Use of the Psychosocial Assessment Tool (PAT) to Identify Risk in Families of Pediatric Liver Transplant Recipients

Faculty Contact: Emily Fredericks, PhD

Background:
The need for routine assessment and management of the psychosocial needs of children and adolescents with liver disease and transplantation within the context of comprehensive clinical care has been recognized. Yet, most pediatric hepatology and transplant clinics are limited in their resources.  Psychosocial risk is a constellation of individual, family, social, and economic factors that, when considered collectively, increases the likelihood that an individual or their family members will experience difficulties managing the challenges of a chronic condition or disease and its treatment. These difficulties may manifest as psychological symptoms or as diminished academic/professional, social, or family functioning of either the patient or a family member.

Objectives:
This quality assurance/improvement project aims to 1) evaluate the Psychosocial Assessment Tool 2.0 (PAT) as an appropriate measure of risk for patient and family psychological distress in the Pediatric Liver Disease and Liver Transplant Clinic; 2) use the PAT to allocate appropriate psychosocial resources and intervention; and 3) determine if psychosocial risk level is associated with the child’s health status and health utilization rates.

Methods:
Parent/guardians of patients within the Pediatric Liver Disease and Liver Transplant Clinic will complete the PAT annually, or as clinically indicated, during regular clinic visits.  Pediatric patients presenting without a parent/guardian (i.e., patients >18 years of age) will complete the PAT independently. The PAT is a brief screening tool comprised of  seven subscales: Family Structure and Resources (e.g., number of adults in the home, financial difficulties, transportation), Social Support (e.g., for childcare, finances), Child Problems (patient internalizing, externalizing, and social problems), Sibling Problems (sibling internalizing, externalizing, and social problems), Family Problems (family conflict, medical problems), Parent Stress Reactions (e.g., jumpy, nightmares), and Family Beliefs (belief in family’s ability to cope and make good treatment decisions). Additional demographic information (e.g., caregiver education, part of faith-based community) is also collected. The PAT takes approximately 5-10 minutes to complete.

Action Plan:
The PAT results will be reviewed by members of the multidisciplinary pediatric liver clinic team. Risk status will be communicated to the parent/patient and appropriate resources and/or referrals for further assessment and intervention will be allocated based on risk level.  Medical records of the pediatric patients will be reviewed to determine factors thought to be related to psychosocial risk.  We hypothesize that results of this quality assurance/improvement initiative will provide us with information regarding the utility of the PAT as a screening tool which will inform clinical decision making and may facilitate the provision of psychosocial care to improve outcomes for patients and families with increased risk.

For more information, please contact:
Emily M. Fredericks, PhD
University of Michigan, Division of Pediatric Psychology
Child Health Evaluation and Research (CHEAR) Unit
300 North Ingalls Building, Room 6E18
Ann Arbor, MI 48109-5456
Email: emfred[at]med.umich[dot]edu