Family psychosocial risk screening guided by the Pediatric Psychosocial Preventative Health Model (PPPHM) using the Psychosocial Assessment Tool (PAT)

Abstract

Background. Although families of children with cancer and other serious medical conditions have documented psychosocial needs, the systematic identifi cation of needs and delivery of evidence-based care remain challenges. Screening for multifaceted family psychosocial risk is a means by which psychosocial treatment needs for pediatric patients and their families can be identifi ed in an effective and inclusive manner. Material and methods. The Pediatric Psychosocial Preventative Health Model (PPPHM) is a model that can guide systematic assessment of family psychosocial risk. The Psychosocial Assessment Tool (PAT) is a brief parent report screener of psychosocial risk based on the PPPHM that can be used for families of infants through adolescents. The PPPHM and the PAT are described in this paper, along with a summary of data supporting systematic risk assessment. Results. The PPPHM outlines three tiers of family psychosocial risk -Universal (low), Targeted (medium), and Clinical (high). The PAT is a validated measure of psychosocial risk. Scores on the PAT, derived from multiple sites and disease conditions, map on to the PPPHM with indications that one-half to two-thirds of families score at the Universal level of risk based on the PAT. Conclusion. The PAT is a unique screener of psychosocial risk, both in terms of its breadth and underlying model (PPPHM), and its length and format. As an example of a means by which families can be screened early in the treatment process, PAT scores and corresponding PPPHM levels can provide direction for the delivery of evidence-based psychosocial care.

Psychosocial Screening in Disorders/Differences of Sex Development: Psychometric Evaluation of the Psychosocial Assessment Tool

“…In line with this model [11], Kazak and colleagues [26] developed the Psychosocial Assessment Tool (PAT) as a means of assessing risk and resiliency factors in families managing pediatric chronic conditions. The PAT is a brief, broad screener of multiple psychosocial contextual factors that is used to triage families into 1 of 3 risk categories so that resources can be effectively and efficiently managed: Universal reflects transient distress but generally good adjustment; Targeted reflects families experiencing some acute distress and some psychosocial risk; and Clinical reflects on-going, escalating, or high-intensity distress with multiple risk factors present.…”

“…Families managing these DSD experiences are not doing so in a vacuum – there are a host of psychosocial (e.g., psychological, socioeconomic) contextual factors that may impact family resilience in the face of medical challenges [for review see Kazak et al 11]. Family resources, social support networks, parent and child emotional-behavioral functioning, and previous interactions with healthcare providers have been implicated in adjustment to chronic conditions and may be more influential in shaping health and well-being outcomes than disease or biomedical variables [12].…”

“…However, the use of multiple measures to assess the variety of potential risk factors poses an administrative burden within the healthcare system and can be limited by (1) the resources required to administer and score measures, (2) the behavioral health expertise required to interpret and communicate results, (3) financial costs to purchasing numerous measures, and (4) families’ willingness/ability to complete multiple measures. Preventive health models offer the framework to circumvent these barriers, particularly in terms of the screening approach, which involves the use of a brief validated measure to identify people currently or at risk of experiencing problems known to occur in a population [11]. Kazak et al[11] describe the Pediatric Psychosocial Preventative Health Model (PPPHM), which highlights (1) screening of all members of the population, (2) importance of universally delivering interventions that promote resiliency and prevent deterioration in family adaptation, and (3) providing specific interventions that match the level of need of families for whom risk factors are identified.…”

“…Preventive health models offer the framework to circumvent these barriers, particularly in terms of the screening approach, which involves the use of a brief validated measure to identify people currently or at risk of experiencing problems known to occur in a population [11]. Kazak et al[11] describe the Pediatric Psychosocial Preventative Health Model (PPPHM), which highlights (1) screening of all members of the population, (2) importance of universally delivering interventions that promote resiliency and prevent deterioration in family adaptation, and (3) providing specific interventions that match the level of need of families for whom risk factors are identified.…”

Quality of Life in Pediatric Cancer Survivors: Contributions of Parental Distress and Psychosocial Family Risk

“…One such factor is psychosocial family risk 18 , which refers to a group of risk factors that have been associated with poor adaptation in families with cancer. Psychosocial family risk has been conceptualized to include low levels of social support (e.g., lack of emotional support or availability of childcare), family problems (e.g., parental substance abuse problems, marital conflict, and child custody disputes), low availability of instrumental resources such as finances or transportation, sibling problems (e.g., sadness and withdrawal, learning difficulties, social difficulties), parental stress reactions (e.g., bad dreams and nightmares), child problems (e.g., mood difficulties, school difficulties, substance use), and negative beliefs about the future (e.g., negative thoughts about family closeness, ability to make treatment decisions, and likelihood child will beat cancer).…”