Engaging hearts and minds: An in-depth qualitative examination of health professionals’ perceptions of, and experiences with, an integrated, hospital-based mental health service dedicated to childhood heart disease

摘要

Introduction: Health authorities are increasingly focused on the prevalence of psychological distress amongst children with critical or chronic physical illness. Whilst collaborative care models are regarded as optimal in delivering high-quality mental health care, the complexity of inter-professional teamwork can challenge implementation. This qualitative study sought to explore health professionals’ perceptions of, and experiences with, an integrated model of mental health care in paediatric heart disease. Methods: Individual, semi-structured interviews were conducted with 10 health professionals from a range of disciplines (paediatric cardiology, neonatology, nursing, social work, health administration) providing clinical care for children with heart disease within the Sydney Children’s Hospitals Network (SCHN), Australia. Interviews explored four key domains: (a) acceptability and feasibility of an integrated mental health service dedicated to childhood heart disease, (b) perceived value and efficacy of the model in improving care and health outcomes, (c) impact of the work on staff and their coping responses, and (d) desire for additional training and support in implementing psychologically-informed paediatric care. Interviews were audiotaped, transcribed verbatim, and analysed thematically using NVivo12. Results: Participants described significant and enduring emotional challenges experienced by children with heart disease and their families. Integrated mental health services were highly valued and perceived as offering specialised psychological assessment and care. Psychologists and social workers within the service were perceived as having an in-depth understanding of patients’ medical experiences, and the service was viewed as accessible and responsive. Participants expressed confidence in the skills of the mental health clinicians, and comfort discussing psychosocial concerns with their colleagues. Tensions between physical and mental health care models were identified. Most participants reported uncertainty about their role in delivering mental health care, viewing their engagement largely as referrers and describing a lack of confidence in their mental health care skills. While participants perceived psychological care as improving patient health and wellbeing, some raised challenges associated with routine psychosocial assessment, including inadequate resources to meet demand, differing patient needs, and patient willingness and capacity to engage given competing demands.  Several participants expressed a desire for more training, particularly regarding communication with families about mental health. Discussion & Conclusion: There is international concern that children with comorbid physical and mental health care needs lack adequate access to high-quality mental health services. Accessibility can be optimised by integrating services. While mental health care is highly valued by health professionals providing care to children with heart disease, there are challenges associated with interdisciplinary work. Balancing differing beliefs, expectations and priorities requires continued interprofessional collaboration. Lessons learned: Models of integrated mental health care that inspire active interdisciplinary collaboration and are co-designed with patients, families, health professionals and other key stakeholders, are likely to have greatest success in sustainable implementation. Limitations: The transferability of these findings outside of the SCHN Cardiac Service is unknown. Suggestions for future research: Increased focus on innovative implementation strategies designed to yield sustainable collaborative care in physical and mental health settings is needed. Exploring the impact of ongoing stakeholder consultation is one avenue for future integrated care research.