Psychological Consultation in a Children's Hospital: An Evaluation of Services

The pediatric psychologist's role in children's inpatient medicalhospitals has rapidly expanded. Few studies have examined thetypes of referrals for psychological consultation or programevaluation of these services. This paper describes an archivalevaluation of the types of referrals received by a pediatricpsychology inpatient service over a period of 4 1/2 years andan evaluation of these services by physicians, nurses, and socialworkers. The survey of services indicated that the most frequentreferrals were for depression/suicide attempt, poor adjustmentto a chronic illness, and behavior problems. Medically relatedproblems accounted for 42% of all of the consults. Approximatelytwo-thirds of the children were referred for outpatient psychologicalservices. The pediatric psychology service was more likely tofollow, on an outpatient basis, children with medically relatedproblems. A 26-item questionnaire obtained an overall responserate of 48% and response rate of 84 and 60% for faculty andresident physicians having contact with the pediatric psychologyconsult service. The evaluation of the pediatric psychologyservice by physicians, nurses, and social workers indicatedoverall satisfaction with the services they received. The levelof satisfaction was strongly related to the level of diagnosticagreement between the physicians/nurses and psychologist. Thelowest level of satisfaction was on verbal and written feedback.Suggestion for further research was offered.     

Psychology in primary health care: effects of brief targeted therapy on children's medical care utilization

Evaluated the impact of psychological treatment for 93 children (ages 1-15) with common behavior, toilet, school, and psychosomatic problems. Children and parents, who were members of a health maintenance organization, had 1-6 visits to a primary care-based psychological consultation service. Individualized treatment was guided by problem-specific behavioral protocols. Parent outcome and behavior checklist ratings indicated improvement or resolution for 74% of children and high satisfaction with the psychological service. Children's use of medical services, especially acute primary care visits, was reduced during the year after treatment; a matched comparison group's use was unchanged. Addressing children's unmet mental health needs reduces medical care utilization. A primary health care model of psychological services provides an integrated system for serving the health and mental health needs of children.     

Psychology services in psychiatric rehabilitation: Service user needs and staff perceptions

There is limited access to specialist clinical psychology services in psychiatric rehabilitation. The paper describes a needs assessment that informed decisions about the most effective way to use available psychology resources. The psychological needs of 24 service users residing in three rehabilitation units were assessed using the Health of the Nation Outcome Scales. Managers and 12 members of staff were also interviewed to elicit their views about the psychologist's potential role. Across all services, there were high levels of unmet needs that could be addressed by psychological interventions. Psychological assessments would help identify which service users would benefit from interventions and should include neuropsychological measures. Staff also reported that they would benefit from consultation and training in psychological approaches. Although this way of working would increase access to psychological resources across the services, it would require commitment from managers towards psychological‐orientated models of care. Copyright © 2007 John Wiley & Sons, Ltd.     

Family systems practice in pediatric psychology

OBJECTIVE: To present a pediatric psychology consultation treatment framework based on family systems and developmental theories. METHODS: After reviewing background relevant to family systems interventions, a five-step protocol (referral, assessment, collaboration, outcome) for consultation is presented, using case examples from our pediatric oncology service, to illustrate joining, focusing, promoting competence and collaboration with patients, families, and staff. RESULTS: Using protocols based on family systems frameworks, pediatric psychologists can offer systems-oriented consultation to patients, families, and healthcare teams. CONCLUSIONS: Further development and evaluation of family systems protocols are necessary to understand the efficacy of these approaches and their role in training and practice.     

