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Increased prevalence of behavioral risks among adolescent and young adult women with psychological distress in the emergency department. Pediatr Emerg Care 2010; 26:93-8. [PMID: 20094003 DOI: 10.1097/pec.0b013e3181cdb883] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mental health problems in adolescents have been recognized as a significant medical concern. They have been associated with risk-taking behaviors during adolescence. OBJECTIVE To determine the prevalence of elevated scores for psychological distress among adolescent girls aged 15 to 21 years who present to a pediatric emergency department (PED) for general medical care and to correlate psychological distress scores with sexual and substance use behaviors. METHODS The study was performed in the PED of an urban general hospital. We enrolled female patients aged 15 to 21 years cared for in the PED. Subjects completed the Center for Epidemiological Studies-Depression Scale 8 (CES-D8); elevated scores were defined as 7 or greater. The survey collected data on demographics, sexual practices, alcohol and drug use, and health care access and utilization. RESULTS Two hundred ninety-nine subjects participated. One hundred forty-one participants (47.7%) had CES-D8 scores of 7 or greater. In multivariate logistic regression, factors associated with increased emotional distress were being white, Hispanic, or of other race; having a recent new sex partner; and recent sex without birth control. Alcohol use in the past 3 months was associated with elevated distress as was having a distant relationship with one's parents/guardians. Those who had never had sex or who had sex in the past but not within the past 3 months were also more likely to have elevated CES-D8 scores compared with those who had sex more recently with the use of birth control. CONCLUSIONS Screening for mental health issues in the emergency department may identify a significant number of adolescent patients in need of further evaluation, especially as half of surveyed patients reported the PED as a usual source of health care.
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Examining Youth Hopelessness as an Independent Risk Correlate for Adolescent Delinquency and Violence. Matern Child Health J 2009; 15:87-97. [DOI: 10.1007/s10995-009-0550-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Duke NN, Borowsky IW. Suicidal events in adolescents: how clear are the warning signs? ACTA ACUST UNITED AC 2009. [DOI: 10.2217/phe.09.52] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Adolescence should mark a time of exploration, self-discovery and the development of a sense of meaning and purpose in life. Adolescent suicidality represents the ultimate threat to these normal developmental processes. Factors impacting the likelihood of adolescent self-directed violence are numerous and this reality can often leave providers and youth advocates with a dilemma when attempting to identify suicidal youths. Universal screening in primary clinic settings provides an opportunity to identify youths most at risk of suicide. Multiple levels exist for provider and youth advocate intervention in the prevention of adolescent suicide.
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Affiliation(s)
- Naomi N Duke
- Center for Adolescent Nursing, School of Nursing, University of Minnesota, 5–140 Weaver-Densford Hall, 308 Harvard Street, SE Minneapolis, MN 55455, USA and Division of Academic General Pediatrics, Department of Pediatrics, Medical School, University of Minnesota, 3rd Floor West, 717 Delaware Street, SE Minneapolis, MN 55414, USA
| | - Iris W Borowsky
- Division of Academic General Pediatrics, Department of Pediatrics, Medical School, University of Minnesota, 3rd Floor West, 717 Delaware Street, SE Minneapolis, MN 55414, USA
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Abstract
OBJECTIVE The impact of the Global War on Terror on two million U.S. military children remains unknown. The purpose of this study was to describe the psychosocial profile of school age children during parental deployment utilizing standardized psychosocial health and stress measures, and to identify predictors of children at "high risk" for psychosocial morbidity during wartime deployment. METHODS Army spouses with a deployed service member and a child aged 5-12 years completed a deployment packet consisting of demographic and psychosocial questions. The psychosocial health measures included the Pediatric Symptom Checklist (PSC), the Parenting Stress Index-Short Form and the Perceived Stress Scale-4. RESULTS Overall, 32% of respondents exceeded the PSC cut off score for their child, indicating "high risk" for psychosocial morbidity and 42% reported "high risk" stress on the Parenting Stress Index-Short Form. Parenting stress significantly predicted an increase in child psychosocial morbidity (odds ratio 7.41, confidence interval 2.9-19.0, p < 0.01). Parents utilizing military support reported less child psychosocial morbidity (odds ratio 0.32, confidence interval 0.13-0.77, p < 0.01) and parental college education was related to a decrease in child psychosocial morbidity (odds ratio 0.33, confidence interval 0.13-0.81, p < 0.02). The effects of military rank, child gender, child age, and race or ethnic background did not reach statistical significance. CONCLUSION Families in this study experiencing deployment identified one-third of military children at "high risk" for psychosocial morbidity. The most significant predictor of child psychosocial functioning during wartime deployment was parenting stress. Military, family and community supports help mitigate family stress during periods of deployment.
