GI Psychologist Is Part of Our Team

By Betsy Turner, PhD

Betsy Turner, PhD Children with chronic gastrointestinal (GI) conditions often experience seemingly “invisible’ symptoms that are not easily understood or felt by anyone other than the child affected. These symptoms may interfere with a child’s daily life, and trigger anxiety and/or depression.

Treatment regimens often include daily medications, regular infusions, dietary modifications and lifestyle changes — all of which can be time-consuming and stressful for children and teens. And to make matters more challenging, some GI conditions are poorly understood outside of specialty care settings.

Many patients with functional GI disorders have experienced symptoms for years without receiving an accurate diagnosis, or may have been told their symptoms were “in their head.” The difficulties that children and adolescents face in coping with GI conditions can impact their entire family.

GI psychology at CHOP

The GI Psychology Program at Children’s Hospital of Philadelphia (CHOP) is a collaboration between the Division of Gastroenterology, Hepatology and Nutrition and the Department of Child and Adolescent Psychiatry and Behavioral Sciences (DCAPBS). At CHOP, psychologists with specialty training in GI disorders help patients (and their families) better understand how a child’s feelings, fears and emotions can impact their chronic GI condition and vice versa.

A team of eight GI psychologists at CHOP work collaboratively with children and families to improve children’s daily functioning and quality of life. Our team strives to promote the overall health and development of pediatric patients with GI symptoms and conditions.

We are committed to providing family-centered, evidence-based and safe psychosocial and behavioral interventions to all GI patients. Our team is invested in training and has created a GI psychology training program for future GI psychologists and other pediatric leaders. Our team members also:

• Conduct innovative research
• Contribute to the literature in pediatric psychology
• Deliver presentations at national gastroenterology and psychology conferences
• Aim to achieve these goals through collaboration and integration of care with medical and psychosocial providers within our division

Exceptional clinical care

Our psychologists provide multiple services and supports to GI patients including:

• Behavioral therapy to manage constipation and encopresis
• Cognitive behavioral therapy to improve GI symptoms and quality of life

These evidence-based interventions target the symptoms of functional abdominal pain, irritable bowel syndrome and rumination syndrome, and improve the likelihood that patients (and families) will stick with the treatment regimen.

Our GI psychologists are available at CHOP’s University City campus in Philadelphia and at five CHOP Specialty Care Centers in Pennsylvania and New Jersey. The GI Psychology team provided 3,328 outpatient visits in FY2019 and 3,546 outpatient visits in
FY2020.

We have been able to continue both individual appointments and interdisciplinary clinic models during the COVID-19 pandemic using telehealth, including shoulder-to-shoulder GI and GI psychology visits. Since March 2020, our team has conducted about 2,900 video visits. The widespread use of telehealth has also increased attendance for all of our disease-specific patient and family support groups.

Specialized interdisciplinary programs

The GI Psychology team works closely with colleagues in medicine, nursing, social work, child life and nutrition to provide compassionate and integrated care. The following programs have been developed in partnership with GI medical colleagues and highlight the benefit of shoulder-to-shoulder GI and GI Psychology visits:

• Chronic Constipation Program (CCP) — This program includes experts in motility with an interdisciplinary consult and coordinated follow-up visits on an every-other-week basis for treatment of chronic constipation. Children and families within this program meet jointly with a motility gastroenterologist, gastroenterology nurse practitioner and psychologist. Families can select from two sites (King of Prussia or Philadelphia) for the program.
• Interdisciplinary Care for Abdominal Pain & Symptoms (ICAPS) — This consultative program provides families with an integrated approach to the care of abdominal pain. Children and families within this program meet jointly with a motility gastroenterologist, psychologist, dietician and social worker. This program is expanding due to the success of the clinic.
• Pancreatic Disorders Program — This program provides interdisciplinary care to children and young adults with pancreatic disease. Children and families within this program meet jointly with a gastroenterologist, psychologist and dietician.
• Support Groups and Family Education Days — Our GI psychologists collaborate with gastroenterology physicians, nurses, dieticians and social workers to provide support groups to children and families with a number of GI disorders including: inflammatory bowel disease (IBD), gastroparesis, eosinophilic esophagitis, celiac disease, and complex intestinal disorders. GI psychologists also contribute to Family Education Days within the Division of Gastroenterology, Hepatology and Nutrition.

Excellence in education

There are very few training programs in GI psychology in the nation. CHOP GI psychologists are actively engaged in training and professional education. For the past 10 years, we’ve offered 6-month training rotations for predoctoral interns in psychology. We also offer year-long externships for graduate psychology students. In its 3-year history, the GI psychology externship has received 31 applications from students matriculating in 14 graduate training programs in clinical, counseling and school psychology. We have accepted and trained seven students.

GI psychologists also provide a didactic training series for GI fellows. Most recently, our program has expanded to include postdoctoral training.

Our GI Psychology Fellowship — currently in its inaugural year — offers an opportunity for advanced clinical practice by providing pediatric psychology services within the Division of Gastroenterology, Hepatology and Nutrition. The fellow provides integrated clinical services and works collaboratively with interdisciplinary team members for patient care, program development and quality improvement projects.

Leaders in the field

CHOP’s GI psychologists are recognized leaders in their fields and sought after for their experience in promoting the overall wellbeing and development of children, teens and young adults with GI symptoms and conditions. Our team members have:

• Provided presentations at national gastroenterology and psychology conferences
• Written book chapters about the management of digestive symptoms and conditions
• Served as primary investigators and co-investigators on quality improvement research in the areas of IBD, celiac disease and GI motility disorders

Betsy Turner is a pediatric psychologist and psychosocial team manager in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at CHOP.