Structured exposure in an unstructured setting: Case study of parental exposure intervention to increase parental mastery of medical care during inpatient hospitalization.


Objective: Parental stress can have an impact on health outcomes of chronically ill children (Cousino & Hazen, 2013). Pediatric psychologists are well suited to address these issues with understanding of empirically supported treatments, impact of mental health on medical care behaviors, and parent–child interactions (Ernst et al., 2015). Use of empirically supported treatments, such as graduated exposure therapy (ET), within an uncontrolled environment such as an inpatient setting can be challenging. This case study illustrates adaptation of ET in an inpatient setting to address parental mastery of medical care. Method: ET was implemented with a mother of an infant with a newly placed tracheostomy to reduce her severe anxiety that was preventing her from interacting with her infant or engaging in medical care necessary for hospital discharge. Results: Through 31 exposure sessions, the patient’s mother met all four treatment targets: daily tracheostomy care, stoma desensitization, tracheostomy tube changes, and suctioning. Self-reported distress data were presented for each exposure. Conclusions: Use of ET with a clear treatment plan and coordinated multidisciplinary inpatient team efforts can successfully reduce severe parental anxiety that is impeding medical care, hindering parent–child interaction, and interfering with parental ability to care for a child with complex medical needs. This article discusses multiple factors that are unique to the inpatient setting and the target behaviors for consideration.

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Clinical Practice in Pediatric Psychology


Impact Statement This case highlights the use of empirically supported treatments to target complex parent behaviors in a pediatric inpatient setting. Reducing barriers to discharge, such as inability to demonstrate adequate medical care, promotes better patient and family outcomes.