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Hacker KA, Williams S, Myagmarjav E, Cabral H, Murphy M. Persistence and change in pediatric symptom checklist scores over 10 to 18 months. Acad Pediatr 2009; 9:270-7. [PMID: 19487170 DOI: 10.1016/j.acap.2009.03.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2008] [Revised: 02/28/2009] [Accepted: 03/17/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There are many studies of the Pediatric Symptom Checklist (PSC), but none has followed a naturalistic sample longitudinally. We aimed to examine persistence and change in PSC scores over time in children seen in an ambulatory pediatric setting. METHODS The sample of 1033 patients was PSC screened at 2 consecutive preventive care visits (10 to 18 months apart) in 2 pediatric clinics. Longitudinal analyses were conducted to assess predictors of change in PSC category and score. RESULTS Approximately 30% of the initially screened population did not return for preventive pediatric care. Those who did not return were significantly more likely to have positive PSC scores than those who returned (8% compared with 4.3%, P < .01). PSC scores were highly stable at visit 2 for those who initially scored negative, but they fluctuated more for those who initially scored positive. After controlling for sociodemographic variables and counseling at either visit, referral at visit 1 (P < .0001) predicted changes in mean PSC scores at visit 2. On average, PSC score decreased 3.2 points among those referred at visit 1 but increased 1.6 points in nonreferred children. CONCLUSIONS This is the first study to document the stability and change in PSC scores in a sample of ambulatory pediatric patients. The statistically significant association between pediatrician referral and improved PSC scores provides evidence for the value of referral in primary care, although the study did not examine the relationship between PSC screening and referral. The high rate of positive scores in children who did not return for follow-up suggests the need for alternative strategies for this population.
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Affiliation(s)
- Karen A Hacker
- Institute for Community Health, Cambridge Health Alliance, 163 Gore Street, Cambridge, Massachusetts 02141, USA.
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Abstract
Pediatric primary care clinicians have unique opportunities and a growing sense of responsibility to prevent and address mental health and substance abuse problems in the medical home. In this report, the American Academy of Pediatrics proposes competencies requisite for providing mental health and substance abuse services in pediatric primary care settings and recommends steps toward achieving them. Achievement of the competencies proposed in this statement is a goal, not a current expectation. It will require innovations in residency training and continuing medical education, as well as a commitment by the individual clinician to pursue, over time, educational strategies suited to his or her learning style and skill level. System enhancements, such as collaborative relationships with mental health specialists and changes in the financing of mental health care, must precede enhancements in clinical practice. For this reason, the proposed competencies begin with knowledge and skills for systems-based practice. The proposed competencies overlap those of mental health specialists in some areas; for example, they include the knowledge and skills to care for children with attention-deficit/hyperactivity disorder, anxiety, depression, and substance abuse and to recognize psychiatric and social emergencies. In other areas, the competencies reflect the uniqueness of the primary care clinician's role: building resilience in all children; promoting healthy lifestyles; preventing or mitigating mental health and substance abuse problems; identifying risk factors and emerging mental health problems in children and their families; and partnering with families, schools, agencies, and mental health specialists to plan assessment and care. Proposed interpersonal and communication skills reflect the primary care clinician's critical role in overcoming barriers (perceived and/or experienced by children and families) to seeking help for mental health and substance abuse concerns.
