Integrating Psychosocial Interventions with Patients with Gastrointestinal Disorders in Primary Care and Specialty Care Services

Jennifer K Paternostro, Erica V Rozbruch, Robert D Friedberg

Abstract


Emphasis on integrated physical and behavioral health care skyrocketed in recent years partially as a result of the Federal Health Care initiatives described in the Affordable Care Act, emergence of the biopsychosocial model, and the ongoing collaboration between medical providers and pediatric psychologists. Integrated models of care demonstrate significant advantages to patients as well as medical providers. Behavioral health problems arise in approximately 50 percent of well-child and pediatric outpatient visits and consume physician time that should be spent addressing medical concerns. Additionally, families who present with behavioral health concerns in primary care settings often utilize greater health care resources than those families that do not present with a behavioral health problem. Thus, integrated behavioral health care allows for better allocation of physician time and resources.

The current article aims to provide a framework for behavioral health integration in primary and specialty clinics, with specific emphasis on treating pediatric patients with gastrointestinal conditions. Chronic conditions such as Crohn’s disease and Ulcerative Colitis are generally managed by a Gastroenterology Specialty Clinic. Patients with chronic medical conditions, like Inflammatory Bowel Disease, are at greater risk of disease distress and psychosocial challenges that would benefit from behavioral health consultation. Further, functional gastrointestinal disorders are believed to largely result from psychosocial distress, and typically respond to behavioral intervention. Pediatric psychologists are well-equipped to support primary and specialty clinics in managing psychosocial challenges that often present in patients with gastrointestinal distress. The current article describes the foundation of integrated care practices and how pediatric psychologists should be utilized in pediatric medical settings.

 


Keywords


Integrated pediatric primary care, gastrointestinal, behavioral health

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References


REFERENCES

Engel GT. A need for a new medical model: A challenge for biomedicine. Science. 1977 Apr 8;196:126-36.

Asarnow JR, Kolko DJ, Miranda J, Kazak AE. The pediatric-centered medical home: Innovative models for improved behavioral health. Am Psychol. 2017 Jan;72(1):13-27.

Stancin T, Perrin EC. Psychologists and pediatricians: Opportunities for collaboration in primary care. Am Psychol. 2014 May-June;69:332-42.

Campo JV, Shafer S, Strohm J, Lucas A, Gelacek-Cassesse C, Saheffer D, et al. Pediatric behavioral health in primary care: A collaborative approach. J Am Psychiatr Nurses Assoc. 2005 Oct 1;11:276-82.

Weitzman CC, Leventhal JM. Screening for behavioral health problems in primary care. Curr Opin Pediatr. 2006 Dec;18(6):641-8.

Friedberg RD, Thordarson MA, Paternostro J, Sullivan P, Tamas M. CBT with youth: Immodest proposals for training the next generation. J Ration Emot Cogn Behav Ther. 2014 March;32(1):110-19.

Saps M. Challenges of caring for children with functional gastrointestinal disorders. Pediatric Annals. 2014 Apr 1;43(4):141-42.

Asarnow JR, Hoagwood KE, Stancin T, Lochman J, Hughes JL, Miranda JM, et al. Psychological science and innovative strategies for informing health care redesign: A policy brief. J Clin Child Adoles Psychol. 2015;44(6):923-32.

Janicke DM, Fritz AM, Rozensky RH. Healthcare reform and preparing the future clinical child and adolescent psychology workforce. 2015;44(6):1030-9.

Aupont O, Doerfler L, Connor DF, Stille C, Tisminetzky M, McLaughlin TJ. A collaborative care model to improve access to pediatric mental health services. Adm Policy Ment Health. 2013 Jul;40(4):264-73.

Kelly JF, Coons HL. Integrated healthcare and professional psychology: Is the setting right for you? Prof Psychol Res Pr. 2012 Dec;43(6):586-95.

Ward-Zimmerman B, Cannata E. Partnering with pediatric primary care: Lessons learned through collaborative colocation. Prof Psychol Res Pr. 2012 Dec;43(6):596-605.

Reed-Knight B, Maddux MH, Deacy AD, Lamparyk K, Stone AL, Mackner L. Brain-gut interactions and maintenance factors in pediatric gastroenterological disorders: Recommendations for clinical care. Clin Pract Ped Psychol. 2017 Mar;5(1):93-105.

