The process of integrating psychology into medical clinics: Pediatric psychology as an example

Ward, Wendy L.; Smith, Allison; Munns, Catherine; Bai, Shasha

doi:10.1177/1359104520982323

Cited by 10 publications

(8 citation statements)

References 24 publications

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“…While a wealth of epidemiological studies has repeatedly confirmed the high rates and clinical significance of undertreated psychiatric comorbidities in epilepsy ( Mula et al, 2021 ), clinical studies that investigate the outcomes of actually implemented screenings and treatment recommendations informed by these epidemiological findings are unfortunately scarce ( Gandy et al, 2021 ). Thus, this naturalistic study is one of the few studies that provide pragmatic guidance on the integration of psychological care within epilepsy care including the formulation of treatment recommendations and systematic follow-up to evaluate outpatient adherence ( Ward et al, 2020 ). Considering patients’ preferences, treatment recommendations were discussed with the majority of patients who were not already receiving any treatment and follow-up yielded high adherence rates in epilepsy and PNES patients (94 and 100%).…”

Section: Discussionmentioning

confidence: 99%

Screening for Psychiatric Comorbidities and Psychotherapeutic Assessment in Inpatient Epilepsy Care: Preliminary Results of an Implementation Study

Michaelis

Schlömer

Lindemann

et al. 2021

Front. Integr. Neurosci.

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Background: Anxiety and depression remain underdiagnosed in routine clinical practice in up to two thirds of epilepsy patients despite significant impact on medical and psychosocial outcome. Barriers to adequate mental health care for epilepsy and/or psychogenic non-epileptic seizures (PNES) include a lack of integrated mental health specialists and standardized procedures. This naturalistic study outlines the procedures and outcome of a recently established psychotherapeutic service.Methods: Routine screening included the Neurological Disorders Depression Inventory for Epilepsy (NDDI-E, cut-off value > 13) and Generalized Anxiety Disorder scale (GAD-7, cut-off value > 5). Positively (above cut-off in at least one questionnaire) screened patients were seen for a standardized interview for mental health disorders and the development of a personalized treatment plan. PNES patients were seen irrespective of their screening score. Resources were provided to support self-help and access to psychotherapy. Patients were contacted 1 month after discharge to evaluate adherence to therapeutic recommendations.Results: 120 patients were screened. Overall, 56 of 77 positively screened patients (77%) were found to have a psychiatric diagnosis through standardized interview. More epilepsy patients with an anxiety disorder had previously been undiagnosed compared to those with a depressive episode (63% vs. 30%); 24 epilepsy patients (62%) with a psychiatric comorbidity and 10 PNES patients (59%) were not receiving any mental health care. At follow-up, 16/17 (94%) epilepsy patients and 7/7 PNES patients without prior psychiatric treatment were adhering to therapeutic recommendations.Conclusion: Integrating mental health specialists and establishing standardized screening and follow-up procedures improve adherence to mental health care recommendations in epilepsy and PNES patients.

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Section: Discussionmentioning

confidence: 99%

Screening for Psychiatric Comorbidities and Psychotherapeutic Assessment in Inpatient Epilepsy Care: Preliminary Results of an Implementation Study

Michaelis

Schlömer

Lindemann

et al. 2021

Front. Integr. Neurosci.

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“…Over the last few decades, there has been increasing interest in the integration of mental health professionals into healthcare teams, including pediatric sub-specialty care. Inclusion of psychologists in medical teams has been shown to have high levels of satisfaction with care for both patients/families and medical providers [ 31 ]. In addition, there is also evidence to suggest that integration of psychologists into medical teams improves patient mental health and medical outcomes as well as being cost saving for healthcare systems [ 32 , 33 ].…”

Section: The Multidisciplinary Approach: Areas Of Focusmentioning

confidence: 99%

A Path FORWARD: Development of a Comprehensive Multidisciplinary Clinic to Create Health and Wellness for the Child and Adolescent with a Fontan Circulation

