Qualitative Insights from Physical and Mental Health Providers in Pediatric Integrated Health Care Settings
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It is widely accepted that the mind and the body are connected, so it is critical to better understand the connection in order to improve the healing process, quality of care, and well-being. Integrated care is associated with improved patient outcomes and is well-positioned to address conditions with known comorbidities (such as chronic health conditions and depression/anxiety), serve people who use primary health care providers for mental health needs (especially racial/ethnic minorities), and address the impact mental health can have on physical health trajectories and outcomes. However, there is disagreement regarding how to best combine treatments. There are more than 150 different definitions of integrated health care in the literature, demonstrating there is no consensus for how to best combine physical and mental health care.
This qualitative dissertation study is designed through the constructivism paradigm lens, and theoretically grounded in the Biopsychosocial Model and the Common Elements and Common Factors Framework. Case study methodology is used to examine the insight of both mental health and physical health providers, who treat the same patients with a chronic condition in six pediatric clinics: cardiology clinic, cystic fibrosis clinic, diabetes clinic, eating disorder clinic, epilepsy clinic, and pain clinic. Thirteen interviews were conducted with medical doctors, nurse practitioners, psychologists, and social workers. The interviews were recorded, transcribed, coded, and analyzed.
Findings and Discussion:
The analysis resulted in three main themes: the mind and the body are inextricably intertwined, silos: structural impediments to combined care (common elements), and the relationships and approaches that reflect the intertwined connection (common factors). The clinics had varying levels of combined care, including the type and amount of formal mental health treatment provided in the clinic (e.g., psychotherapy), a range of communication protocols, and degree of treatment integration. All participant providers agreed that most or all health conditions would benefit from a higher level of combined care. Unexpected findings include adherence as a novel pathway to illustrate the mind-body connection, clinical social workers provide covert mental health treatment in circumstances when formal treatment is not possible, and the relationships the providers have with the families and with other providers can be just as important as the relationship with the patient.
The dissertation concludes with strengths, limitations, implications for both mental health and physical health providers, clinics that provide combined care, hospital administrators and leadership, and policy recommendations.
Schuetz, Nikolaus, "Qualitative Insights from Physical and Mental Health Providers in Pediatric Integrated Health Care Settings" (2023). Research at Children's Mercy Month 2023. 26.