Guthery SL, Hutchings C, Dead JM, Hoff C. National estimates of hospital utilization by children with gastrointestinal disorders: Analysis of the 1997 KIDS’ inpatient database. J Pediatr. 2004 May;144(5):589-594.

Cunningham CL, Banez GA. Pediatric gastrointestinal disorders: Biopsychosocial assessment and treatment. New York, NY: Springer Science+Business Media; 2006.

Kappelman MD, Rifas-Shiman SL, Kleinman K, Ollendorf D, Bousvaros A, Grand RJ, et al. The prevalence and geographic distribution of Crohn’s disease and ulcerative colitis in the United States. Clin Gastroenterol Hepatol. 2007 Dec;5(12):1424-9.

Kappelman MD, Moore KR, Allen JK, Cook SF. Recent trends in the prevalence of Crohn’s disease and ulcerative colitis in a commercially insured US population. Dig Dis Sci. 2013 Feb;58(2):519-25.

Hyams JS, Di Lorenzo C, Saps M, Shulman RJ, Staiano A, van Tilburg M. Functional disorders: Children and adolescents. Gastroenterology. 2016 Feb 15. pii: S0016-5085(16)00181-5.

Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PA. Abdominal pain and irritable bowel syndrome in adolescents: A community-based study. 1996 Aug;129(2):220-6.

Khan S. Children’s National Medical Center. Functional abdominal pain in children [Internet]. American College of Gastroenterology; 2006 [updated 2012 Dec]. Available from: http://patients.gi.org/topics/functional-abdominal-pain-in-children/

Mackner LM, Crandall WV. Brief report: Psychosocial adjustment in adolescents with inflammatory bowel disease. J Pediatr Psychol. 2006 Apr;31(3):281-5.

Burke P, Meyer V, Kocoshis S, Orenstein DM, Chandra R, Nord DJ, et al. Depression and anxiety in pediatric inflammatory bowel disease and cystic fibrosis. J Am Acad Child Adolesc Psychiatry. 1989 Nov;28(6):948-51.

Szigethy E, Levy-Warren A, Whitton S, Bousvaros A, Gauvreau K, Leichtner AM, et al. Depressive symptoms and inflammatory bowel disease in children and adolescents: A cross-sectional study. J Pediatr Gastroenterol Nutr. 2004 Oct;39(4):395-403.

Gold N, Issenman R, Roberts J, Watt S. Well-adjusted children: An alternate view of children with inflammatory bowel disease and functional gastrointestinal complaints. Inflamm Bowel Dis. 2000 Feb 1;6(1):1-7.

Wilhelmsen I. Brain-gut axis as an example of the bio-psycho-social model. Gut. 2000 Dec;47(Suppl 4):iv5-iv7.

Birmaher B, Kheterpal S, Brent DA, Cully M, Balach L, Kaufman J, et al. The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric properties. J Am Acad Child Adolesc Psychiatry. 1997 Apr;36(4):545-53.

Birmaher B, Brent DA, Chiapetta L, Bridge J, Manga S, Baugher M. Psychometric properties of the SCARED: A replication study. J Am Acad Child Adolesc Psychiatry. 1999 Oct;38(10):1230-6.

Holmbeck GN, Thrill AW, Pachanas P, Garber J, Miller KB, Abad M, et al. Evidence based assessment in pediatric psychology: Measures of psychosocial adjustment and psychopathology. J Pediatr Psychol. 2008 Oct;33(9):958-80.

Weersing VR, Gonzalez A, Campo JV, Lucas AN. Brief behavioral therapy for pediatric anxiety and depression: Piloting an integrated approach. Cogn Behav Pract. 2008 May;15(2):126-39.

Weersing VR, Rozenman MS, Maher-Bridge M, Campo J. Anxiety, depression, and somatic distress: Developing a transdiagnostic internalizing toolbox for pediatric practice. Cogn Behav Pract. 2012 Feb 1;19(1):66-82.

Cunningham NR, Lynch-Jordan A, Mezoff AG, Farrell MK, Cohen MB, Kashikar-Zuck S. Importance of addressing anxiety in youth with functional abdominal pain: Suggested guidelines for physicians. J Pediatr Gastroenterol Nutr. 2013 May;56(5):469-74.

