Description and Critical Evaluation of Models of Psychology Practice in the Pediatric Intensive Care Unit

During and after hospitalization in the pediatric intensive care unit (PICU), a significant proportion of patients and their family members experience clinical levels of distress (i.e., traumatic stress, anxiety, and depression). Pediatric psychologists are well-suited to support families during hospitalization and are increasingly present in PICUs. Models of psychology practice have been explored in other pediatric settings, but a comprehensive assessment of models of psychology practice in the PICU has not been conducted. The present study aimed to evaluate current models of psychology practice in PICUs and explore psychologists’ perceptions of the ideal model of care for PICU families. Fourteen participants (13 psychologists, 1 psychology intern; 100% White, 93% female) with recent PICU experience and representing 13 institutions completed a survey and participated in one of five focus groups regarding their institution’s current model of psychology practice and recommendations for the ideal model. The most common institutional model of psychology practice was a hybrid model involving both service-specific psychologists (i.e., psychologists dedicated to a specific pediatric population who see their patients when they are in the PICU) as well as consultation-liaison psychologists (i.e., psychologists who serve multiple inpatient units and are referred to cases in the PICU). Psychologists embedded in the PICU were less common. Participants described that having dedicated PICU time would be ideal and offer several benefits (e.g., improved identification of patients and families). These findings contribute to better understanding of current models of psychology practice and offer preliminary suggestions for an improved model that requires further investigation. Advocacy strategies such as collecting and utilizing outcomes data, sharing information about the role of psychology, establishing standards of care, fostering relationships, and being present in the PICU will support the recommended improvements

“It’s just another added layer of difficulty”: Language access equity and inclusion in pediatric interpreted medical encounters — Provider and interpreter perspectives

Limited English proficient or language-diverse patients and families in pediatric interpreted medical encounters (IME) are susceptible to health disparities and inequities in the US compared to English proficient patients and families in language-concordant medical encounters. Policies to improve access to language services intend to bridge this gap, yet evidence suggests that significant inequities still exist. This study explores perspectives of interpreters and pediatric critical care medical providers to better understand the complexities of IME in pediatric settings. Qualitative data were analyzed from two interview studies with medical interpreters and providers using thematic coding and inductive analysis. Several factors were identified by both interpreters and medical providers that negatively affected communication, equity, and inclusion. These included systems-level factors (e.g., time constraints and language variety), interpersonal factors (e.g., difficulties with communication and mistrust), and intrapersonal factors (e.g., implicit biases and judgements). These results highlight multiple layers of potential inequities which adversely affect patients and families in pediatric IME.; En los encuentros médicos interpretados (EMI) en pediatría en los EE.UU., las personas y familiares que acuden a una consulta médica con un dominio limitado del inglés o con otras lenguas están expuestas a perjuicios y desigualdades en materia de salud, en comparación con aquellas que dominan el inglés y que asisten a las consultas en su idioma. Las políticas para mejorar el acceso a los servicios lingüísticos pretenden salvar esta brecha, pero los datos indican que siguen dándose desigualdades significativas. Este estudio explora las perspectivas de intérpretes y de proveedores de atención sanitaria crítica pediátrica para comprender mejor las complejidades de los EMI en contextos pediátricos. Se analizan los datos cualitativos procedentes de dos estudios con entrevistas a intérpretes y proveedores de atención sanitaria utilizando codificación temática y análisis inductivo. Los resultados muestran que ambos grupos detectan varios factores que afectan negativamente a la comunicación, la equidad y la inclusión. Estos factores se localizan a nivel sistémico (como son las limitaciones de tiempo y la variedad lingüística), interpersonal (por ejemplo, las dificultades de comunicación y la desconfianza) y a nivel intrapersonal (como son los sesgos implícitos y los prejuicios). Estos resultados ponen de manifiesto las múltiples capas de desigualdades potenciales que perjudican a pacientes y familiares en los EMI en pediatría.; En les trobades mèdiques interpretades (EMI) en pediatria als EUA, les persones i familiars que acudeixen a una consulta mèdica amb un domini limitat de l'anglés o amb llengües diferents a aquesta s’exposen a perjudicis i desigualtats en matèria de salut, en comparació amb les que dominen l'anglès i que assisteixen a les consultes en el seu idioma. Les polítiques per millorar l'accés als serveis lingüístics pretenen salvar aquesta escletxa, però les dades indiquen que continuen donant-se desigualtats significatives. Aquest estudi explora les perspectives d’intèrprets i de proveïdors d’atenció sanitària crítica en pediatria per comprendre millor les complexitats de les EMI en contextos pediàtrics. S’analitzen les dades qualitatives procedents de dos estudis amb entrevistes a intèrprets i proveïdors d’atenció sanitària utilitzant una codificació temàtica i una anàlisi inductiva. Els resultats mostren que tots dos grups detecten diversos factors que afecten negativament la comunicació, l'equitat i la inclusió. Aquests factors es localitzen a nivell sistèmic (com són les limitacions de temps i la varietat lingüística), interpersonal (per exemple, les dificultats de comunicació i la desconfiança) i a nivell intrapersonal (com ara els biaixos implícits i els prejudicis). Aquests resultats palesen les múltiples capes de desigualtats potencials que perjudiquen pacients i familiars als EMI en pediatria

