Special Issue "Integrated Multidisciplinary Care for Pediatric Inflammatory Bowel Disease: Supporting Disease and Psychosocial Outcomes"

A special issue of Children (ISSN 2227-9067).

Deadline for manuscript submissions: closed (15 February 2021).

Special Issue Editors

Dr. Anava Wren
E-Mail Website
Guest Editor
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Stanford University, Stanford, CA 94305, USA
Interests: pediatric inflammatory bowel disease; pediatric pain management; mindfulness-based interventions for pain and symptom management and cultivation of positive psychological factors
Dr. Michele Maddux
E-Mail Website
Guest Editor
Division of Developmental and Behavioral Sciences, Children’s Mercy Kansas City; Kansas City, MO 64108, USA; Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO 64110, USA
Interests: biopsychosocial care in pediatric inflammatory bowel disease; transition from pediatric to adult care models; adherence monitoring and intervention

Special Issue Information

Dear Colleagues,

Inflammatory bowel disease (IBD) is a chronic and relapsing disease affecting a growing number of children in the United States. Crohn’s disease (CD) and ulcerative colitis (UC) are the two most common forms of IBD, both causing chronic inflammation to the gastrointestinal tract. The pathophysiology of IBD is thought to be multifactorial and involve a complex interaction between genetic factors, the immune system, gut microbiota, nutrition, and psychosocial factors.

Research has shown an intimate connection between the brain and the gut. Psychosocial factors are strong predictors of negative health outcomes in pediatric IBD, such as risk of relapse, disease activity, nonadherence, healthcare utilization, and higher healthcare costs. Children with IBD are also at an increased risk of emotional/behavioral challenges and poorer quality of life compared to other youth with chronic health conditions, and these challenges have shown strong links to health outcomes.

An integrated multidisciplinary care model for the treatment of pediatric IBD is increasingly common and deemed essential for optimal care. IBD teams that use a holistic and biopsychosocial approach can enhance a child’s long-term health, psychological wellbeing, and quality of life. Gastroenterologists, surgeons, nurses, dieticians, psychologists, and social workers all play a critical role in the management of pediatric IBD.

This Special Issue, “Integrated Multidisciplinary Care for Pediatric Inflammatory Bowel Disease: Supporting Disease and Psychosocial Outcomes,” is dedicated to describing the evidence for, and application of, integrated biopsychosocial IBD care. This Special Issue will accept original research and reviews. Examples include, but are not limited to, manuscripts discussing the brain–gut connection and its implications for biopsychosocial care, medical and psychosocial outcomes in the context of integrated multidisciplinary care models, implementation of biopsychosocial interventions within multidisciplinary care, processes to leverage institutional support for integrated multidisciplinary care, and virtual/telemedicine applications of integrated multidisciplinary care.

We look forward to receiving your contributions.

Dr. Anava Wren
Dr. Michele Maddux
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • inflammatory bowel disease
  • multidisciplinary
  • pediatric
  • biopsychosocial
  • integrated care

Published Papers (7 papers)

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Editorial

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Open AccessEditorial
Integrated Multidisciplinary Treatment for Pediatric Inflammatory Bowel Disease
Children 2021, 8(2), 169; https://doi.org/10.3390/children8020169 - 23 Feb 2021
Cited by 2 | Viewed by 323
Abstract
Inflammatory Bowel Disease (IBD) is a chronic and relapsing inflammatory disorder of the gastrointestinal tract [...] Full article

