommendations emphasize the importance of incorporating advocacy skills into graduate programs, offering mentorship, and providing ongoing professional development to equip psychologists for leadership in evolving healthcare systems. Advocacy is presented not just as a supplement to practice, but as a natural part of psychologists' professional identity. By embedding advocacy into education and practice, psychologists can promote health equity and help ensure policies are based on both scientific evidence and lived experience.

Academic health center (AHC) psychologists finding novel leadership pathways, both within and outside their AHCs, can provide valuable opportunities for professional enrichment and growth. In this manuscript, we describe how psychologists' training, experiences, and skills contribute to leadership success in traditionally medically-led organizations (MLOs). We also describe how four ACH pediatric psychologists, all at different career stages, found unique leadership roles within traditionally medically-led organizations (MLOs). For each leadership role example, we describe (1) how career stage, expertise, and values intersect with the leadership opportunity, (2) the psychologist's organizational context and leadership role structure, and (3) the psychologist's leadership contributions and collaborative strategies. We also provide concrete recommendations to other ACH psychologists who wish to explore leadership roles throughout their careers.

Caregiving can provide purpose and life satisfaction but is often linked to increased burden and reduced quality of life. Understanding mechanisms influencing caregivers' experiences is crucial for effective support. One key factor is illness integration-the extent to which caregivers incorporate the patient's illness into their identity. Caregivers may feel engulfed, reject, accept, or find enrichment in the illness, shaping their psychological outcomes. This study examines the relationships between illness integration, care burden, well-being, and attachment orientation to illuminate identity processes in caregiving and guide interventions to reduce strain and foster resilience. The results from our cross-sectional online survey of 162 informal caregivers indicated that caregivers predominantly accepted their loved ones' illness into their identity, and this acceptance was in turn associated with both their well-being and care-burden. Caregivers high on attachment anxiety reported greater feelings of engulfment by the illness, leading to increased burden and diminished well-being. On the other hand, caregivers high on avoidant attachment struggled to accept the illness, and also experienced heightened burden. This study underscores the significance of illness integration in shaping caregivers' experiences. The findings highlight the need to promote adaptive integration processes and address attachment-related challenges, reducing caregiver strain and enhancing resilience.

Integrated behavioral healthcare has addressed common pediatric primary care concerns including anxiety and depression, but is infrequently applied to somatic symptoms (e.g., chronic pain, fatigue, or syncope unattributable to organic causes), which affect one in three youth. Developing an integrated care model for primary care-where most youth with somatic symptoms first present for evaluation and management-may increase access and positively impact child health. This manuscript summarizes the literature surrounding integrated care for pediatric somatic symptoms and proposes an adapted model for primary care. Drawing from the Pediatric Psychosocial Preventative Health model and cognitive-behavioral protocols for somatic symptom management, we propose that youth with mild to moderate symptoms can be effectively co-managed in primary care by a primary care provider delivering psychoeducation and facilitating team coordination, and an embedded behavioral healthcare provider conducting a brief, targeted intervention. This innovative approach leverages shared clinical responsibilities, as well as youth and families' trust in the primary care setting, to accessibly deliver care for mild-moderate symptoms otherwise unaddressed in current management approaches. Implementation likely requires developing clinician support tools and identifying sustainable billing practices, but may result in accessible, holistic, care that curtails symptom persistence and/or progression.

Pregnant people carrying fetuses with congenital anomalies are at increased risk for depressive symptoms. However, the nature of these symptoms is not well-understood. The present study identified profiles of prenatal depressive symptomatology and examined demographic and clinical predictors of profile membership. Pregnant persons (N = 6657) with a confirmed structural fetal anomaly diagnosis at a maternal-fetal care center completed psychosocial measures. K-means clustering analyses identified profiles. ANOVA and chi-square analyses evaluated predictors. Four profiles emerged: Minimal Depressive Type (n = 2259, 33.93%), Emotionally Dysregulated Type (n = 1909, 28.68%), Anxious and Somatic Type (n = 1789, 26.87%), and High Depressive Type (n = 700, 10.52%); indicating a higher likelihood of somatic, anxious, and emotion dysregulation symptoms rather than feelings of guilt/shame and loss of self. Racial identity, number of live births, antidepressant use, relationship with father of baby, and insurance status were associated with profile membership. Findings contribute to the understanding of perinatal depression among those with fetal anomalies, and highlight the need to further examine the clinical utility of depression profiles and responsiveness to psychosocial intervention.

