Pediatric psychology critical care consultation: An emerging subspecialty.

Abstract

As the field of pediatric psychology expands and evolves, pediatric critical care settings hold considerable promise for our profession. Although extensive mental health needs have been recognized in patients and families affected by care in the pediatric intensive care unit (PICU), specifics regarding the need for, utilization of, and nature of pediatric psychology services have not yet been systematically examined. The current study provides a descriptive analysis of all consecutive referrals to a pediatric psychology consultation service within the critical care setting of a large metropolitan pediatric medical center from January 2006 through December 2009. During the study period, 611 pediatric psychology referrals (4.6% of PICU admissions) were generated. Consultations were initiated by interdisciplinary staff and spanned a diverse and farreaching range of behavioral health needs for patients and family members. Numerous factors were associated with increased need for pediatric psychology consultation, including longer than average hospitalizations, unanticipated critical care admissions, and previously healthy children who had sustained accidental trauma and those with new onset acute critical illness. Of note, the mortality rate within referred patients was significantly higher compared with the general PICU population, suggesting high need for pediatric psychology services during end-of-life care. Findings are discussed with respect to viable consultation models and training of pediatric psychologists who can function capably and confidently in the critical care setting.

Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU

“…Access to psychologists for ICU family members appears limited; psychology consultation service provision range from 4% in the United Kingdom (196) and United States (197) to 29% in Australia (198) for pediatric ICU patients. In one study of adult ICUs in Europe, 37% of relatives had access to psychologists (172).…”

Understanding the Unique Needs of Hospitalized Adolescents and Young Adults Referred for Psychology Consults

“…13 PCL work has tended to focus on youth across the age range with little attention to the potential impact of stages of development on the referred patient’s experience. 14-17 For example, in youth admitted for somatoform disorders, older adolescents were less likely than their preadolescent peers to present with abdominal pain as a primary complaint. 18 Thus, to improve the care of hospitalized AYA and effectively address mental health comorbidities, it is important for the PCL to understand age group differences in mental health care needs.…”

Inpatient pediatric psychology consultation-liaison practice survey.

“…Few inpatient CL psychologists report engagement in research as evidenced by our results and the limited number of published empirical studies in inpatient CL. However, the advent of the new Clinical Practice in Pediatric Psychology journal has supported several recent publications of inpatient CL work (e.g., Piazza-Waggoner et al, 2013;Tunick et al, 2013). Most notable is the dearth of studies on measurement of inpatient CL outcomes or efficacy, an area of much needed investigation in which few inpatient CL psychologists are engaged.…”

“…Despite pediatric psychology inpatient CL being a common service provided by psychologists in medical settings, there is little research describing its practice (Carter, Kronenberger, Scott, & Ernst, 2009). Of the research on pediatric psychology inpatient CL, the majority of studies focus on practice factors related to direct patient care (Brosig & Zahrt, 2006;Carter et al, 2003;Drotar, Spirito, & Stancin, 2003;Olson et al, 1988;Piazza-Waggoner et al, 2013;Rodrigue et al, 1995;Tunick et al, 2013). While these studies have described common referral concerns, referral sources, intervention strategies, and financial reimbursement, they are limited by their description of a single health care setting.…”