Psychosocial supports within pediatric nephrology practices: A pediatric nephrology research consortium survey.

BACKGROUND: The landscape of available psychosocial services within pediatric nephrology care is poorly characterized. However, the effects of kidney disease on emotional health and health-related quality of life are well documented, as is the impact of social determinants of health on kidney disease outcomes. The objectives of this study were to assess pediatric nephrologists' perceptions of available psychosocial services and to elucidate inequities in access to psychosocial care. METHODS: A web-based survey was distributed to members of the Pediatric Nephrology Research Consortium (PNRC). Quantitative analyses were performed. RESULTS: We received responses from 49 of the 90 PNRC centers. With regards to dedicated services, social work was most commonly available (45.5-100%), followed by pediatric psychology (0-57.1%) and neuropsychology (0-14.3%), with no centers having embedded psychiatry. Availability of psychosocial providers was positively associated with nephrology division size, such that as center size increased, access to various psychosocial providers increased. Notably, the majority of respondents indicated that perceived need for psychosocial support exceeds that which is currently available, even at centers with higher levels of current support. CONCLUSIONS: Within the US, there is wide variability in the availability of psychosocial services within pediatric nephrology centers despite a well-documented necessity for the provision of holistic care. Much work remains to better understand the variation in funding for psychosocial services and in utilization of psychosocial professionals in the pediatric nephrology clinic, and to inform key best practices for addressing the psychosocial needs of patients with kidney disease.

Feasibility of psychosis risk assessment for adolescents diagnosed with autism.

LAY ABSTRACT: Individuals with autism may experience a variety of psychiatric symptoms that may cause distress and difficulty functioning. The tools that exist to help evaluate symptoms for psychosis for individuals with autism are limited. We investigated whether a specialized interview for symptoms of psychosis risk could be used for adolescents with autism. We recruited 21 adolescents with autism and 22 typically developing adolescents and interviewed them using the Structured Interview for Psychosis-Risk Syndromes. Participants were asked to rephrase interview questions as a way to understand how they interpreted the question. Their responses were evaluated by clinicians and third-party raters to determine potential response errors. Results of the study showed that youth with autism who have intact language skills are able to answer questions about psychosis risk symptoms as well as their typically developing peers. In general, adolescents across both groups who had more difficulty with nonliteral language (understanding words with multiple meanings) had more difficulty completing the Structured Interview for Psychosis-Risk Syndromes. Problematic items that required more clarification by the clinician involved misinterpretation of words/phrases or questions. Care should be taken to ensure adolescents understand the intent of interviewer questions when assessing risk of psychosis.