P2 Staff experiences of working with children and young people (CYP) experiencing persistent unexplained physical symptoms (PUPS) in the context of a new biopsychosocial model of care

Background An estimated 10-25% of Children and Young People (CYP) experience PUPS (Hinton & Kirk, 2016). PUPS is a complex phenomenon comprising an interplay of biopsychosocial factors. Healthcare professionals working in ‘physical’ health settings often struggle to find a helpful way forward with this group of CYP (Furness et al., 2009). This can lead to break-down in communication between families and professionals and increase medicalisation of symptoms (Furness et al., 2009).

Aims This study aimed to explore healthcare professional’s experiences of caring for CYP presenting with PUPS following the implementation of a specialist biopsychosocial MDT.

Method Individual, semi-structured interviews were conducted with 7 health professionals who had referred CYP into the MDT. An inductive approach to thematic analysis (TA) (Joffe & Yardley, 2004) was used to identify salient themes from the interviews.

Findings Two overarching themes emerged from the interviews, each of which contained numerous sub-themes.Firstly, interviewees drew attention to care for CYP presenting with PUPS being in a state of ‘Disintegration’prior to the implementation of the MDT, both structurally and relationally. Interviewees went on to discuss how implementation of the MDT had allowed for greater structural and relational ‘Integration’. Interviewees reflected on how increased structural and relational integration allowed space for mind-body integration for CYP.

Conclusions The positive experiences of professionals in this study, in addition to literature recommending a biopsychosocial approach to PPS (Lazarus, 2003) and supportive national policy (NHS England, 2016) create a strong case for a multi-disciplinary approach to caring for CYP presenting with PPS. This should include professionals with expertise in physical health, alongside those with psychological expertise and those concerned with the social welfare of CYP.

References

1. Furness P, Glazebrook C, Tay J, Abbas K, Slaveska-Hollis K. Medically unexplained physical symptoms in children: exploring hospital staff perceptions. Clinical child psychology and psychiatry 2009;14(4):575-587.

2. Hinton D, Kirk S. Families’ and healthcare professionals’ perceptions of healthcare services for children and young people with medically unexplained symptoms: a narrative review of the literature. Health & social care in the community 2016;24(1):12-26.

3. Joffe H, Yardley L. Content and Thematic Analysis.In Research methods for Clinical Health Psychology 2004;55-56.London: Sage.

4. Lazarus AA. ( 2003). Multimodal Therapy: A Primer. Retrieved from http://www.zurinstitute.com/multimodaltherapy.html