Abstract
Introduction: Somatic symptom and related disorders (SSRDs) pose persistent challenges in pediatric hospital settings, as children and youth manifest physical symptoms indicative of emotional distress. These complex cases result in high health system utilization, costs, and risks of iatrogenic harm. Due to diagnostic and psychosocial complexity, patients often exhibit varied readiness for mental health assessment and treatment. As part of a broader initiative to integrate physical and mental health care, our tertiary/quaternary pediatric care hospital developed and piloted a shared care model to address the needs of this resource-intensive population.
Methods: An interdisciplinary working group orchestrated the design and implementation of the pathway. Utilizing a logic model and engaging key stakeholders iteratively, the design phase embraced an interdisciplinary team approach. Care pathways were customized based on a patient's readiness for mental health treatment, diagnostic progress, and intensity of required resources. A patient and family engagement advisor played a critical role throughout the pathway development cycle. Further, the pathway design was reviewed by the hospital's Family Advisory Network, and their feedback was thoughtfully incorporated.
The pilot pathway aligns a patient's care journey with their mental health treatment readiness. Non-receptive patients access a care manager with dual physical and mental health expertise, supporting and guiding a shift in patient and caregiver focus towards the mind-body connection. Receptive patients and their caregivers join a group treatment program emphasizing psychoeducation on the mind-body connection led by psychiatry and psychology. The care pathway integrates Occupational Therapy and Physiotherapy resources for functional restoration, as well as regular follow-up by the pediatrician.
Pilot Evaluation Discussions: Evaluation outcomes highlighted a significant decrease in outpatient psychiatry waiting times from 156 to 69 days. Post-launch, patients experienced fewer emergency department visits and imaging exams. The occupational therapist conducted 71 direct patient visits, and the physiotherapist had 50, reflecting active patient engagement. Caregivers praised the organized and tailored care for SSRDs, although highlighted the continued absence of awareness of necessary resources. Providers recognized the benefits of the pathway, including integration of care, care coordination by the care manager, and integral pathway roles (e.g., OT, PT).
Identified Challenges and Opportunities: Challenges noted were the imperative need for staff training in mental health, safety, and risk management. Addressing cognitive biases related to patient care ownership, streamlining data entry, and rectifying under-resourcing of mental health and rehabilitation services were highlighted as ongoing critical gaps. A need for brief therapeutic interventions to bridge the gap between SSRD identification and ongoing treatment supports were identified.
Opportunities include development of a more robust approach to staff education and training, as well as securing access to and funding for rehabilitation services (e.g., occupational and physiotherapy services). Additionally, opportunities exist to improve the use of interdisciplinary rounds as an educational forum.
Conclusions: The implementation of an integrated care pathway for somatic symptoms and related disorders in a pediatric tertiary/quaternary hospital was well received by patients, caregivers and providers. Further evaluative work on how best to address the needs of this high-resource population of patients is critical.