Providing Integrated Behavioral Health Services to Patients With Serious Pediatric Illness

Schwartz, Lisa A.; Feudtner, Chris

doi:10.1001/jamapediatrics.2019.1683

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…Emerging benefits in the integrated pediatric primary care literature suggest that BHI in pediatric specialty clinics could provide similar value (Samsel et al, 2017; Schwartz & Feudtner, 2019). In addition, integrated specialty care may provide benefits beyond integrated primary care, given the complex impact of multimorbidity on overall health care utilization, treatment adherence, and patient and family psychosocial functioning.…”

Section: Available Knowledgementioning

confidence: 99%

“…There are a growing number of articles related to specific BH interventions in pediatric specialty clinics, although the literature is limited regarding BH models and methods of integration (Samsel et al, 2017; Schwartz & Feudtner, 2019). That said, several specialties have standards of care that support BHI (e.g., transplant, oncology, cystic fibrosis), which endorse the transition from viewing BHI as an optional service requiring external funding to an essential service adhering to institutional and accreditation mandates (Garcia et al, 2015; Samsel et al, 2017; Skillings & Lewandowski, 2015; Steele et al, 2015).…”

Section: Models Of Integrationmentioning

confidence: 99%

“…Further, nonadherence to medical treatment for several pediatric chronic conditions (e.g., asthma, diabetes) reaches as high as 50%, which reflects the considerable undertreatment of pediatric chronic health conditions compared to recommended standards of medical care (Kahana et al, 2008). Moreover, when compared to healthy peers across the United States and Europe, youth with chronic physical conditions (and related health challenges) encounter a disproportionately higher degree of emotional and psychosocial burden (Schwartz & Feudtner, 2019); including two to three times higher prevalence of depression and anxiety (Quittner et al, 2014).…”

Section: Unmet Needsmentioning

confidence: 99%

See 2 more Smart Citations

Quality improvement in pediatrics: Survey Needs Assessment for Ambulatory Pediatric Specialties (SNAAPS).

Rice¹,

Alpert-Gillis²,

Cohen³

et al. 2023

Clinical Practice in Pediatric Psychology

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Objective: This article describes a pediatric quality improvement (QI) initiative designed to improve access to behavioral health (BH) care across pediatric specialty clinics. Mental health concerns and chronic health conditions are undertreated in American youth. By implementing a robust biopsychosocial model of care, behavioral health integration (BHI) across pediatric specialty clinics provides opportunities to address mental health concerns, reduce access barriers to mental health care, decrease mental health stigma, improve care continuity, and increase effectiveness of medical care provided. Method: The Survey Needs Assessment in Ambulatory Pediatric Specialties (SNAAPS) was developed and implemented within the pediatric QI initiative following the Plan, Do, Study, Act (PDSA) cycle. The SNAAPS was used to assess medical provider identification of challenging mental health concerns and perceived need for BHI. Results: Results were shared with department stakeholders to inform new integration efforts. Providers reported highest demand for BHI to address issues of depression, anxiety, distress regarding medical diagnosis and treatment, and treatment adherence. Providers reported several BH concerns created barriers to effective medical care and providers only sometimes felt successful in overcoming these barriers to conducting medical care. Conclusions: Demand for BHI was clear across many specialties. Using the SNAAPS as part of the PDSA cycle was a useful process to inform new BHI efforts and therefore facilitate improved effectiveness and quality of health care.

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Section: Available Knowledgementioning

confidence: 99%

Section: Models Of Integrationmentioning

confidence: 99%

Section: Unmet Needsmentioning

confidence: 99%

See 1 more Smart Citation

Quality improvement in pediatrics: Survey Needs Assessment for Ambulatory Pediatric Specialties (SNAAPS).