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Children's mental health emergencies-part 1: challenges in care: definition of the problem, barriers to care, screening, advocacy, and resources. Pediatr Emerg Care 2008; 24:399-408. [PMID: 18562887 DOI: 10.1097/pec.0b013e318177a6c6] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE At a time when there has been a reduction in mental health resources nationwide, the incidence of mental health disorders in children has seen a dramatic increase for many reasons. METHODS A review of the literature was done to identify the epidemiology, barriers to care, useful emergency department (ED) screening methods, and resources regarding pediatric mental health disorders in the ED. RESULTS Although there are many challenges to the provision of care for children with mental health emergencies, some resources are available. Furthermore, ED screening and intervention may be effective in improving patient outcomes. CONCLUSIONS Collaborative efforts with multidisciplinary services can create a continuum of care, promote better identification of children and adolescents with mental health disorders, and promote early recognition and intervention, which are key to effective referral and treatment.
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Abstract
The Pediatric Symptom Checklist-17 (PSC-17) is a brief form of the Pediatric Symptom Checklist that is designed to screen for behavioral health problems in primary care settings. It has been proposed to have three subscales: externalizing, internalizing, and attention problems. In the context of developing a behavioral health screening program in an inner-city primary care practice, we evaluated the construct validity of the PSC-17. A total of 331 families with children between 4 and 12 years of age who were seen for well-child care during the study were invited to complete the PSC-17 and 320 families (96.5%) did so. A confirmatory factor analysis was performed and the Comparative Fit Index and root mean square error of approximation fit statistics were calculated to determine whether the data fit the proposed three-factor model. We found that although the PSC-17 contained three subscales, several items did not load predominantly on the subscale that they were proposed to measure. Specifically, although the five items on the internalizing subscale loaded only on this subscale, only four of the seven externalizing items loaded exclusively on the externalizing subscale, and only two of the five attention items loaded exclusively on the attention problems subscale. Clinicians using the PSC-17 in urban low-income communities should recognize that the externalizing and attention problems subscales of the PSC-17 may not be valid measures of these dimensions of child behavior in this population.
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Steinbaum DP, Chemtob C, Boscarino JA, Laraque D. Use of a psychosocial screen to detect children with symptoms of posttraumatic stress disorder: an exploratory study. ACTA ACUST UNITED AC 2008; 8:32-5. [PMID: 18191779 DOI: 10.1016/j.ambp.2007.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 07/12/2007] [Accepted: 08/18/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the sensitivity and specificity of the parent and youth versions of the 17-item Pediatric Symptom Checklist (PSC-17) for identifying children with symptoms of posttraumatic stress disorder (PTSD). METHODS Cross-sectional convenience samples of children aged 8 to 10 years treated at a primary care pediatrics practice in New York City were recruited. The PSC-17 and its 5-item internalizing subscale were used in both parent- and youth-completed formats. Posttraumatic stress disorder symptoms were identified with the University of California, Los Angeles posttraumatic stress reaction index (UCLA RI), used as a structured interview with the child. RESULTS One hundred fifty-six children enrolled in the study. Twenty-two percent of children met the UCLA RI cutoff for likely PTSD. The youth version of the PSC-17 and its 5-item internalizing subscale identified these children with sensitivities of 78% and 75% and specificities of 77% and 77%, respectively, relative to the UCLA RI. The parent version of the PSC-17 and the internalizing subscale had poorer sensitivities of 44% and 25% and similar specificities of 79% and 92%, respectively. CONCLUSIONS Symptoms of PTSD can be identified using the youth self-report version of the PSC-17. A 5-item subscale of the PSC-17 also performed well and can readily be used in primary care settings.
