An Accidental Scientist: Chance, Failure, Risk-Taking, and Mentoring

An Accidental Scientist: Chance, Failure, Risk-Taking, and Mentoring Abstract I never intended to become a scientist. My career developed on the basis of chance happenings, repeated failure, the willingness to take risks and the acceptance and provision of mentoring. My career has included periods of difficulty and shifted back and forth between academic health centers and universities in Canada. Although I have been amply recognized for my successes, my greatest learning has come from my failures. My greatest satisfaction has been in the development, evaluation and dissemination of interventions. The combination of intellectual stimulation and emotional gratification has meant a rewarding career clinical trial, cognitive–behavioral therapy, gastroenterology, headache, health-care services, intervention outcome, mental health, parenting Chance, rather than design, has been the hallmark of my career. Failure, although difficult, has been an opportunity to learn, not a barrier. Deliberate risk-taking has guided me, but mostly, I am an optimist and have taken risks because I never realized I could fail. Anyway, failure is not so bad. Finally, I have been blessed with amazing mentors and have enjoyed mentoring others. My career alternated between academic hospitals and universities in Canada. In comparison with the United States, pediatric psychology began later in Canada, and the boundaries between pediatric and clinical child psychology have been fluid. I think Phil Firestone and I held the first meeting on pediatric psychology in Canada in May of 1981 in Ottawa. The keynote speakers were Ed Christophersen, Ron Barr, Barney Alexander, Tom Coates, Mike Cataldo, Brian Flay, Kelly Brownell, and Jacqueline Dunbar. We published Pediatric and Adolescent Behavioral Medicine based on the meeting (McGrath & Firestone, 1983). The Early Years I grew up in Ottawa, Canada’s capital, the second of 10 children, in a large, devout, Irish Catholic family. I helped care for my younger siblings and this ignited an interest in helping children. Both parents stopped school at Grade 9, but they were convinced that education was the route to success. From my father, Matt, a bill collector who owned his own business, I learned that hard work and persistence would eventually pay off. From my mother, Jean, I learned the joys of taking care of others. My first notion of a career was to be a Catholic priest. I met Canice Connors, an energetic and charismatic Franciscan, studying to be a psychologist at the University of Ottawa who was filling in at our parish. He influenced me to attend a day seminary for high school. By the end of high school, I surmised that God did not exist and women did and traded my priestly vocation for a career in clinical psychology. I went to University of Ottawa because it was less expensive to live at home. Serge Piccinin taught introductory psychology at the University of Ottawa and engaged students with his stories of his daughter, to illustrate psychological phenomena. I was not in his class but went to all his lectures. The Saskatchewan Adventure 1967–1972 In 1967, a chance to study in another part of Canada for my second year brought me to the University of Saskatchewan in Regina. A cadre of radicals including William Livant, Ann Gustin, William Wynn, and Steve Heeren had, moved to Regina from the United States as psychology professors, and they taught and promoted radical approaches to psychology including Sufi, feminist, and radical political psychology. They were determined to build a new type of anti-capitalist psychology that would serve the people, instead of the ruling classes. Influenced by reading the early behavior therapists such as Joseph Wolpe and Richard B. Stuart, I preferred evidence to dogma, but I was acutely aware of the limits of traditional approaches to psychology. The summer after my second year, I worked at a psychodynamic residential treatment summer camp. We built the road, dug the well, and cooked over campfires in the wilds of northern Saskatchewan. I quit university to work and soon I was running a treatment home with 10 children and 8 staff and attending compulsory group psychodynamic therapy. The next summer I was burned out, quit, worked as a janitor, learned how to clean floors, and completed my undergraduate degree from the University of Saskatchewan Regina Campus in 1970. I applied to and was accepted to study at the University of Michigan with Richard Stuart in a combined Social Work and Psychology graduate program. The scholarship letter was lost in the mail, and I stayed at the University of Saskatchewan, Regina Campus, completing my master’s in 1972 under Ann Gustin, a feminist cognitive behavior therapist. I worked part-time in a clinic during the day and teaching an evening course in Yorkton, a town about 120 miles from Regina. Traveling late at night through blizzards on the prairies in an unreliable Volkswagen Beetle was an adventure I will never forget. Queen’s University 1972–1979 I was admitted to the Clinical Psychology PhD program at Queen’s University in Kingston, Canada in 1972. I was committed to psychology but was troubled by the lack of attention in psychology to socioeconomic disparities that were significant in mental health problems I had survey data for a dissertation on university student stress and abandoned it. Finally, I completed nine studies on measurement of social inadequacy in university students and used several studies in my dissertation. I never attempted to publish my dissertation. Ray Peters, my supervisor, was supportive and tolerant of me but must have wished he had never taken on this difficult, somewhat arrogant, student. I took 7 years after my master’s to complete my PhD. My personal life was also in tatters. I had married my childhood sweetheart. We were beginning our family and our son died shortly after his premature birth because of his immature lungs. It was shattering for both of us. We divorced and I became depressed. It was a miracle that I graduated. At Queen’s I learned how to think like a scientist and learned strong research skills, but I was determined to leave that behind. I wanted to help people solve problems. When I finished my PhD, I swore I would never do any research again. Children’s Hospital of Eastern Ontario, 1979–1989 In a last try to use my psychology training, I applied for a clinical post at the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa. In the interview, John T. Goodman, the Chief of Psychology asked about my research intentions. I bluffed that I would integrate my research into my clinical practice and was offered the job. The next decade transformed me and my career. The sea change began on my first day. I had over 40 referrals, mostly from the community for children with behavior disorders. I was baffled by 4 referrals. Each was hand written on a hospital referral sheet, “RAP, please assess and follow as appropriate.” The signature and the name of the service were incomprehensible. The temporary secretary was unable to help. I was reluctant to ask Dr. Goodman what the referrals were about, so I went to the hospital library. We determined that RAP was recurrent abdominal pain and used electronic searching via a teletype machine to a computer in California. Before this, we would spend days searching volumes of Index Medicus. We found good epidemiological studies that showed RAP was common and anecdotal articles that insisted that RAP was of psychological origin, often because of neurotic mothers. With a small research grant, I conducted a case control study on RAP investigating if RAP was psychogenic. I failed to find difference between cases