Rice¹,

Alpert-Gillis²,

Cohen³

et al. 2023

Clinical Practice in Pediatric Psychology

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“…Children and youth with chronic physical conditions face considerable psychosocial and emotional burden due to their health challenges. 1 Thus far, research that comprehensively examines child and youth multimorbidity-the co-occurrence of physical and mental disorder-is limited, including research on the mechanisms involved in the onset and outcomes of multimorbidity.…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity in Children and Youth Across the Life-course (MY LIFE): protocol of a Canadian prospective study

et al. 2019

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IntroductionMultimorbidity, the co-occurrence of a chronic physical condition and mental disorder, affects a substantial number of children and youth and can lead to compromised quality of life, hardship for families, and an increased burden on the healthcare system. We are conducting a study to document the course of mental disorder in children and youth diagnosed with a chronic physical condition; identify predictors of child and youth multimorbidity; examine whether the effects of these predictors are moderated by relevant psychosocial and biological factors; explore potential inflammatory and stress biomarkers that mediate the onset of child and youth multimorbidity; and, assess whether multimorbidity in children and youth alters patterns of mental health service use.Methods and analysisMultimorbidity in Children and Youth Across the Life-course (MY LIFE) is a prospective study. Two hundred and fifty children and youth aged 2–16 years diagnosed with a chronic physical condition along with one parent will be recruited from the outpatient clinics at a paediatric tertiary care centre. Data will be collected using a multi-informant, multimethod design at four time-points (at recruitment, and at 6, 12 and 24 months postrecruitment). Parents will provide reports for all children/youth. In addition, youth ≥10 years will self-report. Mental disorder will be assessed using structured interviews. On completion of data collection, participant-reported data will be linked to provincial health records to identify mental health services use. Multilevel analyses (survival, proportional hazard, structural equation modelling) will be used to address MY LIFE objectives.Ethics and disseminationThis study has been approved by the University of Waterloo Human Research Ethics Board and the Hamilton Integrated Research Ethics Board. Findings will be disseminated to key stakeholders using a number of outlets (peer-reviewed publications and conferences, lay informational pamphlets, social media).

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“…Approximately, 25% of children and adolescents have a chronic physical illnesses such as asthma, juvenile arthritis, diabetes, epilepsy, or cerebral palsy, which increases their risk of experiencing physical, psychosocial, and emotional health challenges ( Schwartz & Feudtner, 2019 ; van Cleave et al, 2010 ). Estimates suggest that 40% to 50% of these children frequently experience a co-occurring mental illness, known as multimorbidity ( Butler et al, 2018 ; Ferro et al, 2022 ).…”

mentioning

confidence: 99%

Correlates of Moderate-to-Vigorous Physical Activity in Children With Physical Illness and Physical–Mental Multimorbidity

et al. 2022

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This study measured physical activity (PA) and explored its correlates among children with multimorbidity (co-occurring chronic physical and mental illness; MM) versus those with chronic physical illness only (PI). This study used baseline data from the Multimorbidity in Children and Youth Across the Life Course (MY LIFE) study, an on-going cohort study following 263 children with a PI 2 to 16 years of age (mean age: 9.8 years, SD = 4.0; 47.7% female). PA was measured using accelerometry, and demographic and psychosocial variables were collected using questionnaires. Of the 55 children with MM and the 85 with PI with valid accelerometer data, 38.1% and 41.2%, respectively, met average daily PA guidelines. Correlates of moderate-to-physical PA (MVPA) among children with MM were age, ρ(53) = −0.45, p = .001, body mass index (BMI), ρ(48) = −0.28, p = .04, self-perceived behavioral conduct, ρ(24) = −0.45, p = .02, physical health-related quality of life, ρ(51) = 0.56, p < .001, and peer support, ρ(52) = 0.27, p = .04. Correlates of MVPA among children with PI were age, ρ(83) = −0.40, p < .001, sex, ρ(83) = −0.26, p = .01, self-perceived social competence, ρ(31) = 0.42, p = .02, self-perceived athletic competence, ρ(31) = 0.48, p = .005, physical health-related quality of life, ρ(83) = 0.34, p = .001, participation in community sport, ρ(31) = 0.41, p = .02, and family functioning, ρ(83) = 0.26, p = .02. These results demonstrate that children with PI and MM are insufficiently active and their PA is correlated with demographic and psychosocial factors.

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Providing Integrated Behavioral Health Services to Patients With Serious Pediatric Illness

Cited by 10 publications

References 15 publications

Quality improvement in pediatrics: Survey Needs Assessment for Ambulatory Pediatric Specialties (SNAAPS).

Quality improvement in pediatrics: Survey Needs Assessment for Ambulatory Pediatric Specialties (SNAAPS).

Multimorbidity in Children and Youth Across the Life-course (MY LIFE): protocol of a Canadian prospective study

Correlates of Moderate-to-Vigorous Physical Activity in Children With Physical Illness and Physical–Mental Multimorbidity

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