Katherine Shafto

Background/Objective: Adolescents experience stress, anxiety, depression, and chronic pain at rates comparable to adults. Opportunity youth are a unique subset of adolescents/young adults with a higher risk of chronic pain and mental health comorbidities. Group Medical Visits (GMVs) for adults are a well-established model supporting whole-person care for chronic pain and co-incident mental health challenges. Research on GMVs among adolescents is limited. This program evaluation explores the feasibility, acceptability, and sustainability of a chronic pain GMV curriculum adapted for opportunity youth at a residential employment-readiness center. Preliminary signals of program impact were explored as a secondary objective of the study. Methods: After completing a chronic pain GMV training program, two pediatricians adapted and piloted the curriculum for opportunity youth through an 8-week Group Visit Series (GVS) offering integrative and lifestyle-based approaches to mental health, stress, and chronic pain. This was a single-site, uncontrolled, mixed-methods pilot program evaluation. Attendance was recorded as a measure of feasibility. A weekly progress sheet captured pre-/post-visit participant feedback, and semi-structured interviews (n = 6), conducted one month post-GVS, were examined using rapid analysis to explore acceptability. Sustainability was observed by program continuation beyond the pilot. Exploratory participant-reported outcomes were collected through PROMIS-29 (n = 6), PROMIS Positive Affect (n = 5), and Patient Global Impression of Change (n = 6). Results: Fourteen participants enrolled, with nine completing ≥3 visits. Weekly progress sheets demonstrated intra-visit changes from pain, fatigue, and concern to calm. Interview analysis yielded concepts of appreciation for skills learned and the group experience. Sustainability was observed. Six of seven PROMIS-29 domains showed positive signals of improvement, with 6/6 (100%) of respondents meeting a minimal clinical important difference (MCID) threshold for depression and 5/6 (83%) for anxiety. PROMIS-Positive Affect and Patient Global Impression of Change showed positive trends at visit 8. Conclusions: This chronic pain and mental health GVS for opportunity youth was found to be feasible, acceptable, and sustainable. Positive trends in participant-reported depression and anxiety scores were also observed. Larger studies beyond program evaluation are needed to confirm these results.

Pediatric palliative care is a field which focuses on caring for and treating the symptoms and distress typically associated with life-limiting illness. Integrative medicine is supported by evidence and aims to heal the whole person, including all aspects of one’s lifestyle. Therapies offered by integrative medicine often empower patients and families, allowing for a sense of control. This review addresses the merging of integrative medicine philosophy and modalities with the care given to children with life-limiting illness. We review an introduction to integrative medicine, trends in its incorporation in the healthcare setting, application to patients receiving palliative care and the management of specific symptoms. A case study is offered to illustrate these principles.