and controls. The article languished until John Goodman prompted me to submit it. I was amazed when it was accepted (McGrath, Goodman, Firestone, Shipman, & Peters, 1983). Shortly thereafter, I published a practice-oriented paper (McGrath, 1983) to reach those who would not read the scientific paper. My first randomized controlled trial (RCT) was on RAP and was led by a charismatic, academic, general pediatrician, William “Bill” Feldman. We conducted a double-blind, randomized trial of dietary fiber biscuits. Compared with controls, twice as many children with RAP remitted by eating 10 g of supplementary fiber a day (Feldman, McGrath, Hodgson, Ritter & Shipman, 1985). When our gastroenterology colleague left, I stopped research on RAP. It was a good example of how important relationships are to the conduct of research. I became known as the “pain psychologist” and received referrals for a variety of pain problems. My research flourished as we published papers on headache, cancer pain, needle pain, chronic pain, postoperative pain, and measurement and perception of pain. Behavior disorders were still the bulk of my clinical referrals. With my mentor in this area, Philip Firestone, we also organized a series of scientific meetings. Two were published as edited books (McGrath & Firestone, 1983) and helped establish our hospital as a leading Canadian center in pediatric psychology. Because of my strong research profile, I received a Career Scientist Award from the Ontario Ministry of Health, which allowed me to devote more time to research. Peter Humphreys, the chief of neurology, and I completed a series of RCTs demonstrating that migraine could be managed with stress management taught by means of manuals, tapes, and phone calls by coaches (McGrath et al., 1988, 1992). We published the Help Yourself manuals (McGrath, Cunningham, Lascelles & Humphreys, 1990a, b). The program influenced many research and clinical programs in headache and was widely cited. However, it did not sell in the mass market, and the approach was not adopted as a routine treatment for migraine anywhere that I know of. Help Yourself was an academic success but an innovation failure. I learned that changing practice is a sociopolitical process and evidence is only one component. Other issues such as personal preferences of practitioners, the organization of clinical units, a well-organized sales program, and resistance to change are at least as important. Research staff can make or break any project. June Cunningham was one of my first grant-funded employees. She was amazing at running studies and made major conceptual contributions to the eight papers we published. She was a critical part of my success. Anita Unruh, an occupational therapist, and I usually disagreed on conceptual approaches to patients who were referred to both of us. We decided to study how children expressed their pain through their drawings of their headaches (Unruh, McGrath, Cunningham & Humphreys, 1983). We got to know each other and then fell in love and married. Two major projects preoccupied us in the following years. The first was our daughter, Maria (Mika). The second was the first comprehensive textbook on pediatric pain, Pain in Children and Adolescents (McGrath & Unruh, 1987). We adopted Mika when we were about to start a sabbatical to finish writing the book. We had rented our house and were ready to leave for England. We moved to my parents’ cottage for 6 months, while we fulfilled the legal supervision period for the adoption with two word processors and a crib. Anita and I were married for 35 years, and she was my best friend, colleague, and partner until her untimely death from ovarian cancer in July 2017. Bill Feldman and I collaborated on a book with Walter Rosser, the chief of Family Medicine at the University of Ottawa, wrote (Feldman, Rosser & McGrath, 1987). For every recommendation we made, we graded the scientific evidence. The evidence for medical interventions was no stronger than the evidence for psychosocial interventions. Primary Medical Care of Children and Adolescents was published and was a commercial failure, perhaps because of insufficient advertising or maybe we were ahead of our time. I mentored a young psychologist, Susan Pisterman who did early work on intervention with preschool children with ADHD (Pisterman, et al., 1989). I returned to these studies for inspiration for the work I have focused on for the past decade. Throughout my time at CHEO, I had adjunct appointments in Psychology at the University of Ottawa and at Carleton University, allowing me to supervise PhD students. My PhD students were talented and advanced my research. Mario Cappelli did not get into a clinical psychology program so enrolled in the experimental program at Carleton University. In those days, a nonclinical degree was still a back door to the practice of clinical psychology. He was particularly prolific and published seven papers during his studies on a wide range of problems of children with chronic illness. The clinic always generated ideas, many I did not expect. I met Jan Walker when I unsuccessfully tried to assist her with itching in her daughter with kidney disease. The itching was subsequently cured by a transplant. Later, she convinced me to supervise her undergraduate thesis on parental attitudes to organ donation, and she published two papers in medical journals (Walker et al., 1990). As I was ending my Career Scientist Award, I approached the hospital Research Institute for salary support to continue my research. I had published over 60 peer-reviewed papers and 4 books and was successful in grants. In Canada, investigators cannot be paid salary from grants, and so I needed salary from the Research Institute. My request was peremptorily denied, and so I looked for a new job. Clinical Psychology PhD Program, Dalhousie University, 1989–1998; 2002–2004 I landed an ideal job at Dalhousie University as the founding director of their PhD program in clinical psychology. I arrived in a complex political storm. The program was a collaboration with three smaller universities with Dalhousie University being the lead. There was pervasive excitement but also mistrust. Many of my nonclinical colleagues feared the clinical psychology program would lower the standards of the Department. The other universities worried they would be marginalized, and the clinical community thought that Dalhousie might put clinical training secondary to research. I spent most of my time trying to manage the fears of each group and hire a cadre of clinical psychology academics. With constant attention, I managed to make things work. We began the program with 10 students who had been admitted before my hiring. It was stressful, but I learned to manage the politics, build coalitions, and move the agenda forward. I learned that political maneuvering is inevitable when people feel something important is at stake (and sometimes when the issue is trivial). My credibility depended on my reestablishing my research. The week, I arrived at Dalhousie University, Allen Finley, a pediatric anesthesiologist, welcomed me and we started a long productive collaboration. We would meet on Saturday mornings at the Farmers’ Market. Allen and I have had dozens of grants and over 40 papers and 4 edited books together. We also created: the Pediatric Pain Mail List (begun in 1993) http://pediatric-pain.ca/resources/pediatric-pain-mailing-list/ to exchange ideas for treating difficult pain problems; the Pediatric Pain Letter (begun in 1996) http://childpain.org/ppl/, a peer-reviewed source of reviews; two booklets for families, Making Cancer Less Painful (1992) http://pediatric-pain.ca/wp-content/uploads/2013/04/MakingCancerLessPainful.pdf