Integrating Psychological Screening Into Medical Care for Youth With Abdominal Pain

Cunningham, N.; Moorman, Erin; Brown, Courtney; Mallon, Daniel; Chundi, Pavan K.; Mara, Constance A.; Pentiuk, Scott; Lynch-Jordan, A.; Dykes, Dana M. H.; Elfers, Julie; Farrell, Michael

doi:10.1542/peds.2017-2876

Cited by 20 publications

(48 citation statements)

References 40 publications

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“…Clinical data were gathered from 56 children between the ages of 9-14 with FAPD from a large Midwestern children's hospital using de-identified data as a part of an Institutional Review Board approved process. These youth were also involved in prior studies examining (1) clinical characteristics of youth with FAPD [7][8][9], (2) neuroimaging of pain, or (3) behavioral interventions for FAPD [14,15]. The participant's gastroenterologist confirmed that the patient met criteria for FAPD based on ROME IV guidelines and also performed an FC assay.…”

Section: Methodsmentioning

confidence: 99%

“…Participants were stratified into risk groups (range: 0-3) based on their scores on the measures detailed below. These measures were administered as part of their clinical care to determine risk status [7,15]. Clinical elevations in all three domains listed below were defined as the most clinically complex FAPD group.…”

Section: Clinical Riskmentioning

confidence: 99%

“…Screen for Child Anxiety Related Disorders-Child Report (SCARED) [19,20] A 41-item measure (total score range: 0-82) that assesses anxiety symptoms. It has been validated in pediatric chronic pain samples [21,22] and is used to screen for anxiety in children with FAPD [8,15]. A cut-off of ≥ 25 is indicative of clinically significant anxiety [19,20] and has been shown to correspond to increased pain-related impairment and pain levels in youth with chronic pain including FAPD [7,8,14,15].…”

Section: Clinical Riskmentioning

confidence: 99%

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Elevated fecal calprotectin is linked to psychosocial complexity in pediatric functional abdominal pain disorders

et al. 2021

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Objective Children with functional abdominal pain disorders (FAPD) and clinical elevations in three risk areas (anxiety, functional disability, and pain) have been found to be at increased risk for persistent disability. We evaluated if the presence of these three risk factors corresponded with greater gastrointestinal inflammation (measured via fecal calprotectin; FC) compared to those with no risk factors. FC concentration differences between children with three risk factors and those with one and two risk factors were explored. Results Fifty-six children with FAPD (Mage = 12.23) completed measures of anxiety (Screen for Child Anxiety Related Disorders), disability (Functional Disability Inventory), and pain intensity (Numeric Rating Scale). Participants were stratified into risk groups (range: 0–3). Fisher’s exact tests were conducted to determine if children with three versus fewer risk factors were more likely to have elevated FC (≥ 50 µg/g) versus normal levels. Children with three risk factors (MFC = 86.04) were more likely to have elevated FC compared to children with zero (MFC = 25.78), one (MFC = 38.59), and two risk factors (MFC = 45.06; p’s < 0.05). Those with three risk factors had borderline elevated FC concentrations whereas those with fewer had normal FC concentrations. Findings suggest the importance of a biopsychosocial approach to help elucidate a FAPD phenotype.

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Section: Methodsmentioning

confidence: 99%

Section: Clinical Riskmentioning

confidence: 99%

Section: Clinical Riskmentioning

confidence: 99%

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Elevated fecal calprotectin is linked to psychosocial complexity in pediatric functional abdominal pain disorders

et al. 2021

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“…Given the associations between GI distress and anxiety, routine screening for anxiety symptoms within all GI distress presentations by pediatricians, teachers, school nurses, and other child-facing professionals could likely help to increase appropriate referrals (Cunningham et al, 2018). However, because these individuals at initial access points for youth mental healthcare do not always have training, resources, or time to administer such mental health evaluations, using GI symptoms to assess psychopathologcal risks may be useful as a preliminary step.…”

