201
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Splett JW, George MW, Zaheer I, Weist MD, Evans SW, Kern L. Symptom Profiles and Mental Health Services Received Among Referred Adolescents. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-017-9244-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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202
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Abstract
Anxiety disorders are common in youth. Because somatic complaints are a hallmark feature of anxiety, these students frequently visit their school nurse, creating an ideal opportunity for nurses to identify and assist them. In an effort to better understand current practices, we surveyed a large sample ( N = 93) of school nurses. Results indicated that the majority of nurses perceived anxiety as the most prevalent mental health issue in their students. Moreover, the majority of nurses reported that they did not use any formal screening tool or intervention protocol and stated wanting to expand their training in anxiety intervention. These data suggest that school nurses identify anxiety as a top problem but do not receive adequate training to address it. Data from this survey may be used to plan how best to fill gaps in nurse training and practices that can enhance nurses' capacity to optimize outcomes for anxious students.
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Affiliation(s)
- Michela A Muggeo
- 1 Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
| | - Golda S Ginsburg
- 1 Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
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203
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Lyon AR, Cook CR, Brown EC, Locke J, Davis C, Ehrhart M, Aarons GA. Assessing organizational implementation context in the education sector: confirmatory factor analysis of measures of implementation leadership, climate, and citizenship. Implement Sci 2018; 13:5. [PMID: 29310673 PMCID: PMC5759223 DOI: 10.1186/s13012-017-0705-6] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 12/27/2017] [Indexed: 12/03/2022] Open
Abstract
Background A substantial literature has established the role of the inner organizational setting on the implementation of evidence-based practices in community contexts, but very little of this research has been extended to the education sector, one of the most common settings for the delivery of mental and behavioral health services to children and adolescents. The current study examined the factor structure, psychometric properties, and interrelations of an adapted set of pragmatic organizational instruments measuring key aspects of the organizational implementation context in schools: (1) strategic implementation leadership, (2) strategic implementation climate, and (3) implementation citizenship behavior. Method The Implementation Leadership Scale (ILS), Implementation Climate Scale (ICS), and Implementation Citizenship Behavior Scale (ICBS) were adapted by a research team that included the original scale authors and experts in the implementation of evidence-based practices in schools. These instruments were then administered to a geographically representative sample (n = 196) of school-based mental/behavioral health consultants to assess the reliability and structural validity via a series of confirmatory factor analyses. Results Overall, the original factor structures for the ILS, ICS, and ICBS were confirmed in the current sample. The one exception was poor functioning of the Rewards subscale of the ICS, which was removed in the final ICS model. Correlations among the revised measures, evaluated as part of an overarching model of the organizational implementation context, indicated both unique and shared variance. Conclusions The current analyses suggest strong applicability of the revised instruments to implementation of evidence-based mental and behavioral practices in the education sector. The one poorly functioning subscale (Rewards on the ICS) was attributed to typical educational policies that do not allow for individual financial incentives to personnel. Potential directions for future expansion, revision, and application of the instruments in schools are discussed.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Clayton R Cook
- University of Minnesota, 250 Education Sciences Bldg, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Eric C Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Office 104, Miami, FL, 33136, USA
| | - Jill Locke
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Chayna Davis
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Mark Ehrhart
- University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816-1390, USA
| | - Gregory A Aarons
- University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093, USA.,Child and Adolescent Services Research Center, 9500 Gilman Drive (0812), La Jolla, CA, 92093, USA
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204
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Hobbs Knutson K, Meyer MJ, Thakrar N, Stein BD. Care Coordination for Youth With Mental Health Disorders in Primary Care. Clin Pediatr (Phila) 2018; 57:5-10. [PMID: 29090598 DOI: 10.1177/0009922817733740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Many children are treated for mental health disorders in primary care settings. The system of care (SOC) provides a framework for collaboration among pediatric mental health providers, but it is unclear if youth treated for mental health disorders in primary care receive such coordination. At the South Boston Community Health Center from September /2012 to August 2013 for 74 individuals ≤18 years, the odds of contact with SOC agencies (mental health, education, child protective services, juvenile justice and developmental disabilities) were compared for mental health treatment in primary versus specialty care. The odds of SOC contact within primary care were lower compared to specialty care (OR = 0.43, 95% CI = 0.29-0.66), specifically for mental health (OR = 0.54, 95% CI = 0.25-1.2), education (OR = 0.12, 95% CI = 0.050-0.28), and child protective services (OR = 0.64, 95% CI = 0.22-1.9). As care coordination may improve health outcomes, increased support and education for care coordination specific to youth treated for mental health disorders in primary care settings may be warranted.
