Comprehensive psychosocial screening in a pediatric diabetes clinic

Abstract

Objective: The ISPAD recommends routine, comprehensive psychosocial screening for adolescents with diabetes. However, few clinics have implemented procedures consistent with these guidelines. This study describes the results of a universal, comprehensive psychosocial screening program in an integrated pediatric diabetes clinic located within an academic medical center.Research Design and Methods: Participants included 232 ethnically diverse adolescents with type 1 diabetes (55.5% female; M age = 14.85; 58.5% Hispanic; 20% Black). Adolescents completed screening measures on iPads in the waiting room before their medical visit. The proportion of adolescents screening positive on each psychosocial measure was assessed, and regression analyses evaluated how psychosocial variables accounted for variance in insulin non-adherence and glycemic control (measured by A1c).Results: Psychosocial concerns were common and ranged from 7% of adolescents screening positive for disordered eating and suicide risk to 52% screening positive for low motivation to manage diabetes. A1c and insulin non-adherence were positively correlated with suicide risk, depressive symptoms, anxiety, disordered eating, diabetes stress, blood glucose monitoring stress, family conflict, and total number of elevations, and negatively correlated with intrinsic motivation. Insulin non-adherence, disordered eating, diabetes stress, and family conflict uniquely predicted A1c. Age, motivation, and family conflict uniquely predicted insulin non-adherence. Eightythree percent of eligible youth completed the screener. Referrals by physicians to the team psychologist increased by 25% after the screening program was implemented.Conclusions: Comprehensive psychosocial screening can be effectively implemented as part of routine pediatric diabetes care and can identify adolescents in need of additional supports.

All together: Integrated care for youth with type 1 diabetes

“…52,53 Further, the stepped care approach provided targeted treatment to ensure the right intensity of care. 20 The quantitative findings also showed that almost two thirds of the adolescents in our sample identified three or more concerns related to a variety of domains such as worries, responsibilities, and family conflict, further illustrating the importance of a holistic approach. We found that adolescents with low emotional well-being indicated many of the same concerns compared to the adolescents without low emotional well-being.…”

“…14,15 While some diabetes clinics have started to implement routine psychosocial screening during regular visits, [16][17][18][19] there continues to be a need for evidence-based models to support the integration of mental health care into diabetes outpatient clinics. 11,12,20 Implementing routine psychosocial screening into existing or new care models requires practice change and can impact clinic and healthcare provider workloads and workflows. 10,21 Generally, when mental health problems are identified by diabetes clinicians, treatment is generally deferred to mental health specialists who often are not part of the diabetes inter-professional team and might not be aware of the nuances related to adolescent T1D experiences.…”

Transitioning to Telehealth Services in a Pediatric Diabetes Clinic During COVID-19: An Interdisciplinary Quality Improvement Initiative

“…Also displayed in Fig. 1 , psychology consultation rates consistently corresponded to psychosocial screener completion rates, which is unsurprising given that many consultations are scheduled in response to elevated scores on the screener (Brodar et al, 2021 ). Thus, consultation rates also began to decline prior to the shift to telehealth (30% in December to 20% in February).…”

“…In May 2018, our clinic adopted routine psychosocial screening procedures. This change corresponded to a 24.9% increase in psychology consultation rates within the clinic over the following 10 months, with consultations specifically for mental health concerns (versus diabetes management or health behavior-related issues) increasing by 71.9% (see Brodar et al, 2021 , for details). The screening protocol included measures of life satisfaction, depression and suicide risk, anxiety, eating disorders, and diabetes-specific measures of self-management behaviors, family conflict, stress, and intrinsic motivation.…”

“…We aimed to restore psychosocial screening and psychology consultation rates to pre-pandemic levels within 3 months. Our clinic’s psychosocial screening procedures and psychology consultations play an important role in identifying youth in need of additional support (Brodar et al, 2021 ). As such, it was critical to address the declining screening and consultation rates, particularly given the increase in mental health concerns in youth related to the pandemic, especially among youth with chronic illnesses (Hawke et al, 2020 ).…”