The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs

Janice S. Cohen; John S. Lyons; Eric I. Benchimol; Nicholas Carman; Camille Guertin; David R. Mack

doi:10.1016/j.jpsychores.2019.02.002

The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs

Janice S. Cohen, John S. Lyons, Eric I. Benchimol, Nicholas Carman, Camille Guertin, David R. Mack

Research output: Contribution to journal › Article › peer-review

7 Scopus citations

Abstract

Objective: The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. Methods: We performed a cross-sectional study of children (aged 8–17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization. Results: Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2–3 on the pIBD-INTERMED “mental health/cognitive threat” item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17–24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00–122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70–43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00–45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity. Conclusions: The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.

Original language	English
Pages (from-to)	26-33
Number of pages	8
Journal	Journal of Psychosomatic Research
Volume	119
DOIs	https://doi.org/10.1016/j.jpsychores.2019.02.002
State	Published - Apr 2019

Bibliographical note

Funding Information:
All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf and declare that (1) JC received partial support from Janssen Canada Inc., for the submitted work; (2) JSL, EI, CG and DRM have no competing interests to report. NC has previously received funding from Abbvie. The funders had no role in the study design, collection, analysis, and interpretation of data, preparation of the manuscript, or in the decision to submit the manuscript for publication.

Funding Information:
The authors wish to thank R. Singleton, A. Mack, L. Lenz, S. Hazel, L. Smith, S. Pira, and H. Rath-Wilson and J. Seymour for their contributions to the completion of this study. A Career Development Award from the Canadian Child Health Clinician Scientist Program , Canada and a New Investigator Award from the Canadian Institutes of Health Research , Canadian Association of Gastroenterology , and Crohn's and Colitis Canada supported EIB , Canada. Writing assistance was provided by Pauline Lavigne. This work was support by grants received from the IBD Foundation , Ontario Ministry of Health and Long-Term Care Academic Health Sciences Centres Alternate Funding Plan Innovation Fund, Canada, Children's Hospital of Eastern Ontario (CHEO), CHEO Research Institute , Canada, an investigator-initiated grant from Janssen Inc. , Canada and the Division of Gastroenterology, Hepatology & Nutrition, CHEO.

Funding Information:
The authors wish to thank R. Singleton, A. Mack, L. Lenz, S. Hazel, L. Smith, S. Pira, and H. Rath-Wilson and J. Seymour for their contributions to the completion of this study. A Career Development Award from the Canadian Child Health Clinician Scientist Program, Canada and a New Investigator Award from the Canadian Institutes of Health Research, Canadian Association of Gastroenterology, and Crohn's and Colitis Canada supported EIB, Canada. Writing assistance was provided by Pauline Lavigne. This work was support by grants received from the IBD Foundation, Ontario Ministry of Health and Long-Term Care Academic Health Sciences Centres Alternate Funding Plan Innovation Fund, Canada, Children's Hospital of Eastern Ontario (CHEO), CHEO Research Institute, Canada, an investigator-initiated grant from Janssen Inc., Canada and the Division of Gastroenterology, Hepatology & Nutrition, CHEO.

Publisher Copyright:
© 2019

Keywords

Biopsychosocial screening
Children
Crohn's disease
Inflammatory bowel disease
Integrated care
Ulcerative colitis

ASJC Scopus subject areas

Clinical Psychology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jpsychores.2019.02.002

Cite this

@article{15bec4d9ce5149cf87a4bbebf8514bca,

title = "The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs",

abstract = "Objective: The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. Methods: We performed a cross-sectional study of children (aged 8–17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization. Results: Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2–3 on the pIBD-INTERMED “mental health/cognitive threat” item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17–24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00–122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70–43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00–45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity. Conclusions: The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.",

keywords = "Biopsychosocial screening, Children, Crohn's disease, Inflammatory bowel disease, Integrated care, Ulcerative colitis",

author = "Cohen, {Janice S.} and Lyons, {John S.} and Benchimol, {Eric I.} and Nicholas Carman and Camille Guertin and Mack, {David R.}",

