The Role of Pediatric Psychologists in the Transition of Youth to Adult Health Care: A Descriptive Qualitative Study of Their Practice and Recommendations

Targeted Transition Readiness Workshops for Pediatric Brain Tumor Survivors: Feasibility, Acceptability, and Preliminary Effects

Pediatric brain tumor survivors (PBTS) are at risk for late effects related to their diagnosis and treatment. Long-term medical follow-ups are deemed essential, implying a transition from pediatric to adult healthcare settings. This pilot study aims to assess the feasibility, acceptability, and preliminary effects of a targeted transition readiness intervention for PBTS. The program consisted of three hybrid workshops that targeted disease-related self-management skills, social skills, and cognitive functioning, as well as parallel workshops for their caregivers. The feasibility and acceptability were assessed through recruitment, retention, and satisfaction rates. Preliminary effects were primarily assessed via a pre/post assessment of transition readiness skills using the Transition Readiness Assessment (TRAQ) questionnaire. Among the eligible dyads, 12 (38%) consented to participate. Ten dyads participated in at least two workshops, and six dyads participated in all workshops. Overall, the participants were satisfied with the intervention (parents = 86%; PBTS = 73%). Although not statistically significant, a clinically relevant post-workshop increase in transition readiness skills was observed for PBTS (d = 0.36) and their caregivers (d = 0.25). The results suggest the relevance of the intervention and encourage further developments. Adjustments are needed to optimize reach and efficacy. The workshops have the potential to be adapted to be more accessible and shorter.

Topical review: The role of psychologists in healthcare transition

Objective

Adolescents and young adults (AYAs) with chronic medical conditions often face significant challenges while transitioning from pediatric to adult healthcare (healthcare transition, HCT). Although some guidelines exist on how to facilitate this process, the specific role of psychologists in promoting successful HCT is not clearly defined. In this topical review, we propose a conceptual framework integrating the role of psychology within HCT. We also provide an agenda for behavioral health researchers investigating ways to improve transition services/care for emerging adults.

Method

We first review existing standards of care and HCT guidelines. Using existing literature and the Got Transition model as a theoretical foundation, we developed a conceptual framework to outline the specific roles and recommendations for integrating psychologists in the HCT process, including recommendations for future research in this area.

Results

Limited research has systematically examined the efficacy and effectiveness of HCT services, which vary widely across institutions and populations. Further, existing HCT guidelines/recommendations largely exclude the role of psychologists during this process. There are many opportunities for psychologists to provide essential services as part of an interdisciplinary HCT team and to better understand how to improve these models of care.

Conclusions

Psychologists offer a unique and specialized element essential to fostering effective HCT. These professionals can take a more active role in promoting successful HCT from both clinical and research perspectives.

The Health Care Transition Needs of Adolescents and Emerging Adults with Chronic Pain: A Narrative Review

The aim of this narrative review was to provide an overview of what is known about the health care transition process in pediatric chronic pain, barriers to successful transition of care, and the roles that pediatric psychologists and other health care providers can play in the transition process. Searches were run in in Ovid, PsycINFO, Academic Search Complete, and PubMed. Eight relevant articles were identified. There are no published protocols, guidelines, or assessment measures specific to the health care transition in pediatric chronic pain. Patients report many barriers to the transition process, including difficulty attaining reliable medical information, establishing care with new providers, financial concerns, and adapting to the increased personal responsibility for their medical care. Additional research is needed to develop and test protocols to facilitate transition of care. Protocols should emphasize structured, face-to-face interactions and include high levels of coordination between pediatric and adult care teams.

Protocol for evaluation of the feasibility and preliminary efficacy of a targeted transition readiness workshop intervention for pediatric brain tumor survivors

BACKGROUND

Pediatric brain tumor survivors (PBTS) are at risk of physical, cognitive, and psychosocial challenges related to their diagnosis and treatment. Routine follow-up care as adults is therefore essential to their long-term health and quality of life. In order to successfully navigate to adult healthcare, it is recommended that youth develop transition readiness skills. Existing transition readiness interventions often focus on disease management. However, PBTS are also at risk of social competence and cognitive functioning challenges. In this paper, we describe the protocol of this pilot study and the methodology that will be used for the evaluation of the feasibility, acceptability, and preliminary efficacy testing of the first targeted transition intervention workshops specifically designed to meet the needs of PBTS and their caregivers.