Providing care to pediatric oncology patients involves delivering sensitive information to families, addressing diverse psychosocial needs, and navigating patient and family emotions. Psychosocial providers embedded within pediatric oncology clinics are uniquely qualified to address communication gaps between patients and providers, provide support to patients, and facilitate collaborative discussions between patients and the medical team. This quality improvement project aimed to describe the impact of including psychosocial providers in critical conversations between medical teams and families. Through conversation tracking, members of the psychosocial team recorded their involvement in thirty-six critical conversations. The psychosocial team offered various interventions including therapeutic processing, emotional assessment, medical translation, psychosocial support, child-focused support, and facilitation of discussions between families and medical providers. While challenges were identified including time and availability, physicians noted several benefits of psychosocial involvement, particularly in addressing emotional needs and enhancing communication with families. Psychosocial providers also noted benefits including demonstrating alignment with the medical team and enhancing the support that they are able to provide the family following the conversation. By integrating psychosocial support into critical conversations, medical providers can foster a patient-centered approach to care and optimize care delivery to effectively support families facing childhood cancer diagnoses.

Stroke is a major cause of disability, and patients who suffer strokes have limited mobility and functional tasks, necessitating daily reliance on caregivers. However, caregivers of stroke patients often experience depression and anxiety, negatively impacting their mental health and reducing their quality of life. Psychoeducational interventions may be a solution to support the well-being of stroke caregivers. This study is performed to assess the overall effectiveness of individual psychoeducational interventions for caregivers of stroke patients. A thorough search of Scopus, PubMed, Web of Science, and Cochrane databases was performed for published studies in English up to June 2023. Clinical trials assessing the efficacy of psychoeducational interventions on quality of life, depression, or care burden among stroke caregivers compared to usual care were included. A total of 18 clinical trials, 16 randomized clinical trials (RCTs), and two non-RCTs, with a total of 2007 patients, were included. The study's pooled results revealed a significant increase in the quality of life in the group receiving psychoeducational interventions compared to the comparison group (SMD = 0.34, 95% CI 0.13-0.55, p value = 0.002), while no significant difference was found in terms of depression (SMD =  - 0.05, 95% CI  - 0.23 to 0.14, p value = 0.62) or caregiver burden (SMD =  - 0.61, 95% CI  - 1.65 to 0.44, p value = 0.25). Psychoeducation programs should be considered as a supportive intervention to improve quality of life in caregivers; however, their impact on depression and caregiver burden remains inconclusive. However, further studies with a larger sample size are needed to confirm the results.

Severe fatigue in adolescents with immune dysregulation disorders (IDD) is prevalent and affects daily functioning. This study tested Internet-based cognitive behavior therapy (I-CBT) for the treatment of persistent fatigue in adolescents with IDD. This study used a multiple single-case experimental design (SCED) with a randomized waiting list period of 7-26 weeks, followed by 26 weeks of I-CBT and a 16-week follow-up. Nine adolescents participated, focusing on fatigue severity as the primary outcome. Secondary outcomes included physical functioning, school absence, and, if applicable, pain severity. Pre-post-differences were examined across subjects and individually for weekly measures. At the group level, pre-post-differences in primary and secondary outcomes were examined using mixed models. The across-subject analyses demonstrated the expected effect for fatigue severity. Furthermore, there was a significant reduction in fatigue severity and school absence, and improvement in physical functioning. Single-case analyses demonstrated significant reductions in fatigue in 5/9 patients post-I-CBT, with improvements in physical functioning noted in 6/9 patients. Effect sizes ranged from medium to large. Pain severity significantly improved in 1/5 patients with a small effect size. In a sample of nine adolescents, results indicated that I-CBT could be an effective and feasible treatment of persistent severe fatigue in IDD.