Research

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Open AccessArticle
Mindfulness-Based Virtual Reality Intervention for Children and Young Adults with Inflammatory Bowel Disease: A Pilot Feasibility and Acceptability Study
Children 2021, 8(5), 368; https://doi.org/10.3390/children8050368 - 05 May 2021
Viewed by 136
Abstract
The aim of this pilot study was to assess: (1) the feasibility and acceptability of a Mindfulness-Based Virtual Reality (MBVR) intervention among children and young adults with Inflammatory Bowel Disease (IBD), and (2) the preliminary efficacy of MBVR on key psychological (anxiety) and [...] Read more.
The aim of this pilot study was to assess: (1) the feasibility and acceptability of a Mindfulness-Based Virtual Reality (MBVR) intervention among children and young adults with Inflammatory Bowel Disease (IBD), and (2) the preliminary efficacy of MBVR on key psychological (anxiety) and physical (pain) outcomes. Participants were 62 children to young adults with IBD (M = 15.6 years; 69.4% Crohn’s disease; 58% male) recruited from an outpatient pediatric IBD clinic. Participants completed a baseline assessment, underwent the 6-min MBVR intervention, completed a post-intervention assessment and study satisfaction survey, and provided qualitative feedback. Results suggest strong feasibility and acceptability. Participants reported high levels of satisfaction with MBVR including high levels of enjoyment (M = 4.38; range 1–5) and relaxation (M = 4.35; range 1–5). Qualitative data revealed several key themes including participants interest in using MBVR in IBD medical settings (e.g., hospitalizations, IBD procedures, IBD treatments), as well as in their daily lives to support stress and symptom management. Preliminary analyses demonstrated improvements in anxiety (t = 4.79, p = 0.001) and pain (t = 3.72, p < 0.001) following MBVR. These findings provide initial support for the feasibility and acceptability of MBVR among children and young adults with IBD. Results also suggest MBVR may improve key IBD outcomes (e.g., anxiety, pain) and highlight the importance of conducting a randomized controlled trial and more rigorous research to determine intervention efficacy. Full article
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Open AccessArticle
Does Parenting Style Affect Adolescent IBD Transition Readiness and Self-Efficacy Scores?
Children 2021, 8(5), 367; https://doi.org/10.3390/children8050367 - 04 May 2021
Viewed by 157
Abstract
Background: Transition to adult-centered care requires adolescents with inflammatory bowel disease (IBD) to acquire a set of independent self-management skills. Transition success can be affected by maturity, cognitive development, and many other factors. Our hypothesis was that parenting style would be associated with [...] Read more.
Background: Transition to adult-centered care requires adolescents with inflammatory bowel disease (IBD) to acquire a set of independent self-management skills. Transition success can be affected by maturity, cognitive development, and many other factors. Our hypothesis was that parenting style would be associated with increased self-efficacy and therefore transitions readiness. Methods: A prospective cohort survey study of adolescents with IBD and their parents from October 2018 to October 2019 was performed. Participants completed the IBD-Self-Efficacy Scale- Adolescent questionnaire (IBD-SES-A) and the Transition Readiness Assessment Questionnaire (TRAQ). Parents completed the Parent Styles and Dimensions Questionnaire (PSDQ-short form). Demographic and disease information were also collected. Results: Sixty-nine participants were included for full analysis (36 males and 33 females); mean age was 18.2 years, and average age of IBD diagnosis 13 years. Overall, 83% of participants were non-Hispanic Caucasian, and 84% reported parental annual income over USD 100,000. All 69 parents reported an authoritative parenting style. Females have significantly higher TRAQ scores than males (p = 0.0004). TRAQ scores differed significantly between age groups, with 20 to 22 years old having higher scores (p ≤ 0.0001). TRAQ and IBD-SES-A scores did not differ by parental education or parenting style. Conclusion: Given the inability to delineate different parenting, this study was unable to demonstrate a protective parenting style associated with better transitions readiness and self-efficacy scores in adolescents with IBD. Within the context of authoritative parenting, we did find that females and older adolescents had higher transition readiness scores. Additional research into psychosocial determinants of transition readiness, and the importance of multidisciplinary management with an integrated team including psychologist and social workers, can help improve IBD transition outcomes. Full article
Open AccessArticle
Evaluating a Standardized Transition of Care Process for Pediatric Inflammatory Bowel Disease Patients
Children 2020, 7(12), 271; https://doi.org/10.3390/children7120271 - 04 Dec 2020
Viewed by 426
Abstract
To reduce lapses in care for pediatric inflammatory bowel disease (IBD) patients approaching adulthood, a health maintenance transition visit (HMV) was developed to supplement standard medical care (SMV). Our aim was to assess the effect of the HMV on transition readiness. A retrospective [...] Read more.
To reduce lapses in care for pediatric inflammatory bowel disease (IBD) patients approaching adulthood, a health maintenance transition visit (HMV) was developed to supplement standard medical care (SMV). Our aim was to assess the effect of the HMV on transition readiness. A retrospective chart review was conducted at a single center with demographics and clinical data from HMV and SMV visits. Effectiveness of the HMV was assessed by the patient health questionanaire-9 (PHQ-9) and transition readiness assessment questionnaire (TRAQ) scores. A total of 140 patients, 80% Caucasian and 59% male completed an HMV. The mean age was 18 ± 2 years old, and 93% of patients reported inactive or mild disease. Patients who completed at least 1 prior HMV scored significantly higher on the TRAQ when transferring to adult care compared to patients transferred at their first HMV visit (92 vs. 83, p < 0.05). Of patients with no prior depression diagnosis, 36% had a positive screen for depression. A significant relationship was identified between disease status and PHQ-9 (p < 0.05). This study demonstrated a structured HMV increased transition readiness and quantified the significant under-diagnosis of depression in this population, emphasizing the importance of screening. These results indicate depression may affect patients’ transition preparedness. Full article
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Review

