Evaluation of psychology practice models in the pediatric intensive care unit

Objective: Pediatric intensive care unit (PICU) patients and their families experience significant distress, which can increase risk for post-PICU psychological morbidity. Pediatric psychologists are well-suited to mitigate the psychological impact of PICU admissions. However, a comprehensive assessment of PICU psychology practice models is lacking. This mixed-methods study aimed to evaluate current and propose improved PICU psychology practice models. Methods: Fourteen participants (13 psychologists and 1 intern) from 13 United States institutions completed a 39-item survey and participated in focus groups. Participants described their institution’s current psychology practice model and recommended improvements. Results: Most institutions (77%) employed a hybrid model involving service-specific psychologists (i.e., psychologists dedicated to specific pediatric populations who follow their patients in the PICU) and consultation-liaison psychologists (i.e., psychologists who serve multiple inpatient units including the PICU). Psychologists embedded in the PICU were less common (8%). Participants recommended a model wherein psychologists have dedicated PICU time, citing benefits including improved patient/family identification, more specialized PICU knowledge, increased availability, and better medical team relationships. Conclusions: Most PICU psychology practice models use a hybrid approach, yet psychologists recommend an embedded model wherein psychologists have dedicated PICU time. Future research should evaluate improved practice models from the viewpoint of a more diverse group of psychology providers and other stakeholders (e.g., physicians, patients, and family members).