TABLE 2

SSRD CP Scripts and Handout

Description
Family introductory handoutYour child currently has physical symptoms that are causing great worry and may leave you with questions and concerns. Your family is attempting to understand your child’s symptoms and get an explanation for why your child continues to have physical symptoms. These symptoms are impairing and getting in the way of your child’s health and success. We understand that your child’s illness has been difficult for your child and everyone in your family.
At this time, your child will be admitted to the hospital for a brief stay to conduct an evaluation with the goals of the following:
 • understanding your child’s symptoms and their impact on functioning;
 • providing a diagnosis or diagnoses;
 • providing an explanation for your child’s symptoms;
 • providing some symptomatic relief for your child; and
 • developing a plan for continued care to improve your child’s functioning.
Your child’s evaluation will include the following:
 • a careful review of previous medical records and information about your child;
 • completion of previous medical records and information about your child;
 • completion of any further evaluations as needed; and
 • working together with a team that may include pediatricians, pediatric
 • subspecialists, psychiatry, psychology, social work, physical therapy, occupational therapy, speech therapy, and child life.
At the end of your child’s stay, your child will have a completed evaluation, discussion of results, review of diagnoses, and explanations for symptoms as well as a plan for future symptom care. Your child’s symptoms may not be gone when your child is ready to leave the hospital. We will work to establish goals to improve your child’s health and help your child return to normal activities, including a plan to collaborate with your child’s school, primary care doctor, and other providers in the community to promote your child’s functioning and improvement on discharge.
Sample script
 Introducing psychiatry and other consultations to the family“We are going to review all the tests and treatments you’ve done so far to determine what has been helpful, what needs to be repeated, and what new tests and consultations are needed. We see many children with symptoms similar to what your child has and have a standard multidisciplinary approach to care that includes different consultants from medical specialties, surgical specialties, physical and/or occupational therapy, social work, psychiatry and/or psychology, etc. This comprehensive approach will help us better understand the nature of your child’s symptoms and the impact on all areas of his or her life and will also help us develop an effective management plan.” You may include this last sentence here or only in the context below.
If family is resistant to psychiatry consultation or asks for more information regarding this, clarify that psychiatry helps with the following:
 • understanding the child’s symptoms;
 • assessing the impact of the symptoms on the child and on the family; and
 • helping the child and family cope with the symptoms and get their lives back.
 Introducing the use of measures“As part of our evaluation, we have some measures for you and your child to complete that will help us in our assessment. These measures take approximately [insert number] minutes to complete and help us standardize our evaluation process while being as thorough as possible. The measures assess [insert examples based on measures being administered]. Please be assured that completing these measures is voluntary, and if you do not wish to do so, this would not change the care that you receive while in the hospital.”
 Informing family meeting“As we said at the beginning of your child’s hospital stay, after completing your child’s evaluation, we come together as a multidisciplinary team to discuss what we think is contributing to your child’s symptoms and what we think the treatment should be. We want to give you a chance to ask questions and to be sure that you feel comfortable about our assessment and treatment plan. We understand how debilitating these symptoms have been and want to take our time to be sure we address your questions or concerns.”
“We want to share with you a summary of your child’s symptoms, why we consulted with the specialists we did, what diagnoses we were considering, and what our findings did or did not support. Please tell us along the way if we have any part of the history wrong or if there is anything you do not understand. And please let us know if there is any particular medical condition or diagnosis that you feel we have not adequately addressed.”
 • [Patient name] first presented with:
 • Previous workup included:
 • Our team performed the following tests and/or evaluations:
 • We found the following:
 • Given these findings and with the input from our specialists, we think your child’s symptoms are best understood asa:
 • In our experience, symptoms due to [insert here] respond best to the following treatment approach:
 Discussing the mind-body connection“The brain and body are connected and communicate through nerves, hormones, and chemicals. We call this the mind-body connection. Sometimes it’s hard to understand how the mind-body connection contributes to symptoms, so we want to explain that. The body automatically sends information to the brain, and at the same time, the brain automatically sends information to the body to communicate feelings, such as fear and pain.”
“You may have heard of the ‘fight-flight-freeze’ response. When we sense danger, the brain tells the body to stay on alert using electrical and chemical signals. The body starts doing things to help us survive; for example, lungs breathe faster and shallower, and [the] heart beats faster and harder to get more oxygen to the brain and muscles. Muscles tense up, getting ready to fight or run. All of these reactions happen quickly and automatically, without us even thinking about it. Later, when the danger is gone, the brain tells the body to calm down, but the experience can leave a physical toll on the body. This is our body’s response to stress, also known as the physiology of stress.”
“Stress can be positive or negative, and although we may not consider something ‘dangerous’ or stressful, our bodies can experience the effects of stress through physical symptoms. In this way, we can view the physical symptoms as the body telling us it is feeling distressed or that we are feeling the emotion or stress in our bodies.”
  • a If an SSRD is being considered or the diagnosis has been made, the attending physician leading the meeting should use the actual diagnosis rather than a symptom or general language (eg, conversion rather than “stress”). Ask psychiatry colleagues present to give their assessment of potential contributors that have been determined from the psychiatric evaluation performed. Additional explanatory handouts can be used as needed, including the AACAP Facts for Families on SSRD.1