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Open AccessReview
Telemedicine and Integrated Multidisciplinary Care for Pediatric IBD Patients: A Review
Children 2021, 8(5), 347; https://doi.org/10.3390/children8050347 - 28 Apr 2021
Viewed by 208
Abstract
The global COVID-19 pandemic brought with it an unprecedented, widespread implementation of telemedicine services, requiring pediatric inflammatory bowel disease (IBD) providers to shift in-person clinic visits to a virtual platform. With the passing of the one-year anniversary of the global pandemic, telemedicine continues [...] Read more.
The global COVID-19 pandemic brought with it an unprecedented, widespread implementation of telemedicine services, requiring pediatric inflammatory bowel disease (IBD) providers to shift in-person clinic visits to a virtual platform. With the passing of the one-year anniversary of the global pandemic, telemedicine continues to be offered and utilized. Although it remains unclear as to the extent to which telemedicine services will be used in the future, it is critical to understand how integrated multidisciplinary treatment—the standard of care in pediatric IBD—is delivered through a virtual platform. This paper provides an overview of the existing literature examining integrated multidisciplinary care for pediatric IBD provided via telemedicine. The author also presents one integrated multidisciplinary IBD program’s response to the global pandemic and subsequent transition to telemedicine. Challenges around implementation and directions for future research in this area are also discussed. Full article
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Other

Open AccessCommentary
Applying Telemedicine to Multidisciplinary Pediatric Inflammatory Bowel Disease Care
Children 2021, 8(5), 315; https://doi.org/10.3390/children8050315 - 21 Apr 2021
Viewed by 166
Abstract
Multidisciplinary care is essential to the delivery of comprehensive, whole-person care for children and adolescents with inflammatory bowel disease (IBD). Team members may include medical, psychosocial, and ancillary providers as well as patient and family advocates. There is significant variability in how this [...] Read more.
Multidisciplinary care is essential to the delivery of comprehensive, whole-person care for children and adolescents with inflammatory bowel disease (IBD). Team members may include medical, psychosocial, and ancillary providers as well as patient and family advocates. There is significant variability in how this care is delivered from center to center, though prior to the COVID-19 pandemic, most care occurred during in-person visits. At the onset of the pandemic, medical systems world-wide were challenged to continue delivering high quality, comprehensive care, requiring many centers to turn to telemedicine technology. The aim of this manuscript is to describe the process by which we converted our multidisciplinary pediatric and adolescent IBD visits to a telemedicine model by leveraging technology, a multidisciplinary team, and quality improvement (QI) methods. Finally, we put our experience into context by summarizing the literature on telemedicine in IBD care, with a focus on pediatrics and multidisciplinary care. Full article
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Open AccessCommentary
Leveraging Institutional Support to Build an Integrated Multidisciplinary Care Model in Pediatric Inflammatory Bowel Disease
Children 2021, 8(4), 286; https://doi.org/10.3390/children8040286 - 08 Apr 2021
Viewed by 298
Abstract
While the biopsychosocial nature of inflammatory bowel disease (IBD) is now well accepted by clinicians, the need for integrated multidisciplinary care is not always clear to institutional administrators who serve as decision makers regarding resources provided to clinical programs. In this commentary, we [...] Read more.
While the biopsychosocial nature of inflammatory bowel disease (IBD) is now well accepted by clinicians, the need for integrated multidisciplinary care is not always clear to institutional administrators who serve as decision makers regarding resources provided to clinical programs. In this commentary, we draw on our own experience in building successful integrated care models within a division of pediatric gastroenterology (GI) to highlight key considerations in garnering initial approval, as well as methods to maintain institutional support over time. Specifically, we discuss the importance of making a strong case for the inclusion of a psychologist in pediatric IBD care, justifying an integrated model for delivering care, and addressing finances at the program level. Further, we review the benefit of collecting and reporting program data to support the existing literature and/or theoretical projections, demonstrate outcomes, and build alternative value streams recognized by the institution (e.g., academic, reputation) alongside the value to patients. Ultimately, success in garnering and maintaining institutional support necessitates moving from the theoretical to the practical, while continually framing discussion for a nonclinical/administrative audience. While the process can be time-consuming, ultimately it is worth the effort, enhancing the care experience for both patients and clinicians. Full article
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