Elise R. McKelvey, PsyD · Ellen C. Joseph, PhD · Tiffany Duffing, PhD
Poster presented at the 2026 NASPGHAN/CPNP/APGNN Annual Meeting | October 22–24, 2026 | San Diego, CA
Background
Pediatric gastrointestinal (GI) psychology interventions are evidence-based and increasingly recognized as an important component of multidisciplinary care for pediatric GI conditions. Access to specialty GI psychology services, however, remains limited by geographic barriers, insufficient specialist availability, and logistical challenges connecting patients to appropriately trained providers.
Community-based telehealth psychology practices are an emerging model for expanding access to specialty behavioral health care, yet little is known about how patients actually find and engage with these services in real-world settings. Characterizing referral pathways, patient demographics, and treatment utilization within a specialty telehealth practice may help inform future dissemination and access efforts.
This study examined referral patterns, patient demographics, presenting concerns, and treatment engagement within a community-based pediatric GI psychology telehealth practice.
Methods
Administrative and clinical tracking data were retrospectively reviewed for 758 referred pediatric patients (ages 0–18) seen between January 2024 and May 2026. Descriptive statistics characterized demographics, geographic distribution, referral pathways, presenting concerns, and treatment engagement.
Variables examined: age, gender, geographic location, referral source, presenting concern (IBS, IBD, functional abdominal pain [FAP], functional nausea, upper GI concerns, encopresis, other GI concerns, non-GI concerns, and general mental health concerns), treatment completion status, and session utilization.
Results
WHO WAS REFERRED
Out of 4,888 total patients referred for gastropsychology services practice-wide between January 2024 and May 2026, pediatric patients made up only 15.5% (N=758). Average age at referral was 13.4 years (range 3–18). The majority of established pediatric patients were adolescents (n = 169, 62.6%) rather than younger children (n = 101, 37.4%). Of patients with gender documented, 54.6% identified as female, 44.4% male, and 0.9% non-binary.
GENDER (OF PATIENTS WITH GENDER DOCUMENTED)
| Gender | % |
|---|---|
| Female | 54.6% |
| Male | 44.4% |
| Non-binary | 0.9% |
WHERE REFERRALS CAME FROM
Referrals originated from 34 states. Among patients with geographic data available (n=442), 76.5% were from the VA–MD–DC region.
REFERRAL SOURCE (SUBSET WITH SOURCE DOCUMENTED)
| Pathway | Share |
|---|---|
| Provider referral | 73.0% |
| Internet search | 13.7% |
| Family / friend recommendation | 4.8% |
WHY FAMILIES SOUGHT CARE
Overwhelming, pediatric patients were referred for GI specific concerns (96.9%). For patients who established care, the most common specific diagnoses were IBS (11.5%), FAP (10.8%), functional nausea (10.8%). “Other GI concerns” represented 51.5% of the cohort.
REASON FOR REFERRAL (SUBSET WITH REASON DOCUMENTED)
| Presenting Concern | Share |
|---|---|
| Other GI concerns | 51.5% |
| IBS | 11.5% |
| Functional abdominal pain | 10.8% |
| Functional nausea | 10.8% |
| IBD | 5.0% |
| Upper GI concerns | 4.2% |
| Encopresis | 3.1% |
| Non-GI concerns | 1.9% |
| General mental health | 1.2% |
TREATMENT DURATION
Among terminated patients with session data available (n=117), mean treatment utilization was 11.3 sessions (median 10.0; range 1–60).
Conclusions
Provider referral networks appear central to connecting pediatric patients with specialty GI psychology services, underscoring the importance of interdisciplinary collaboration in facilitating access to behavioral health care. The broad geographic spread of referrals across 34 states, together with diverse presenting concerns, suggests substantial unmet demand for specialized pediatric GI psychology services beyond any singular practice’s traditional geographic catchment area.
Pediatric referrals made up only 15.5% of overall practice referrals — raising the concern that many pediatric patients who could benefit from specialty GI psychology services are not being identified, referred, or successfully connected to care.
Community-based telehealth specialty practices represent an important strategy for expanding access to behavioral GI care given a limited pediatric GI psychology workforce. Future efforts should focus on strengthening referral pathways, expanding interdisciplinary training opportunities, and developing scalable care models capable of meeting growing demand, so pediatric patients can access timely, specialized behavioral care regardless of location.
Limitations
This was a retrospective, single-practice review of administrative and clinical tracking data, so findings reflect this practice’s referral network and telehealth model and may not generalize to other settings. Geographic data were available for only a subset of patients (n=442) and referral-source and session-utilization data were similarly incomplete for parts of the sample, which may affect the precision of those estimates.