note = "Funding Information: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf and declare that (1) JC received partial support from Janssen Canada Inc., for the submitted work; (2) JSL, EI, CG and DRM have no competing interests to report. NC has previously received funding from Abbvie. The funders had no role in the study design, collection, analysis, and interpretation of data, preparation of the manuscript, or in the decision to submit the manuscript for publication. Funding Information: The authors wish to thank R. Singleton, A. Mack, L. Lenz, S. Hazel, L. Smith, S. Pira, and H. Rath-Wilson and J. Seymour for their contributions to the completion of this study. A Career Development Award from the Canadian Child Health Clinician Scientist Program , Canada and a New Investigator Award from the Canadian Institutes of Health Research , Canadian Association of Gastroenterology , and Crohn's and Colitis Canada supported EIB , Canada. Writing assistance was provided by Pauline Lavigne. This work was support by grants received from the IBD Foundation , Ontario Ministry of Health and Long-Term Care Academic Health Sciences Centres Alternate Funding Plan Innovation Fund, Canada, Children's Hospital of Eastern Ontario (CHEO), CHEO Research Institute , Canada, an investigator-initiated grant from Janssen Inc. , Canada and the Division of Gastroenterology, Hepatology & Nutrition, CHEO. Funding Information: The authors wish to thank R. Singleton, A. Mack, L. Lenz, S. Hazel, L. Smith, S. Pira, and H. Rath-Wilson and J. Seymour for their contributions to the completion of this study. A Career Development Award from the Canadian Child Health Clinician Scientist Program, Canada and a New Investigator Award from the Canadian Institutes of Health Research, Canadian Association of Gastroenterology, and Crohn's and Colitis Canada supported EIB, Canada. Writing assistance was provided by Pauline Lavigne. This work was support by grants received from the IBD Foundation, Ontario Ministry of Health and Long-Term Care Academic Health Sciences Centres Alternate Funding Plan Innovation Fund, Canada, Children's Hospital of Eastern Ontario (CHEO), CHEO Research Institute, Canada, an investigator-initiated grant from Janssen Inc., Canada and the Division of Gastroenterology, Hepatology & Nutrition, CHEO. Publisher Copyright: {\textcopyright} 2019",

year = "2019",

month = apr,

doi = "10.1016/j.jpsychores.2019.02.002",

language = "English",

volume = "119",

pages = "26--33",

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TY - JOUR

T1 - The pediatric inflammatory bowel disease INTERMED

T2 - A new clinical tool to assess psychosocial needs

AU - Cohen, Janice S.

AU - Lyons, John S.

AU - Benchimol, Eric I.

AU - Carman, Nicholas

AU - Guertin, Camille

AU - Mack, David R.

N1 - Funding Information: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf and declare that (1) JC received partial support from Janssen Canada Inc., for the submitted work; (2) JSL, EI, CG and DRM have no competing interests to report. NC has previously received funding from Abbvie. The funders had no role in the study design, collection, analysis, and interpretation of data, preparation of the manuscript, or in the decision to submit the manuscript for publication. Funding Information: The authors wish to thank R. Singleton, A. Mack, L. Lenz, S. Hazel, L. Smith, S. Pira, and H. Rath-Wilson and J. Seymour for their contributions to the completion of this study. A Career Development Award from the Canadian Child Health Clinician Scientist Program , Canada and a New Investigator Award from the Canadian Institutes of Health Research , Canadian Association of Gastroenterology , and Crohn's and Colitis Canada supported EIB , Canada. Writing assistance was provided by Pauline Lavigne. This work was support by grants received from the IBD Foundation , Ontario Ministry of Health and Long-Term Care Academic Health Sciences Centres Alternate Funding Plan Innovation Fund, Canada, Children's Hospital of Eastern Ontario (CHEO), CHEO Research Institute , Canada, an investigator-initiated grant from Janssen Inc. , Canada and the Division of Gastroenterology, Hepatology & Nutrition, CHEO. Funding Information: The authors wish to thank R. Singleton, A. Mack, L. Lenz, S. Hazel, L. Smith, S. Pira, and H. Rath-Wilson and J. Seymour for their contributions to the completion of this study. A Career Development Award from the Canadian Child Health Clinician Scientist Program, Canada and a New Investigator Award from the Canadian Institutes of Health Research, Canadian Association of Gastroenterology, and Crohn's and Colitis Canada supported EIB, Canada. Writing assistance was provided by Pauline Lavigne. This work was support by grants received from the IBD Foundation, Ontario Ministry of Health and Long-Term Care Academic Health Sciences Centres Alternate Funding Plan Innovation Fund, Canada, Children's Hospital of Eastern Ontario (CHEO), CHEO Research Institute, Canada, an investigator-initiated grant from Janssen Inc., Canada and the Division of Gastroenterology, Hepatology & Nutrition, CHEO. Publisher Copyright: © 2019

PY - 2019/4

Y1 - 2019/4

N2 - Objective: The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. Methods: We performed a cross-sectional study of children (aged 8–17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization. Results: Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2–3 on the pIBD-INTERMED “mental health/cognitive threat” item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17–24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00–122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70–43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00–45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity. Conclusions: The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.

AB - Objective: The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. Methods: We performed a cross-sectional study of children (aged 8–17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization. Results: Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2–3 on the pIBD-INTERMED “mental health/cognitive threat” item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17–24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00–122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70–43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00–45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity. Conclusions: The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.

KW - Biopsychosocial screening

KW - Children

KW - Crohn's disease

KW - Inflammatory bowel disease

KW - Integrated care

KW - Ulcerative colitis

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The pediatric inflammatory bowel disease INTERMED: A new clinical tool to assess psychosocial needs

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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