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Marshall KH, Pincus HA, Tesson S, Lingam R, Woolfenden SR, Kasparian NA. Integrated psychological care in pediatric hospital settings for children with complex chronic illness and their families: a systematic review. Psychol Health 2024; 39:452-478. [PMID: 35635028 DOI: 10.1080/08870446.2022.2072843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 03/07/2022] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To synthesize and critically evaluate evidence on the effectiveness of integrated psychological care models for children with complex chronic illness within pediatric hospital settings and provide recommendations for successful implementation. DESIGN Six electronic databases (Medline, Cochrane, Embase, PsycINFO, Scopus, CINAHL) were systematically searched for English language studies including families of children aged 0-17 years with complex chronic illness. Eligible studies reported on psychology or neuropsychology screening, assessment, intervention, or services provided within a pediatric hospital setting. RESULTS Fifteen studies were identified for review; nine assessed a psychological service, five examined psychosocial screening, and one examined a neuropsychology service. Three studies demonstrated the effectiveness of integrated psychological services in improving child or parent physical, psychological, or behavioral health outcomes. Uptake of psychosocial screening was high (84-96%), but only 25-37% of children or families identified as 'at-risk' engaged with on-site psychology services. Integrated psychological services offering consultations at the same time and location as the child's medical visit reported the highest rates of uptake (77-100%). CONCLUSIONS The available evidence supports co-location of child medical and psychological services. A more consistent and comprehensive approach to the assessment of patient- and caregiver-reported outcomes and implementation effectiveness is recommended.
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Affiliation(s)
- Kate H Marshall
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Harold A Pincus
- Department of Psychiatry, Columbia University and the New York State Psychiatric Institute, New York, NY, USA
- Irving Institute for Clinical and Translational Research, Columbia University and New York‑Presbyterian Hospital, New York, NY, USA
| | - Stephanie Tesson
- Heart Centre for Children, The Sydney Children's Hospitals Network, Sydney, NSW, Australia
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Raghu Lingam
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - Susan R Woolfenden
- Population Child Health Clinical Research Group, School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney local health District, Sydney, NSW, Australia
| | - Nadine A Kasparian
- Cincinnati Children's Center for Heart Disease and Mental Health, Heart Institute and Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Abstract
Various screening questionnaires have been established to identify psychopathology in children and adolescents. Some of these instruments include the pediatric symptom checklist (PSC), the pediatric symptom checklist (CBCL) and reporting questionnaire for children (RQC). However, many of the patients and their families may not speak English, and this can be a barrier to identifying and properly treating monolingual Spanish-speaking patients and families. There is a need for optimal mental health screening in Spanish speaking populations given the continued growth of the United States as a diverse country with complex demographic structure. Because of the diversity within the use of Spanish in Hispanic countries of origin, the aim of this study is to present unified Spanish versions of the RQC and PSC achieved through simultaneously and independently translating them into three versions of Spanish (RQC-SP and PSC-SP). To test the psychiatric validity of RQC-SP and PSC-SP, these both were administered simultaneously along with the Spanish version of the CBCL, which had already been well established. All three of these tools were given to Spanish speaking parents of pediatric outpatients (n = 22) while waiting for their clinic appointments. The RQC-SP had a correlation to the CBCL with R = 0.779 and p < 0.001. The RQC-SP as compared with the CBCL had a false negative of 0/8 (0.00) with a sensitivity of 8/8 = 1.00. The false positives were 2/14 (0.143) and specificity 12/15 (0.85). The PSC-SP correlated with the CBCL with R = 0.897 and p < 0.001. The PSC-SP correlation with the CBCL had false negative of 7/8 (0.875) and sensitivity of 1/8 (0.125) and false positive 0/14 (0.00) and specificity 14/14 (1.00). The RQC-SP and PSC-SP are brief, well-validated, reliable instruments designed.
