Kristin Kullgren

In this single-site, retrospective, descriptive chart review and survey, we investigated changes in pediatric behavioral health needs during the COVID-19 pandemic and the relationship between virtual schooling and hospitalized children’s mental health. Subjects included patients aged 6 and 18 years during the 2015 to 2019 and 2020 to 2021 school years who received inpatient mental health care. Parents of patients admitted in 2020 to 2021 were surveyed regarding their child’s schooling. We additionally described and compared subjects using descriptive data, including proxies for illness severity, and assessed how these outcomes changed during the pandemic and correlated with school modality. During the pandemic, the distribution of diagnoses changed, and some markers of severity increased. Patients in exclusively virtual school had higher rates of mood and anxiety disorders and tic disorders, and lower …

BackgroundWhile factors such as race, sex, gender identity, and socioeconomic status impact the diagnosis and treatment of a variety of conditions, there are few studies examining their influence on somatic symptom and related disorders (SSRDs), particularly in the pediatric population.ObjectiveIn this review, we outline the existing literature on how sociodemographic characteristics influence the overall care of pediatric SSRDs. Throughout this literature review, we highlight opportunities for further research, including potential disparities in evaluation, management, and outcomes along several sociodemographic domains.MethodsWe conducted a thorough review of the evidence for potential impact of race, sex, gender identity, and socioeconomic status on the presentation, diagnosis, management, and outcomes of pediatric somatization and SSRDs.ResultsRecent studies evaluating the impact of race on SSRD …

Objective Parental stress can have an impact on health outcomes of chronically ill children (Cousino & Hazen, 2013). Pediatric psychologists are well suited to address these issues with understanding of empirically supported treatments, impact of mental health on medical care behaviors, and parent–child interactions (Ernst et al., 2015). Use of empirically supported treatments, such as graduated exposure therapy (ET), within an uncontrolled environment such as an inpatient setting can be challenging. This case study illustrates adaptation of ET in an inpatient setting to address parental mastery of medical care. Method ET was implemented with a mother of an infant with a newly placed tracheostomy to reduce her severe anxiety that was preventing her from interacting with her infant or engaging in medical care necessary for hospital discharge. Results Through 31 exposure sessions, the patient’s mother met all …

COVID-19 has presented a variety of challenges to the provision of psychology services. In the first month of the pandemic, pediatric consultation–liaison (CL) psychologists reported significant changes in methodology of service delivery (Steinberg et al. in Clin Pract Pediatr Psychol 9:1, 2020). To better understand how and if these changes persisted, as well as other emerging trends, a follow-up study examined changes and challenges six months into the pandemic. An anonymous questionnaire assessed topics related to pediatric CL psychology including practice changes, perception of changes, and institutional support. The questionnaire was sent to the APA Society of Pediatric Society’s special interest group listservs. Thirty responses were analyzed. Quantitative results showed participants’ beliefs that telemedicine is equally efficacious to in-person services for outpatient psychological care, but less effective …

Methods: A 28-item anonymous survey was emailed to PICU providers at a Midwestern, Level I Pediatric Trauma Center via Qualtrics. Questions included: demographics, TIC specific questions related to knowledge, comfort, and training history/interest, and barriers to TIC education and practice.Results: 107 respondents from multiple disciplines including nursing (68.2%), respiratory therapy, critical care physician attendings and fellows, patient technicians, pharmacy, and spiritual care participated. Slightly under half were not familiar with the concept of TIC, almost three-quarters had no previous TIC training, and most reported moderate to low levels of comfort in providing TIC. Barriers to learning about TIC included time, burnout, staffing, and uncertainty about the value of TIC. Most want more TIC training (68.42%) while others might or are unsure (28.42%). Most respondents are willing to devote less than 60 …

