CHOP's Integrative Health Program

Maria Mascarenhas, MBBS; Jessi Erlichman, MPH; Robin Miccio, MS, LMT

The Integrative Health (IH) Program at CHOP subscribes to a novel patient care approach using the whole-person health model. As healthcare systems evolve away from viewing health as the absence of disease, CHOP recognizes the need to address the multidimensional aspects of patient health—mind, body and spirit. Grounded in CHOP’s family-centered care model, IH not only helps to make sick children well, but contributes toward healthy futures for our children and families. The IH Program is in alignment with CHOP’s tripartite mission to integrate excellent patient care, innovative research, and quality professional education.

In 2014, the program was established under leadership of Maria Mascarenhas, MBBS. At that time, the program’s service areas of focus were limited to the outpatient setting with multidisciplinary integrative gastroenterology, nutrition, food reactions, and acupuncture clinics.

The program’s range of services expanded rapidly since inception and now includes a wide array of IH offerings: yoga, massage, acupuncture, energy therapy, mindfulness, aromatherapy, and IH physician consult service pilot. These services are available in the inpatient setting at the Philadelphia Campus and will be offered at the Middleman Family Pavilion, CHOP’s new hospital in King of Prussia.

Evidence-based practice informs the therapeutic services offered and the conditions we treat. IH therapists are consulted for a range of conditions, including pain management and anxiety; they collaborate as part of the patient’s care team and are fully integrated into the electronic medical record. Families can also self-refer to receive services. IH Program portfolio of offerings are imbedded across all units, particularly in Oncology, Gastroenterology, and Adolescent Medicine. For example, Tracey Jubelirer, MD, is the program director of the Integrative Oncology Program, which provides a range of IH therapies to oncology patients across multiple service sites, in addition to offering a monthly multidisciplinary IH clinic for cancer patients.

We are also exploring a quality improvement project with partners in the Philadelphia Campus Emergency Department to pilot acupuncture for pain conditions.

Research to study effectiveness

Although IH therapies remain popular, there are many unanswered questions regarding efficacy and mechanisms of action, especially for pediatric patients. The IH Program at CHOP contributes to the expansion of knowledge through the pursuit of research. The program has partnered with numerous clinical groups to elucidate mechanisms of action and therapeutic effectiveness for subset conditions.

Through a partnership with the Lustgarten Center for GI Motility, the program is testing whether abdominal myofascial release (massage) can improve gut motility, heart rate variability, and symptoms in patients with irritable bowel syndrome. The IH team also collaborated with the Center for Pediatric Inflammatory Bowel Disease to assess whether yoga could improve quality of life and self-efficacy in pediatric patients with IBD. Preliminary results suggest the yoga intervention was effective in improving quality of life, and these improvements were sustained many months post intervention. The mindfulness study is ongoing with promising results on improving quality of life.

Recognizing the emotional burden caring for a child with chronic disease has on caregivers, IH partnered with Chris Feudtner, MD, PhD, MPH, and his team to develop a Coping Kit for parents of children with chronic disease. We use the coping kit in our community-based wellness education program.

In collaboration with the Food Allergy Center, PennCHOP Microbiome Program, and Penn Center for Nutritional Science and Medicine (PenSAM), we are looking to identify a biomarker in patients with unexplained food reactions. Partnering with researchers in CHOP’s Cancer Center, we have conducted studies on the use of acupuncture for pain management in adolescents and young adults, feasibility of a nutritional intervention with a low-glycemic diet for leukemia patients in mitigating obesity, and more recently understanding the feasibility of yoga therapy in neuroblastoma patients receiving immunotherapy.

Education for staff, families, community

Finally, the IH Program provides education to staff, patients and their families, and the community at large through various mechanisms. CHOP staff can access modules covering breathwork, caring touch, and aromatherapy. Our holistic nurse offers additional classes on utilization of these practices in clinical care. The program sponsors an annual symposium in the fall. The content varies each year and is oriented toward topics of interest for our clinicians. The sixth annual symposium is scheduled for September 30, 2022, and will focus on IH therapies for common pediatric conditions.

In partnership with the University of Arizona Integrative Medicine in Residency Program, we have trained more than 80 pediatric residents, fellows, advanced practice providers, and physicians.

We offer wellness classes to patient families, schools, and the community through our BE-WEHL project (Behavioral Health –Wellness Equity for a Healthy Life) for children in underserved communities (see related article on Page 3—hyperlink to BeWHEL article once posted). Doctors can refer patients experiencing stress to this program via Epic.

Our Culinary Medicine Program partners with the Department of Clinical Nutrition, Perelman School of Medicine, and Vetri Community Partnership to educate medical students, pediatric residents, patients, and their families. We have shifted from in- person classes to virtual classes during the pandemic. In addition, the Integrative Oncology Program has purchased a mobile cooking cart and plans to host cooking demonstrations for patients with cancer in partnership with our medical chefs and Clinical Nutrition.

For more information about the IH program, email us at integrativehealth@chop.edu or visit our website. See the menu of our services.

Contributed by: Maria Mascarenhas, MBBS, Jessi Erlichman, MPH, Robin Miccio, MS, LMT