Description and Critical Evaluation of Models of Psychology Practice in the Pediatric Intensive Care Unit

During and after hospitalization in the pediatric intensive care unit (PICU), a significant proportion of patients and their family members experience clinical levels of distress (i.e., traumatic stress, anxiety, and depression). Pediatric psychologists are well-suited to support families during hospitalization and are increasingly present in PICUs. Models of psychology practice have been explored in other pediatric settings, but a comprehensive assessment of models of psychology practice in the PICU has not been conducted. The present study aimed to evaluate current models of psychology practice in PICUs and explore psychologists’ perceptions of the ideal model of care for PICU families. Fourteen participants (13 psychologists, 1 psychology intern; 100% White, 93% female) with recent PICU experience and representing 13 institutions completed a survey and participated in one of five focus groups regarding their institution’s current model of psychology practice and recommendations for the ideal model. The most common institutional model of psychology practice was a hybrid model involving both service-specific psychologists (i.e., psychologists dedicated to a specific pediatric population who see their patients when they are in the PICU) as well as consultation-liaison psychologists (i.e., psychologists who serve multiple inpatient units and are referred to cases in the PICU). Psychologists embedded in the PICU were less common. Participants described that having dedicated PICU time would be ideal and offer several benefits (e.g., improved identification of patients and families). These findings contribute to better understanding of current models of psychology practice and offer preliminary suggestions for an improved model that requires further investigation. Advocacy strategies such as collecting and utilizing outcomes data, sharing information about the role of psychology, establishing standards of care, fostering relationships, and being present in the PICU will support the recommended improvements

Communication About Medication by Providers-Adolescent and Young Adult Version: Confirmatory Factor Analyses

Abstract Objective To replicate the factor structure of a patient-report measure of provider communication about key medication prescription information, the Communication about Medication by Providers-Adolescent and Young Adult (CAMP-AYA) Version. We evaluated whether the 15-item, two-factor structure identified previously could be replicated via confirmatory factor analysis, and we also examined fit of unidimensional and bifactor models. Associations of CAMP-AYA Total and Factor Scores with provider satisfaction and select patient and medication characteristics were also examined. Methods Participants were 739 AYA (ages 18–25) who completed the CAMP-AYA, a provider satisfaction rating, and provided demographic and medication information. Results  The bifactor model was best fitting (χ2 [75] = 689.60, p &amp;lt; .0001; root mean squared error of approximation = 0.11, 90% CI [0.10, 0.11]; Comparative Fit Index = 0.98; Tucker–Lewis Index = 0.98; Standardized Root Mean Square Residual Index = 0.02). Internal consistency reliabilities for Total and Factor Scores were high (αs &amp;gt; .89) and Total and Factor Scores were associated with provider satisfaction (ps &amp;lt; .001). CAMP-AYA scores varied as a function of type of prescription (short vs. long term; new vs. refill), with higher scores reported in the context of long term (&amp;gt;30-day course) or refilled prescriptions (ps &amp;lt; .007) in most cases. Conclusions  This study provides additional support for the reliability of the CAMP-AYA as a tool to assess AYA perceptions of provider key information coverage about medication prescriptions. </jats:sec