A phlebotomist’s words and actions play a crucial role in success of a blood draw and in providing a supportive patient experience. This study examined use of comfort measures during a pediatric blood draw. The phlebotomist’s use of soft words, positioning, distraction, coaching/support were observed with sixty children between 3-14 years of age during a blood draw. The level of fear/anxiety before and during the blood draw was recorded by an RA. The child’s level of fear/anxiety was observed and reported by the parent/caregiver after the procedure. Comfort measures provided by phlebotomists, the parent/caregiver’s report of their child’s usual response, and the parent’s level of fear with needles were compared. Comfort measures were offered inconsistently across age groups. Distraction was the most frequent measure (85%), followed by coaching/support (72%). Positioning was used more often with younger children (42%) than with older children (7%). Despite the high use of comfort measures, many children (56%) had levels of 2-4 fear/anxiety. The parent/caregiver often predicted their child’s level of fear/anxiety. Phlebotomists can benefit from interdisciplinary collaboration opportunities and developmentally appropriate education, including comfort measures, to mitigate patients’ pain and fear. Given the importance of creating a positive patient-family centered environment, introductions, and interactions to build a trusting rapport are crucial. Additionally, this research highlighted the importance of self-advocacy by pediatric patients and families. When providers ask and listen, and children are brave enough to share their voice... the …

Background and objectivesPrevious studies have demonstrated an increase in mental health emergencies among youth seen in ambulatory and emergency room settings during the COVID-19 pandemic. This study investigates rates of mental health-related consultation and markers of illness severity since the start of the pandemic.MethodsWe evaluated all pediatric patients admitted to a single children’s hospital from March 2019 to March 2021 who received psychiatry and/or psychology consults. We report the absolute number of these patients, as well as the proportion of all study site admissions who received such consults. Severity of psychiatric illness was described in terms of LOS, disposition, and use of restraints and psychotropic medications.ResultsThe number and proportion of pediatric patients receiving psychiatry and/or psychology consults rose during the pandemic. Participants also became …

MethodsThis single-site retrospective study compared psychiatric initial and follow-up consultations for pediatric inpatients at a 234-bed academic, urban, Midwestern Children’s Hospital between July and January during 2017 to 2021. In addition, variations in psychiatry initial consultation volumes relative to total hospital volume from July 1, 2019, to January 31, 2021, were analyzed. The July to January time period was chosen because it was not till July 2020 that we started to see a rise in inpatient hospitalizations similar to prepandemic volumes.

Objective This study aimed to examine the efficacy of a psychological screening tool for hospitalized pediatric patients to identify those at high risk for adjustment difficulties and optimize referrals to pediatric behavioral health (BH) providers. Specifically, this study evaluated the PROMIS® Parent Proxy 25 to capture the psychosocial needs of the inpatient pediatric population admitted to the general medicine floor in a free standing children’s hospital. Methods The PROMIS® Parent Proxy 25 was administered to parents of children ages 5 to 17 (N= 128). Chart review was used to group children into those who did or did not receive BH consultation during their admission. Results Results indicate that the PROMIS® Parent Proxy Anxiety and Depression scales consistently differentiated between children’s consultation status while also indicating a notable level of unmet need in children who did not receive BH …

Background Pediatric patients with increasing psychiatric needs introduce a substantial challenge for inpatient care. This study illustrates how the COVID-19 pandemic has influenced the number and acuity of psychiatry and psychology consults among pediatric inpatients at a tertiary care hospital. Methods The study population included all pediatric patients (ages 0-25) admitted to University of Michigan’s CS Mott Children’s Hospital between March 2019 and March 2021 who received a psychology and/or psychiatry consult. Three time periods were defined: pre-pandemic, 3/1/19-3/15/20; early pandemic, 3/16/20-6/30/20; and steady-state pandemic, 7/1/20-2/28/21. The patients were described demographically and clinically. To assess differences among time periods, ANOVA testing was conducted for numeric variables and chi-square tests were used for categorical variables. The number of pediatric inpatients …

Objective The novel coronavirus 2019 (COVID-19) pandemic has led to a rapid shift in the health care landscape. To meet the psychological needs of children/adolescents in the medical setting, pediatric consultation-liaison (CL) psychologists have had to radically adapt their traditional forms of practice. Method To understand this adaptation, a questionnaire was sent to members of the consultation-liaison and related special interest groups of the Society of Pediatric Psychology (American Psychological Association Division 54). Questions included: participant background; practice setting; prepandemic/peri-pandemic psychological service delivery methodology; speed/level of support for service transition; and open-ended questions on challenges and benefits of providing CL services during the pandemic. Responses to open-ended questions were coded using content analysis. Results Between April 6 and April …