and Pain, Pain, Go Away (1994, 2003,) http://pediatric-pain.ca/wp-content/uploads/2013/04/PPGA2003.pdf. Somewhat later, I began writing a column, Ask Dr. Pat, for a local newspaper and on several websites, for example, www.crfh.ca. Finally, we established the International Forum on Pediatric Pain, a small, biennial meeting where there is intensive discussion of research and clinical advances at an idyllic seaside resort in Nova Scotia (McGrath & Finley, 2003). I have published over 300 articles, 140 editorials, comments and published abstracts, 14 books, and >50 book chapters. Although books and books chapters are usually not well cited, they serve a knowledge translation function, allow for development of ideas that might not fit in a journal article, and book chapters often allow graduate students to have a first author publication. My students at Dalhousie quickly became productive, and my research gained momentum and became grant funded. The most helpful was a no-strings-attached Pain Grant from Bristol Myers Squibb for $50,000 US per year (1993–1998). There was no application, and I had never done any work for Bristol Myers Squibb, and it was a surprise. The grant spurred pilot data for new areas. The only obligation was to attend a yearly meeting of the five awardees in some interesting venue. I got awards from the Canadian Pain Society and the American Pain Society. One award had a stipend I used to start the Dr. John Goodman Award for a trainee-published paper in pediatric pain recognizing my mentor from my Ottawa days. I was named an Officer of the Order of Canada, Canada’s most prestigious award. My family and one of my patients and her mother were able to attend. I now serve on the advisory committee that recommends Order of Canada recipients. I stepped down as the head of the clinical psychology program after about a decade in the post. I was glad to return full-time to the professorate. The advent of the Canadian Institutes of Health Research (CIHR), which replaced the much more narrowly focused and less well-funded Medical Research Council of Canada, allowed me to increase my grant capture mostly with pragmatic behavioral trials. I led colleagues, Craig, vonBaeyer, Stevens, Johnston, and Finley, from Vancouver, Saskatoon, Toronto, Montreal, and Halifax in obtaining a training grant on Pain in Child Health (PICH) from the CIHR. The grant began in 2001, and I stepped down from the leadership in 2012. We also obtained grants from the Mayday Fund for international participants from >14 countries. We funded students and developed many training opportunities (von Baeyer et al., 2014). PICH continues to transform pediatric pain trainees from isolated individuals into a supportive network of productive scientists under the leadership of Bonnie Stevens. Since its inception, over $5 million has been invested and a thousand papers have been published on pediatric pain by PICH trainees. Along with increased funding available for the CIHR, Canada developed Canada Research Chairs. I held a chair from 2002 to 2016, until I suggested my chair be transferred to one of my mid-career colleagues. Strongest Families™ I planned another foray into distance delivery of health care with the aim of increasing access. I developed a system of paraprofessionals delivering a manualized intervention for common child mental health problems teaching parents and children with videos and telephone calls (www.strongestfamilies.com). Consulting with administrators and parents, I discovered an appetite for this approach. Many clinicians, though, were skeptical and some hostile to the idea of paraprofessionals treating children without ever seeing them. Our program is family-centered: staff work when it is convenient for families; we treat families as valued collaborators and build on their strengths. I did not realize the original name, Family Help, was patronizing until we created the new name, Strongest Families, in response to a lawyer’s letter claiming trademark infringement. Some modules failed but we emerged with four modules—anxiety, attention deficit, oppositional defiant disorder, and bed-wetting. Even before we published papers, we had requests to provide services. Cathy Thurston, an administrator and clinician in a rural area of Nova Scotia, was a key reason for our success. She knew what administrators needed. Patricia Pottie, a nurse, was the research coordinator of our trials (McGrath et al., 2011) and then became the president and CEO of the not-for-profit company. She also completed an Interdisciplinary PhD examining therapeutic alliance between coaches and families (Lingley-Pottie & McGrath, 2008). We wanted to insure our employees were well treated, so we offered the same benefits as the hospital had. Initially, I recruited mental health professionals to the Board. Finally, I realized I needed business people as well because they knew business. We now have 70 employees and helped over 4,500 families in Canada past year. Strongest Families is providing service in Finland under the leadership of Dr. Andre Sourander, and we are beginning a national rollout of Strongest Families New Zealand. Strongest Families won the Manning Principal Award as the best innovation in Canada (2013), the Mental Health Commission Award for Social Innovation (2013), and the Governor General’s Award for Innovation (2017). The awards were for scaling up Strongest Families. Our proprietary IT system (Wozney et al., 2016) enhances efficiency and standardization. We made many mistakes. For example, three times we tried to have Strongest Families run locally. As a result of our failures, we will second senior staff to oversee implementation and we have clear, detailed contracts. The Bureaucrat Years 2007–2017 In 2007, I was appointed as the, first nonmedical head of research at the IWK. It was a steep learning curve. I thought that a vice president had power and could make things happen but that proved to be true only when decisions did not require additional funding and could be executed entirely within my own portfolio. My days quickly became filled with meetings. After 5 years, I became Vice President of Research and Innovation at the two academic health authorities in Nova Scotia, the IWK, and Capital District Health Authority. Political forces were at play, and soon, the nine health authorities other than the IWK were amalgamated. I became the Vice President of Research, Innovation, and Knowledge Translation for all of the health system in Nova Scotia. The only increases in research funding came when I linked research directly with patient care. The Transforming Research into Care (TRIC) grants (http://www.cdha.nshealth.ca/discovery-innovation/qeii-fdn-tric-grants) required: co-leadership by a scientist and an administrator; patient engagement; immediate benefit to patients; and evidence of sustainability if successful. I also sponsored Microresearch (http://www.microresearch-international.ca/), which was developed by two physicians from Nova Scotia in Africa, and we brought it home to our rural and marginalized communities. Microresearch trains and coaches teams from the community in research to answer local health questions. Chez NICU, a corporate research project, is a system to provide education, social support, and advanced communication among Neonatal Intensive Care Unit parents, their families, doctors, nurses, and community health-care professionals. Chez NICU was funded by the IWK Foundation and Atlantic Canada Opportunities Agency, the federal economic development agency. Cisco systems is a corporate partner leading commercialization. A nurse researcher, Marsha Campbell-Yeo, is the Principal Investigator. I had excellent administrators in both of