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Lakatos PP, Rodas NV, Matic T, Williams ME, Samora LL, Carson MC. Providing Continuity in Infant Mental Health Services for Medically Fragile Infants and Their Families. J Clin Psychol Med Settings 2024; 31:5-18. [PMID: 37000305 PMCID: PMC10924710 DOI: 10.1007/s10880-023-09957-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/01/2023]
Abstract
Having a baby who is prenatally or postnatally diagnosed with a medical condition places considerable stress on the parents, infants, and their developing relationship. Infant mental health (IMH) services offer an opportunity to address the challenges and support the parent-infant relationship. The present study outlined a continuum of care IMH program embedded within various medical settings of a large metropolitan children's hospital. Applications of IMH principles within the fetal care center, neonatal intensive care unit, high risk infant follow-up clinic, and the patient's home are described. Descriptive data about families served across settings and a case study are provided in order to illustrate the implementation of this unique IMH intervention model.
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Affiliation(s)
- Patricia P Lakatos
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA.
| | - Naomi V Rodas
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Tamara Matic
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Marian E Williams
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Laura L Samora
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Melissa C Carson
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
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Abstract
Diagnosis of a fetal anomaly in pregnancy increases the risk for perinatal mental health difficulties, including anxiety, depression, and traumatic stress among expectant parents. Common emotional challenges include uncertainty about the diagnosis/prognosis, anticipated neonatal course, fears of fetal or neonatal demise, loss of a typical, uncomplicated pregnancy and postpartum course, and disruption of family roles due to medical care-related activities and restrictions. Psychologists in multidisciplinary fetal care centers are uniquely positioned to assess mental health risks and address the needs of expectant parents. Psychologists bring additional expertise in screening and assessment, clinical interventions to promote coping and symptom reduction while preparing for birth and a complicated neonatal course, consultation and effective communication, and programmatic development. This review paper provides an overview of the challenges and behavioral health risks for expectant parents carrying a fetus with a birth defect and the unique role psychologists play to support patients and families within fetal care settings.
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Dempsey AG, Keller-Margulis MA. Developmental and medical factors associated with parenting stress in mothers of toddlers born very preterm in a neonatal follow-up clinic. Infant Ment Health J 2020; 41:651-661. [PMID: 32845537 DOI: 10.1002/imhj.21890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The purpose of this exploratory, cross-sectional study was to identify child-related factors associated with maternal parenting stress in toddlers born very preterm and followed in a neonatal follow-up (NFU) clinic. The study aimed to describe the associations of current medical complications and presence of developmental delays with total parenting stress. Participants were 53 mother-child dyads presenting in a NFU clinic. Mothers completed the Parenting Stress Index-Short Form (PSI-SF), and children were administered the Brigance Early Head Start Screen II. Medical variables were also collected from the child's medical record. Approximately 24% of mothers had at least one elevated subscale score on the PSI-SF. Regression analyses indicated that receipt of early intervention services was associated with increased parenting stress among mothers of toddlers born very preterm, though number of current medical complications was not. Parents of children born very preterm are at increased risk for parenting stress that extends beyond discharge from the neonatal intensive care unit . Clinicians working in NFU clinics are positioned to monitor for increased parenting stress, particularly among families of children with emerging signs of developmental delay.
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Affiliation(s)
- Allison G Dempsey
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Milena A Keller-Margulis
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas
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Cunningham NR, Moorman E, Brown CM, Mallon D, Chundi PK, Mara CA, Pentiuk S, Lynch-Jordan AM, Dykes DMH, Elfers J, Farrell MK. Integrating Psychological Screening Into Medical Care for Youth With Abdominal Pain. Pediatrics 2018; 142:peds.2017-2876. [PMID: 30045930 DOI: 10.1542/peds.2017-2876] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pediatric functional abdominal pain disorders are common, costly, and disabling. Clinical anxiety is highly prevalent and is associated with increased pain and functional disability. Thus, a psychological screening process is recommended but is infrequently used in current practice. METHODS A screening process for patient-reported anxiety (Screen for Child Anxiety and Related Disorders), functional disability (Functional Disability Inventory), and pain levels was implemented in a large gastroenterology division within a major medical center. Quality improvement methods and traditional analytic approaches were used to test the feasibility and outcomes of routine screening in patients ages 8 to 18 with abdominal pain. RESULTS Screening rates increased from <1% to >80%. A total of 1291 patients who reported having abdominal pain completed the screening during the first 6 months. Clinically significant anxiety (43.1%), at least moderate disability (45%), and elevated pain (61.5%) were common in children with abdominal pain. The presence of clinically significant anxiety corresponded with higher pain and pain-related disability. Twenty-one percent of youth had clinical elevations in all 3 areas. In such instances, medical providers received an automated prompt to tailor care, including to consider a psychological referral. After the project implementation, psychological referral rates increased from 8.3 per 1000 patients to 15.2 per 1000 patients. CONCLUSIONS Systematic screening for anxiety, pain, and pain-related disability as a routine part of medical care can be reliably implemented with clinically meaningful results. Future directions include examining the role of anxiety over the long-term and reducing clinician burden.
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Affiliation(s)
- Natoshia R Cunningham
- Divisions of Behavioral Medicine and Clinical Psychology, .,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Erin Moorman
- Divisions of Behavioral Medicine and Clinical Psychology
| | - Courtney M Brown
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,General and Community Pediatrics, and.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Daniel Mallon
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Gastroenterology, Hepatology and Nutrition, and
| | - Pavan K Chundi
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
| | - Constance A Mara
- Divisions of Behavioral Medicine and Clinical Psychology.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Scott Pentiuk
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Gastroenterology, Hepatology and Nutrition, and
| | - Anne M Lynch-Jordan
- Divisions of Behavioral Medicine and Clinical Psychology.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Dana M H Dykes
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Gastroenterology, Hepatology and Nutrition, and
| | | | - Michael K Farrell
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio.,Gastroenterology, Hepatology and Nutrition, and
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