Pediatric diabetes patients infrequently access outpatient psychology services following screening and referral: Implications for practice

Vassilopoulos, Areti; Valenzuela, Jessica M.; Tsikis, Joanna; Reitblat, Lital; Blanco, Ernesto J.; Nicholls, Shelley; Wolf, Risa M.

doi:10.1080/02739615.2019.1653763

Cited by 8 publications

(16 citation statements)

References 41 publications

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“…However, referrals do not directly translate to patients’ accessing care or improving diabetes management. In pediatric diabetes care, less than 25% of youth obtain outpatient mental health services after receiving a referral due to a positive mental health screen (Vassilopoulos et al, 2019 ). This issue remains unstudied in adult diabetes care, but in the general population, only half of adults with psychiatric diagnoses access behavioral health services (Han et al, 2017 ) and primary care physicians report more difficulty referring patients to mental health services than to any other specialty (Cunningham, 2009 ).…”

Section: Discussionmentioning

confidence: 99%

Patient and Provider Views on Psychosocial Screening in a Comprehensive Diabetes Center

Brodar

Greca

Leite

et al. 2022

J Clin Psychol Med Settings

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Section: Discussionmentioning

confidence: 99%

Patient and Provider Views on Psychosocial Screening in a Comprehensive Diabetes Center

Brodar

Greca

Leite

et al. 2022

J Clin Psychol Med Settings

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“…One study found that less than one-quarter of youth with diabetes enrolled in community-based outpatient mental health services after receiving a referral during a diabetes clinic visit. 39 Another found that 22% of pediatric patients with diabetes scheduled a visit with a mental health provider who worked as part of the diabetes care team in their clinic, and 82% of those who scheduled a visit followed through, 40 underscoring the critical role of integrated care models for ensuring that youth with diabetes access mental health care. 41 It is clear that if screening programs are initiated, there must be a process for appropriate referrals to address those concerns that are identified.…”

Section: Discussionmentioning

confidence: 99%

“…Although routine psychosocial screening in pediatric diabetes clinics may be an effective tool to identify youth who are struggling with psychosocial problems and refer them to appropriate resources for care, screening and referral alone are not sufficient to ensure that care is actually received. One study found that less than one‐quarter of youth with diabetes enrolled in community‐based outpatient mental health services after receiving a referral during a diabetes clinic visit 39 . Another found that 22% of pediatric patients with diabetes scheduled a visit with a mental health provider who worked as part of the diabetes care team in their clinic, and 82% of those who scheduled a visit followed through, 40 underscoring the critical role of integrated care models for ensuring that youth with diabetes access mental health care 41 .…”

Section: Discussionmentioning

confidence: 99%

Comprehensive psychosocial screening in a pediatric diabetes clinic

et al. 2021

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Objective: The ISPAD recommends routine, comprehensive psychosocial screening for adolescents with diabetes. However, few clinics have implemented procedures consistent with these guidelines. This study describes the results of a universal, comprehensive psychosocial screening program in an integrated pediatric diabetes clinic located within an academic medical center.Research Design and Methods: Participants included 232 ethnically diverse adolescents with type 1 diabetes (55.5% female; M age = 14.85; 58.5% Hispanic; 20% Black). Adolescents completed screening measures on iPads in the waiting room before their medical visit. The proportion of adolescents screening positive on each psychosocial measure was assessed, and regression analyses evaluated how psychosocial variables accounted for variance in insulin non-adherence and glycemic control (measured by A1c).Results: Psychosocial concerns were common and ranged from 7% of adolescents screening positive for disordered eating and suicide risk to 52% screening positive for low motivation to manage diabetes. A1c and insulin non-adherence were positively correlated with suicide risk, depressive symptoms, anxiety, disordered eating, diabetes stress, blood glucose monitoring stress, family conflict, and total number of elevations, and negatively correlated with intrinsic motivation. Insulin non-adherence, disordered eating, diabetes stress, and family conflict uniquely predicted A1c. Age, motivation, and family conflict uniquely predicted insulin non-adherence. Eightythree percent of eligible youth completed the screener. Referrals by physicians to the team psychologist increased by 25% after the screening program was implemented.Conclusions: Comprehensive psychosocial screening can be effectively implemented as part of routine pediatric diabetes care and can identify adolescents in need of additional supports.

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“…In addition to increasing options for consultation services provided during medical visits, telehealth enables youth and their families to access psychological support more easily between visits by reducing barriers related to scheduling and transportation (Wade et al, 2020 ). Youth who receive mental health referrals from their medical clinic seldom follow up and receive services (Vassilopoulos et al, 2019 ). Therefore, future research should examine the impact of telehealth on youths’ access to psychological care when delivered through integrated health settings.…”

Section: Discussionmentioning

confidence: 99%

Transitioning to Telehealth Services in a Pediatric Diabetes Clinic During COVID-19: An Interdisciplinary Quality Improvement Initiative

Brodar

Hong

Liddle

et al. 2021

J Clin Psychol Med Settings

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COVID-19 necessitated a rapid shift to telehealth for psychologists offering consultation-liaison services in pediatric medical settings. However, little is known about how psychologists providing these services adapted to using telehealth service delivery formats. This report details how our interdisciplinary team identified declining psychosocial screener completion and psychology consultation rates as primary challenges following a shift to telehealth within a pediatric diabetes clinic. We utilized the Plan-Do-Study-Act (PDSA) quality improvement framework to improve screening and consultation rates, which initially declined during the telehealth transition. Screening and consultation rates dropped initially, but recovered to nearly pre-pandemic levels following three PDSA intervention cycles. During implementation, challenges arose related to the feasibility of patient interactions, interdisciplinary collaboration, patient engagement, and ethical issues. Clinics shifting psychology consultation-liaison services to telehealth should prioritize interdisciplinary communication, elicit perspectives from all clinic professionals, leverage the electronic health record, and develop procedures for warm handoffs and navigating ethical issues.

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Pediatric diabetes patients infrequently access outpatient psychology services following screening and referral: Implications for practice

Cited by 8 publications

References 41 publications

Patient and Provider Views on Psychosocial Screening in a Comprehensive Diabetes Center

Patient and Provider Views on Psychosocial Screening in a Comprehensive Diabetes Center

Comprehensive psychosocial screening in a pediatric diabetes clinic

Transitioning to Telehealth Services in a Pediatric Diabetes Clinic During COVID-19: An Interdisciplinary Quality Improvement Initiative

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