the health authorities who kept the offices running efficiently. Leadership is important, but administrators, at the middle and lower levels, are the ones that make an organization work, and are the unrecognized heroes. Similarly, my administrator and research associates in my research group at the IWK kept the research going, while I was a bureaucrat. I enjoyed being mentored and mentoring and have received recognition for mentoring Martin P. Levin Mentorship Award of the Society of Pediatric Psychology; the Canadian Pain Society Mentorship Award, and the International Forum on Pediatric Pain, Pat Award. This last award was named after me, and the trophy is evocative, a coffee cup on a pedestal. Mentoring, in my opinion, is best when different disciplines mix, when bold ideas are championed and warm acceptance and high standards are promoted. The Next Challenge 2017- In September 2017, I retired from my Vice President posts and returned full-time to Dalhousie University as Professor of Psychiatry with cross appointments in Community Health and Epidemiology and Pediatrics. My major task is to develop the plan for a PhD in Psychiatry Research. My research now focuses on the development and evaluation of a variety of e-health applications. I also participate in pediatric pain research that is led by others. My colleagues and I are also editing the second edition of the Oxford Textbook of Pediatric Pain (McGrath, Stevens, Walker & Zempsky, 2013). Reflections I have been lucky to have an extraordinarily rewarding career. Opportunities have come to me by chance, but I was ready to act when they arose. I do not know what chance will bring me. I hope for a few more failures, a few more risks, and more mentoring. The future of pediatric psychology, in my opinion, lies in changing systems not just in researching and delivering care using current models. The insights and discoveries of pediatric psychology must be available to those who can benefit most in both developed and developing worlds. Automating what can be automated and standardizing work so that it can be done by less expensive staff is the only way we can serve all of those who need our services. E-health increasingly provides the opportunity to automate some tasks. Standardization of tasks is easier to implement and easier to monitor with e-health. However, the needs of the child and family must come first. The data and our patients’ feedback can show us the way. Our job is to listen. My advice to those starting in the field is to get excellent training and associate with individuals and teams who have similar goals. Be ambitious and do not accept that the way things are currently done is the best way. Be optimistic that change is possible and do not be afraid of failure. Worry less about the needs of our profession and more about the needs of our patients/clients and those who never become our patients/clients but should be. Have fun; you spend too much time at work for it to be miserable. Acknowledgments P.J.M.G.’s research is supported by the Canadian Institutes of Health Research. Dr. Lori Wozney and Ms. Swati Rathore provided editorial assistance. The comments of the reviewers and editors improved the manuscript. Funding Conflicts of interest: None declared. References Feldman W., McGrath P., Hodgson C., Ritter H., Shipman R. T. ( 1985). The use of dietary fiber in the management of simple, childhood, idiopathic, recurrent, abdominal pain: Results in a prospective, double-blind, randomized, controlled trial. American Journal of Diseases of Children , 139, 1216– 1218. Google Scholar CrossRef Search ADS PubMed  Feldman W., Rosser W., McGrath P. J. ( 1987). Primary medical care of children and adolescents . New York: Oxford University Press. Lingley-Pottie P., McGrath P. J. ( 2008). A paediatric therapeutic alliance occurs with distance intervention. Journal of Telemedicine and Telecare , 14, 236– 240. doi: 10.1258/jtt.2008.080101 Google Scholar CrossRef Search ADS PubMed  McGrath P. J., Firestone P. (Eds.) ( 1983). Pediatric and adolescent behavioral medicine: Issues in treatment . New York: Springer Publishing Company. McGrath P. J., Humphreys P., Goodman J. T., Keene D., Firestone P., Jacob P., Cunningham S. J. ( 1988). Relaxation prophylaxis for childhood migraine: A randomized placebo-controlled trial. Developmental Medicine and Child Neurology , 30, 626– 631. Google Scholar CrossRef Search ADS PubMed  McGrath P. J., Humphreys P., Keene D., Goodman J. T., Lascelles M. A., Cunningham S. J., Firestone P. ( 1992). The efficacy and efficiency of a self-administered treatment for adolescent migraine. Pain , 49, 321– 324. Google Scholar CrossRef Search ADS PubMed  McGrath P. ( 1983). Psychological aspects of recurrent abdominal pain. Canadian Family Physician , 29, 1655– 1659. Google Scholar PubMed  McGrath P. J., Goodman J. T., Firestone P., Shipman R., Peters S. ( 1983). Recurrent abdominal pain: A psychogenic disorder? Archives of Disease in Childhood , 58, 888– 890. Google Scholar CrossRef Search ADS PubMed  McGrath P. J., Cunningham S. J., Lascelles M. A. & Humphreys P. (Eds.) ( 1990a). Help Yourself (Professional Handbook): A treatment for migraine headaches  (pp. 61). Ottawa, Canada: University of Ottawa Press. McGrath P. J., Cunningham S. J., Lascelles M. A., Humphreys P. ( 1990b). Help yourself: A treatment for migraine headaches [Patient manual and audiotape] . Ottawa, Canada: University of Ottawa Press. McGrath P. J., Lingley-Pottie P., Thurston C., MacLean C., Cunningham C., Waschbusch D. A., Watters C., Stewart S., Bagnell A., Santor D., Chaplin W. ( 2011). Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: Randomized trials and overall analysis. Journal of the American Academy of Child & Adolescent Psychiatry , 50, 1162– 1172. doi: 10.1016/j.jaac.2011.07.013 Google Scholar CrossRef Search ADS   McGrath P. J., Stevens B., Walker S., Zempsky W. (Eds.) ( 2013). The Oxford textbook of paediatric pain . Oxford, England: Oxford University Press. Google Scholar CrossRef Search ADS   McGrath P. J., Unruh A. ( 1987). Pain in children and adolescents . Amsterdam, The Netherlands: Elsevier. McGrath P. J., Finley G. A. (Eds.) ( 2003). Pediatric pain: Biological and social context . Seattle, WA: IASP Press. Pisterman S., McGrath P., Firestone P., Goodman J. T., Webster I., Mallory R. ( 1989). Outcome of parent-mediated treatment of preschoolers with attention deficit disorder with hyperactivity. Journal of Consulting and Clinical Psychology , 57, 628– 635. Google Scholar CrossRef Search ADS PubMed  Unruh A., McGrath P., Cunningham S. J., Humphreys P. ( 1983). Children's drawings of their pain. Pain , 17, 385– 392. Google Scholar CrossRef Search ADS PubMed  von Baeyer C. L., Stevens B. J., Chambers C. T., Craig K. D., Finley G. A., Grunau R. E., Johnston C. C., Pillai Riddell R., Stinson J. N., Dol J., Campbell-Yeo M., McGrath P. J. ( 2014). Training highly qualified health research personnel: The Pain in Child Health consortium. Pain Research and Management , 19, 267– 274. Google Scholar CrossRef Search ADS PubMed  Walker J. A., McGrath P. J., MacDonald N. E., Wells G., Petrusic W., Nolan B. E. ( 1990). Parental attitudes toward pediatric organ donation: A survey. CMAJ , 142, 1383– 1387. Google Scholar PubMed  Wozney L., McGrath P. J., Newton A., Huguet A., Franklin M., Perri K., Leuschen K., Toombs E., Lingley-Pottie P. ( 2016). Usability, learnability and performance evaluation of Intelligent Research and Intervention Software: A delivery platform for eHealth interventions. Health Informatics Journal , 22, 730– 743. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Pediatric Psychology Oxford University Press

An Accidental Scientist: Chance, Failure, Risk-Taking, and Mentoring

