TABLE 1.

Psychosocial challenges/barriers and recommended strategies

Challenge	Potential impact on AIH management	Strategies for medical teams	Referral
Logistical and Socioeconomic Stable housing and meals Adequate health insurance Transportation Child care	Adherence Challenges: limited resources and necessity for prioritization of basic needs (e.g., having housing), attending visits may not be logistically feasible (e.g., time of work) Impact on Wellbeing: added stress to existing challenges with basic needs	Increase flexibility (offer a variety of dates/times for appointments, choice of virtual or in person) Find local providers if possible	Social work: Help to find resources Disability services: Connect with Medicaid, other statewide supports, school accommodations
Health Literacy and Knowledge Communicating with doctors Managing health insurance Understanding disease Understanding management recommendations	Adherence Challenges: difficulty problem‐solving and advocating, not taking medication when feeling well, avoidance of health‐care visits, lack of understanding of necessity of seeking health‐care Impact on Wellbeing: more uncertainty and related distress	Give clear, simple, straightforward directions for attaining medication, taking medication, and when to follow up with doctor Give information in multiple formats Allocate additional time for teaching about illness	Social work: teach health literacy, assist in health‐care management Disability advocate: assist in health‐care management
Mental Health Mood concerns (anxiety, depression) organization and memory (ADHD, developmental delays, intellectual disability) Parent mood concerns	Adherence Challenges: lack of motivation or organization, limited reminders from parents Impact on Wellbeing: More intense emotional concerns surrounding diagnosis, prognosis, and disease progression	Suggest and help to problem‐solve strategies for improving health behaviors, such as scheduled reminders, calendars, pill boxes Take time to answer questions related to worries and concerns and provide validation	Behavior therapist: teach behavioral techniques to increase healthy behaviors, problem‐solving, address mood concerns Counselor: teach to coping skills for chronic illness PCP or psychiatrist: prescribe psychiatric medications
Social Support General family functioning Parent/child relationship Social/peer relationships Caregiver support system	Adherence Challenges: family conflict increasing child oppositional behavior, lack of organization, limited help with management behaviors Impact on Wellbeing: Caregivers or child may become more overwhelmed with managing chronic illness, feel alone in disease management	Work with parents and child to problem‐solve challenges around medication adherence (e.g., who sets reminder, parents' involvement) Validate concerns	Parent and child support groups: increase social support Family therapist: address family conflict and functioning