Integrated care to address child and adolescent health in the 21st century: A clinical review

Abstract

Background Increasing specialisation and technical sophistication of medical tools across the 21st century have contributed to dramatic improvements in the life‐expectancy of children and adolescents with complex physical health problems. Concurrently, there is growing appreciation within the community of the extent that children and adolescents experience mental disorders, which are more prevalent in those with complex chronic, serious or life‐limiting health conditions. In this context, there are compelling reasons for paediatric services to move to a model of care that promotes greater integration of child psychiatry within the medical, somatic teams that care for children and adolescents in children’s hospitals. Aims In this article, we discuss the range of medical disorders managed by contemporary paediatrics. Materials and Methods We conducted a broad review of the literature and existing services, and use individual accounts to illustrate adolescents’ healthcare preferences in the context of the challenges they experience around their mental health. Results Relevant disorders include life‐limiting disorders, such as cancer; disorders involving the brain, such as epilepsy; common chronic disorders, such as asthma and diabetes; psychiatric emergencies, such as deliberate self‐harm; and conditions that most commonly present to paediatric services, but where psychiatric input is required, such as severe eating disorders, somatic symptom disorders and gender dysphoria. The persisting legacy of the historical separation of physical and mental health services is described. Yet there are many models of service integration that can promote more collaborative care between psychiatrists and medical specialists, including some which have been taken to scale. Discussion In essence, clinical teams in children’s hospitals require more collaborative approaches that facilitate early recognition and treatment of the psychological aspects of illness as an integral part of patient‐centred, family‐focussed paediatric care, rather than as something that is bolted on when things go wrong. Conclusion Whilst trust and goodwill between services and providers will be required for novel models of care to be implemented, evaluation of these new models and incorporation of young people’s healthcare preferences is needed.

Disease control and psychiatric comorbidity among adolescents with chronic medical conditions: a single-centre retrospective study

“…In conclusion, psychiatric morbidity and poor disease control of chronic medical conditions are prevalent and closely intertwined among adolescents, reinforcing the importance of collaboration between medical and psychiatric care 37. Maximising mental health before adolescents transfer to adult health services appears especially important given the associations of both poor mental health and the transfer of care itself with unsatisfactory adherence to treatment and increased rates of emergency visits and hospitalisation 12 38 39…”

Community paediatricians’ experience of joint working with child and adolescent mental health services: findings from a British national survey

“…However, adapting these models in the UK to improve collaboration between paediatrics and CAMHS would need to consider the additional resource implications for both services, especially for paediatricians who may experience a further increase in workload 46 48. In the mean time, pending strategic changes such as in commissioning, front-line clinicians in paediatric and CAMHS services can support improved collaboration by adopting some of the strategies suggested by Fazel and colleagues 49…”

Adolescent paediatric transplant patients’ experiences of transition to adult services

“…The management of chronic and progressively deteriorating illnesses in children has improved significantly with increasing numbers of children reaching young adulthood (Fazel et al 2021;Murphy Salem & Graham 2021). Extended survival has meant that the transition of the chronically ill adolescent from paediatric to adult care is a necessary, yet complex phenomenon (Francis et al 2018).…”

“…Extended survival has meant that the transition of the chronically ill adolescent from paediatric to adult care is a necessary, yet complex phenomenon (Francis et al 2018). As adolescence is a time of developmental transition, clinicians need to be aware of normal developmental issues, to understand the impact a chronic condition may have on the child's behaviour during adolescence and the transition from paediatric to adult health services (Fazel et al 2021). The life stage of adolescence is increasingly recognised as a specialist area of medical practice (Lee et al 2016).…”