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Abstract I never intended to become a scientist. My career developed on the basis of chance happenings, repeated failure, the willingness to take risks and the acceptance and provision of mentoring. My career has included periods of difficulty and shifted back and forth between academic health centers and universities in Canada. Although I have been amply recognized for my successes, my greatest learning has come from my failures. My greatest satisfaction has been in the development, evaluation and dissemination of interventions. The combination of intellectual stimulation and emotional gratification has meant a rewarding career clinical trial, cognitive–behavioral therapy, gastroenterology, headache, health-care services, intervention outcome, mental health, parenting Chance, rather than design, has been the hallmark of my career. Failure, although difficult, has been an opportunity to learn, not a barrier. Deliberate risk-taking has guided me, but mostly, I am an optimist and have taken risks because I never realized I could fail. Anyway, failure is not so bad. Finally, I have been blessed with amazing mentors and have enjoyed mentoring others. My career alternated between academic hospitals and universities in Canada. In comparison with the United States, pediatric psychology began later in Canada, and the boundaries between pediatric and clinical child psychology have been fluid. I think Phil Firestone and I held the first meeting on pediatric psychology in Canada in May of 1981 in Ottawa. The keynote speakers were Ed Christophersen, Ron Barr, Barney Alexander, Tom Coates, Mike Cataldo, Brian Flay, Kelly Brownell, and Jacqueline Dunbar. We published Pediatric and Adolescent Behavioral Medicine based on the meeting (McGrath & Firestone, 1983). The Early Years I grew up in Ottawa, Canada’s capital, the second of 10 children, in a large, devout, Irish Catholic family. I helped care for my younger siblings and this ignited an interest in helping children. Both parents stopped school at Grade 9, but they were convinced that education was the route to success. From my father, Matt, a bill collector who owned his own business, I learned that hard work and persistence would eventually pay off. From my mother, Jean, I learned the joys of taking care of others. My first notion of a career was to be a Catholic priest. I met Canice Connors, an energetic and charismatic Franciscan, studying to be a psychologist at the University of Ottawa who was filling in at our parish. He influenced me to attend a day seminary for high school. By the end of high school, I surmised that God did not exist and women did and traded my priestly vocation for a career in clinical psychology. I went to University of Ottawa because it was less expensive to live at home. Serge Piccinin taught introductory psychology at the University of Ottawa and engaged students with his stories of his daughter, to illustrate psychological phenomena. I was not in his class but went to all his lectures. The Saskatchewan Adventure 1967–1972 In 1967, a chance to study in another part of Canada for my second year brought me to the University of Saskatchewan in Regina. A cadre of radicals including William Livant, Ann Gustin, William Wynn, and Steve Heeren had, moved to Regina from the United States as psychology professors, and they taught and promoted radical approaches to psychology including Sufi, feminist, and radical political psychology. They were determined to build a new type of anti-capitalist psychology that would serve the people, instead of the ruling classes. Influenced by reading the early behavior therapists such as Joseph Wolpe and Richard B. Stuart, I preferred evidence to dogma, but I was acutely aware of the limits of traditional approaches to psychology. The summer after my second year, I worked at a psychodynamic residential treatment summer camp. We built the road, dug the well, and cooked over campfires in the wilds of northern Saskatchewan. I quit university to work and soon I was running a treatment home with 10 children and 8 staff and attending compulsory group psychodynamic therapy. The next summer I was burned out, quit, worked as a janitor, learned how to clean floors, and completed my undergraduate degree from the University of Saskatchewan Regina Campus in 1970. I applied to and was accepted to study at the University of Michigan with Richard Stuart in a combined Social Work and Psychology graduate program. The scholarship letter was lost in the mail, and I stayed at the University of Saskatchewan, Regina Campus, completing my master’s in 1972 under Ann Gustin, a feminist cognitive behavior therapist. I worked part-time in a clinic during the day and teaching an evening course in Yorkton, a town about 120 miles from Regina. Traveling late at night through blizzards on the prairies in an unreliable Volkswagen Beetle was an adventure I will never forget. Queen’s University 1972–1979 I was admitted to the Clinical Psychology PhD program at Queen’s University in Kingston, Canada in 1972. I was committed to psychology but was troubled by the lack of attention in psychology to socioeconomic disparities that were significant in mental health problems I had survey data for a dissertation on university student stress and abandoned it. Finally, I completed nine studies on measurement of social inadequacy in university students and used several studies in my dissertation. I never attempted to publish my dissertation. Ray Peters, my supervisor, was supportive and tolerant of me but must have wished he had never taken on this difficult, somewhat arrogant, student. I took 7 years after my master’s to complete my PhD. My personal life was also in tatters. I had married my childhood sweetheart. We were beginning our family and our son died shortly after his premature birth because of his immature lungs. It was shattering for both of us. We divorced and I became depressed. It was a miracle that I graduated. At Queen’s I learned how to think like a scientist and learned strong research skills, but I was determined to leave that behind. I wanted to help people solve problems. When I finished my PhD, I swore I would never do any research again. Children’s Hospital of Eastern Ontario, 1979–1989 In a last try to use my psychology training, I applied for a clinical post at the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa. In the interview, John T. Goodman, the Chief of Psychology asked about my research intentions. I bluffed that I would integrate my research into my clinical practice and was offered the job. The next decade transformed me and my career. The sea change began on my first day. I had over 40 referrals, mostly from the community for children with behavior disorders. I was baffled by 4 referrals. Each was hand written on a hospital referral sheet, “RAP, please assess and follow as appropriate.” The signature and the name of the service were incomprehensible. The temporary secretary was unable to help. I was reluctant to ask Dr. Goodman what the referrals were about, so I went to the hospital library. We determined that RAP was recurrent abdominal pain and used electronic searching via a teletype machine to a computer in California. Before this, we would spend days searching volumes of Index Medicus. We found good epidemiological studies that showed RAP was common and anecdotal articles that insisted that RAP was of psychological origin, often because of neurotic mothers. With a small research grant, I conducted a case control study on RAP investigating if RAP was psychogenic. I failed to find difference between cases and controls. The article languished until John Goodman prompted me to submit