Systems Issues and Considerations

  • Deirdre A. L. CaplinEmail author
  • Laura M. Bennett-Murphy
  • Anne E. Kazak
Part of the Issues in Clinical Child Psychology book series (ICCP)


Psychologists are trained to understand their clients as embedded in and affected by multiple systems. Bronfenbrenner’s social ecological theory explains development as occurring within a series of layered, nested, interacting systems. It also serves as a model for medical adherence, health promotion, and healthcare disparities. This chapter utilizes Bronfenbrenner’s model to examine the many roles of the CL psychologist by placing the psychologist within those systems. First, we examine how the psychologist affects and is affected by patients, families, students, colleagues, clinics, institutions, and national policy. Further, we consider how psychologists promote health, effect behavior change, educate, and promote better delivery of healthcare within those systems. Drawing on a rich and diverse literature, this chapter outlines the multifaceted nature of CL psychology and the unique role psychologists play in addressing the mental health needs of children across the medical continuum.


Consultation-liaison Integrative pediatric behavioral healthcare Interprofessional pediatric practice Hospital systems 


  1. Ajiboye, P. O. (2007). Consultation-liaison psychiatry: The past and the present. African Journal of Medicine and Medical Sciences, 36(3), 201–205.PubMedGoogle Scholar
  2. APA Center for Psychology and Health. (2014). Integrated health care. Washington, DC: Author.Google Scholar
  3. Astin, J. A., Soeken, K., Sierpina, V. S., & Clarridge, B. R. (2006). Barriers to the integration of psychosocial factors in medicine: Results of a national survey of physicians. Journal of the American Board of Family Medicine, 19, 557. Scholar
  4. Bachrach, D., Anthony, S., & Detty, A. (2014). State strategies for integrating physical and behavioural health services in a changing medicaid environment. New York, NY: The Commonwealth Fund.
  5. Bell, S. T., Brown, S. G., Colaneri, A., & Outland, N. (2018). Team composition and the ABCs of teamwork. American Psychologist, 73, 349. Scholar
  6. Bierenbaum, M. L., Katsikas, S., Furr, A., & Carter, B. D. (2013). Factors associated with non-reimbursable activity on an inpatient pediatric consultation-liaison service. Journal of Clinical Psychology in Medical Settings, 20, 464. Scholar
  7. Bronfenbrenner, U. (1994). Ecological models of human development. Readings on the Development of Children, 2, 37–43. Retrieved from Scholar
  8. Brown, R. T., Freeman, W. S., Brown, R. A., Belar, C., Hersch, L., Hornyak, L. M., … Reed, G. (2002). The role of psychology in health care delivery. Professional Psychology: Research and Practice, 33, 536. Scholar
  9. Buche, J., Singer, P. A., Grazier, K., King, E., Maniere, E., & Beck, A. J. (2017). Primary care and behavioral health workforce integration: Barriers and best practices. Ann Arbor, MI: University of Michigan Behavioral Health Workforce Research Center. Retrieved from Scholar
  10. Carter, B. D., Kronenberger, W. G., Scott, E., & Ernst, M. M. (2009). Inpatient Pediatric Consultation—Liaison. In M.C. Roberts & R. G. Steele (Eds.) Handbook of pediatric psychology (4th ed., pp. 114–129)Google Scholar
  11. Carter, B. D., Kronenberger, W. G., Scott, E. L., Kullgren, K. A., Piazza-Waggoner, C., & Brady, C. E. (2018). Inpatient pediatric consultation-liaison. In M. C. Roberts & R. G. Steele (Eds.), Handbook of pediatric psychology (5th ed.). New York, NY: The Guilford Press.Google Scholar
  12. Gordon-Elliott, J. S., & Muskin, P. R. (2010). An approach to the patient with multiple physical symptoms or chronic disease. Medical Clinics of North America, 94(6), 1207–1216. Scholar
  13. Groopman, J. (2007). How doctors think (pp. 33–34). Boston, MA: Houghton Miffin.Google Scholar
  14. Institute of Medicine. (2010). The healthcare imperative: Lowering costs and improving outcomes: Workshop series summary.
  15. Janicke, D. M., Fritz, A. M., & Rozensky, R. H. (2015). Healthcare reform and preparing the future clinical child and adolescent psychology workforce. Journal of Clinical Child and Adolescent Psychology, 53, 1030. Scholar
  16. Johansen, C., Torenholt, R., Hommel, E., Wittrup, M., Cleal, B., & Willaing, I. (2014). Psychology & psychotherapy barriers to addressing psychological problems in diabetes: Perspectives of diabetologists on routine diabetes consultations in Denmark. Journal of Psychology and Psychotherapy, 4, 141. Scholar