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Affiliation(s)
- Deborah P Steinbaum
- Division of General Pediatrics, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Commentary: caring for the psychosocial needs of children: from advocacy to structural change. ACTA ACUST UNITED AC 2008; 8:8-10. [PMID: 18191775 DOI: 10.1016/j.ambp.2007.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Accepted: 11/14/2007] [Indexed: 11/20/2022]
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Cheung AH, Zuckerbrot RA, Jensen PS, Stein REK, Laraque D. Expert survey for the management of adolescent depression in primary care. Pediatrics 2008; 121:e101-7. [PMID: 18166529 DOI: 10.1542/peds.2006-3560] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Primary care clinics have become the "de facto" mental health clinics for teens with mental health problems such as depression; however, there is little guidance for primary care professionals who are faced with treating this population. This study surveyed experts on key management issues regarding adolescent depression in primary care where empirical literature was scant or absent. METHODS Participants included experts from family medicine, pediatrics, nursing, psychology, and child psychiatry, identified through nonprobability sampling. The expert survey was developed on the basis of information from focus groups with patients, families, and professionals and from the research literature and included sections on early identification, assessment and diagnosis, initial management, treatment, and ongoing management. Means, standard deviations, and confidence intervals were calculated for each survey item. RESULTS Seventy-eight of 81 experts agreed to participate (return rate of 96%). Fifty-three percent of the experts (n = 40) were primary care professionals. Experts endorsed routine surveillance for youth at high risk for depression, as well as the use of standardized measures as diagnostic aids. For treatment, "active monitoring" was deemed appropriate in mild depression with recent onset. Medication and psychotherapy were considered acceptable options for treatment of moderate depression without complicating factors such as comorbid illness. Fluoxetine was rated as the most appropriate antidepressant for use in this population. Finally, experts agreed that patients who are started on antidepressants should be followed within 2 weeks after initiation. CONCLUSIONS Survey results support the identification and management of adolescent depression in the primary care setting and, in specific situations, referral and co-management with specialty mental health professionals. Even with the recent controversies around treatment, experts across primary care and specialty mental health alike agreed that active monitoring, pharmacotherapy with selective serotonin reuptake inhibitors, and psychotherapy can be appropriate under certain clinical circumstances when initiated within primary care settings.
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Affiliation(s)
- Amy H Cheung
- Department of Psychiatry, University of Toronto, 33 Russell St, Third Floor Tower, Toronto, Ontario, M5S 2S1, Canada.
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Hart CN, Kelleher KJ, Drotar D, Scholle SH. Parent-provider communication and parental satisfaction with care of children with psychosocial problems. PATIENT EDUCATION AND COUNSELING 2007; 68:179-85. [PMID: 17643912 PMCID: PMC2099312 DOI: 10.1016/j.pec.2007.06.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2006] [Revised: 05/14/2007] [Accepted: 06/09/2007] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The objective of the present paper was to determine the association between parent-provider communication and parent ratings of satisfaction and quality of care for a group of parents of children identified with a psychosocial problem. METHODS A sample of 804 parents of children with psychosocial concerns enrolled in the Child Behavior Study (CBS) was used for the present analyses. As part of the CBS, parents of children with psychosocial problems answered questions that assessed parent-provider communication and parent ratings of satisfaction and quality of care. RESULTS Overall, parents reported good communication with their child's provider. Eighty-two percent of parents were very satisfied with the care received and 68% reported a very high quality of care. Parent-provider communication (e.g., collaboration and mutual understanding) was strongly related to parental reports of both satisfaction and quality of care. CONCLUSIONS Parent-provider communication is an important correlate of parental report of satisfaction and quality of care. Involvement of parents in the treatment planning process was particularly important in determining satisfaction and quality ratings within this sample. PRACTICE IMPLICATIONS When working with families with identified psychosocial concerns, the use of collaboration and an empathic style by providers may enhance the quality of care parents report receiving from their primary care clinicians.
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Abstract
Suicide is the third-leading cause of death for adolescents 15 to 19 years old. Pediatricians can take steps to help reduce the incidence of adolescent suicide by screening for depression and suicidal ideation and behavior. This report updates the previous statement of the American Academy of Pediatrics and is intended to assist the pediatrician in the identification and management of the adolescent at risk of suicide. The extent to which pediatricians provide appropriate care for suicidal adolescents depends on their knowledge, skill, comfort with the topic, and ready access to appropriate community resources. All teenagers with suicidal thoughts or behaviors should know that their pleas for assistance are heard and that pediatricians are willing to serve as advocates to help resolve the crisis.
