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Management of High Acuity Patients in Pediatric Medical Settings: The Role of Consultation/Liaison Psychologists During the Growing Mental Health Crisis

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Abstract

Since the onset of the COVID-19 pandemic, consultation/liaison (C/L) psychologists had to drastically shift their practices to care for psychiatrically acute pediatric patients admitted to medical settings. The aim of the current study was to provide an updated state of the field surrounding these changes and their implications for clinical practice. Psychologists and psychology post-doctoral fellows completed an anonymous, 51-item survey distributed via a national professional organization listserv. The results review responses, by percentages, about C/L team composition and practice patterns, as they relate to suicide risk assessments, transfers to inpatient psychiatric and other levels of care, intervention for boarding patients, and disposition and safety planning. Thematically coded qualitative responses regarding impact and management of high acuity patients are also summarized. The state of the field outlined by this survey suggests an increase in C/L assessments and interventions delivered to pediatric patients with acute psychiatric needs, as well as a reverberating effects on provider wellness. Ensuring providers establish competency for this subset of patients is vital to the continued provision of optimal patient care and to sustained provider wellness. Considerations for the field are explored.

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Funding

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Author information

Authors and Affiliations

  1. Department of Psychology, Johns Hopkins All Children’s Hospital, 880 Sixth Street South, Suite 460, Saint Petersburg, FL, 33713, USA

    Marissa A. Feldman

  2. Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Anna Monica Agoston

  3. Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Amanda N. Burnside

  4. Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA

    Natacha D. Emerson

  5. Center for Pediatric Behavioral Health, Cleveland Clinic Children’s, Cleveland, OH, USA

    Emily Mudd

  6. Mental Health Services, Children’s Minnesota, Minneapolis, MN, USA

    Kate Z. Koehn

  7. Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA

    Lauren E. Gallanis

Authors
  1. Marissa A. Feldman
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  2. Anna Monica Agoston
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  3. Amanda N. Burnside
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  4. Natacha D. Emerson
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  5. Emily Mudd
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  6. Kate Z. Koehn
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  7. Lauren E. Gallanis
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Contributions

Drs. MAF, AMA, NDE, EM, KZK, and LEW contributed to the conceptualization, survey development, and study design. Dr. MAF contributed to data collection and qualitative analysis, drafting, and final editing. Dr. AMA contributed to drafting the quantitative results section. Dr. ANB contributed to drafting the introduction section and editing all sections of the manuscript. Dr. Emerson contributed to drafting the introduction sections and editing all sections of the manuscript. Dr. EM contributed drafting the discussion section. Dr. KZK contributed to analyzing and drafting the qualitative results section. Dr. LEW contributed to drafting the quantitative results section and editing all sections of the manuscript.

Corresponding author

Correspondence to Marissa A. Feldman.

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Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical Approval

The study was approved by the Johns Hopkins University Institutional Review Board.

Consent to Participate

Informed consent was implied by individuals electing to click the hyperlink from the invitation email and submitting the completed survey.

Consent for Publication

Not applicable. Participants answered the survey anonymously.

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Feldman, M.A., Agoston, A.M., Burnside, A.N. et al. Management of High Acuity Patients in Pediatric Medical Settings: The Role of Consultation/Liaison Psychologists During the Growing Mental Health Crisis. J Clin Psychol Med Settings (2024). https://doi.org/10.1007/s10880-024-10010-y

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