Promoting a holistic family care model: Ethical and practical considerations for treating adult caregivers in integrated pediatric settings.

Abstract

Objective: As pediatric behavioral health concerns are increasingly identified and addressed within pediatric primary care and family medicine practices, behavioral health providers (BHPs) in integrated primary care (IPC) are often faced with not only addressing the psychosocial needs of their child patients, but also confronting the needs of those patients' caregivers. Given the extensive body of evidence demonstrating that child mental health is associated with caregiver mental health, continued discussions of addressing caregiver mental health within the integrated care context are warranted. Method: The current paper will discuss obstacles to establishing family-centered comprehensive behavioral care including ethical concerns around informed consent, scope of practice, and dual relations, and various practice considerations. Results: The obstacles are greater for establishing family-centered comprehensive behavioral care within pediatric settings compared to family practice settings due to the additional practice considerations. The potential benefit to children and the broader family system may warrant the effort. Conclusions: By identifying and discussing these issues, BHPs working within pediatric and family medicine settings are encouraged to engage in active dialogue with hospital and clinic administrators to overcome systemic barriers and to think flexibly about how BHPs might expand upon existing approaches in order to utilize the IPC opportunity to address parent mental health concerns that may otherwise impede a child's treatment progress. Implications for Impact StatementTreating adult caregivers within pediatric primary or family care settings has the potential of vastly improving the mental health of the entire family. Integrated pediatric primary care provides an ideal setting for behavioral health providers to provide holistic family care. To do this effectively, ethical and practical barriers must be discussed and dismantled.

Suicidality in bereaved parents within pediatric institutions: Recommendations for managing ethical challenges.

“…and the interests of the child. In pediatric settings, parent-directed psychological services are typically delivered “in service of the child” and have been associated with improved health outcomes for children (Maragakis et al, 2021; Weitzman et al, 2014). In these circumstances, children are typically the “identified patients” and the focus of organizational policies and clinical practices.…”

“…In the absence of standard operating procedures (SOP) for managing mental health emergencies in parents within pediatric institutions, the substantial clinical, logistical, and ethical challenges can be overwhelming. Although caring for parents is explicitly recommended as a standard for psychosocial care in some clinical populations (e.g., pediatric cancer; Lichtenthal et al, 2015; Steele et al, 2015; Weaver et al, 2015) and palliative care (Jones et al, 2014; Wiener et al, 2015), ethical guidelines for providing services to parents in pediatric settings have only recently emerged (Andrews, 2021; Maragakis et al, 2021).…”

“…In his seminal paper, Andrews (2021) presents a framework guided by the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (American Psychological Association [APA], 2017) for considering the ethical challenges unique to providing mental health care to parents 1 within pediatric settings. Maragakis and colleagues (Maragakis et al, 2021) discuss some of these ethical challenges within a primary care setting and advocate for parent-directed psychological services. They acknowledge the unique ethical dilemmas associated with managing caregiver suicidality or more severe mental health concerns in primary care and argue that behavioral health providers are obliged to serve as a “bridge” for caregivers even when the level of care required is not feasible or beyond the scope of practice in primary care.…”

“…They acknowledge the unique ethical dilemmas associated with managing caregiver suicidality or more severe mental health concerns in primary care and argue that behavioral health providers are obliged to serve as a “bridge” for caregivers even when the level of care required is not feasible or beyond the scope of practice in primary care. However, explicit and detailed consideration of the ethical challenges associated with management of parent suicidality, specifically, is not described by Andrews (2021) or Maragakis and colleagues (2021).…”

Incorporating DEI informed-frameworks and increasing access to parent-focused interventions in pediatric psychology.

“…As the pediatric heath system has evolved from paternalistic to collaborative, and from patient-centered to family-centered care, there have been increased opportunities to fully engage parents as important members of the treatment team and integrate enhanced support of parent needs in the context of child wellness (Kahhan & Junger, 2021). While there is increased recognition of the need for parent-focused support, ethical, legal, and logistical barriers must be navigated in order to assess parent psychosocial functioning and respond to needs in the pediatric environment (Maragakis et al, 2021). In practice, this means that parents all too often remain “invisible patients,” (Manne, 2005) at risk for increased burden as a result of their child’s medical condition but lacking access to appropriate care (Boettcher et al, 2021; Pelentsov et al, 2016).…”