it. I was amazed when it was accepted (McGrath, Goodman, Firestone, Shipman, & Peters, 1983). Shortly thereafter, I published a practice-oriented paper (McGrath, 1983) to reach those who would not read the scientific paper. My first randomized controlled trial (RCT) was on RAP and was led by a charismatic, academic, general pediatrician, William “Bill” Feldman. We conducted a double-blind, randomized trial of dietary fiber biscuits. Compared with controls, twice as many children with RAP remitted by eating 10 g of supplementary fiber a day (Feldman, McGrath, Hodgson, Ritter & Shipman, 1985). When our gastroenterology colleague left, I stopped research on RAP. It was a good example of how important relationships are to the conduct of research. I became known as the “pain psychologist” and received referrals for a variety of pain problems. My research flourished as we published papers on headache, cancer pain, needle pain, chronic pain, postoperative pain, and measurement and perception of pain. Behavior disorders were still the bulk of my clinical referrals. With my mentor in this area, Philip Firestone, we also organized a series of scientific meetings. Two were published as edited books (McGrath & Firestone, 1983) and helped establish our hospital as a leading Canadian center in pediatric psychology. Because of my strong research profile, I received a Career Scientist Award from the Ontario Ministry of Health, which allowed me to devote more time to research. Peter Humphreys, the chief of neurology, and I completed a series of RCTs demonstrating that migraine could be managed with stress management taught by means of manuals, tapes, and phone calls by coaches (McGrath et al., 1988, 1992). We published the Help Yourself manuals (McGrath, Cunningham, Lascelles & Humphreys, 1990a, b). The program influenced many research and clinical programs in headache and was widely cited. However, it did not sell in the mass market, and the approach was not adopted as a routine treatment for migraine anywhere that I know of. Help Yourself was an academic success but an innovation failure. I learned that changing practice is a sociopolitical process and evidence is only one component. Other issues such as personal preferences of practitioners, the organization of clinical units, a well-organized sales program, and resistance to change are at least as important. Research staff can make or break any project. June Cunningham was one of my first grant-funded employees. She was amazing at running studies and made major conceptual contributions to the eight papers we published. She was a critical part of my success. Anita Unruh, an occupational therapist, and I usually disagreed on conceptual approaches to patients who were referred to both of us. We decided to study how children expressed their pain through their drawings of their headaches (Unruh, McGrath, Cunningham & Humphreys, 1983). We got to know each other and then fell in love and married. Two major projects preoccupied us in the following years. The first was our daughter, Maria (Mika). The second was the first comprehensive textbook on pediatric pain, Pain in Children and Adolescents (McGrath & Unruh, 1987). We adopted Mika when we were about to start a sabbatical to finish writing the book. We had rented our house and were ready to leave for England. We moved to my parents’ cottage for 6 months, while we fulfilled the legal supervision period for the adoption with two word processors and a crib. Anita and I were married for 35 years, and she was my best friend, colleague, and partner until her untimely death from ovarian cancer in July 2017. Bill Feldman and I collaborated on a book with Walter Rosser, the chief of Family Medicine at the University of Ottawa, wrote (Feldman, Rosser & McGrath, 1987). For every recommendation we made, we graded the scientific evidence. The evidence for medical interventions was no stronger than the evidence for psychosocial interventions. Primary Medical Care of Children and Adolescents was published and was a commercial failure, perhaps because of insufficient advertising or maybe we were ahead of our time. I mentored a young psychologist, Susan Pisterman who did early work on intervention with preschool children with ADHD (Pisterman, et al., 1989). I returned to these studies for inspiration for the work I have focused on for the past decade. Throughout my time at CHEO, I had adjunct appointments in Psychology at the University of Ottawa and at Carleton University, allowing me to supervise PhD students. My PhD students were talented and advanced my research. Mario Cappelli did not get into a clinical psychology program so enrolled in the experimental program at Carleton University. In those days, a nonclinical degree was still a back door to the practice of clinical psychology. He was particularly prolific and published seven papers during his studies on a wide range of problems of children with chronic illness. The clinic always generated ideas, many I did not expect. I met Jan Walker when I unsuccessfully tried to assist her with itching in her daughter with kidney disease. The itching was subsequently cured by a transplant. Later, she convinced me to supervise her undergraduate thesis on parental attitudes to organ donation, and she published two papers in medical journals (Walker et al., 1990). As I was ending my Career Scientist Award, I approached the hospital Research Institute for salary support to continue my research. I had published over 60 peer-reviewed papers and 4 books and was successful in grants. In Canada, investigators cannot be paid salary from grants, and so I needed salary from the Research Institute. My request was peremptorily denied, and so I looked for a new job. Clinical Psychology PhD Program, Dalhousie University, 1989–1998; 2002–2004 I landed an ideal job at Dalhousie University as the founding director of their PhD program in clinical psychology. I arrived in a complex political storm. The program was a collaboration with three smaller universities with Dalhousie University being the lead. There was pervasive excitement but also mistrust. Many of my nonclinical colleagues feared the clinical psychology program would lower the standards of the Department. The other universities worried they would be marginalized, and the clinical community thought that Dalhousie might put clinical training secondary to research. I spent most of my time trying to manage the fears of each group and hire a cadre of clinical psychology academics. With constant attention, I managed to make things work. We began the program with 10 students who had been admitted before my hiring. It was stressful, but I learned to manage the politics, build coalitions, and move the agenda forward. I learned that political maneuvering is inevitable when people feel something important is at stake (and sometimes when the issue is trivial). My credibility depended on my reestablishing my research. The week, I arrived at Dalhousie University, Allen Finley, a pediatric anesthesiologist, welcomed me and we started a long productive collaboration. We would meet on Saturday mornings at the Farmers’ Market. Allen and I have had dozens of grants and over 40 papers and 4 edited books together. We also created: the Pediatric Pain Mail List (begun in 1993) http://pediatric-pain.ca/resources/pediatric-pain-mailing-list/ to exchange ideas for treating difficult pain problems; the Pediatric Pain Letter (begun in 1996) http://childpain.org/ppl/, a peer-reviewed source of reviews; two booklets for families, Making Cancer Less Painful (1992) http://pediatric-pain.ca/wp-content/uploads/2013/04/MakingCancerLessPainful.pdf and Pain, Pain, Go Away (1994, 