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Berlin KS, Kamody RC, Banks GG, Silverman AH, Davies WH. Empirically Derived Parental Feeding Styles for Young Children and Their Relations to Weight, Mealtime Behaviors, and Childhood Behavior Problems. CHILDRENS HEALTH CARE 2014. [DOI: 10.1080/02739615.2014.891207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Whitaker TM, Bada HS, Bann CM, Shankaran S, LaGasse L, Lester BM, Bauer CR, Hammond J, Higgins R. Serial pediatric symptom checklist screening in children with prenatal drug exposure. J Dev Behav Pediatr 2011; 32:206-15. [PMID: 21200328 PMCID: PMC3069136 DOI: 10.1097/dbp.0b013e318208ee3c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine screening results obtained by serial annual behavioral assessment of children with prenatal drug exposure. METHOD The Maternal Lifestyle Study enrolled children with prenatal cocaine exposure (PCE) at birth for longitudinal assessments of developmental, behavioral, and health outcomes. At 8, 9, 10, 11, and 12 years of age, caregivers rated participants on the Pediatric Symptom Checklist (PSC). Serial PSC results were compared with an established broad-based behavioral measure at 9, 11, and 13 years. PSC results were analyzed for 1081 children who had at least 2 annual screens during the 5-year time span. Most subjects (87%) had 4 or more annual screens rated by the same caregiver (80%). PSC scores (and Positive screens) over time were compared at different time points for those with and without PCE. Covariates, including demographic factors and exposures to certain other substances, were controlled. RESULTS Children with PCE had significantly higher scores overall, with more Positive screens for behavior problems than children without PCE. Children with PCE had more externalizing behavior problems. Children exposed to tobacco prenatally and postnatally also showed higher PSC scores. Over time, PSC scores differed slightly from the 8-year scores, without clear directional trend. Earlier PSC results predicted later behavioral outcomes. CONCLUSION Findings of increased total PSC scores and Positive PSC screens for behavioral concerns in this group of children with prenatal substance exposure support the growing body of evidence that additional attention to identification of mental health problems may be warranted in this high-risk group.
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Affiliation(s)
- Toni M Whitaker
- Department of Pediatrics, Boling Center for Developmental Disabilities, University of Tennessee College of Medicine, Memphis, TN 38105, USA.
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Gleason MM, Zeanah CH, Dickstein S. Recognizing young children in need of mental health assessment: Development and preliminary validity of the early childhood screening assessment. Infant Ment Health J 2010; 31:335-357. [DOI: 10.1002/imhj.20259] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hayutin LG, Reed-Knight B, Blount RL, Lewis J, McCormick ML. Increasing parent-pediatrician communication about children's psychosocial problems. J Pediatr Psychol 2009; 34:1155-64. [PMID: 19270030 DOI: 10.1093/jpepsy/jsp012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the differential effects of two scoring procedures for a parent-completed measure, the Pediatric Symptom Checklist (PSC), designed to assess children's behavioral and emotional functioning, on parent-pediatrician communication concerning psychosocial issues. METHODS Prior to their medical appointment, 174 parents of children aged 4-16 were assigned to one of three experimental conditions: (1) typical medical care control, (2) Staff-Scored PSC administration, or (3) Parent-Scored PSC administration. Following the appointment, parent perception of parent-pediatrician communication was assessed. RESULTS For children with more emotional and behavioral problems, participants in the Parent-Scored group and the Staff-Scored group had better parent-pediatrician communication scores than those in the control group. CONCLUSIONS Both the Staff-Scored and Parent-Scored administrations of the PSC improved parent-pediatrician communication on psychosocial issues. The Parent-Scored PSC removed the scoring burden on the medical personnel.
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Gupta S, Crawford SG, Mitchell I. Screening children with asthma for psychosocial adjustment problems: a tool for health care professionals. J Asthma 2006; 43:543-8. [PMID: 16939996 DOI: 10.1080/02770900600857267] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To develop a brief questionnaire for health care professionals to use in screening children with asthma for psychosocial adjustment problems. METHOD The initial version of the Childhood Asthma Resiliency Questionnaire (CARQ) listed 85 items focusing on self-esteem, medical fears, peer relationships, family relations, stress, and depression. The number of items was reduced after focus groups and pilot testing. In pilot tests, 100 children with asthma completed the CARQ. Parents completed the Child Behavior Checklist (CBCL). Another sample of 73 children with mild asthma was also obtained. RESULTS The total CARQ score was significantly correlated (p < 0.001) with Total Problems, Internalizing, and Externalizing Problems on the CBCL. Children with more hospitalizations and more days of school missed from asthma had significantly higher scores on the CARQ compared to children with less functional morbidity. CONCLUSION The CARQ appears to be a useful brief measure to help clinicians identify children at risk for problems adjusting to asthma.
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Affiliation(s)
- S Gupta
- Departments of Psychology and Pediatrics, Alberta Children's Hospital, and the University of Calgary, Calgary, Alberta, Canada.