Evaluation of psychology practice models in the pediatric intensive care unit

Objective: Pediatric intensive care unit (PICU) patients and their families experience significant distress, which can increase risk for post-PICU psychological morbidity. Pediatric psychologists are well-suited to mitigate the psychological impact of PICU admissions. However, a comprehensive assessment of PICU psychology practice models is lacking. This mixed-methods study aimed to evaluate current and propose improved PICU psychology practice models. Methods: Fourteen participants (13 psychologists and 1 intern) from 13 United States institutions completed a 39-item survey and participated in focus groups. Participants described their institution’s current psychology practice model and recommended improvements. Results: Most institutions (77%) employed a hybrid model involving service-specific psychologists (i.e., psychologists dedicated to specific pediatric populations who follow their patients in the PICU) and consultation-liaison psychologists (i.e., psychologists who serve multiple inpatient units including the PICU). Psychologists embedded in the PICU were less common (8%). Participants recommended a model wherein psychologists have dedicated PICU time, citing benefits including improved patient/family identification, more specialized PICU knowledge, increased availability, and better medical team relationships. Conclusions: Most PICU psychology practice models use a hybrid approach, yet psychologists recommend an embedded model wherein psychologists have dedicated PICU time. Future research should evaluate improved practice models from the viewpoint of a more diverse group of psychology providers and other stakeholders (e.g., physicians, patients, and family members)

“It Has Added Another Layer of Stress”: COVID-19’s Impact in the PICU

OBJECTIVE The novel coronavirus disease 2019 (COVID-19) pandemic has dramatically changed health care delivery and impacted health care providers. However, little is known about the impact of the pandemic in PICUs. In this qualitative study, we aimed to assess pediatric critical care providers’ perspectives on the impact of the COVID-19 pandemic on the experiences of patients and families in the PICU and on their personal and professional lives. METHODS Nineteen pediatric critical care and complex care attending physicians and nurse practitioners from a PICU in a tertiary, freestanding children’s hospital in the Midwest completed a semistructured, qualitative interview. Transcripts were analyzed by using thematic analysis. RESULTS For both PICU providers and patients and families, participants described a negative overall impact of the pandemic, especially relating to increased stress and fear of contracting the disease. Disease precautions such as visitor restrictions and restricting movement were reported to be particularly stressful for families because they limited coping strategies (eg, in-person social support). Providers described changes to the work environment, patient care, and their personal lives. CONCLUSIONS Results elucidate the perceived impacts of COVID-19 and associated hospital precautions on the lives of PICU providers, patients, and families. Providers, patients, and families likely require additional psychosocial support during the pandemic. When possible, policies regarding disease management should maximize safety while minimizing additional stress. Further research is needed to explore patient and family perspectives regarding the impact of COVID-19 and to evaluate the continued impact of COVID-19 over time. </jats:sec

Emerging Adults’ Adherence to Preventative Health Guidelines in Response to COVID-19

Abstract Objective To examine rates of emerging adults’ (EA) adherence to preventative health behavior recommendations during early months of the COVID-19 pandemic and to investigate demographic (i.e., gender, years of education, socioeconomic status, school enrollment status, and living situation) and exposure and impact-related correlates of adherence. Methods Participants were 273 [M (SD) age = 22 (2.1) years, 55% female, 32% from minoritized groups] EA completed an online survey of adherence to 11 preventative health behaviors recommended by the Centers for Disease Control (CDC) during summer 2020. Participants rated adherence via a visual analog scale. Participants also reported demographic information and completed the COVID-19 Exposure and Family Impact Adolescent and Young Adult Version (CEFIS-AYA). Results Median levels of adherence to preventative recommendations ranged from 66% to 100%. Highest adherence levels (Mdn &amp;gt; 90%) were reported for quarantining if exposed to COVID-19; covering mouth when sneezing; avoiding the elderly/those at high risk; and avoiding large gatherings. Median adherence was &amp;lt;80% for mask wearing; maintaining a 6-foot distance; avoiding in-person visits with romantic partners or friends; and disinfecting surfaces. Female gender was the only variable significantly associated with overall adherence, and it explained 4% of the variance. Conclusions Following guidelines related to social distancing practices may be particularly challenging for EA, possibly because of unique developmental needs of this group, and males may be at greater risk for non-adherence to CDC recommendations. Therefore, public health messaging and adherence intervention development should be designed with males and social distancing practices in mind. </jats:sec