2003,) http://pediatric-pain.ca/wp-content/uploads/2013/04/PPGA2003.pdf. Somewhat later, I began writing a column, Ask Dr. Pat, for a local newspaper and on several websites, for example, www.crfh.ca. Finally, we established the International Forum on Pediatric Pain, a small, biennial meeting where there is intensive discussion of research and clinical advances at an idyllic seaside resort in Nova Scotia (McGrath & Finley, 2003). I have published over 300 articles, 140 editorials, comments and published abstracts, 14 books, and >50 book chapters. Although books and books chapters are usually not well cited, they serve a knowledge translation function, allow for development of ideas that might not fit in a journal article, and book chapters often allow graduate students to have a first author publication. My students at Dalhousie quickly became productive, and my research gained momentum and became grant funded. The most helpful was a no-strings-attached Pain Grant from Bristol Myers Squibb for $50,000 US per year (1993–1998). There was no application, and I had never done any work for Bristol Myers Squibb, and it was a surprise. The grant spurred pilot data for new areas. The only obligation was to attend a yearly meeting of the five awardees in some interesting venue. I got awards from the Canadian Pain Society and the American Pain Society. One award had a stipend I used to start the Dr. John Goodman Award for a trainee-published paper in pediatric pain recognizing my mentor from my Ottawa days. I was named an Officer of the Order of Canada, Canada’s most prestigious award. My family and one of my patients and her mother were able to attend. I now serve on the advisory committee that recommends Order of Canada recipients. I stepped down as the head of the clinical psychology program after about a decade in the post. I was glad to return full-time to the professorate. The advent of the Canadian Institutes of Health Research (CIHR), which replaced the much more narrowly focused and less well-funded Medical Research Council of Canada, allowed me to increase my grant capture mostly with pragmatic behavioral trials. I led colleagues, Craig, vonBaeyer, Stevens, Johnston, and Finley, from Vancouver, Saskatoon, Toronto, Montreal, and Halifax in obtaining a training grant on Pain in Child Health (PICH) from the CIHR. The grant began in 2001, and I stepped down from the leadership in 2012. We also obtained grants from the Mayday Fund for international participants from >14 countries. We funded students and developed many training opportunities (von Baeyer et al., 2014). PICH continues to transform pediatric pain trainees from isolated individuals into a supportive network of productive scientists under the leadership of Bonnie Stevens. Since its inception, over $5 million has been invested and a thousand papers have been published on pediatric pain by PICH trainees. Along with increased funding available for the CIHR, Canada developed Canada Research Chairs. I held a chair from 2002 to 2016, until I suggested my chair be transferred to one of my mid-career colleagues. Strongest Families™ I planned another foray into distance delivery of health care with the aim of increasing access. I developed a system of paraprofessionals delivering a manualized intervention for common child mental health problems teaching parents and children with videos and telephone calls (www.strongestfamilies.com). Consulting with administrators and parents, I discovered an appetite for this approach. Many clinicians, though, were skeptical and some hostile to the idea of paraprofessionals treating children without ever seeing them. Our program is family-centered: staff work when it is convenient for families; we treat families as valued collaborators and build on their strengths. I did not realize the original name, Family Help, was patronizing until we created the new name, Strongest Families, in response to a lawyer’s letter claiming trademark infringement. Some modules failed but we emerged with four modules—anxiety, attention deficit, oppositional defiant disorder, and bed-wetting. Even before we published papers, we had requests to provide services. Cathy Thurston, an administrator and clinician in a rural area of Nova Scotia, was a key reason for our success. She knew what administrators needed. Patricia Pottie, a nurse, was the research coordinator of our trials (McGrath et al., 2011) and then became the president and CEO of the not-for-profit company. She also completed an Interdisciplinary PhD examining therapeutic alliance between coaches and families (Lingley-Pottie & McGrath, 2008). We wanted to insure our employees were well treated, so we offered the same benefits as the hospital had. Initially, I recruited mental health professionals to the Board. Finally, I realized I needed business people as well because they knew business. We now have 70 employees and helped over 4,500 families in Canada past year. Strongest Families is providing service in Finland under the leadership of Dr. Andre Sourander, and we are beginning a national rollout of Strongest Families New Zealand. Strongest Families won the Manning Principal Award as the best innovation in Canada (2013), the Mental Health Commission Award for Social Innovation (2013), and the Governor General’s Award for Innovation (2017). The awards were for scaling up Strongest Families. Our proprietary IT system (Wozney et al., 2016) enhances efficiency and standardization. We made many mistakes. For example, three times we tried to have Strongest Families run locally. As a result of our failures, we will second senior staff to oversee implementation and we have clear, detailed contracts. The Bureaucrat Years 2007–2017 In 2007, I was appointed as the, first nonmedical head of research at the IWK. It was a steep learning curve. I thought that a vice president had power and could make things happen but that proved to be true only when decisions did not require additional funding and could be executed entirely within my own portfolio. My days quickly became filled with meetings. After 5 years, I became Vice President of Research and Innovation at the two academic health authorities in Nova Scotia, the IWK, and Capital District Health Authority. Political forces were at play, and soon, the nine health authorities other than the IWK were amalgamated. I became the Vice President of Research, Innovation, and Knowledge Translation for all of the health system in Nova Scotia. The only increases in research funding came when I linked research directly with patient care. The Transforming Research into Care (TRIC) grants (http://www.cdha.nshealth.ca/discovery-innovation/qeii-fdn-tric-grants) required: co-leadership by a scientist and an administrator; patient engagement; immediate benefit to patients; and evidence of sustainability if successful. I also sponsored Microresearch (http://www.microresearch-international.ca/), which was developed by two physicians from Nova Scotia in Africa, and we brought it home to our rural and marginalized communities. Microresearch trains and coaches teams from the community in research to answer local health questions. Chez NICU, a corporate research project, is a system to provide education, social support, and advanced communication among Neonatal Intensive Care Unit parents, their families, doctors, nurses, and community health-care professionals. Chez NICU was funded by the IWK Foundation and Atlantic Canada Opportunities Agency, the federal economic development agency. Cisco systems is a corporate partner leading commercialization. A nurse researcher, Marsha Campbell-Yeo, is the Principal Investigator. I had excellent administrators in both of the health authorities who kept the offices running efficiently. Leadership is