et al. 2022

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Today, it is anticipated most individuals diagnosed with single-ventricle malformation will survive surgical reconstruction through a successful Fontan operation. As greater numbers of patients survive, so has the recognition that individuals with Fontan circulation face a variety of challenges. The goal of a normal quality and duration of life will not be reached by all. The hurdles fall into a variety of domains. From a cardiovascular perspective, the Fontan circulation is fundamentally flawed by its inherent nature of creating a state of chronically elevated venous pressure and congestion, accompanied by a relatively low cardiac output. Ventricular dysfunction, atrioventricular valve regurgitation, and arrhythmia may directly impact cardiac performance and can progress with time. Problems are not limited to the cardiovascular system. Fontan circulatory physiology impacts a multitude of biological processes and health parameters outside the heart. The lymphatic circulation is under strain manifesting as variable degrees of protein-rich lymph loss and immune system dysregulation. Organ system dysfunction develops through altered perfusion profiles. Liver fibrosis is ubiquitous, and a process of systemic fibrogenesis in response to circulatory stressors may affect other organs as well. Somatic growth and development can be delayed. Behavioral and mental health problems are common, presenting as clinically important levels of anxiety and depression. Most striking is the high variability in prevalence and magnitude of these complications within the population, indicating the likelihood of additional factors enhancing or mitigating their emergence. We propose that optimal care for the individual with single ventricle and a Fontan circulation is ideally offered in a comprehensive multidisciplinary manner, with attention to elements that are beyond cardiac management alone. In this report, we share the concepts, our experiences, and perspectives on development of a clinic model—the “Fontan rehabilitation, wellness and resilience development” or FORWARD program. We provide insights into the mechanics of our multidisciplinary model of care and the benefits offered serving our growing population of individuals with a Fontan circulation and their families.

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“…Recent work by Ward et al (2021) outlines differences in reimbursement systems (e.g., contracts, fee for service) and encourages psychologists and administrators working to support further integration of pediatric psychology to consider expanding services available to promote patient and staff satisfaction. Other resources, such as the American Psychological Association (APA) and their work on reimbursement (Bailey, 2020) and the Board of Psychology in the state of interest may be useful in better understanding reimbursement issues for a given geographic region.…”

Section: Addressing Funding Concernsmentioning

confidence: 99%

“…Pediatric psychologists, with both health and child psychology training, are uniquely suited to provide such services in pediatric specialty clinic settings, acting as partners and consultants for a variety of reasons across virtually all medical specialties (Drotar, 1977). Integrating psychology within medical clinics has many positive associations, including improved early identification of mental illness, increased access to indicated mental health treatments, reduced medical care utilization, increased patient and provider satisfaction, and cost-effectiveness (Conroy & Logan, 2014;Dore-Stites & Butcher, 2020;McGrady, 2014McGrady, , 2018Walter et al, 2019;Ward et al, 2021;Yarbro & Mehlenbeck, 2016).…”

mentioning

confidence: 99%

Physician interest in hiring pediatric psychologists in specialty care roles.

Dawson¹,

David²,

Threlkeld³

2023

Clinical Practice in Pediatric Psychology

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Objective: Integration of pediatric psychology into medical specialty clinics remains an ongoing need in pediatrics, which is dependent on hiring psychologists. The perspectives of physicians who may be involved in the hiring process are not well-understood. This study sought to identify the considerations of physicians in leadership positions in medical training programs. Methods: Participants included a national sample of 64 physician training directors across five specialty areas (gastroenterology, hematology/oncology, neurology, urology, and cardiology). Physicians completed a survey assessing knowledge of pediatric psychology, the current integration of psychologists and trainees, and considerations for hiring pediatric psychology. Physicians provided feedback on a fictional pediatric psychology applicant's "cold email." Results: The majority (65.6%) of participants reported current psychology integration in the overarching specialty (e.g., neurology); however, integration of psychology trainees and psychology within each subspecialty population (e.g., epilepsy) was less prevalent. Participants indicated varied responses to the "cold email" and identified several considerations in the hiring of pediatric psychologists, including funding, applicant's experience/expertise, and role in the hiring decision. Conclusions: Physician training directors indicated a generally positive interest in working with psychology. Respondents offered diverse considerations related to hiring pediatric psychologists, including multiple considerations specific to the "cold email." Funding barriers were highlighted as an obstacle. Implications for Impact StatementThe study explores areas of pediatric psychology integration and room for (hiring) expansion in five pediatric specialty medical disciplines, with a specific focus on physician considerations in hiring. We offer recommendations for prospective psychologists seeking employment in pediatric specialty and subspecialty care.

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The process of integrating psychology into medical clinics: Pediatric psychology as an example

Cited by 10 publications

References 24 publications

Screening for Psychiatric Comorbidities and Psychotherapeutic Assessment in Inpatient Epilepsy Care: Preliminary Results of an Implementation Study

Screening for Psychiatric Comorbidities and Psychotherapeutic Assessment in Inpatient Epilepsy Care: Preliminary Results of an Implementation Study

A Path FORWARD: Development of a Comprehensive Multidisciplinary Clinic to Create Health and Wellness for the Child and Adolescent with a Fontan Circulation

Physician interest in hiring pediatric psychologists in specialty care roles.

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