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McCart MR, Davies WH, Phelps LF, Heuermann W, Melzer-Lange MD. Psychosocial needs of African American youth presenting to a pediatric emergency department with assault-related injuries. Pediatr Emerg Care 2006; 22:154-9. [PMID: 16628096 DOI: 10.1097/01.pec.0000202453.42108.f1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study was to identify the psychosocial needs confronting African American youth assaulted in their community. METHODS A convenience sample of 36 African American youth (mean age, 14.8 years; range, 10-18 years) who presented to a pediatric emergency department with violent interpersonal injuries was interviewed to identify the psychosocial issues they were facing. Participants also completed self-report measures of violence exposure and trauma symptoms, and their parents completed a screening measure of the youths' emotional and behavioral functioning. RESULTS During the interview, the youth reported 178 different concerns that were content-analyzed and placed into 10 thematic categories labeled anger/aggressive behavior (78% of respondents), general internalizing symptoms (61%), peer difficulties (53%), parent/family conflict (50%), posttraumatic stress symptoms (47%), academic concerns (42%), physical health concerns (39%), safety concerns (39%), and public service concerns (17%). Elevated rates of historical violence exposure and trauma symptoms were observed on the self-report measures, and one third of the youths' parents reported levels of emotional and behavioral problems that would warrant further clinical attention. CONCLUSION African American assault victims are experiencing a broad range of psychosocial needs. To bolster youth recovery and reduce the risk of future injury, researchers and practitioners need to identify effective methods of assessing these needs in the emergency department so that youth victims of interpersonal violence can be referred for appropriate follow-up services.
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Affiliation(s)
- Michael R McCart
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA.
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Stoppelbein L, Greening L, Jordan SS, Elkin TD, Moll G, Pullen J. Factor analysis of the Pediatric Symptom Checklist with a chronically ill pediatric population. J Dev Behav Pediatr 2005; 26:349-55. [PMID: 16222174 DOI: 10.1097/00004703-200510000-00002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The psychometric properties and factor structure of a widely used screening measure for behavioral and emotional dysfunction, the Pediatric Symptom Checklist (PSC), was extended to a population of chronically ill children. Parents of 404 children ranging from 6 to 17 years of age and diagnosed with either insulin-dependent diabetes mellitus (IDDM) or sickle cell disease (SCD) completed the PSC while waiting for a routine medical appointment. The measure's internal consistency was found to be high, Cronbach's alpha = .89, and test-retest reliability across 4 months was observed to be acceptable, r = .77. A principal components analysis with an oblique (promax) rotation yielded a four-factor solution with factors that included items representative of internalizing, externalizing, attention, and chronic illness-related problems, respectively. Cronbach alpha estimates ranged from .78 to .83 for the first three factors but was lower for the chronic illness-related problems factor (Cronbach's alpha = .60). A three-factor solution and reliability estimates were recomputed without the chronic illness items that yielded the same reliability estimates for each of the three factors and for the full scale. The three-factor solution was also found to be similar to a published factor structure obtained with a primary care sample, r(c) = .90-.91. The findings lend support to extending the PSC's clinical utility to tertiary care pediatric settings. Further research is recommended with a broader range of chronic illness groups to increase generalizability.
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Affiliation(s)
- Laura Stoppelbein
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi 39216, USA
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Luby JL, Heffelfinger A, Koenig-McNaught AL, Brown K, Spitznagel E. ThePreschool Feelings Checklist: a brief and sensitive screening measure for depression in young children. J Am Acad Child Adolesc Psychiatry 2004; 43:708-17. [PMID: 15167087 DOI: 10.1097/01.chi.0000121066.29744.08] [Citation(s) in RCA: 139] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Childhood depression is widely underrecognized in primary health care settings. This phenomenon appears to increase with younger age. Evidence has been provided for a valid depressive syndrome among preschool children. Based on the need for the earliest possible identification of depression, the development of a brief screening measure to capture young children with markers of depression from these community settings was developed and tested. METHOD A group of 174 preschool children underwent a comprehensive psychiatric assessment. The majority of this study group was ascertained from primary care settings using a 20-item checklist designed to capture depressive symptoms in young children. The assessment included the Diagnostic Interview Schedule for Children Version modified for young children and the Child Behavior Checklist. Ratings on the checklist were subsequently compared with these independent measures of psychopathology using several analytic strategies. RESULTS The Preschool Feelings Checklist demonstrated high internal consistency, and 16 items showed strong associations with independent diagnostic measures of internalizing symptoms and major depressive disorder. The Preschool Feelings Checklist demonstrated high specificity and sensitivity for the identification of major depressive disorder at a cutoff score 3 or more. CONCLUSIONS The Preschool Feelings Checklist is a brief and valid screening measure highly feasible for use in primary care settings. It demonstrated utility for the identification of preschoolers in need of formal mental health evaluation for depression.