  17. Kazak, A. E. (1989). Families of chronically ill children: A systems and social-ecological model of adaptation and challenge. Journal of Consulting and Clinical Psychology, 57, 25. Scholar
  18. Kazak, A. E., Nash, J. M., Hiroto, K., & Kaslow, N. J. (2017). Psychologists in patient-centered medical homes (PCMHs): Roles, evidence, opportunities, and challenges. American Psychologist, 72, 1. Scholar
  19. Klein, S., & Hostetter, M. (2014). In focus: Integrating behavioral health and primary care. Quality Matters Archive. New York, NY: The Commonwealth Fund.Google Scholar
  20. Kullgren, K. A., Tsang, K. K., Ernst, M. M., Carter, B. D., Scott, E. L., & Sullivan, S. K. (2015). Inpatient pediatric psychology consultation-liaison practice survey. Clinical Practice in Pediatric Psychology, 3, 37. Scholar
  21. Mack, J. W., Ilowite, M., & Taddei, S. (2017). Difficult relationships between parents and physicians of children with cancer: A qualitative study of parent and physician perspectives. Cancer, 123, 675. Scholar
  22. Miller, B. F., Ross, K. M., Melek, S. P., Davis, M. M., Kathol, R., & Gordon, P. (2017). Payment reform in the patient-centered medical home: Enabling and sustaining integrated behavioral health care. American Psychologist, 72, 55. Scholar
  23. National Academy of Engineering and Institute of Medicine Committee on Engineering and the Health Care System. (2005). A framework for a systems approach to health care delivery. In P. Reid, W. Compton, J. Grossman, & G. Fanjiang (Eds.), Building a better delivery system: A news engineering/health care partnership. Washington, DC: National Academies Press. Retrieved from Scholar
  24. Pidano, A. E., Arora, P., Gipson, P. Y., Hudson, B. O., & Schellinger, K. B. (2018). Psychologists and pediatricians in the primary care sandbox: Communication is key to cooperative play. Journal of Clinical Psychology in Medical Settings, 25, 32. Scholar
  25. Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M. R., & Rahman, A. (2007). No health without mental health. The Lancet, 370, 859. Scholar
  26. Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73, 433. Scholar
  27. Rozensky, R. H., & Janicke, D. M. (2012). Commentary: Healthcare reform and psychology’s workforce: Preparing for the future of pediatric psychology. Journal of Pediatric Psychology, 37, 359. Scholar
  28. Schmaling, K. B., Giardino, N. D., Korslund, K. E., Roberts, L. J., & Sweeny, S. (2002). The utility of interdisciplinary training and service: Psychology training on a psychiatry consultation-liaison service. Professional Psychology: Research and Practice, 33, 413. Scholar
  29. Seid, M., Opipari-Arrigan, L., Gelhard, L. R., Varni, J. W., & Driscoll, K. (2009). Barriers to care questionnaire: Reliability, validity, and responsiveness to change among parents of children with asthma. Academic Pediatrics, 9, 106. Scholar
  30. Sulik, L. R., & Sarvet, B. (2016). Collaborating with primary care. In M. K. Dulcan (Ed.), Dulcan’s textbook of child and adolescent psychiatry (2nd ed., pp. 1075–1087). Arlington, VA: American Psychiatric Association.Google Scholar
  31. Tynen, W. D., Woods, K., & Carpenter, J. (2009). Integrating child psychology services in primary care. Retrieved from
  32. Ward, W., Zagoloff, A., Rieck, C., & Robiner, W. (2018). Interprofessional education: Opportunities and challenges for psychology. Journal of Clinical Psychology in Medical Settings, 25, 250. Scholar
  33. Weisz, J. R., Doss, A. J., & Hawley, K. M. (2005). Youth psychotherapy outcome research: A review and critique of the evidence base. Annual Review of Psychology, 56, 337. Scholar
  34. Wissow, L. S., van Ginneken, N., Chandna, J., & Rahman, A. (2016). Integrating children’s mental health into primary care. Pediatric Clinics of North America, 63, 97. Scholar
  35. Young, P. L., Olsen, L., & McGinnis, J. M. (2010). Value in health care: Accounting for cost, quality, safety, outcomes, and intervention: Workshop summary. Washington, DC: National Academies Press.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Deirdre A. L. Caplin
    • 1
    Email author
  • Laura M. Bennett-Murphy
    • 1
  • Anne E. Kazak
    • 2
    • 3
  1. 1.Department of PediatricsUniversity of Utah School of Medicine, Primary Children’s HospitalSalt Lake CityUSA
  2. 2.Center for Healthcare Delivery Science, Nemours Children’s Health SystemWilmingtonUSA
  3. 3.Department of PediatricsSidney Kimmel Medical School of Thomas Jefferson UniversityPhiladelphiaUSA

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