{'fraction_non_alphanumeric': 0.024902615470228158, 'fraction_numerical': 0.004451864218141347, 'mean_word_length': 5.470747074707471, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Tools to guide the identification and implementation of care consistent with the psychosocial Standards of care

Fifteen evidence‐based Standards of psychosocial care for children with cancer and their families have been established. Despite the importance of implementing the standards, significant barriers and challenges exist. In order to overcome barriers to implementation and assess the level of current psychosocial care, a model of evaluating psychosocial care (Matrix) and a set of pathways toward achieving optimal care (Guidelines) were developed. This special report describes the process involved in the creation of standard templates and development of content based on rigorous reviews from multidisciplinary psychosocial experts, focus groups, and multiple revisions based on further expert review. The resulting Matrix and Guidelines are included as Supplemental Information.

Several studies demonstrated that while the spirit of the Standards were being met in some centers, there were fiscal and institutional challenges to implementation, and overall uptake was slow. 3,[12][13][14] Additionally, the authors received tremendous support to implement the Standards along with frequent requests for guidance on best practices for adopting the Standards across cancer centers of different sizes or current level of resources. These data and requests from frontline clinicians suggested that delivery models and implementation tools for individual cancer site use were needed. Implementation of practice standards, however, requires attention to the day-to-day responsibilities of psychosocial providers, the constraints they face, and the practice of psychosocial care in medical settings. Implementation also requires an honest assessment of the quality of care currently provided at each pediatric cancer center. This paper provides the methodology used to develop tools that can now guide the identification and implementation of care consistent with the standards of psychosocial care.

METHODS
A Matrix and Guidelines Working Group was formed, consisting of members of the Standards leadership group, first authors of each of the published Standards, 6 and other representatives from pediatric oncology, nursing, social work, psychology, psychiatry, education, and child life. The Standards leadership group explored potential implementation models [15][16][17][18][19]

Matrix
For each Standard, the Matrix has three columns: (a) the published Standard; (b) the domains and essential elements to consider in the assessment or implementation of that Standard; and (c) levels, a 1-5 scoring rubric.

Guidelines
The Guidelines include the Standard across the top and has three columns: (a) Actions describe what the Standard requires for implementation (eg, conduct systematic assessments of youth and family psychosocial health care needs); (b) Strategies are the specific tasks to assist providers and teams in their implementation of the Standard; and (c) Resources/Tools provide assessment tools, interventions, organizations, trainings, articles, and more (including live links) that may be helpful in implementing the recommended strategies.
The Matrix and Guidelines templates underwent five iterative revisions based on extensive reviews within our working group, multidisciplinary expert opinion, and a working group meeting with patient advocates and experts of the CPCM.

RESULTS
Finalizing the 15-Standard Matrix and Guidelines to prepare it for dissemination and use was an eight-step process. Suggested edits for each Standard were reviewed by the leadership group (Lori Wiener, Mary Jo Kupst, Wendy Pelletier, and Amanda L. Thompson) as well as other content experts, and were accepted only after consensus agreement.
Step 1. Initial drafts of the Matrix and Guidelines for each Standard were created (Lori Wiener and Mary Jo Kupst).
Step 2. Each initial draft of the Matrix and Guidelines was sent to the primary authors for the paper on that Standard for review and edits.
The primary authors were asked to bring the Matrix and Guidelines to their pediatric cancer site for review. They were specifically encouraged to ask, "Can the Matrix, as written, be used to confidently rate where we stand on implementing this Standard within our program?" and "Are the Guidelines clearly written, helpful, and potentially useful in increasing our score/full implementation?" Step 3. Once all 15 standards were reviewed by the primary authors, the Matrix and Guidelines underwent additional reviews by multidisciplinary experts in psychosocial care and the specific standard topic (eg, Note. Content has been converted from its original online form to table format for publication.
Step 6. The next layer of reviews was provided electronically by Step 7. Final reviews and edits were made, focusing on consistent formatting, content, and style.
Step 8 There are several other potential benefits to utilizing the Matrix and Guidelines. These tools can help academic and community-based centers identify areas where care can be improved. They can be used at multiple time points to chart changes, review growth, and identify resources that enable changes (eg, moving from no systematic process for psychosocial screening to consistent screening using a standardized method), which can link changes to care. 15 They provide QI/QA opportunities, as well as support for psychosocial programs to upgrade their services with their institutions.
While the reviewers reported that the Matrix and Guidelines appear to be user friendly and feasible to utilize in pediatric oncology settings, additional steps are needed, particularly to ensure sustainability. These are some limitations to the current tools and important caveats that must be considered by users. In the Guidelines, links are provided for resources and tools, where available; however, authors cannot guarantee the currency, accuracy, relevance, or completeness of information found on linked, external websites as these change over time. We aimed to include resources and clinical tools that have a strong evidence base, but where these were limited, those commonly used in pediatric oncology settings were included. In addition, we recognize that new assessment tools and interventions are continuously being developed and tested for youth and families, so the list cannot be exhaustive and will require updating. Further, we recognize that most resources are US-based and may not be applicable to psychosocial providers practicing in international centers. There may be other appropriate resources not included in these Guidelines that are available in other countries.
In summary, there is a critical need to establish clear indicators and to effectively assess quality of care across multiple pediatric cancer centers. This is now possible with the publication of the evidence-based Standards of care and the Matrix and Guidelines as implementation tools. These tools can be disseminated widely at no cost, and they have the potential to provide greater uniformity of the highest quality of psychosocial care across.

ACKNOWLEDGMENTS
The authors wish to acknowledge Drs Anne Kazak, Robert Noll, and