昆明市金星社区居民心理咨询知晓率调查

目的了解社区居民对心理咨询的知晓率,为开展心理卫生服务作决策依据。方法采用现场调查方法,使用自行设计的心理咨询知晓率调查问卷,共20条问题,由志愿者自己填写问卷。结果受访者女性多于男性,年龄多在40～59岁(71.43%),初中及初中以上的文化居多,多为退休及无工作的低收入者。59.52%主要通过报刊、书籍了解心理咨询,40.48%承认自己存在不同程度的心理问题,认为子女教育(26.19%),社会适应(19.05%)是当前最感到困惑和痛苦的问题,但愿接受心理咨询的人不多,47.6%认为现在寻求心理咨询不方便。多愿接受谈心式的心理咨询(40.48%),57.14%认为心理咨询师应由心理专业人员担任。结论居民有心理卫生保健的需求,但对心理咨询的认识不足,心理卫生的宣传和教育亟待加强。     

Minority status and the risk of serious childhood injury and death

OBJECTIVE: Minority populations have an increased risk for trauma, but little is known about injury rates for minority children. This study compares the causes, rates and outcomes of traumatic injuries between minority and white children in a statewide population sample. METHODS: A cohort study of 5,973 children (age <16) receiving inpatient care for treatment of acute injuries at the pediatric trauma centers in Ohio from 1999--2001. Case records were analyzed for race, injury type, injury severity, length of stay and demographic information. Supplemental data sources included the 2000 U.S. census and Ohio Vital Statistics death certificates 1996--2001. MAIN OUTCOME MEASURES: Hospital admission rate, mortality rate, length of stay, rate of admission to rehabilitation service. RESULTS: African-American children, who composed the vast majority of the minority population sample, were 7.7 more times likely to sustain a burn or gunshot wound, seven times more likely to be struck by a car, six times more likely to be intentionally injured and over twice as likely to killed by an injury than white children. However, after adjusting for injury severity, they have the same mortality, hospital length of stay and referral rate to rehabilitation as white children. CONCLUSION: Trauma has a far greater impact on minority children than on white children. Research and development of injury prevention initiatives that specifically target minority children are urgently needed.     

Panic disorder in children and adolescents

Panic disorder (PD) in children and adolescents is a disabling and chronic condition, which is accompanied by psychosocial and academic difficulties both during adolescence and into adulthood. In this article, the prevalence, clinical characteristics, risk factors, comorbid states, differential diagnosis, and treatment of PD are reviewed. Although PD was thought to be rare in children and adolescents, the prevalence of PD in community samples ranges between 0.5% and 5.0, and in pediatric psychiatric clinics from 0.2% to 10%. Panic attacks are reported to be equally prevalent in males and females. Clinical studies have shown that the majority of the PD pediatric patients receiving consultation in clinics are older adolescents, Caucasian, female, and middle class. Up to 90% of children and adolescents with PD have other anxiety disorders (generalized anxiety disorder/overanxious disorder, separation anxiety disorder, social phobia or agoraphobia), or mood disorders (major depressive disorder or bipolar disorder). PD patients can be misdiagnosed or having neurologic, cardiovascular, pulmonary, or gastrointestinal illness. Psychoeducation and psychosocial treatments are recommended, and it appears that selective serotonin reuptake inhibitors (SSRIs) are a safe and promising treatment for children and adolescents with PD. The clinical characteristics, long-term course, and treatment of PD in children and adolescents needs to be further assessed by well-designed studies.     

Empirical data about women's attitudes towards a hypothetical pediatric biobank

Researchers at the University of Chicago sought institutional review board (IRB) approval to establish both an obstetrical biobank (Chicago Lying-in Pregnancy Program [CLIPP]) and a pediatric biobank (KidsGene). Before KidsGene was approved, the IRB requested additional ethical review. The research ethics consultation service noted that no empirical data existed about parental attitudes towards this type of project. Postpartum women 18 years or older who delivered at the University of Chicago Hospitals and had live infants on the General Care Nursery service were approached about participating in a survey about the CLIPP biobank and about a hypothetical pediatric biobank. Two hundred thirty-nine women were consented and completed most or all of the survey. Eighty-two percent self-classified as Black and seven percent were Caucasians. Caucasians were the most willing to enroll their children hypothetically into a pediatric biobank with non-Black minorities being the most uncertain about what they would do. Almost half of the women thought that the research had the main goal of advancing science although a similar number expressed the belief that the research had the main goal of helping their individual child. Women supported use of the samples for a wide array of pediatric conditions. Comprehension of research practices, trust in medical researchers, and a belief that the research findings would be used fairly correlated with enrollment. Our survey found that most women support biobank development for research purposes. Most respondents expressed optimism that the results will yield significant benefits and that the benefits will be distributed fairly.     