Mano KEJ, Evan JR, Tran ST, Khan KA, Weisman SJ, Hainsworth KR. The psychometric properties of the SCARED in pediatric chronic pain. J Pedaitr Psychol. 2012 Oct;37(9):999-1011.

March JS. The Multidimensional Anxiety Scale for Children [2nd Edition; MASC-2]. Tonawanda, NY: Multi-Health Systems; 2013.

Kalapurkel S, Carpino EA, Lebel A, Simons L. “Pain can’t stop me”: Examining pain self-efficacy and acceptance as resilience processes among youth with chronic headache. J Pediatr Psychol. 2015 Oct;40(9):926-33.

Chan SF, Connelly M, Wallace DP. The relationship between pain characteristics, peer difficulties, and emotional functioning among adolescents seeking treatment for chronic pain: A test of mediational models. J Pediatr Psychol. 2017 Oct 1;42(9):941-51.

Kovacs M. The Children’s Depression Inventory-2 manual. North Tonawanda, NY: Multi-Health Systems; 2010.

Horst S, Shelby G, Anderson J, Acra S, Polk DB, Saville BR, et al. Predicting persistence of functional abdominal pain from childhood into young adulthood. Clin Gastroenterol Hepatol. 2014 Dec;12(12):2026-32.

Laird KT, Sherman AL, Smith CA, Walker LS. Validation of the abdominal pain index using a revised scoring method. J Pediatr Psychol. 2015 June 1;40(5):517-25.

Allgaier AK, Fruhe B, Pietsch K, Saravo B, Baethmann M, Schulte-Korne G. Is the children’s depression inventory short version a valid screening tool in pediatric care? A comparison to its full-length version. J Psychosom Res. 2012 Nov;73(5):369-74.

Beck AT. Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.

Pinquart M, Shen Y. Depressive symptoms in children and adolescents with chronic physical illness: An updated meta-analysis. J Pediatr Psychol. 2011 May;36(4):375-84.

Williams SE, Zahka NE. Treating somatic symptoms in children and adolescents. New York: Guilford; 2017.

Reid GJ, Gilbert CA, McGrath PJ. The pain coping questionnaire: Preliminary validation. Pain. 1998 May;75(1-2):83-96.

Walker LS, Smith CA, Garber J, van Slyke DA. Development and validation of the pain response inventory for children. Psychol Assess. 1997;9(4):392-405.

Weisz JR, McCabe MA, Dennig MD. Primary and secondary control among children undergoing medical procedures: Adjustment as a function of coping style. J Consult Clin Psychol. 1994 Apr;62(2):324-32.

Weisz JR. Psychotherapy for children and adolescents: Evidence-based treatments and case examples. New York, NY: Cambridge University Press; 2004.

Compas BE, Jaser SS, Dunn M, Rodriguez EM. Coping with chronic illness in childhood and adolescence. Annu Rev Clin Psychol. 2012 Apr 27;8:445-80.

Connor-Smith JK, Compas BE, Wadsworth ME, Thomsen AH, Saltzman H. Responses to stress in adolescence: Measurement of coping and involuntary stress responses. J Consult Clin Psychol. 2000 Dec;68(6):976-92.

Blount RL, Simons LE, Devine KA, Jaaniste T, Cohen LL, Chambers CT, et al. Evidence-based assessment of coping and stress in pediatric psychology. J Pediatr Psychol. 2008 Oct;33(9):1021-45.

Patterson JM, McCubbin HI. Adolescent coping style and behaviors: Conceptualization and measurement. J Adolesc. 1987 Jun;10(2):163-86.

Vitaliano PP, Russo J, Carr JE, Maiuro RD, Becker J. The ways of coping checklist: Revision and psychometric properties. Multivariate Behav Res. 1985 Jan 1;20(1):3-26.

Tobin DL. User’s manual for the Coping Strategies Inventory. Ohio University: Athens Unpublished manuscript; 1991.

Folkman S, Lazarus RS. An analysis of coping in middle-aged community sample. J Health Soc. Behav. 1980 Sep;21(3):219-39.