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Habis A, Tall L, Smith J, Guenther E. Pediatric emergency medicine physicians' current practices and beliefs regarding mental health screening. Pediatr Emerg Care 2007; 23:387-93. [PMID: 17572523 DOI: 10.1097/01.pec.0000278401.37697.79] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Only 20% of children with mental health issues are identified and receiving appropriate treatment nationally. The emergency department (ED) may represent a significant opportunity to provide selective pediatric mental health screening to an at-risk population. OBJECTIVE To describe the current standard of care and perceived limitations among pediatric emergency medicine (PEM) physicians regarding mental health screening. METHODS A 23-question survey on screening practices for pediatric mental illness (PMI) was sent to PEM physician participants identified through the American Academy of Pediatrics Section on Emergency Medicine mailing list. RESULTS Of the 576 physicians meeting our inclusion criteria, 384 (67%) surveys were returned. Eighty-six percent of respondents indicated screening for PMI in 10% or less of their eligible patients. Overall, 43% of respondents indicated screening only if the chief complaint was psychiatric in nature. The remaining 217 physicians most commonly screened for depression (83%), suicidality (76%), and substance abuse (67%). Only 9% of physicians stated that they used evidence-based medicine in determining their screening practices. Women physicians (odds ratio, 1.94; 95% confident interval, 1.08-3.47) and those using evidence-based medicine (odds ratio, 3.88; 95% confidence interval, 1.92-7.85) were more likely to conduct screening. Significant limitations to screening identified by respondents include the following: time limitations (93%), absence of a validated screening tool (62%), limited resources (46%), and lack of training (44%). Eighty-eight percent of physicians believe that a validated and standardized screening tool would improve their ability to identify PMI. CONCLUSIONS Routine PMI screening is conducted infrequently by most PEM physicians. Improved physician education/training and the development of a validated ED-specific mental health screening tool would assist PEM physicians in the early detection of PMI.
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Affiliation(s)
- Arie Habis
- Division of Pediatric Emergency Medicine, Children's Memorial at Central Dupage Hospital, Northwestern University Feinberg School of Medicine, Winfield, IL 60190, USA.
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Gardner W, Lucas A, Kolko DJ, Campo JV. Comparison of the PSC-17 and alternative mental health screens in an at-risk primary care sample. J Am Acad Child Adolesc Psychiatry 2007; 46:611-618. [PMID: 17450052 DOI: 10.1097/chi.0b013e318032384b] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To validate the 17-item version of the Pediatric Symptom Checklist (PSC-17) as a screen for common pediatric mental disorders in primary care. METHOD Patients were 269 children and adolescents (8-15 years old) whose parents completed the PSC-17 in primary care waiting rooms. Children were later assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). The PSC-17's subscales were compared with K-SADS-PL diagnoses and measures of anxiety, depression, general psychopathology, functioning, and impairment. RESULTS In receiver operating characteristics analyses, the PSC-17 subscales performed as well as competing screens (Child Depression Inventory, the parent and child Screens for Child Anxiety-Related Disorders) and Child Behavior Checklist subscales (Aggressive, Anxious-Depressed, Attention, Externalizing, Internalizing, and Total) in predicting diagnoses of attention-deficit/hyperactivity disorder, externalizing disorders, and depression (area under the curve > or =0.80). The instrument was less successful with anxiety (area under the curve = 0.68). None of the screens were highly sensitive, many were insensitive, and all would have low positive predictive value in low-risk primary care populations. CONCLUSIONS The PSC-17 and its subscales are briefer than alternative questionnaires, but performed as well as those instruments in detecting common mental disorders in primary care. Continued research is needed to develop brief yet sensitive assessment instruments appropriate for primary care.
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Affiliation(s)
- William Gardner
- Drs. Gardner and Campo and Ms. Lucas are with the Center for Innovation in Pediatric Practice, Columbus Children's Research Institute and the Departments of Pediatrics and Psychiatry at The Ohio State University; and Dr. Kolko is with the Department of Psychiatry at the University of Pittsburgh Medical Center.
