Optimising Evidence-Based Psychological Treatment for the Mental Health Needs of Children with Epilepsy: Principles and Methods

Abstract

There are potent evidence-based psychological treatments for youth with mental health needs, yet they are rarely implemented in clinical practice, especially for youth with mental health disorders in the context of chronic physical illness such as epilepsy. Implementation science, the study of the translation of research into practice, can promote the uptake of existing effective interventions in routine clinical practice and aid the sustainable integration of psychological treatments with routine health care. The aim of this report was to use four implementation science methods to develop a version of an existing effective psychological treatment for mental health disorders [the Modular Approach to Treatment of Children with Anxiety, Depression or Conduct Problems (MATCH-ADTC)] for use within paediatric epilepsy services: (a) literature search; (b) iterative focus groups underpinned by normalisation process theory; (c) Plan-Do-Study-Act methods; and (d) qualitative patient interviews. Findings: Three modifications were deemed necessary to facilitate implementation in children with both mental health disorders and epilepsy. These were (a) a universal brief psychoeducational component addressing the relationship between epilepsy and mental health; (b) supplementary, conditionally activated interventions addressing stigma, parental mental health and the transition to adulthood; and (c) additional training and supervision. The intervention needed relatively little alteration for implementation in paediatric epilepsy services. The modified treatment reflected the scientific literature and the views of clinicians and service users. The multi-method approach used in this report can serve as a model for implementation of evidence-based psychological treatments for children with mental health needs in the context of other chronic illnesses.

Managing depression and anxiety in people with epilepsy: A survey of epilepsy health professionals by the ILAE Psychology Task Force

“…One solution is the improvement of neurology and psychiatry residency programs with expanded curricula covering neurologic aspects of psychiatric disorders and vice versa to reduce this competency‐related barrier 13 . In relation to psychologists, there has also been recognition that some specialist training may be needed for the optimal delivery and tailoring of psychological interventions for PWE 35–37 . For instance, it has been recommended that mental health professionals, especially those working in medical settings, should have basic knowledge about epilepsy and psychological interventions should ideally be implemented by professionals in direct contact with the medical epilepsy specialists treating the patients 10,34 .…”

“…13 In relation to psychologists, there has also been recognition that some specialist training may be needed for the optimal delivery and tailoring of psychological interventions for PWE. [35][36][37] For instance, it has been recommended that mental health professionals, especially those working in medical settings, should have basic knowledge about epilepsy and psychological interventions should ideally be implemented by professionals in direct contact with the medical epilepsy specialists treating the patients. 10,34 In addition, it is recommended that psychological interventions are modified to accommodate common cognitive difficulties common in PWE, 37 including the use of written handouts.…”

M.I.C.E—Mental Health Intervention for Children with Epilepsy: a randomised controlled, multi-centre clinical trial evaluating the clinical and cost-effectiveness of MATCH-ADTC in addition to usual care compared to usual care alone for children and young people with common mental health disorders and epilepsy—study protocol

“…Epilepsy-relevant content was integrated throughout the treatment, such as epilepsy-related examples in worksheets. The epilepsy materials were developed and finalised in earlier stages of the programme of research [ 24 ].…”

Feasibility of low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions: a case series

“…Increased recognition and early treatment of emotional and behavioural difficulties in children with genetic disorders can be supplemented by understanding and researching any distinctive patterns or features which may occur in this population. Current evidence suggests that standard mental health treatments need little or no modification for special populations (Shafran et al, 2020); however robust outcome studies are required.…”