Pediatric Psychology Critical Care Consultation: An Emerging Subspecialty

Abstract

As the field of pediatric psychology expands and evolves, pediatric critical care settings hold considerable promise for our profession. Although extensive mental health needs have been recognized in patients and families affected by care in the pediatric intensive care unit (PICU), specifics regarding the need for, utilization of, and nature of pediatric psychology services have not yet been systematically examined. The current study provides a descriptive analysis of all consecutive referrals to a pediatric psychology consultation service within the critical care setting of a large metropolitan pediatric medical center from January 2006 through December 2009. During the study period, 611 pediatric psychology referrals (4.6% of PICU admissions) were generated. Consultations were initiated by interdisciplinary staff and spanned a diverse and far-reaching range of behavioral health needs for patients and family members. Numerous factors were associated with increased need for pediatric psychology consultation, including longer than average hospitalizations, unanticipated critical care admissions, and previously healthy children who had sustained accidental trauma and those with new onset acute critical illness. Of note, the mortality rate within referred patients was significantly higher compared with the general PICU population, suggesting high need for pediatric psychology services during end-of-life care. Findings are discussed with respect to viable consultation models and training of pediatric psychologists who can function capably and confidently in the critical care setting.