The Pediatric INTERMED: A New Clinical-Decision Making Tool for Operationalizing Biopsychosocial Case Complexity in Children and Youth with Chronic Physical Conditions. Janice S. Cohen, Ph.D., C. Psych. David Mack, MD,.FAAP, FRCPC John Lyons, Ph.D Children’s Hospital of Eastern Ontario
The Pediatric INTERMED: A New Clinical-Decision Making Tool for Operationalizing Biopsychosocial Case Complexity in Children and Youth with Chronic Physical Conditions
Janice S. Cohen, Ph.D., C. Psych.
David Mack, MD,.FAAP, FRCPC
John Lyons, Ph.D
Children’s Hospital of Eastern Ontario
University of Ottawa
Information obtained from semi-structured interview, review of available chart information, and input from members of the health care team
e.g., length of stay, number of specialists involved, poorer quality of life at discharge, biological indicators of care (e.g., HbA1c values in a diabetic population)
(10 vignettes drawn from GI service- ½ with IBD, 10 vignettes children referred to neurology service for investigation of headaches)
Symptom Severity of available chart information, and input from members of the health care team: This item describes severity or acuity of physical symptoms related to the reason for current illness presentation. In case of an acute illness most often these symptoms will disappear or diminish, while in an existing chronic disease these symptoms might disappear, remain or increase.
0 No physical symptoms or symptoms resolve with treatment.
1 Mild symptoms, which do not interfere with current functioning.
2 Moderate symptoms, which interfere with current functioning.
3 Severe symptoms leading to inability to perform most functional activities.
Parenting Skills of available chart information, and input from members of the health care team
0- Parents/caregiver have good monitoring and discipline skills, and have no difficulty supervisring child/youth’s medical care
1- Parents/caregivers provide generally adequate monitoring/discipline, but they may occasionally encounter difficulty supervising child/youth’s medical care
2- Parents/caregivers reportdifficulties monitoring and/or disciplining the child/youth, and have problems supervising child/youth’s medical care.
3- Parents/caregivers are unable to discipline and monitor the child/youth and the child/youth is at medical risk due to the absence of supervision of his/her medical care.
Children’s Depression Inventory
Multidimensional Anxiety Scale for Children
Child Behaviour Checklist
Functional Disability Inventory (involvement in daily activities/tasks)
Competence Scales from the Child Behaviour Checklist
Pediatric Inventory for Parents
Family Inventory of Life Events and Changes (family stresses and functioning)
Family Inventory of Resources for Management (family strengths)
IMPACT – III -A quality of life measure specific to paediatric IBD.
Biological Domain: self-report measures that tap domains assessed by the PED-INTERMED.
Health Care Domain:
Average Inter-rater reliability = .82
Range from .64-90, with 5/7 reliabilities falling between .86 and .90
Total Clinical Outcomes Model – TCOM (Lyons 2004)
Child/Youth/Family Level Case Complexity
Community/Network Level Case Complexity
Full System Level (provincial, federal, network of paediatric hospitals)