Psychologists Meet Needs of Children, Families in Integrated Care Model

A team of OU Health pediatric psychologists — integrated within Oklahoma Children’s Hospital and multiple primary care and specialty clinics — provides mental and behavioral health services that are crucial for the overall well-being of children and their families.

On any given day, psychologists support a family whose toddler has received a difficult cancer diagnosis, an adolescent with diabetes who will soon be caring for his own health as an adult, a student experiencing anxiety at school, and youth in a multitude of other scenarios.

Because they are part of interdisciplinary care teams, the psychologists collaborate with physicians and other healthcare providers to meet each child and family’s specific needs. That approach, while still mostly found in academic healthcare settings, is recognized for its ability to best deliver care in the biopsychosocial model.

“The psychology field is moving toward integrated care as an effort to decrease stigma, increase access to care, improve care management, be more cost-effective and lower risks.

Because physicians have a limited amount of time to cover many things, we can save them some time and enhance overall patient care by diving deeper into the areas that we have expertise in as psychologists. In turn, a patient who is healthier mentally is going to function better overall and have improved treatment adherence. We have a great team, and I believe an integrated team provides better care,” said Amy Cherry, Ph.D., director of the Pediatric Psychology Program and an associate professor in the Department of Pediatrics, Section of General and Community Pediatrics.

The Pediatric Psychology Team is comprised of 11 psychologists, nine with faculty appointments in the Section of General and Community Pediatrics and two in the Section of Hematology-Oncology. Three are integrated in primary care clinics and the rest provide care and consultations in specialty clinics and on inpatient floors, in disciplines that include gastroenterology, rheumatology, endocrinology, nephrology, cystic fibrosis, and others. The team has grown steadily over the past 15 years and is considered a model for both traditional mental health services and care that is provided for patients with specific medical diagnoses.

J. Carrick Carter, Psy.D., is the director of psychosocial services for the Jimmy Everest Center for Cancer and Blood Disorders in Children, where the psychology team meets with all patients newly diagnosed with cancer and provides care and support to families as needed throughout treatment. The center has several specialty clinics, including the Brain Tumor Clinic, the Neurocutaneous Syndromes Clinic, the Sickle Cell Clinic, the Bleeding Disorders Clinic, and the Cancer Survivorship Clinic.

The team’s initial role is to simply meet patients and families where they are in handling the heavy news of a

cancer diagnosis. “We try to normalize the large spectrum of natural responses to something that is challenging,” Carter said. “We also assess a family’s needs — for some families, they’re very practical needs, like where they are going to stay during treatment when they live three hours away. Then we follow them during the treatment process. Maybe a child is trying to get used to being poked with a needle all the time, or they’re struggling with being away from home. We teach them some skills to handle things like that.

Amy Cherry, Ph.D.

“Research tells us, and my clinical experience supports it, that most families are very resilient and are able to find a new norm, find the support they need, figure out the practical aspects of the situation, and manage very well. We are there to help them along the way,” Carter added.

At the other end of the spectrum is the Survivorship Clinic, which helps families and patients who have survived cancer learn to manage treatment-related issues and side effects, as well as the reality that they will be at risk for secondary cancers and illnesses.

“Research shows that some children who survive cancer will have problems with mood, memory, relationship-building, attention, and in other areas,” Carter said. “We also work on health maintenance behaviors, like diet, exercise and adherence to medication, because those are important for their long-term health. And a lot of times, parents are more likely to develop a trauma response to their child being diagnosed with cancer than the child is. The family functioning can change after that, so we address those situations as well.”

Pediatric psychologists play a crucial role in helping young people learn to manage their chronic conditions without the help of parents and to develop confidence in engaging with medical providers, in preparation for transitioning to an adult services doctor. Elements of transition readiness work include helping adolescents understand their medication dosages and reading lab reports, setting reminders for their

appointments, and prioritizing their mental health and well-being as part of managing their medical condition.

Noel Jacobs, Ph.D., who works in the Gastroenterology and Hepatology Clinic, said that young adults, once living independently, may end up needing emergency care for health situations that could have been prevented. He begins working with patients on transition readiness at age 14 or soon after. The time of transfer to an adult healthcare provider is based on the patient’s overall readiness and conversations with both the patient and the medical provider. If patients need to transfer before they are fully ready — if they are moving to another city, for example — the healthcare team works with them to find the best clinic and provider, and Jacobs tries to remain in contact until they’ve had their first visit with the new provider, if not longer.

Noel Jacobs, Ph.D.

“For example, my patients who have inflammatory bowel disease or those who have received a liver transplant are more likely to live with extra stress on a daily basis, in addition to the stress that day-to-day life brings us,” Jacobs said. “I tell my patients that I’m a ‘quality of life’ doctor because I care about them feeling capable about the things they want to do, having fun in their lives, and feeling empowered in their medical care.”

Pediatric psychologists working in primary care clinics play an important role in addressing overall mental and behavioral health. They care for patients with traditional issues such as depression, anxiety, trauma and school problems, typically seeing them the same day they see their medical doctor. A psychologist’s skills also are important for topics like weight management, vaccine hesitancy or smoking cessation. For patients who are diagnosed with a chronic condition, such as asthma, psychologists help them understand what will be required to manage the condition over the long term.

J. Carrick Carter, Psy.D.

“Any type of chronic health condition is going to require some behavior change,” Cherry said, “whether it is taking medicine, changing your diet or exercising. Our job is to assess where families are, help them identify their reasons/motivation to work on some of those things, and assist them in overcoming barriers to behavior change.”

Ryan Blucker, Ph.D., is the psychologist at the Super Niños Clinic, located off campus at the Latino Community Development Agency. One of the most important ways that mental health has been integrated into the clinic is through the use of routine mental health screening forms, just as families complete medical forms on their first visit. The forms not only provide information that might need follow-up, but they help to normalize children receiving both medical and mental health services.

Ryan Blucker, Ph.D.

“That’s at the heart of integrated care — for psychologists and medical providers to work together in a system so that patients and families understand that this is all healthcare,” Blucker said. “When families understand that their children are being screened because everyone who comes to the clinic is screened, it helps to reduce some of the stigma about mental health. I’ve seen a shift among our patients who recognize that this is just a normal part of care. Quite a few families now call the clinic directly and ask for an appointment with me rather than waiting to be referred. That’s an encouraging sign that mental healthcare is not only acceptable, but it’s something that families have been thinking about.”

As part of an academic health system, the pediatric psychology team conducts a variety of research studies, often focusing on quality improvement. Current projects include assessing protocols for responding to post-partum depression; studying adjustment issues for families of newly diagnosed cancer patients; and creating strategies to address interpersonal conflict and violence.

The team is also active as educators, working with several levels of trainees to prepare them for their careers. They

include students working toward master’s and doctoral degrees, pre-doctoral interns and post-doctoral residents. The psychologists also interact with medical residents from pediatrics and family medicine. For many trainees, it’s their first exposure to integrated care.

“I tell our trainees that it’s important to listen and meet people where they are,” Carter said. “We need to use our training and knowledge, but it’s important to approach every interaction with a family as a unique interaction, rather than feeling like we’re reading from a script. We need to get to know these families and hear their stories, worries and struggles, and to learn about their lives outside the walls of our clinics and hospital so that we can tailor our recommendations based on their specific needs. Sometimes our work is difficult, but it’s very meaningful and an honor to be present with people when they come to us for their care.”