Integrated psychological care in paediatric hospital settings: Determining implementation success

• Main Authors: Kate Marshall, James Newham, Raghu Lingam, Nadine Kasparian
• Format: Article
• Language: English
• Published: Ubiquity Press 2019-08-01
• Series: International Journal of Integrated Care
• Subjects: paediatrics; mental health care; integration outcomes
• Online Access: https://www.ijic.org/articles/4928

Introduction: Children with critical or chronic physical illness and their families report high levels of psychological distress alongside, or as a result of, demanding treatment protocols. Calls for accessible, evidence-based and cost-effective mental health care to be integrated in routine physical health care are not new, but the content, format and efficacy of these services are largely unknown. Our aim was to identify, synthesise and critically evaluate the evidence on integrated mental health care in paediatric hospitals, and provide a set of evidence-based recommendations for successful integration. Methods: Six electronic databases were systematically searched for English language studies involving children with medical illness aged 0-18 years. Studies were eligible for inclusion if they reported on a psychosocial screening, assessment and/or intervention provided within an existing paediatric hospital service. No restrictions were made on trial design. Data was extracted following eight implementation outcomes: acceptability (satisfaction with the service), adoption (service utilization), appropriateness (patients’ perceived suitability of the service), feasibility (providers’ perception of utility), fidelity (service is delivered as intended), cost (cost-effectiveness of service), penetration (embedding into practice), and sustainability (continuation of service within hospital system). Results: A total of 10 studies were identified as eligible for review.Of these, five studies described psychosocial care provided within specialty clinics (2 cardiology, 2 epilepsy, 1 dermatology), three studies reported on psychological screening practices in hospital wards (2 general wards, 1 oncology), and two studies evaluated delivery of a manualised psychological intervention for hospital inpatients (2 oncology). Psychological services provided in paediatric hospitals were most commonly identified as both acceptable and feasible. Utilization of services varied according to the overall engagement of medical practitioners and hospital staff. Data on overall efficacy, cost-effectiveness, and service sustainability was under-reported across studies. Discussion & Conclusion: The importance of integrated psychological care as part of holistic paediatric care is well-established; yet as this review demonstrates, there is a striking lack of evidence on the efficacy of implementing these models for children with chronic illness and their families. Integration of mental health care into paediatric hospitals is significantly influenced by individual, organisational and system level factors. Integrated service implementation requires strong provider commitment and yet limited evidence on the markers of service efficacy is a significant barrier to widespread adoption. Our review provides a platform for establishing co-ordinated, collaborative mental health care for this highly vulnerable population of children and families. Lessons learned: Evidence-based, conceptually driven implementation frameworks are vital for integrating psychological care into paediatric health care. Clear, universally used measures of efficacy are required to improve service uptake and outcomes. Our findings provide vital guidance for systemic and organisational change. Limitations: Studies reporting on implementation, efficacy and cost-effectiveness of integrated mental health services within paediatric hospitals are scarce. Our review is limited by the inclusion of only English language, peer-reviewed articles. Suggestions for future research: Methodologically rigorous research, including longitudinal assessment of health outcomes and costs is needed to truly assess the impact of these services for children and their families.