important, but administrators, at the middle and lower levels, are the ones that make an organization work, and are the unrecognized heroes. Similarly, my administrator and research associates in my research group at the IWK kept the research going, while I was a bureaucrat. I enjoyed being mentored and mentoring and have received recognition for mentoring Martin P. Levin Mentorship Award of the Society of Pediatric Psychology; the Canadian Pain Society Mentorship Award, and the International Forum on Pediatric Pain, Pat Award. This last award was named after me, and the trophy is evocative, a coffee cup on a pedestal. Mentoring, in my opinion, is best when different disciplines mix, when bold ideas are championed and warm acceptance and high standards are promoted. The Next Challenge 2017- In September 2017, I retired from my Vice President posts and returned full-time to Dalhousie University as Professor of Psychiatry with cross appointments in Community Health and Epidemiology and Pediatrics. My major task is to develop the plan for a PhD in Psychiatry Research. My research now focuses on the development and evaluation of a variety of e-health applications. I also participate in pediatric pain research that is led by others. My colleagues and I are also editing the second edition of the Oxford Textbook of Pediatric Pain (McGrath, Stevens, Walker & Zempsky, 2013). Reflections I have been lucky to have an extraordinarily rewarding career. Opportunities have come to me by chance, but I was ready to act when they arose. I do not know what chance will bring me. I hope for a few more failures, a few more risks, and more mentoring. The future of pediatric psychology, in my opinion, lies in changing systems not just in researching and delivering care using current models. The insights and discoveries of pediatric psychology must be available to those who can benefit most in both developed and developing worlds. Automating what can be automated and standardizing work so that it can be done by less expensive staff is the only way we can serve all of those who need our services. E-health increasingly provides the opportunity to automate some tasks. Standardization of tasks is easier to implement and easier to monitor with e-health. However, the needs of the child and family must come first. The data and our patients’ feedback can show us the way. Our job is to listen. My advice to those starting in the field is to get excellent training and associate with individuals and teams who have similar goals. Be ambitious and do not accept that the way things are currently done is the best way. Be optimistic that change is possible and do not be afraid of failure. Worry less about the needs of our profession and more about the needs of our patients/clients and those who never become our patients/clients but should be. Have fun; you spend too much time at work for it to be miserable. Acknowledgments P.J.M.G.’s research is supported by the Canadian Institutes of Health Research. Dr. Lori Wozney and Ms. Swati Rathore provided editorial assistance. The comments of the reviewers and editors improved the manuscript. Funding Conflicts of interest: None declared. References Feldman W., McGrath P., Hodgson C., Ritter H., Shipman R. T. ( 1985). The use of dietary fiber in the management of simple, childhood, idiopathic, recurrent, abdominal pain: Results in a prospective, double-blind, randomized, controlled trial. American Journal of Diseases of Children , 139, 1216– 1218. Google Scholar CrossRef Search ADS PubMed  Feldman W., Rosser W., McGrath P. J. ( 1987). Primary medical care of children and adolescents . New York: Oxford University Press. Lingley-Pottie P., McGrath P. J. ( 2008). A paediatric therapeutic alliance occurs with distance intervention. Journal of Telemedicine and Telecare , 14, 236– 240. doi: 10.1258/jtt.2008.080101 Google Scholar CrossRef Search ADS PubMed  McGrath P. J., Firestone P. (Eds.) ( 1983). Pediatric and adolescent behavioral medicine: Issues in treatment . New York: Springer Publishing Company. McGrath P. J., Humphreys P., Goodman J. T., Keene D., Firestone P., Jacob P., Cunningham S. J. ( 1988). Relaxation prophylaxis for childhood migraine: A randomized placebo-controlled trial. Developmental Medicine and Child Neurology , 30, 626– 631. Google Scholar CrossRef Search ADS PubMed  McGrath P. J., Humphreys P., Keene D., Goodman J. T., Lascelles M. A., Cunningham S. J., Firestone P. ( 1992). The efficacy and efficiency of a self-administered treatment for adolescent migraine. Pain , 49, 321– 324. Google Scholar CrossRef Search ADS PubMed  McGrath P. ( 1983). Psychological aspects of recurrent abdominal pain. Canadian Family Physician , 29, 1655– 1659. Google Scholar PubMed  McGrath P. J., Goodman J. T., Firestone P., Shipman R., Peters S. ( 1983). Recurrent abdominal pain: A psychogenic disorder? Archives of Disease in Childhood , 58, 888– 890. Google Scholar CrossRef Search ADS PubMed  McGrath P. J., Cunningham S. J., Lascelles M. A. & Humphreys P. (Eds.) ( 1990a). Help Yourself (Professional Handbook): A treatment for migraine headaches  (pp. 61). Ottawa, Canada: University of Ottawa Press. McGrath P. J., Cunningham S. J., Lascelles M. A., Humphreys P. ( 1990b). Help yourself: A treatment for migraine headaches [Patient manual and audiotape] . Ottawa, Canada: University of Ottawa Press. McGrath P. J., Lingley-Pottie P., Thurston C., MacLean C., Cunningham C., Waschbusch D. A., Watters C., Stewart S., Bagnell A., Santor D., Chaplin W. ( 2011). Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: Randomized trials and overall analysis. Journal of the American Academy of Child & Adolescent Psychiatry , 50, 1162– 1172. doi: 10.1016/j.jaac.2011.07.013 Google Scholar CrossRef Search ADS   McGrath P. J., Stevens B., Walker S., Zempsky W. (Eds.) ( 2013). The Oxford textbook of paediatric pain . Oxford, England: Oxford University Press. Google Scholar CrossRef Search ADS   McGrath P. J., Unruh A. ( 1987). Pain in children and adolescents . Amsterdam, The Netherlands: Elsevier. McGrath P. J., Finley G. A. (Eds.) ( 2003). Pediatric pain: Biological and social context . Seattle, WA: IASP Press. Pisterman S., McGrath P., Firestone P., Goodman J. T., Webster I., Mallory R. ( 1989). Outcome of parent-mediated treatment of preschoolers with attention deficit disorder with hyperactivity. Journal of Consulting and Clinical Psychology , 57, 628– 635. Google Scholar CrossRef Search ADS PubMed  Unruh A., McGrath P., Cunningham S. J., Humphreys P. ( 1983). Children's drawings of their pain. Pain , 17, 385– 392. Google Scholar CrossRef Search ADS PubMed  von Baeyer C. L., Stevens B. J., Chambers C. T., Craig K. D., Finley G. A., Grunau R. E., Johnston C. C., Pillai Riddell R., Stinson J. N., Dol J., Campbell-Yeo M., McGrath P. J. ( 2014). Training highly qualified health research personnel: The Pain in Child Health consortium. Pain Research and Management , 19, 267– 274. Google Scholar CrossRef Search ADS PubMed  Walker J. A., McGrath P. J., MacDonald N. E., Wells G., Petrusic W., Nolan B. E. ( 1990). Parental attitudes toward pediatric organ donation: A survey. CMAJ , 142, 1383– 1387. Google Scholar PubMed  Wozney L., McGrath P. J., Newton A., Huguet A., Franklin M., Perri K., Leuschen K., Toombs E., Lingley-Pottie P. ( 2016). Usability, learnability and performance evaluation of Intelligent Research and Intervention Software: A delivery platform for eHealth interventions. Health Informatics Journal , 22, 730– 743. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

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Journal of Pediatric PsychologyOxford University Press

Published: Apr 6, 2018

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