During Covid-19 pandemics, a drop of 39% of all visits was observed through all Quebec pediatric emergency rooms for adolescents from 12 to 17 years old. Meanwhile, consultation for mental health problems showed a rise after waves 1 and 2. Adolescents were heavily impacted by the pandemic, SSRD being one expression of their difficulties. In 2019, a need for a dedicated clinic for somatisation was recognized through a survey in our Pediatric University Center. SSRD were identified in most specialities. They represented 10% of all patients and clinicians reported that they were sometimes uncomfortable with SSRD patients. These results are still relevant as the pandemic is ongoing. An increase of SSRD patients is expected as students will be returning to their classrooms this fall. The main objective of this paper is to describe the development and content of a structured program for adolescent patients with somatic disorder in a Pediatric University Center during the Covid-19 pandemic.
An extensive literature review was done on SSRD treatment programs for adolescents. An international group of experts met monthly through a teleconsultation platform; this group includes specialists in Adolescent Medicine in Canada, England and France, psychiatrists, pediatricians, nurses, and psychotherapists. Sessions were 90-minutes long and were held between May 2020 and July 2021. Two leaders structured the task force and dispatched the tasks to favor collaboration between the pediatric and psychiatric team members.
The literature review shows that health professional teams have developed unique models, contingent upon local resources and experiences of the actors involved. Our model is unique and inspired by existing ones. It consists of different paths and levels of treatment and includes: - Centralized access with a structured process for referral classification from minor cases (light functional impacts) to complex ones (severe functional impacts/ chronic condition/ multiple medical investigations, denial of non-organic causes, etc.). - Ambulatory services for minor cases with a medical evaluation by a pediatrician and a nurse, including HEADS questionnaire, resistance to diagnosis assessment, SSRD educational material for patients/parents, psychoeducation, follow-up. - Ambulatory services for complex cases, including the same as above, except the initial evaluation is done by all team members, and follow-up includes resistance to diagnosis management, group and individual therapy. - In-patient admission for evaluation and treatment for complex cases and symptoms, addressing through an intensive program, severe functional symptoms with an interdisciplinary team. Socialization and return to school are also taken care of. The model includes a role of expertise with other medical networks via telemedicine
Creating a structured approach for adolescents with SSRD is perceived as a need in a Pediatric University Center. Furthermore, it is especially important to anticipate a surge of adolescents with SSRD due to the pandemic consequences on mental and physical health. The use of recent technologies facilitated the process. Describing the development of a comprehensive and collaborative model for adolescents with SSRD between pediatrics and psychiatry has never been done and could be useful for other pediatric hospitals meeting the same challenges.
© 2022 Published by Elsevier Inc.