Novel Interventions in Children’s Health Care (NICH): Innovative treatment for youth with complex medical conditions.

Abstract

There is a well-known subgroup of children and adolescents with complex medical conditions who have many psychosocial challenges that put them at risk for repeated and, at times, avoidable hospitalizations. Intensive behavioral health interventions that address the multitude of problems associated with complex medical conditions have proven effective in improving adherence to treatment, improving overall psychosocial functioning, and reducing avoidable hospitalizations. Based largely on this research, we adapted and augmented a family-based problem-solving intervention for youth with complex medical conditions who have been repeatedly hospitalized. The intervention involves intensive family based problem solving augmented with care coordination and case management. The intervention is implemented in the family’s home, in the hospital, in the clinic, over e-mail, via video teleconferencing, and by text. To our knowledge, this effort is a first in the application of intensive behavioral health care for youth with complex medical conditions who are repeatedly hospitalized. We describe the theoretical and empirical underpinnings of the intervention, provide a description of the intervention using a case example, and present “lessons learned” from our efforts toward reducing hospitalizations and utilization of services in a population of youth with complex medical conditions who have repeatedly experienced avoidable hospitalizations.

Technology-assisted interventions for parents of young children: Emerging practices, current research, and future directions

“…Participants reported decreased isolation, increased knowledge, and increased parenting efficacy. VTC sessions have also been integrated with other forms of intervention delivery (Harris et al, 2013). For example, designed for parents of children with complex medical conditions, the Behavioral Family Systems Therapy model utilizes home visits, email, clinic visits, VTC, and text messages.…”

Practice-based approach to assessing and treating nonadherence in pediatric regimens.

“…It also may be useful to set small goals initially that are achievable and have a high likelihood of success with patients that are questioning their abilities or motivation to be adherent. This may not only improve confidence in their abilities to be adherent to their regimen (Harris et al, 2013), but also lead to the experience of positive health outcomes.…”

NICH at Its Best for Diabetes at Its Worst: Texting Teens and Their Caregivers for Better Outcomes

“…NICH services involve intensive homeand community-based treatment for patients and their families intended to reduce barriers to disease management. Because NICH is grounded in the ecological systems theory of human development, interventions are delivered across the multiple systems in which youth are embedded and in the settings in which health behaviors are developed and maintained (see Harris et al 17 for a more thorough description of the NICH intervention and theoretical bases). Thus, text messaging is used in combination with in-person interventions whenever possible to increase contact with patients and families, provide immediate reinforcement for diabetes management, assist with on-the-fly problem solving, build rapport, provide skills coaching, and ultimately improve adherence to the diabetes regimen.…”

“…17,19 At the time of this study, NICH services were being provided by eight interventionists with caseloads of approximately 8 to 10 patients and families each. Supervision was provided by doctoral-level providers, and NICH interventionists received 2 hours of weekly interdisciplinary group supervision (eg, psychologists, pediatricians, nurses, public health professionals, social workers) as well as weekly individual supervision and phone support as needed.…”