Supplemental Materials

Inpatient Pediatric Psychology Consultation-Liaison Practice Survey

by K. Kullgren et al., 2015, Clinical Practice in Pediatric Psychology

Inpatient CL Practice Survey

*I AGREE TO TAKE PART IN THIS STUDY (Confirming my consent to participate)

yes (1)

no (2)

If “yes” is selected, then skip to 1. If “no” is selected, then skip to end of survey.

1. Do you currently do inpatient pediatricconsultation/liaison?

Yes

No

If “no” is selected, then skip to end of survey.

2. How many years have you been a practicing pediatric psychologist?

current graduate student

current intern

current post-doctoral fellow

0-5 years

6-10 years

11-15 years

16-20 years

>20 years

3. If you have a faculty appointment, at what level?

Lecturer

Instructor

Assistant professor

Associate professor

Professor

N/A

4. Where did you receive your formativetraining in pediatric psychology C/L (check all that apply)?

Graduate school

Pre-doctoral internship

Post-doctoral fellowship

On the job

5. Are you a member of the SPP Div 54C/L Special Interest Group (SIG)?

yes

no

6. Are you the appropriate person to comment on the characteristics of your C/L service within your institution including service structure, FTE allocation, and service provision?

yes

I'm not sure, but I'll try

no

If “yes”or “I’m not sure, but I’ll try” are selected, then skip to 7. If “no” is selected, then skip to 17.

7. Name of your institution (this will be kept confidential and will only be used to reduce overlapping/conflicting information from C/L psychologists at the same institution):

8. Your institution is an

Academic medical center

Private hospital

Public hospital

Other ______

9. Within what type of hospital does your C/L service operate?

Pediatric hospital (stand-alone)

Pediatric unit of a medical center (self-contained unit)

Pediatric beds in a general hospital

Other ______

10. What is the number ofpediatric beds (not including psychiatric)in your hospital?

11. At your institution, pediatric psychology inpatientC/Lis housed in:

Department/division of psychology

Department/division of psychiatry

Private practice consultant

Other ______

12. Do psychologists who provide inpatient consults also provide outpatient consults (i.e., NON-ROUTINE services in general medical or specialty pediatric clinics, e.g. assessing suicidality in a dialysis patient)?

Yes, to subspecialty clinics

Yes, to all outpatient clinics

No, there is a separate set of outpatient psychology providers

No, patients are sent to the ED

Other ______

13. If you answered yes to the above question, what percentage of consults are outpatient?

14. Pleasedescribe the composition of your C/L team:

Number / Total # FTE / Length of rotation (for trainees)
Psychologists
Psychiatrists
Nurses
Psychology predoctoral interns
Psychology postdoctoral fellows
Child psychiatry residents/fellows
General psychiatry residents
Pediatric residents
Psychology practicum students
Medical students
Social work students
Other

15. At your institution the inpatient C/L service provides psychology coverage (check all that apply):

Monday - Friday business hour coverage

Monday- Friday evening coverage (i.e., would come in to see a patient)

Weekend coverage (i.e., would come in to see a patient or are already on site)

Monday - Friday evening phone consultation coverage

Weekend phone consultation coverage

Psychiatry provides evening and weekend coverage

Other ______

16. Does your institutionhave any of the following? (check all that apply):

Med-psych unit

Adolescent medicine unit

Behavioral response team

none of the above

17. Are you the appropriate person to comment on the training structure of your C/L service?

yes

I'm not sure, but I'll try

no

If “yes” or “I’m not sure, but I’ll try” is selected, then skip to 18. If “no” is selected then skip to 20.

18. Please check the appropriate responses regarding medical resident training in C/L psychology:

I do not train medical residents.

I deliver didactic lectures on psychology C/L.

I provide Informal teaching around specific patient consults.

I allow medical residents to shadow on inpatient consults.

Other ______

19. What percentage of consults are seen by:

______Trainee only

______Trainee with attending check-in

______Trainee & attending co-evaluation/treatment

______Attending only

20. Are you the appropriate person to comment on administrative issues within your C/L service (i.e., leadership structure, insurance, billing, costs)?

yes

I'm not sure, but I'll try

no

If “yes” or “I'm not sure, but I'll try” is selected, then skip to 21. If “no” is selected then skip to 41.