| | - Amanda Lucas
- Drs. Gardner and Campo and Ms. Lucas are with the Center for Innovation in Pediatric Practice, Columbus Children's Research Institute and the Departments of Pediatrics and Psychiatry at The Ohio State University; and Dr. Kolko is with the Department of Psychiatry at the University of Pittsburgh Medical Center
| | - David J Kolko
- Drs. Gardner and Campo and Ms. Lucas are with the Center for Innovation in Pediatric Practice, Columbus Children's Research Institute and the Departments of Pediatrics and Psychiatry at The Ohio State University; and Dr. Kolko is with the Department of Psychiatry at the University of Pittsburgh Medical Center
| | - John V Campo
- Drs. Gardner and Campo and Ms. Lucas are with the Center for Innovation in Pediatric Practice, Columbus Children's Research Institute and the Departments of Pediatrics and Psychiatry at The Ohio State University; and Dr. Kolko is with the Department of Psychiatry at the University of Pittsburgh Medical Center
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Tzoumas AC, Tzoumas JL, Burlingame GM, Nelson PL, Wells MG, Gray DD. The Y-OQ-12: psychosocial screening of youth in primary care medicine using items from an outcome measure. Clin Psychol Psychother 2007. [DOI: 10.1002/cpp.554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Brown JD, Wissow LS, Gadomski A, Zachary C, Bartlett E, Horn I. Parent and teacher mental health ratings of children using primary-care services: interrater agreement and implications for mental health screening. ACTA ACUST UNITED AC 2006; 6:347-51. [PMID: 17116609 PMCID: PMC1761112 DOI: 10.1016/j.ambp.2006.09.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2006] [Revised: 08/24/2006] [Accepted: 09/14/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine interrater agreement when screening for child mental health problems during primary-care visits. METHODS Children aged 5 to 10 (n = 227) and one of their parents were systematically recruited from the waiting rooms of 15 primary-care sites located in Baltimore, Md; Washington, DC; and rural New York from 2002 to 2005. The parent and teacher of the child completed the Strengths and Difficulties Questionnaire to measure the child's emotions, behaviors, and functional impairment. RESULTS Parents and teachers identified a similar proportion of children as having high symptoms (25% vs 23%) and high impairment (27% vs 32%) but rarely agreed in their assessments of specific children. Parent ratings alone missed 52% of children rated by teachers as having both high symptoms and high impairment (kappa = 0.15). Only 6% of these discrepant visits were for mental health problems, making it unlikely that teacher reports would have been solicited. CONCLUSIONS Parent reports failed to detect half of school-aged children considered to be seriously disturbed by their teachers. Efforts to improve detection of mental health problems by using screening tools in primary care may require algorithms that help providers judge when to solicit teacher reports and how to interpret conflicting information from parents and teachers.
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Affiliation(s)
- Jonathan D Brown
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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68
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Hacker KA, Myagmarjav E, Harris V, Suglia SF, Weidner D, Link D. Mental health screening in pediatric practice: factors related to positive screens and the contribution of parental/personal concern. Pediatrics 2006; 118:1896-906. [PMID: 17079560 DOI: 10.1542/peds.2006-0026] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals were to examine factors related to positive Pediatric Symptom Checklist scores in an urban practice and to examine the relative contribution of parental/personal concern about emotional and behavioral problems to mental health problem identification. METHODS Annual screening using the Pediatric Symptom Checklist was implemented in Cambridge Pediatrics (Cambridge, MA). A social worker was colocated in the clinic to provide therapeutic interventions for patients. A sample of 1668 screened patients between 4 years 11 months and 19 years of age was used for analysis. Bivariate and multivariate analyses were conducted to determine factors predictive of positive Pediatric Symptom Checklist scores, including demographics, socioeconomic indicators, enrollment in counseling, and parental/personal concern. Parental/personal concern, counseling, and positive Pediatric Symptom Checklist scores were examined to determine their efficacy as screening methods. RESULTS Six percent of the population had positive Pediatric Symptom Checklist scores. There were statistically significant relationships between a positive score and being in counseling, parental/personal concern, having public insurance, and living in an area with median household incomes of less than 50,000 dollars. Parental/personal concern was 40% sensitive for a positive score. A positive Pediatric Symptom Checklist score with or without parental/personal concern identified 3.8% of the population; parental/personal concern with or without a positive Pediatric Symptom Checklist score identified 4.5%. CONCLUSIONS Mental health screening can be effectively implemented in a pediatric practice. Colocated mental health professionals provide additional support. The combination of a screening tool and questions about parental/personal concern and present counseling can provide critical information about a child's mental health.
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Affiliation(s)
- Karen A Hacker
- Institute for Community Health, Cambridge Health Alliance, 163 Gore St, Cambridge, MA 02141, USA.
