Evaluation of Psychology Practice Models in the Pediatric Intensive Care Unit

Abstract

Objective: Pediatric intensive care unit (PICU) patients and their families experience significant distress, which can increase risk for post-PICU psychological morbidity. Pediatric psychologists are well-suited to mitigate the psychological impact of PICU admissions. However, a comprehensive assessment of PICU psychology practice models is lacking. This mixed-methods study aimed to evaluate current and propose improved PICU psychology practice models. Methods: Fourteen participants (13 psychologists and 1 intern) from 13 United States institutions completed a 39-item survey and participated in focus groups. Participants described their institution’s current psychology practice model and recommended improvements. Results: Most institutions (77%) employed a hybrid model involving service-specific psychologists (i.e., psychologists dedicated to specific pediatric populations who follow their patients in the PICU) and consultation-liaison psychologists (i.e., psychologists who serve multiple inpatient units including the PICU). Psychologists embedded in the PICU were less common (8%). Participants recommended a model wherein psychologists have dedicated PICU time, citing benefits including improved patient/family identification, more specialized PICU knowledge, increased availability, and better medical team relationships. Conclusions: Most PICU psychology practice models use a hybrid approach, yet psychologists recommend an embedded model wherein psychologists have dedicated PICU time. Future research should evaluate improved practice models from the viewpoint of a more diverse group of psychology providers and other stakeholders (e.g., physicians, patients, and family members).

Implications for Impact Statement

Research suggests that advocating for embedded psychologists in the PICU would likely improve care and psychosocial outcomes.