21. What is the administrative structure of your C/L service?

Psychologist director

Psychiatrist director

Co-director (psychologist and psychiatrist share directorship)

No centralized director of the C/L service

Other ______

22. Do you have to get insurance pre-authorization before seeing inpatients?

Yes

No

Unsure

23. In your service, who physically/electronicallycodes the bill for consults?

attending psychologist

psychology trainee

utilization review/coder

unsure

24. What percentage of the following codes are used billing for inpatient consults:

______Health & Behavior codes (i.e., 96150, 96152, etc.)

______Psychotherapy CPT codes (i.e., 90901, 90816, etc.)

______Consultation codes (e.g., 99652)

25. What percentage of your service's C/L consults with patients with the following types of insurance:

______Medicaid

______Private insurance

______Self-pay

______No insurance

26. What percentage of actual cost of the C/L service is covered by:

______Billing/collections

______Research funding

______Hospital support

______Department/division (psychology/psychiatry) support

______Other

27. At your institution, inpatient psychology consults are triaged by (select all that apply):

administrative support person

psychology intern

psychology fellow

attending psychologist

Other ______

28. If your service is psychology only, is there a separate psychiatry C/L service in your hospital?

Yes. Please describe how it is decided which service sees a particular patient. ______

No

N/A

29. Do you document in an electronic medical record?

Yes

No

30. Do you use a templated note for psychology consult reports?

Yes

No

31. Patient evaluations/intervention appointments are typically:

scheduled for a particular time

drop-in

both equally

32. Do you see patients in (check all that apply):

an office/treatment room off the inpatient floor

an office/treatment room on the inpatient floor

the patient's private room

the patient's shared room

other ______

33. Do you use treatment protocols for specific patient populations? If yes, please describe (i.e., chronic pain, conversion d/o)

Yes ______

No

34. What percentage of your clinical time is:

______Face to face with patient

______Staff education about a specific patient

______Medical rounds

______Staff education about a more general topic

______Other

35. Average (mean)# of NEW consults per week:

36. Average (mean) # ofCONTACTS per patient:

37. Average (mean) daily psychology C/L census:

38. Average (mean) length of response time:

same day

24 hours

>24 hours

39. Which factors impact the decision for your C/L service to see a particular patient:

No impact / Moderate Impact / Major Impact
Attending availability /  /  / 
Trainee availability /  /  / 
Insurance issues /  /  / 
Medical team requests /  /  / 
Appropriateness of consult /  /  / 
Case complexity /  /  / 
Other /  /  / 

40. With regard to outcomes measurement, do you:

yes / no
Keep a clinical database? /  / 
Measure/track outcomes? /  / 
Do Quality Improvement projects? /  / 
Conduct outcomes research? /  / 

41. Please answer the following questions regarding your opinion about your C/L practice.

Always / Most of the time / Sometimes / Rarely / Never
I feel that I have enough resources/support to do my job in inpatient pediatric psychology C/L. /  /  /  /  / 
I feel able to balance the unpredictability and uncertainty of the position. /  /  /  /  / 
I feel burnt out in my role as a C/L psychologist. /  /  /  /  / 
I have enough time for research. /  /  /  /  / 
I have enough time for teaching/training. /  /  /  /  / 
I feel respected by the physicians that I work with. /  /  /  /  / 
I feel that the physicians I work with understand what I do. /  /  /  /  / 
I struggle with the boundaries between my role as a C/L psychologist and the other psychosocial providers in the hospital (i.e., child life, social work, psychiatry, etc.). /  /  /  /  / 
My C/L service works well with child psychiatry. /  /  /  /  / 
I have adequate outpatient resources to refer patients to upon discharge. /  /  /  /  / 
I am satisfied in my role as a C/L psychologist. /  /  /  /  / 

42. Please include any comments specific to the challengesinherent to the practice ofinpatient C/L psychology that you think it would be important for others to know:

43. Please provide your email address if you would like to receive the results of this survey.

44. Please provide your email address if you would like to be included in a raffle for a $20 Amazon gift card.