Parents of children newly diagnosed with autism report higher parenting stress levels than parents of typically developing children. Parent-mediated interventions include parents as interventionists in their child's intervention but often require increased parent effort and time to engage in the intervention. We investigated the influence of a parent-mediated early intervention for autistic children, the Bridge Skill Development Program, on parenting stress and child outcomes.

Psychologists in inpatient settings may be called upon to evaluate patients mental health when patients request to terminate interventions or refuse to engage in life- sustaining treatments. Although rates of distress are high in patients experiencing acute and chronic illness, especially as symptoms impact quality of life, less has been written on the nuances of assessing how affective symptoms may influence treatment decisions. This article describes some of the challenges health care providers may face in situations in which patients appear to be actively or passively withdrawing from care. We offer suggestions for assessment and considerations for referrals and resources to guide providers in conceptualization and intervention within these situations. This paper can ideally serve as a guide to aid psychologists to assist the medical team, the patient, and their family with appropriate decision-making regarding terminating medical care and to ensure these decisions were not unduly influenced by a potentially treatable and modifiable mood concern.

Although common, insomnia is often undertreated and underrecognized in primary care settings. Few studies have examined primary care provider (PCP) perspectives to better understand the context of insomnia assessment and treatment. The purpose of the current study was to examine Veterans Affairs (VA) provider knowledge and practice regarding the assessment and treatment of insomnia by utilizing qualitative inquiry. We recruited PCPs at a VA healthcare facility located in the southeastern United States to engage in a qualitative descriptive study of their perspectives on the management of insomnia in the primary care setting. Participants completed a demographic form and semi-structured interviews. Interview data were analyzed using a rapid qualitative analysis approach. 12 PCPs participated in semi-structured interviews. Themes were knowledge gaps in appropriate assessment, treatment, and documentation practices. Providers tended to focus on the event that precipitated insomnia rather than factors that perpetuate it and relied heavily on sleep hygiene recommendations. Systemic barriers, such as time constraints, also impeded the highest quality of care. PCPs may benefit from additional training on factors that maintain insomnia and on evidence-based treatments for insomnia. There may also be an opportunity to develop tools such as shared decision-making aids to increase referrals to evidence-based treatments. Development of strategies to facilitate assessment and treatment of insomnia disorder in the context of busy, fast-paced primary care settings may be beneficial to veterans and civilians with sleep disorders.

Few studies have examined effects of intrinsic motivation (IM) on adaptive behaviors among adolescents with type 1 diabetes (T1D), although greater IM has been associated with less diabetes-related family conflict (FC) and increased regimen adherence. Greater FC has also been associated with disordered eating behaviors (DEBs). We examined the moderating role of IM between FC and DEBs in a culturally diverse sample of youth with T1D. 226 adolescents (Mage = 15.03, 59.3% female, 65.8% Hispanic, 19.0% Black, MA1c = 8.19%, 74.30% eligible for subsidized health insurance) completed pre-visit screening measures assessing IM, FC, and DEBs. Gender, race, ethnicity, A1c, BMI, and insurance status were obtained from medical records and treated as covariates. Black youth had higher rates of DEBs (p < .01) and A1c levels (p < .001) than White youth. Significant correlations were observed across study variables. Accounting for covariates, IM moderated the relationship between FC and DEBs, whereby the effect of FC on DEBs emerged strongest at low IM (p < .001). As IM levels increased, the effect of FC on DEBs decreased, making the relationship between FC and DEBs non-significant. Greater IM for diabetes management attenuates the association between FC and DEBs. Promoting IM may decrease FC and DEBs in youth with T1D.