Varni JW, Seid M, Kurtin PS. PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001 Aug;39(8):800-12.

Varni JW, Bendo CB, Shulman RJ, Self MM, Nurko S, Franciosi JP, et al. Interpretability of the PedsQLTM gastrointestinal symptoms scales and gastrointestinal worry scales in pediatric patients with functional and organic gastrointestinal diseases. J Pediatr Psychol. 2015 Jul;40(6):591-601.

Beidas RS, Stewart RE, Walsh L, Lucas S, Downey MM, Jackson K, et al. Free, brief, and validated: Standardized instruments for low-resource mental health settings. Cogn Behav Pract. 2015 Feb 1;22(1):5-19.

Gray WN, Denson LA, Baldassano RN, Hommel KA. Treatment adherence in adolescents with inflammatory bowel disease: The collective impact of barriers to adherence and anxiety/depressive symptoms. J Pediatr Psychol. 2012 Apr;37(3):282-91.

Logan D, Zelikovsky N, Labay L, Spergel J. The illness management survey: Identifying adolescents’ perceptions of barriers to adherence. J Pediatr Psychol. 2003 Sep;28(6):383-92.

Hommel KA, Baldassano RN. Brief report: Barriers to treatment adherence in pediatric inflammatory bowel disease. J Pediatr Psychol. 2010 Oct;35(9):1005-10.

Kahana S, Drotar D, Frazier T. Meta-analysis of psychological interventions to promote adherence to treatment in pediatric chronic health conditions. J Pediatr Psychol. 2008 Jul;33(6):590-611.

Schurman JV, Cushing CC, Carpenter E, Christenson K. Volitional and accidental nonadherence to pediatric inflammatory bowel disease treatment plans: Initial investigation of associations with quality of life and disease activity. J Pediatr Psychol. 2011 Jan;36(1):116-25.

Hanghoj S, Boisen KA. Self-reported barriers to medication adherence among chronically ill adolescents: A systematic review. J Adolesc Health. 2014 Feb;54(2):121-38.

Hommel KA, Greenley RN, Maddux MH, Gray WN, Mackner LM. Self-management in pediatric inflammatory bowel disease: A clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr. 2013 Aug;57(2):250-7.

Blanchard EB, Schwarz SP, Suls JM, Gerardi MA, Scharff L, Greene B, et al. Two controlled evaluations of multicomponent psychological treatment of irritable bowel syndrome. Behav Res Ther. 1992 Mar;30(2):175-89.

Hunt MG, Ertel E, Coello JA, Rodriguez L. Empirical support for a self-help treatment for IBS. Cognit Ther Res. 2015 Apr;39(2):215-27.

Radziwon CD, Lackner JM. Cognitive behavioral therapy for IBS: How useful, how often, and how does it work? Curr Gastroenterol Rep. 2017 Aug 17;19(10):1-8.

Lackner JM. The role of psychosocial factors in functional gastrointestinal disorders. Front Gastrointest Res. 2014;33:104-16.

Levy RL, van Tilburg MA, Langer SL, Romano JM, Walker LS, Mancl LA, et al. Effects of a cognitive behavioral therapy intervention trail to improve disease outcomes in children with inflammatory bowel disease. Inflamm Bowel Dis. 2016 Sep;22(9):2134-48.

Asarnow JR, Rozenman M, Wiblin J, Zeltzer L. Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: A meta-analysis. JAMA Pediatr. 2015 Oct;169(10):929-37.

Davis K, Stremikis K, Squires D, Schoen D. Mirror, Mirror on the Wall, 2014 Update: How the US Health Care System Compares Internationally. New York, NY: The Commonwealth Fund; 2014.

Campo JV. Annual research review: Functional somatic symptoms and associated anxiety and depression – developmental psychopathology in pediatric practice. J Child Psychol Psychiatry. 2012 May;53(5):575-92.

The Crohn’s and Colitis Foundation of America. The facts about inflammatory bowel diseases [internet]. The Crohn’s and Colitis Foundation of America [published 2014 Nov]. Available from:http://www.crohnscolitisfoundation.org/assets/pdfs/updatedibdfactbook.pdf




DOI: http://dx.doi.org/10.18103/imr.v4i4.687

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