METHODS

This study will use a mixed method to evaluate three 1 ½-h workshops targeted for dyads (N = 40) of PBTS (14 years or older) and their parents. Dyads will be recruited via a community pediatric cancer organization and the long-term follow-up clinic of a large pediatric hospital. Participants will complete an online survey which includes the Transition Readiness Assessment Questionnaire (TRAQ) before and after the workshops. Each workshop will cover a specific topic related to PBTS transition readiness: disease management, social competence, and cognitive functioning. Workshops will follow the same structure: topic presentation, discussion by a post-transfer survivor or parent, teaching two strategies, and workshop evaluation. Workshops will be co-led by healthcare specialists and patient partners. Feasibility and acceptability will be assessed via recruitment, attendance, retention, and Likert scales, and they will be analyzed by describing and comparing rates. Satisfaction will be measured using satisfaction surveys and audio-recorded focus groups. Qualitative data will be described through thematic content analysis. In order to test the preliminary efficacy of this study, we will compare transition readiness skills pre- and post-workshops using paired samples T test and ANCOVA to examine the impact of workshop on TRAQ skills.

DISCUSSION

Results of the study will inform refinement and future broader implementation of targeted transition readiness workshops for the specific needs of pediatric brain tumor survivors.

[Changes in autonomy and attachment to parents and caregivers during transition to adult services]

The transition from pediatric to adult care is a risky period in the care of a child or adolescent with a chronic illness. This pivotal stage is also part of an evolutionary process of individuation and empowerment that is both global and specific. The security felt, both in relationships with parents and caregivers, is fundamental to these processes. It is this security that will enable the young person to develop nuanced, flexible strategies for adjusting to the different kinds of changes he will have to face in his situation as a patient and, more broadly, in his daily life. Enrolled in multiple networks of relationships, yet autonomous, he or she will become an agent of his or her own life, of which medical care is one aspect.

Articulating viewpoints to better define and respond to the needs of adolescents and young adult survivors of pediatric brain tumors

PURPOSE

Adolescents and young adult survivors of pediatric brain tumors (AYA-PBTS) often experience difficulties with social skills, pursuit of studies and employment. This study explored pediatric long-term survivors' perspective on their post-treatment needs and ways to improve resources and interventions.

METHODS

We used an original method of three sequential focus group interviews by adding the perspectives of survivors (15-22 years), parents and health professionals (total N = 22). Participants were recruited using purposive sampling from the long-term follow-up clinic at a Canadian tertiary hospital. We used computer-assisted analysis to draw themes from each group and compare thematic content across groups.

RESULTS

Categorization of participants' responses resulted in three domains: personal life, education and work. Participants mentioned the improvement of communication tools to facilitate access to timely information, the organization of counseling to improve employment integration, and tailoring interventions to optimize the return to daily activities in aftercare. Subsequent inductive analysis revealed three overarching trends among groups: multipurpose social networking, AYA-PBTS-specific information websites and transition tools and procedures.

CONCLUSION AND IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

This study identified solutions for AYA-PBTS' specific needs in aftercare. This population needs up-to-date post-treatment information and refined outreach procedures. Future research should define and prioritize these suggested solutions.

Trends in Psychiatric Hospitalization of Children and Adolescents in Spain between 2005 and 2015

Eating disorders are on top of chronic conditions in children and adolescents, and the most severe cases may require hospitalization. Inpatient psychiatric treatment is one of the most expensive ones and therefore the efforts when treating eating disorders should focus on avoiding and shortening admissions, as well as preventing readmissions. Advances in of eating disorders treatment lie in an accurate knowledge of those patients requiring admission. This study examined the Conjunto Mínimo Básico de Datos-the largest public hospitalization database in Spain-to estimate the prevalence of eating and other psychiatric disorders during childhood and adolescence. It is a cross-sectional study of the hospital discharges in Castilla y León (Spain) from 2005 to 2015, in which patients under 18 years old with a psychiatric diagnosis at discharge were selected. Trends in the rates of hospitalization/1000 hospitalizations per year were studied by joinpoint regression analysis. Conclusions: eating disorders were the only group that presented an upward and continuous trend throughout the study period. This statistically significant increase showed an annual change of 7.8%.