GI Psychology Partnership

What Is the GI Psychology Partnership?

In 2004, pediatric gastroenterologists in Hasbro Children’s division of pediatric gastroenterology, hepatology and nutrition entered into a partnership with psychologists from the Division of Child and Adolescent Psychiatry. There was a recognition that kids with stomachaches, celiac disease, soiling issues and inflammatory bowel disease (IBD) could benefit from screenings for behavioral and emotional symptoms that might be making their symptoms worse or interfere with the treatment of their conditions.

Many of the treatments for these GI conditions are partly behavioral. Treatments might involve any combination of taking certain medicines, eating in a certain way, practicing new toileting habits, learning how to manage stress and making sure that, despite their symptoms, patients are still growing and developing as kids. Instead of referring kids to a pediatric psychologist in another part of the hospital to work on these things, psychologists became a part of the GI team. Families could see the psychologist in the GI clinic the same way they saw their doctor, the nurses or the dietitian. GI doctors and psychologists could more easily collaborate on treatment plans and keep each other up-to-date along the way.

With this partnership, the GI doctors have also been able to teach pediatric psychology trainees what they need to know about how GI disorders impact kids. At the same time, pediatric psychologists have taught GI trainees how things like stress and coping mechanisms can impact kids' GI treatment. The partnership has also become a rich opportunity to collaborate on research that studies how medical and behavioral factors interact in the health of kids with GI disorders.

How Does Having the Psychology Staff Present Within the Clinic Help With Treatment Adherence and Follow-up Care/Referrals?

Frequently, when a family in the GI clinic first hears about the benefits of seeing a psychologist for the GI problem their child is having, a psychologist will stop into the consultation room to say hello, to describe what services are offered and to explain how to set up an appointment. This demystifies the process.

Also, because kids are seeing the psychologist in the GI clinic, it can remove some the stigma that might be associated with going to a separate office labeled psychology. Sometimes, kids work with the psychologist exclusively on the problem that brought them to GI in the first place, for example, attending school more often even when they have stomachaches, or adjusting to having a new diagnosis of inflammatory bowel disease. But, this connection with a psychologist also provides an opportunity to examine the whole child and work on other challenges that may not be what initially brought them to the GI clinic, such as reducing anxiety or developing healthy behaviors like eating a nutritious diet and getting good sleep.

Are Partnerships Like This Becoming More Common?

There has been an increasing realization that, in medicine, we need to treat the whole person. If we only address medical, genetic and physiological aspects of an illness, we're missing opportunities to make an even bigger improvement in overall health. We know that emotions, stress, family situation, attitudes and life events can impact a person’s health. These factors also impact how well a patient adheres to what their doctor has recommended and how much their illness interferes with their life.

Many health care providers are talking about the importance of providing physical and behavioral health services in the same place and we're seeing more instances of these in adult primary care and pediatric primary care offices. The GI Psychology Partnership at Hasbro Children's Hospital is providing that care in a specialty pediatric practice and is integrating the care of patients with the training of pediatric psychologists and pediatric gastroenterologists, as well as research into gastrointestinal illnesses in children.

You Also Conduct Research as Part of the Partnership. What Types of Things Are You Studying?

Researchers in the GI clinic created the nation's first multi-center behavioral health registry of newly-diagnosed children and teens with IBD, including Crohn's disease and ulcerative colitis. The registry looks at the influence of psychosocial and behavioral factors (such as stress, emotional, social and family functioning) on IBD disease activity and outcomes in young patients, and also looks closely at adherence - how kids do with taking their medicine. For example, my colleagues found that younger children’s medication adherence is nearly triple that of older adolescents.

GI and psychology have also collaborated on studies looking at the treatment of feeding disorders in young children, adherence to a gluten-free diet in children with celiac disease, and the effects of stress on the immune response in teens with IBD.

What Might Your Research Findings Mean for Patients and Families in the Future?

The information that we gather could help us identify psychosocial and physical signs that tell us about the course of IBD and how it responds to treatments. This could, in turn, lead to improved treatments for both adults and children.

We also know that taking commonly prescribed oral medications for IBD is challenging for patients. Our research suggests that screening for emotional and behavioral problems, especially among older adolescents, would be important in identifying those teens who are at risk for not taking their medications as prescribed and who might benefit from interventions.

Across several of our studies, results suggest that biological solutions (medicine and physical treatments), although critically necessary, when applied without attention to behavioral issues, are not likely to provide the level of therapeutic benefit that can be provided with a combined biobehavioral approach. This reaffirms that our collaborative approach in the GI Psychology Partnership is effective and beneficial to our patients.