Section: Discussionmentioning

confidence: 99%

Using gastrointestinal distress reports to predict youth anxiety risk: Implications for mental health literacy and community care

Bloom

Douglas

VanTieghem

et al. 2021

Developmental Psychobiology

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This study investigates the generalizability and predictive validity of associations between gastrointestinal (GI) symptoms and youth anxiety to establish their utility in community mental health decision‐making. We analyzed data from youth ages 3 to 21 years in volunteer cohorts collected in Los Angeles (N = 327) and New York City (N = 102), as well as the Healthy Brain Network cohort (N = 1957). Youth GI distress was measured through items taken from the parent‐reported Child Behavior Checklist (CBCL). We examined generalizability of GI–anxiety associations across cohorts and anxiety reporters, then evaluated the performance of these models in predicting youth anxiety in holdout data. Consistent with previous work, higher levels of gastrointestinal distress were associated with more parent‐reported youth anxiety behaviors in all three cohorts. Models trained on data from the Healthy Brain Network cohort predicted parent‐reported and child‐reported anxiety behaviors, as well as clinician‐evaluated anxiety diagnoses, at above chance levels in holdout data. Models which included GI symptoms often, but not always, outperformed models based on age and sex alone in predicting youth anxiety. Based on the generalizability and predictive validity of GI–anxiety associations investigated here, GI symptoms may be an effective tool for child‐facing professionals for identifying children at risk for anxiety (Preprint: https://psyarxiv.com/zgavu/).

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“…For example, it is possible to compare rates of telehealth use among providers within a group to assess whether adoption has been embraced by providers equally, as well as rates of provider appointment slot utilization and patient no-shows. Within the chronic pain literature, screening tools within EHR have been successfully implemented to identify patients with anxiety and functional disability among youth with abdominal pain [ 18 ]. This approach to screening has multiple implications for use with telehealth, including screening for patient appropriateness for telehealth-delivered chronic pain treatment.…”

Section: Introductionmentioning

confidence: 99%

Evaluating Telehealth Implementation in the Context of Pediatric Chronic Pain Treatment during COVID-19

Richardson

Parker

Chavez³

et al. 2021

Children

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Telehealth has emerged as a promising healthcare delivery modality due to its ability to ameliorate traditional access-level barriers to treatment. In response to the onset of the novel coronavirus (COVID-19) pandemic, multidisciplinary pain clinics either rapidly built telehealth infrastructure from the ground up or ramped up existing services. As the use of telehealth increases, it is critical to develop data collection frameworks that guide implementation. This applied review provides a theoretically-based approach to capitalize on existing data sources and collect novel data to inform virtually delivered care in the context of pediatric pain care. Reviewed multisource data are (1) healthcare administrative data; (2) electronic chart review; (3) clinical health registries; and (4) stakeholder feedback. Preliminary telehealth data from an interdisciplinary pediatric chronic pain management clinic (PPMC) serving youth ages 8–17 years are presented to illustrate how relevant implementation outcomes can be extracted from multisource data. Multiple implementation outcomes were assessed, including telehealth adoption rates, patient clinical symptoms, and mixed-method patient-report telehealth satisfaction. This manuscript provides an applied roadmap to leverage existing data sources and incorporate stakeholder feedback to guide the implementation of telehealth in pediatric chronic pain settings through and beyond COVID-19. Strengths and limitations of the modeled data collection approach are discussed within the broader context of implementation science.

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Integrating Psychological Screening Into Medical Care for Youth With Abdominal Pain

Abstract: 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.

Cited by 20 publications

References 40 publications

Elevated fecal calprotectin is linked to psychosocial complexity in pediatric functional abdominal pain disorders

Elevated fecal calprotectin is linked to psychosocial complexity in pediatric functional abdominal pain disorders

Using gastrointestinal distress reports to predict youth anxiety risk: Implications for mental health literacy and community care

Evaluating Telehealth Implementation in the Context of Pediatric Chronic Pain Treatment during COVID-19

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