By Justin Faiola
Spending time at SickKids can be an exhausting and nerve-wracking experience for a child or adolescent. Having a complex condition at a young age can take an immense physical toll on a patient, but the experience can also place a significant burden on their mental health. At the same time, physical symptoms that a patient experiences can be related not only to biological factors, but also to psychological and social ones. Without an integrated approach to care, effectively addressing their needs can be difficult.
To address this challenge, the CL Psychiatry Program, formerly called Medical Psychiatry, at SickKids was established in 1979 to provide comprehensive, interdisciplinary and collaborative care to children and adolescents with complex co-occurring physical and psychiatric illnesses, including those with distressing and impairing physical symptoms.
"Up to 40 per cent of children and teens with medical conditions have mental health concerns," says Dr. Claire De Souza, Medical Director of the CL Psychiatry Program. "Their complex needs span their development and can affect adherence to treatment, academic achievement, social adjustment and family functioning."
The arrival of the Medical Psychiatry Alliance (MPA), of which SickKids is a partner, has allowed the CL Psychiatry Program to expand further to meet the growing need for this integrated model of care. Under the MPA's mandate, the program has launched a new service delivery model which focuses on providing specialized interdisciplinary assessment and treatment, including an expansion of individual, group and family therapy tailored to specific medical/mental health populations.
The CL Psychiatry Program now consists of eight full-time and part-time staff psychiatrists, a psychologist, two clinical nurse specialists, a registered nurse, a case manager, two social workers and two administrative assistants.
"The MPA has provided a timely opportunity to assemble a very skilled team which can focus on much needed care and education for young patients who experience combined physical and mental health issues," says Dr. Tony Pignatiello, Associate Psychiatrist-in-Chief at SickKids and MPA Director of Child and Youth Health and Family Services. "The team's approach also includes families and clinicians within SickKids and in the community."
Children, adolescents and their families are referred to the CL Psychiatry Program for consultation and treatment by the medical and surgical in-patient units of SickKids. Outpatient consultation and treatment for patients referred by various subspecialists, paediatricians and family physicians is also provided, including TeleHealth and TeleLink consultation to other hospitals and children's mental health centres across Ontario.
The patients who are referred to the CL Psychiatry program include those with:
- co-occurring physical and psychiatric illnesses;
- distressing and impairing physical symptoms which cannot be fully explained by the underlying medical conditions, if present;
- complex emotional and/or behavioural challenges who require preparation for an upcoming hospitalization or procedure;
- acute changes in mental status and/or behaviour related to medical conditions and/or treatment; and
- problems with adhering to or refusing medical treatment.
In addition, the program actively engages in partnerships with many community-based service providers to facilitate integrated care by coordinating treatment plans, helping patients and families with system navigation and continuing with patient follow-ups beyond SickKids.
"Collaborative care, along with education and capacity building is central to the program's work," says Pignatiello. "To truly make a difference, health-care practitioners of all disciplines need to work together alongside patients and families to address the needs of those with medical-mental health issues in a holistic way."
The program is actively involved in developing and evaluating evidence-informed protocols in collaboration with various departments and disciplines in order to optimize care for children, adolescents and their families.