Abstracts

Rationale:
Childhood epilepsy can have a significant impact on the psychological health and quality of life of parents (Lv et al, 2009). Parents of children with epilepsy (PCE) report higher rates of stress related to concerns for their child’s health and the demands of caring for a medically complex child.  Parental mental health issues likely negatively affect children with epilepsy.  However, few pediatric epilepsy centers are addressing this gap in clinical care.  To meet this need, the Washington University Pediatric Epilepsy Center at St. Louis Children’s Hospital (SLCH) in partnership with the Washington University Perinatal Behavioral Health Service (PBHS) and the June Jessee Memorial Foundation established a program run by an Epilepsy Behavioral Health Therapist.  The therapist provided co-located psychoeducation, mental health screenings, and referrals to outpatient therapy to PCEs during an inpatient admission. This program is described herein, discussing implementation, workflow, and community response of the initial year.
Method:
In its initial year, The Epilepsy Behavioral Health program identified 247 potential families. Eligible PCEs have at least one child aged 0-5 with an existing or suspected diagnosis of epilepsy (all types) that were admitted to the inpatient Neurology unit of SLCH. PCEs were approached in-person or by phone during their child’s admission. Therapist provided written and verbal information on resources, coping strategies, and the common symptoms of anxiety, depression, and trauma disorders.  Parents could accept, decline, or enroll in services.  Enrollment required a mental health screening and was followed by referrals to appropriate resources. Screenings consisted of a psychosocial interview and use of a validated measure (combined PHQ-9/GAD-7 or EPDS depending on child’s age). Parents were assessed for history of psychological disorders and trauma, current stressors, and current symptoms of anxiety, depression and/or trauma disorder. The therapist was co-located within the Neurology Epilepsy Monitoring Unit to provide ease of access to these services. All contacts were tracked. Data gathered during the psychosocial interviews were reported within a RedCap database.
Results:
The population was primarily (76%) female with diverse socioeconomic backgrounds. Engagement rates were high with 190 PCEs of 247 accepting or enrolling in services. Most declines were passive (e.g., away from bedside, did not return phone calls) with only 4 active rejections of the services. In interview, most PCEs described their caregiving role as chronically stressful and emotionally challenging.  Stays in the inpatient unit further added to the stress. Initial scores from the screenings suggest that PCEs report both a history of psychological diagnoses as well as current symptoms of psychological disorders at a much higher rate than the general population. Of those enrolling in services, nearly half report current, clinically significant symptoms of anxiety and/or depression. 15 PCEs were referred to Epilepsy Behavioral Health outpatient therapy on campus. 12 (80%) attended at least one appointment. No show rate was 10% for ongoing appointments, significantly less than the estimated outpatient average of 20% (DeFife, Conklin, Smith, & Poole, 2010).
Conclusion:
The results of the initial year indicate that PCEs are interested in these services, that there is an unmet clinical need for behavioral health resources in this community, and that follow-up services are utilized at a high rate.  Co-location and grant funding eliminated barriers to treatment and addressed an important gap in family-centered pediatric care. 
Funding:
:June Jessee Memorial Foundation, St. Louis Children's Hospital Foundation