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Goodfriend M, Bryant T, Livingood W, Goldhagen J. A model for training pediatricians to expand mental health services in the community practice setting. Clin Pediatr (Phila) 2006; 45:649-54. [PMID: 16928843 DOI: 10.1177/0009922806291018] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A model of training pediatricians in mental health diagnosis and intervention was developed to increase the pediatrician's competency in dealing with the increasing number of children with these problems. The model consisted of a pediatric psychiatrist working in collaboration with community pediatricians and training pediatricians in mental health interview and evaluation techniques, recognition and diagnosis of behavioral and mental disorders, and intervention and treatment. Following implementation of this model, the community pediatricians demonstrated an increase in mental health diagnoses in their practices. This model represents one approach in preparing pediatricians to respond to the increasing number of children with mental health and behavioral problems.
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Affiliation(s)
- Marlene Goodfriend
- Duval County Health Department, University of Florida-Jacksonville, Department of Pediatrics, Jacksonville, FL, USA
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Clabby JF. Helping depressed adolescents: a menu of cognitive-behavioral procedures for primary care. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2006; 8:131-41. [PMID: 16912815 PMCID: PMC1540388 DOI: 10.4088/pcc.v08n0302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2005] [Accepted: 11/07/2005] [Indexed: 10/20/2022]
Abstract
Depression among adolescents has received recognition as a significant psychiatric problem that requires prompt intervention. This article will help primary care providers to understand the significance of adolescent depression, recognize its prevalence in primary care, cite the evidence supporting cognitive-behavioral therapy (CBT) as a treatment for depressed adolescents, recognize the challenges of using CBT in primary care, and use 7 different CBT approaches with their patients. Psychiatric diagnoses may be present in 38% of adolescents who see a primary care physician, and among that number, depression is the most common diagnosis. Cognitive-behavioral therapy provides a scientifically proven tool for those physicians who want to provide their young depressed patients an effective counseling approach. Cognitive-behavioral therapy enhances self-control, perceptions of personal efficacy, rational problem-solving skills, social skills, and participation in activities and physical exercise that bring the adolescent a sense of pleasure or mastery. CBT has been proven to be effective when delivered by physicians who have received significant instructions. Unfortunately, CBT techniques can at first seem overly abstract, overwhelming in number, and difficult to teach in the 15-minute visit. However, CBT techniques can be made clear and accessible for a busy physician. The case of a depressed 14-year-old male high school student who comes to his physician for a pre-participation sports physical is presented to illustrate the application of CBT in primary care.
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Affiliation(s)
- John F Clabby
- CentraState Medical Center Family Medicine Residency and the Department of Family Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Freehold, NJ, USA.
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Lieberman A, Adalist-Estrin A, Erinle O, Sloan N. On-site mental health care: a route to improving access to mental health services in an inner-city, adolescent medicine clinic. Child Care Health Dev 2006; 32:407-13. [PMID: 16784496 DOI: 10.1111/j.1365-2214.2006.00620.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Lieberman
- Albert Einstein Medical Center, Department of Pediatrics, Philadelphia, PA 19141, USA.
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Pachter LM, Auinger P, Palmer R, Weitzman M. Do parenting and the home environment, maternal depression, neighborhood, and chronic poverty affect child behavioral problems differently in different racial-ethnic groups? Pediatrics 2006; 117:1329-38. [PMID: 16585331 PMCID: PMC1475725 DOI: 10.1542/peds.2005-1784] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether the processes through which parenting practices, maternal depression, neighborhood, and chronic poverty affect child behavioral problems are similar or different in minority and nonminority children in the United States. METHODS Data from 884 white, 538 black, and 404 Latino families with children who were 6 to 9 years of age in the National Longitudinal Survey of Youth were analyzed. The outcome, child behavioral problems, was measured using the Behavior Problems Index externalizing and internalizing subscales. The effects of chronic poverty, neighborhood, maternal depression, and parenting on the outcome were analyzed using multigroup structural equation modeling. RESULTS Chronic poverty affected child behavioral problems indirectly through the other variables, and parenting practices had direct effects in each racial/ethnic group. The effects of maternal depression were partially mediated through parenting in the white and Latino samples but were direct and unmediated through parenting practices in the black sample. Neighborhood effects were present in the white and black samples but were not significant for the Latino sample. CONCLUSIONS Chronic poverty, neighborhood, maternal depression, and parenting practices have effects on child behavioral problems in white, black, and Latino children, but the processes and mechanisms through which they exert their effects differ among the groups. The differences may be related to social stratification mechanisms as well as sociocultural differences in family and childrearing practices.