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Affiliation(s)
- Joan L Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110,
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Abstract
OBJECTIVES Efficient and accurate instruments for assessing child psychopathology are increasingly important in clinical practice and research. For example, screening in primary care settings can identify children and adolescents with disorders that may otherwise go undetected. However, primary care offices are notorious for the brevity of visits and screening must not burden patients or staff with long questionnaires. One solution is to shorten assessment instruments, but dropping questions typically makes an instrument less accurate. An alternative is adaptive testing, in which a computer selects the items to be asked of a patient based on the patient's previous responses. This research used a simulation to test a child mental health screen based on this technology. RESEARCH DESIGN Using half of a large sample of data, a computerized version was developed of the Pediatric Symptom Checklist (PSC), a parental-report psychosocial problem screen. With the unused data, a simulation was conducted to determine whether the Adaptive PSC can reproduce the results of the full PSC with greater efficiency. SUBJECTS PSCs were completed by parents on 21,150 children seen in a national sample of primary care practices. RESULTS Four latent psychosocial problem dimensions were identified through factor analysis: internalizing problems, externalizing problems, attention problems, and school problems. A simulated adaptive test measuring these traits asked an average of 11.6 questions per patient, and asked five or fewer questions for 49% of the sample. There was high agreement between the adaptive test and the full (35-item) PSC: only 1.3% of screening decisions were discordant (kappa = 0.93). This agreement was higher than that obtained using a comparable length (12-item) short-form PSC (3.2% of decisions discordant; kappa = 0.84). CONCLUSIONS Multidimensional adaptive testing may be an accurate and efficient technology for screening for mental health problems in primary care settings.
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Affiliation(s)
- William Gardner
- University of Pittsburgh School of Medicine, Pennsylvania, USA.
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Natarajan A, Olson AL. PREVENTIVE HEALTH CARE FOR CHILDREN. Prim Care 1995. [DOI: 10.1016/s0095-4543(21)00550-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Butz AM, Malveaux FJ, Eggleston P, Thompson L, Huss K, Kolodner K, Rand CS. Social factors associated with behavioral problems in children with asthma. Clin Pediatr (Phila) 1995; 34:581-90. [PMID: 8565388 DOI: 10.1177/000992289503401103] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The objective of this study was to describe the proportion of children with a behavior problem and examine which independent variables are associated with the presence of a behavior problem in a group of 392 inner-city children with asthma. Data on child asthma symptoms, medication use, health-care utilization, and school absences were obtained from the parent during a structured telephone interview. Included in the interview was a measure of behavior problems and social support questions. Children classified with a high level of asthma symptoms were more than twice as likely to experience a behavior problem than children classified with a low level of asthma symptoms (P = 0.002). Use of theophylline medication was not correlated with behavior problems (P = 0.45). Significant variables were low level of social support and high or moderate level of asthma symptoms. We have identified a group of children at risk for behavior problems, specifically in families that lack adequate social and financial resources.
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Affiliation(s)
- A M Butz
- Johns Hopkins University, School of Nursing, Baltimore, MD 21205, USA
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Kuhn BR, Allen KD, Shriver MD. Behavioral management of children's seizure activity. Intervention guidelines for primary-care providers. Clin Pediatr (Phila) 1995; 34:570-5. [PMID: 8565386 DOI: 10.1177/000992289503401101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We present behavioral treatment guidelines, based on empirically established behavioral interventions, for pediatric paroxysmal disorders. The guidelines include affirming the disability and normalizing the role of the environment; teaching the child anticonvulsant coping behaviors; giving caregivers guidelines to encourage independent functioning; and involving teachers and other supervising adults in treatment. The guidelines were developed for economic feasibility, time efficiency, and easy execution in any primary-care clinic. A patient report demonstrates significant reduction in drug-refractory seizures in an 11-year-old girl by implementing the guidelines. Discussion is provided on effective implementation of the behavioral guidelines in the primary-care clinic.
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Affiliation(s)
- B R Kuhn
- Department of Psychology, University of Nebraska Medical Center, Omaha, USA
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