The Future of Children's Health Care: What Do We Do?

The current status of children's health care is examined fromnegative, positive, and neutral perspectives. In answer to thequestion posed in the title, "what do we do" about the situation,several proposals are advanced for the future of pediatric psychologyand children's health care. These include (a) orientation tothe prevention of psychological and physical problems, (b) promotionof health-enhancing life-styles, (c) collaboration with allieddisciplines in psychosocial care of children, (d) creativityin developing new and innovative service provision, and (e)diversification of activities and interests in pediatric psychology.     

Review: cognitive and psychological outcomes in pediatric heart transplantation

OBJECTIVE: To review empirical literature investigating the cognitive and psychological effects of pediatric heart transplantation. METHODS: Electronic and library searches were used to identify empirical studies examining the cognitive and psychological effects of pediatric heart transplantation. Only studies investigating cognitive or psychological outcomes, either prospectively or cross-sectionally, were reviewed. RESULTS: Preliminary findings suggest that children and adolescents generally functioned within the normal range on most measures of cognitive functioning post-transplant. However, a complicated transplant course caused by infections or rejections may place these recipients at increased risk for cognitive difficulties post-transplant. Studies also suggested that approximately 20%-24% of pediatric heart transplant recipients experienced significant symptoms of psychological distress (e.g., anxiety, depression, behavior problems) during the first year post-transplant. CONCLUSIONS: Research suggests that some recipients are at risk for cognitive and psychological difficulties post-transplant and may require additional academic remediation and/or psychological intervention to address these challenges. Given the limited number of empirical studies available at this time, continued research investigating cognitive and psychological outcomes following pediatric heart transplantation is needed.     

小儿智力糖浆联合综合康复训练对孤独症儿童 语言障碍的临床疗效

目的 观察小儿智力糖浆联合综合康复训练对孤独症儿童语言障碍的临床疗效。方法 选择我院2017年4月~2018年6月收治的106例孤独症儿童,按照随机数字表法分为观察组与对照组,各53例,对照组采用常规康复训练治疗,观察组在此基础上联合小儿智力糖浆治疗,比较两组患儿孤独症治疗评估量表评分与生活质量评分。结果 观察组患儿语言、行为、社交以及感知觉评分均低于对照组,差异有统计学意义（P＜0.05）;观察组患儿生理、心理、环境、社会关系评分均高于对照组,差异有统计学意义（P＜0.05）。结论 小儿智力糖浆联合综合康复训练治疗孤独症儿童效果乐观,可有效提高患儿生活质量,改善患儿孤独症状。     

A psychiatric consultation service for hospitalized children

The authors describe the organization of the child psychiatric consultation service of the Massachusetts General Hospital. They review the conceptual framework of consultation to pediatric inpatients and analyze a nine-month study of 72 consultations by categorizing them according to the type of request for consultation. The largest number of requests (38%) reflected the children's concerns about their illnesses and hospitalization. Liaison activities, designed to provide information and to help the staff tolerate stress, are exemplified in five brief case reports     

医学生心理健康教育现状研究

目的了解医学生对心理健康教育知识的掌握及对心理健康问题的看法,为提高心理健康教育学选修课教学效果,促进大学生心理健康提供参考。方法自编调查问卷对某医学院87名学生进行调查。结果97.6%的医学生认为心理健康教育学选修课对自身有启发、帮助作用。但在遇到心理困扰难以解决时,57.6%的学生基本不会主动寻求心理健康服务。医学生大多希望采取网上咨询和高校心理辅导中心的心理健康服务形式。结论心理健康教育应结合医学生的特点和实际情况,整合各方面的力量,建立全方位的心理健康服务体系。     

Neuropsychological Features and Differential Diagnosis of Sleep Apnea Syndrome in Children

Recognizing the signs and effects of pediatric apnea is essential for accurate diagnosis and treatment of children with psychological difficulties. Sleep apnea can have serious deleterious effects on children's cognitive, behavioral, and physiological functioning. Diurnal effects include inattention, decreased academic performance, oppositionality, and restlessness, stemming from frequent nocturnal arousals, excessive daytime sleepiness, and hypoxia. Clinically, the effects of pediatric apnea appear similar to characteristics of other childhood disorders, most notably attention deficit hyperactivity disorder. Efforts to screen for sleep apnea should be regularly employed, especially for children who present with the symptoms discussed. Additional study of pediatric apnea is needed to heighten clinicians' awareness and improve diagnostic accuracy.     

