Characterizing psychosocial services in a pediatric urology practice

Rena Xu¹, Lillian C Hayes², Peter Y Cai³, Amanda Meers⁴, Kelsey Tulley⁵, Richard C Antonelli⁶, Carlos R Estrada⁷

Affiliations

¹ Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: rena.xu@childrens.harvard.edu.
² Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: lillian.hayes@childrens.harvard.edu.
³ Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: peter.cai@childrens.harvard.edu.
⁴ Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Social Work, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: amanda.meers@childrens.harvard.edu.
⁵ Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Child Life Services, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: kelsey.tulley@childrens.harvard.edu.
⁶ Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: richard.antonelli@childrens.harvard.edu.
⁷ Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: carlos.estrada@childrens.harvard.edu.

PMID: 38030431
PMCID: PMC11032223
DOI: 10.1016/j.jpurol.2023.11.011

Characterizing psychosocial services in a pediatric urology practice

Rena Xu et al. J Pediatr Urol. 2024 Apr.

. 2024 Apr;20(2):242.e1-242.e8.

doi: 10.1016/j.jpurol.2023.11.011. Epub 2023 Nov 16.

Authors

Rena Xu¹, Lillian C Hayes², Peter Y Cai³, Amanda Meers⁴, Kelsey Tulley⁵, Richard C Antonelli⁶, Carlos R Estrada⁷

Affiliations

¹ Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: rena.xu@childrens.harvard.edu.
² Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: lillian.hayes@childrens.harvard.edu.
³ Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: peter.cai@childrens.harvard.edu.
⁴ Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Social Work, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: amanda.meers@childrens.harvard.edu.
⁵ Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Child Life Services, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: kelsey.tulley@childrens.harvard.edu.
⁶ Department of Pediatrics, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA. Electronic address: richard.antonelli@childrens.harvard.edu.
⁷ Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Surgery, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: carlos.estrada@childrens.harvard.edu.

PMID: 38030431
PMCID: PMC11032223
DOI: 10.1016/j.jpurol.2023.11.011

Abstract

Introduction: Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families.

Objective: To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital.

Study design: Following Institutional Review Board approval, an adapted version of the Care Coordination Measurement Tool (CCMT) was used to collect data prospectively on non-billable activities performed by a psychologist, social worker (SW), and certified child life specialist (CCLS) in a pediatric urology department. Variables included activity type, time spent per activity, and outcomes affected. Demographic data included age, sex, race, state, zip code, insurance type, and language.

Results: From April to October 2022, 3096 activities were performed in support of psychosocial needs over 947 encounters for 527 patients. The median patient age was 9.2 years (IQR 4.8-12.4); 48.4 % were male. The psychosocial providers most commonly identified care coordination needs related to delivery of urologic care (73.4 %), mental/behavioral/developmental health (29.1 %), and referral and appointment management (19.9 %). The largest proportion of time was spent on providing direct psychosocial support (45.9 %), consisting of psychosocial assessments, education, and other behavioral health interventions. A large proportion of time was also spent on care coordination activities, namely logistics and navigation support (35.9 %). Relative time allocation across activities varied by provider type (p < 0.001); care coordination constituted 64.2 % of non-billable activities for the psychologist, 57.8 % for the SW, and 12.3 % for the CCLS. Activities were associated with treatment plan modification in 37.7 % (n = 357), outpatient coordination in 22.5 % (n = 213), and treatment plan adherence in 19.0 % (n = 180) of encounters.

Discussion: This study enhances our understanding of psychosocial needs of patients in a pediatric urology practice by assessing non-billable psychosocial services not otherwise captured in the clinical workflow. In addition to direct psychosocial support, care coordination activities constitute a large proportion of such services. These data provide valuable insight into the range of activities necessary for the provision of specialty pediatric medical care.

Conclusion: Psychosocial providers in a pediatric urology practice perform many non-billable care coordination and psychosocial support activities. Characterizing these activities is important for beginning to understand patients' psychosocial needs and informing resource deployment.

Keywords: Care coordination; Pediatric urology; Psychosocial intervention; Psychosocial support; Social determinants of health.

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Conflict of interest statement

Conflict of interest The authors have no financial or personal conflicts of interest to disclose.

References

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1. American Psychological Association. APA Dictionary of Psychology: Psychosocial. https://dictionary.apa.org/psychosocial. [Accessed 13 June 2023].

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Characterizing psychosocial services in a pediatric urology practice

Affiliations

Characterizing psychosocial services in a pediatric urology practice

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous