Integrated psychological care in pediatric hospital settings for children with complex chronic illness and their families: a systematic review

Abstract

Objective

To synthesize and critically evaluate evidence on the effectiveness of integrated psychological care models for children with complex chronic illness within pediatric hospital settings and provide recommendations for successful implementation.

Design

Six electronic databases (Medline, Cochrane, Embase, PsycINFO, Scopus, CINAHL) were systematically searched for English language studies including families of children aged 0–17 years with complex chronic illness. Eligible studies reported on psychology or neuropsychology screening, assessment, intervention, or services provided within a pediatric hospital setting.

Results

Fifteen studies were identified for review; nine assessed a psychological service, five examined psychosocial screening, and one examined a neuropsychology service. Three studies demonstrated the effectiveness of integrated psychological services in improving child or parent physical, psychological, or behavioral health outcomes. Uptake of psychosocial screening was high (84–96%), but only 25–37% of children or families identified as ‘at-risk’ engaged with on-site psychology services. Integrated psychological services offering consultations at the same time and location as the child’s medical visit reported the highest rates of uptake (77–100%).

Conclusions

The available evidence supports co-location of child medical and psychological services. A more consistent and comprehensive approach to the assessment of patient- and caregiver-reported outcomes and implementation effectiveness is recommended.

Keywords:

• Pediatric
• chronic illness
• psychological stress
• mental health
• integrated care

Acknowledgements

We thank Dr. Kim Brandes for her early contributions to the literature search, and Ms. Diane Oake for her assistance checking the data. Kate Marshall is the recipient of a University of New South Wales Scientia PhD Scholarship. Dr. Stephanie Tesson is the recipient of a National Health and Medical Research Council (NHMRC) of Australia Postgraduate Scholarship. Dr. Nadine A. Kasparian is the recipient of a National Heart Foundation of Australia Future Leader Fellowship (101229) and a Harkness Fellowship in Health Care Policy and Practice (2018–2019) from the Commonwealth Fund.

Disclosure statement

The authors have no disclosures to report.

Data availability statement

The data that support the findings of this study are available from the corresponding author (NK) upon reasonable request.

Additional information

Funding

This work was supported by a Project Grant from the National Health and Medical Research Council (NHMRC) of Australia (Kasparian APP1081001).