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Affiliation(s)
- Lee M Pachter
- Department of Pediatrics, University of Connecticut School of Medicine, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA.
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Ohene SA, Ireland M, McNeely C, Borowsky IW. Parental expectations, physical punishment, and violence among adolescents who score positive on a psychosocial screening test in primary care. Pediatrics 2006; 117:441-7. [PMID: 16452364 DOI: 10.1542/peds.2005-0421] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We sought to examine the relationship between perceived and stated parental expectations regarding adolescents' use of violence, parental use of physical punishment as discipline, and young adolescents' violence-related attitudes and involvement. METHODS Surveys were completed by 134 youth and their parents attending 8 pediatric practices. All youth were 10 to 15 years of age and had scored positive on a psychosocial screening test. RESULTS Multivariate analyses revealed that perceived parental disapproval of the use of violence was associated with a more prosocial attitude toward interpersonal peer violence and a decreased likelihood of physical fighting by the youth. Parental report of whether they would advise their child to use violence in a conflict situation (stated parental expectations) was not associated with the adolescents' attitudes toward interpersonal peer violence, intentions to fight, physical fighting, bullying, or violence victimization. Parental use of corporal punishment as a disciplining method was inversely associated with a prosocial attitude toward interpersonal peer violence among the youth and positively correlated with youths' intentions to fight and fighting, bullying, and violence victimization. CONCLUSIONS Perceived parental disapproval of the use of violence may be an important protective factor against youth involvement in violence, and parental use of physical punishment is associated with both violence perpetration and victimization among youth. Parents should be encouraged to clearly communicate to their children how to resolve conflicts without resorting to violence and to model these skills themselves by avoiding the use of physical punishment.
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Affiliation(s)
- Sally-Ann Ohene
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA
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Duke N, Ireland M, Borowsky IW. Identifying psychosocial problems among youth: factors associated with youth agreement on a positive parent-completed PSC-17. Child Care Health Dev 2005; 31:563-73. [PMID: 16101652 DOI: 10.1111/j.1365-2214.2005.00551.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The choice of informant is a critical piece in the identification of psychosocial problems in youth. While many behavioural measures have been adapted to include information from multiple sources, in the case of parents and youth, poor agreement has been found. Our study purpose was to identify youth and parent factors associated with whether the youth agrees with a positive parent-completed screen of youth psychosocial problems. METHODS Parents of youth aged 10-15 years who were seen for a medical visit at eight clinics completed the 17-item Pediatric Symptom Checklist (PSC-17). Youth scoring positive on the screen and their parents/guardians were interviewed by telephone after the visit (n = 145). We conducted bivariate and multivariate analyses to identify parent characteristics and child factors associated with whether the youth agrees with the positive parent-completed screen. RESULTS Fifty per cent of youth participants agreed with their parent on a positive parent-completed PSC-17 based on their completion of the Y-PSC-17 as a self-report measure. Youth who reported a positive Y-PSC-17 in agreement with their parent were twice as likely to meet diagnostic cut-offs on sub-scales of anxiety/depression and aggression on the Child Behaviour Checklist (P < 0.01 and P < 0.05 respectively), reported lower parent-child connectedness (P < 0.01) and their parents reported more anger/frustration (P < 0.05) than youth who disagreed with the positive parent-completed screen. Most of these associations remained significant when controlling for the other factors and demographic characteristics in multivariate analysis. CONCLUSIONS Findings indicate that when the youth agrees with a positive parent-completed PSC-17, there is higher parent frustration, lower parent-child connectedness, and the youth is more likely to have a diagnosis of an emotional or behavioural disorder. Thus, when possible, the use of both parent and youth as informants provides necessary information in formulating a comprehensive treatment strategy to address the psychosocial needs of youth.
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Affiliation(s)
- N Duke
- Department of Pediatrics, Division of General Pediatrics and Adolescent Health, University of Minnesota, Minneapolis, 55455, USA.
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