Somatic symptoms and related disorders (SSRD) share the hallmark feature of the presence of physical symptoms in the absence of identifiable disease, accompanied by associated psychological distress and impairment. As somatic symptoms are common among children and adolescents, a consultation-liaison (CL) psychologist is likely to encounter SSRD in practice. Studies on the etiology of SSRD point to contributions of biological, psychological, and social factors; as such, biopsychosocial diagnosis, assessment, and treatment are most effective. For CL psychologists, collaborative communication with healthcare providers is essential to present a coordinated diagnostic and treatment message. Psychological assessment should balance medical and psychological information while setting the stage for a functional approach to symptom management. Cognitive behavioral therapy (CBT) is the recommended …

Headache is a common presenting complaint in emergency departments (EDs), with the goal of improving acute pain. However, youth with chronic headaches may demonstrate broad functional impairment in their lives due to headaches. Our objective was to determine if degree of functional impairment predicts ED course for patients with headache as part of a clinical protocol. One hundred and thirty-seven pediatric patients presenting to an ED with headache were included. Patients and parents were administered the Functional Disability Index (FDI) and ED charts were reviewed to evaluate outcomes. Higher child-reported FDI scores were associated with more medications, longer ED stay, and admission. High parent-proxy FDI score was associated with longer ED stay. Both pain score and parent-proxy FDI score were associated with imaging. The FDI was a more useful predictor of visit resources than pain …

BACKGROUND Pediatric somatic symptom and related disorders (SSRDs) are common with high health care costs and use because of lack of standardized, evidence-based practice. Our hospital implemented a clinical pathway (CP) for SSRD evaluation and management. Our study objective was to evaluate health care cost and use associated with the organization’s SSRD CP in the emergency department (ED) and inpatient settings hypothesizing lower cost and use in the CP group relative to controls. METHODS We conducted a retrospective analysis of costs and use before and after implementation of the SSRD CP. Data were collected from the hospital’s electronic health record and the Pediatric Health Information System database. Participants included pediatric patients on the CP (“P” group) and control groups with an SSRD diagnosis and mental health consultation either the year before the CP (“C” group …

The Issues in Clinical Child Psychology book series represents a broad spectrum of professional psychology books, integrating clinical psychology with the development of children, adolescents, and their families and developmental psychopathology. The age coverage ranges from infancy to childhood to adolescence. Populations of interest include normally developing children and those exhibiting problems in developmental, behavioral, psychological, health, and academic realms. Settings include schools, mental health clinics, independent practice, pediatric offices and centers, and juvenile facilities. Topics of interest include developmental psychopathology, externalizing and internalizing disorders, assessment and diagnosis, interventions and treatments, consultation, prevention, school mental health, normal and abnormal development, family psychology, service delivery, diversity and cultural differences, and …

OBJECTIVES The diagnostic category of somatic symptom and related disorders (SSRDs), although common, is often poorly recognized and suboptimally managed in inpatient pediatric care. Little literature exists to address SSRDs in the inpatient pediatric setting. The purpose of the study was to characterize current SSRD practice, identify problem areas in workflow, and develop a standardized approach to inpatient evaluation and management at a tertiary care academic children’s hospital. METHODS A multidisciplinary group identified patients with SSRD admitted between May 2012 and October 2014. A retrospective chart review on a convenience sample was performed to identify population characteristics and current practice. Lean methodology was used to define current state practice and future state intervention. These methods were used to guide identification of problem …

Ever since the establishment of the subspecialty of pediatric psychology, psychologists have been called upon to provide consultation to their pediatrician colleagues in ever-expanding roles and in a variety of medical settings. In response, a number of models have been created to address how psychologists fit into the overall health-care system in order to address those psychosocial factors that can have a major impact on prevention/early intervention in pediatric illness and injury and overall adjustment and quality of life. This chapter addresses both theoretical and pragmatic issues in establishing and maintaining a viable consultation-liaison service while avoiding personal and professional burnout.