Considerations for intensive treatment programs among youth with medical and behavioral health concerns

Abstract

In the United States, it is estimated that more than 40% of youth have at least one chronic health condition (National Survey of Children’s Health, 2020). Some of the most commonly encountered concerns include eating disorders, cystic fibrosis, substance use disorders, behavioral problems comorbid with intellectual and developmental disabilities, and gender dysphoria. The estimated prevalence of eating disorders among youth ranges from 0.3% to 22.7% (Dahlgren & Wisting, 2016), of cystic fibrosis among newborns from 0.28% to 0.4% (Goldbeck, Fidika, Herle, & Quittner, 2014), of substance use disorder from 13.4% to 26.3% (Volkow, Han, Einstein, & Compton, 2021), of comorbid behavior problems from 38.9% to 58.9% among youth with intellectual disabilities (Gurney, McPheeters, & Davis, 2006), and of gender dysphoria and related concerns from 1.3% to 19% (Baum et al., 2018; Rider, McMorris, Gower, Coleman, & Eisenberg, 2018; Shields et al., 2013). Specialty medical and/or behavioral health services are often required to address the symptoms and concomitant functional impairment associated with these conditions (National Survey of Children’s Health, 2020). Medical interventions for these conditions commonly include emergency weight restoration via tube-feeding for eating disorders (Chan, Jaffe, D’Souza, Lowe, & Matthews-Rensch, 2021; Hale & Logomarsino, 2019); antibiotic regimens, selective gene modulator therapies, and portable airway clearance devices for cystic fibrosis (Goldbeck, Fidika, Herle, & Quittner, 2015); medication-assisted treatment to include naltrexone or suboxone for substance use disorders (MAT; Maglione et al., 2018); psychopharmacological agents, such as mood stabilizers or atypical antipsychotics, for severely disruptive behaviors co-occurring with intellectual and developmental disabilities (Jones et al., 2018; Lee, Vidal, & Findling, 2018); and hormone replacement treatment or corrective surgery for gender dysphoria (Butler, de Graaf, Wren, & Carmichael, 2018; Claahsen-van der Grinten et al., 2021) to directly address condition-specific symptoms.