Emergency management of blunt trauma in children

Apart from the trend to nonoperative treatment of blunt abdominal injuries, based on accurate CT diagnosis, most of the recent and anticipated changes in pediatric trauma are organizational. They include resuscitation and triage before hospitalization, the use of designated trauma centers, resuscitation by trauma teams, noninvasive diagnosis and monitoring, comprehensive pediatric intensive care, the use of objective measures of outcome, and improved rehabilitation programs (Templeton JM: personal communication). The treatment of individual cases is based on simple but well-established principles. The key steps in management are to recognize children with life-threatening injuries (on the basis of the mechanism of injury or a Pediatric Trauma Score less than or equal to 8 or a Revised Trauma Score less than or equal to 11), to support the function of vital organs by establishing and maintaining adequate respiratory gas exchange and circulation, and to identify all important injuries by thorough and ongoing assessment.     

A multicenter, randomized clinical trial of a cognitive remediation program for childhood survivors of a pediatric malignancy

Survivors of childhood cancer whose malignancy and/or treatment involved the central nervous system may demonstrate a consistent pattern of neurocognitive deficits. The present study evaluated a randomized clinical trial of the Cognitive Remediation Program (CRP). Participants were 6- to 17-year-old survivors of childhood cancer (N = 161; 35% female, 18% Hispanic, 10% African American, 64% Caucasian, 8% other) who were at least 1 year off treatment and who manifested an attentional deficit. They were enrolled at 7 sites nationwide. Two thirds of the participants were randomly assigned to cognitive remediation. All participants were assessed using a battery of academic achievement/neurocognitive tests and parent/teacher measures of attention. The CRP resulted in parent report of improved attention and statistically significant increases in academic achievement. Effect sizes were modest but were comparable with those for other clinical trials of brain injury rehabilitation and for psychological interventions in general. The CRP is presented as a potentially beneficial treatment for many survivors of pediatric cancer. Long-term clinical significance remains unproven. Further work is needed to improve effect sizes and treatment compliance and to address the needs of other populations with pediatric brain injury.     

某三级甲等综合医院住院患者精神科会诊3年资料分析

目的:了解某三级甲等综合医院精神/心理服务需求的特点。方法:汇总某三甲综合医院2006年7月1日-2009年6月30日期间所有经心理医学科会诊的患者共2082例次,分析会诊率、会诊科室、会诊原因、精神科诊断及随诊情况。结果:3年来会诊率由1.01%升至1.48%,随诊率为15.77%。重症监护病房会诊率最高(4.77%),特需科室随诊比例最高(27.04%)。占1%以上的邀请会诊原因有10类,其中"目前情绪症状"最多,占28.4%。精神科诊断以"神经症性、应激性障碍及焦虑状态"为主,占44.2%,诊断为躯体形式障碍及医学不能解释的症状(Medical Unexplained symptoms,MUS)的患者随诊比例最高,达26.6%。结论:综合医院对精神/心理服务的需求全面,精神专科应提供全面深入、特点突出的会诊联络服务。     

Program Considerations in Comprehensive Care of Chronically Ill Children

This paper focuses on four areas of program development in meetingcomprehensive care needs of children with chronic illness andtheir families: Case consultation, liaison, research, and trainingare presented as integral parts of the collaboration processbetween medicine and psychology. Potential differences in thecollaborative process are noted, and corrective strategies aresuggested. Emphasis in case consultation and research is placedon understanding the overlooked phenomenon of successful adaptationof chronically ill children and their families. Training requirementsare specified as extending beyond traditional clinical childpsychology and pediatric psychology. There is need for prototypicalpsychosocial programs in comprehensive care for this underservedpopulation.