Adaptations Made to Pediatric Consultation-Liaison Psychiatry Service Delivery During the Early Months of the COVID-19 Pandemic: A North American Multisite Survey.

BACKGROUND: The COVID-19 pandemic led to rapid changes in clinical service delivery across hospital systems nationally. Local realities and resources were key driving factors impacting workflow changes, including for pediatric consultation-liaison psychiatry service (PCLPS) providers. OBJECTIVE: This study aims to describe the early changes implemented by 22 PCLPSs from the United States and Canada during the COVID-19 pandemic. Understanding similarities and differences in adaptations made to PCLPS care delivery can inform best practices and future models of care. METHODS: A 20-point survey relating to PCLPS changes during the COVID-19 pandemic was sent to professional listservs. Baseline hospital demographics, hospital and PCLPS workflow changes, and PCLPS experience were collected from March 20 to April 28, 2020, and from August 18 to September 10, 2020. Qualitative data were collected from responding sites. An exploratory thematic analysis approach was used to analyze the qualitative data that were not dependent on predetermined coding themes. Descriptive statistics were calculated using Microsoft Excel. RESULTS: Twenty-two academic hospitals in the United States and Canada responded to the survey, with an average of 303 beds/hospital. Most respondents (18/22) were children's hospitals. Despite differences in regional impact of COVID-19 and resource availability, there was significant overlap in respondent experiences. Restricted visitation to one caregiver, use of virtual rounding, ongoing trainee involvement, and an overall low number of COVID-positive pediatric patients were common. While there was variability in PCLPS care delivery occurring virtually versus in person, all respondents maintained some level of on-site presence. Technological limitations and pediatric provider preference led to increased on-site presence. CONCLUSIONS: To our knowledge, this is the first multicenter study exploring pandemic-related PCLPS changes in North America. Findings of this study demonstrate that PCLPSs rapidly adapted to COVID-19 realities. Common themes emerged that may serve as a model for future practice. However, important gaps in understanding their effectiveness and acceptability need to be addressed. This multisite survey highlights the importance of establishing consensus through national professional organizations to inform provider and hospital practices.

Evidence-Based Practice: Physiotherapy for Children and Adolescents with Motor Symptoms of Conversion Disorder.

Clinical Case: A boy aged 14 years with conversion disorder who presented with an ataxic gait pattern experienced complete symptom resolution after engaging in physiotherapy (PT) as part of interdisciplinary treatment. Clinical Question: Is there evidence to support the use of PT in children and adolescents with motor symptoms of conversion disorder? Evidence: All the extant paediatric literature consists of case studies and case series. Some exciting research has been published in the adult literature that suggests the potential positive benefits of PT. Limitation of the Evidence and Future Research: The paediatric literature is limited in quantity and quality. In the adult literature, most studies are limited in that they do not control for the type of motor symptoms and do not evaluate PT independent of interdisciplinary treatment. In future research, it would be pertinent to (1) evaluate PT independent of interdisciplinary treatment, (2) control for the type of motor symptoms, and (3) describe theoretical models. Recommendation for Clinical Question: Expert consensus and emerging evidence suggest that PT may be beneficial in adults with conversion disorder, but the evidence in the paediatric population is insufficient.

Cas clinique : un garçon de 14 ans ayant un trouble de conversion qui a consulté à cause d'une démarche ataxique, a présenté une résolution totale de ses symptômes après avoir intégré la physiothérapie à son traitement interdisciplinaire. Question clinique : des données probantes appuient-elles le recours à la physiothérapie chez les enfants et les adolescents ayant des symptômes moteurs de troubles de conversion? Données probantes : en pédiatrie, toutes les publications sur le sujet sont des études et des séries de cas. Des recherches intéressantes parues dans des publications sur les adultes laissent croire aux bienfaits de la physiothérapie. Limites des données probantes et futures recherches : la quantité et la qualité des publications en pédiatrie sont limitées. Dans les publications sur les adultes, la plupart des études sont limitées parce qu'elles ne contrôlent pas le type de symptômes moteurs ni n'évaluent la physiothérapie indépendamment du traitement interdisciplinaire. Lors de futures recherches, il serait pertinent de 1) évaluer la physiothérapie de manière indépendante du traitement interdisciplinaire, 2) contrôler le type de symptômes moteurs et 3) décrire les modèles théoriques. Recommandation de la question clinique : selon le consensus d'experts et des données probantes émergentes, la physiothérapie peut être bénéfique chez des adultes présentant un trouble de conversion, mais les données probantes sont insuffisantes pour tirer la même conclusion dans la population pédiatrique.