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Affiliation(s)
| | | | - Nisha Thakrar
- 3 South Boston Community Health Center, Boston, MA, USA
| | - Bradley D Stein
- 4 RAND Corporation, Pittsburgh, PA, USA.,5 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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205
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Vasiliadis HM, Diallo FB, Rochette L, Smith M, Langille D, Lin E, Kisely S, Fombonne E, Thompson AH, Renaud J, Lesage A. Temporal Trends in the Prevalence and Incidence of Diagnosed ADHD in Children and Young Adults between 1999 and 2012 in Canada: A Data Linkage Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:818-826. [PMID: 28616934 PMCID: PMC5714116 DOI: 10.1177/0706743717714468] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There is a need for the routine monitoring of treated attention-deficit hyperactivity disorder (ADHD) for timely policy making. The objective is to report and assess over a decade the prevalence and incidence of diagnosed ADHD in Canada. METHODS Administrative linked patient data from the provinces of Manitoba, Ontario, Quebec, and Nova Scotia were obtained from the same sources as the Canadian Chronic Diseases Surveillance Systems to assess the prevalence and incidence of a primary physician diagnosis of ADHD ( ICD-9 and ICD-10 codes: 314, F90.x) for consultations in outpatient and inpatient settings (Med-Echo in Quebec, the Canadian Institute of Health Information Discharge Abstract Database in the 3 other provinces, plus the Ontario Mental Health Reporting System). Dates of service, diagnosis, and physician specialty were retained. The estimates were presented in yearly brackets between 1999-2000 and 2011-2012 by age and sex groups. RESULTS The prevalence of ADHD between 1999 and 2012 increased in all provinces and for all groups. The prevalence was approximately 3 times higher in boys than in girls, and the highest prevalence was observed in the 10- to 14-year age group. The incidence increased between 1999 and 2012 in Manitoba, Quebec, and Nova Scotia but remained stable in Ontario. Incident cases were more frequently diagnosed by general practitioners followed by either psychiatrists or paediatricians depending on the province. CONCLUSION The prevalence and incidence of diagnosed ADHD did not increase similarly across all provinces in Canada between 1999 and 2012. Over half of cases were diagnosed by a general practitioner.
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Affiliation(s)
- Helen-Maria Vasiliadis
- University of Sherbrooke, Faculty of Medicine and Health Sciences, Research Center–Hôpital Charles LeMoyne, Longueuil, Québec
| | - Fatoumata Binta Diallo
- Bureau d’information et d’études en santé des populations, Institut national de santé publique du Québec, Québec City, Québec
| | | | - Mark Smith
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba
| | - Donald Langille
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Elizabeth Lin
- Department of Psychiatry, Centre for Addiction and Mental Health, Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Ontario
| | - Steve Kisely
- School of Medicine, The University of Queensland, Queensland, Australia
- Departments of Psychiatry, Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Eric Fombonne
- Oregon Health and Sciences University, Portland, Oregon
| | | | - Johanne Renaud
- Department of Psychiatry, CIUSSS Douglas Mental Health University Institute, McGill University, Montreal, Québec
| | - Alain Lesage
- Université de Montréal, Institut Universitaire de Santé Mentale Montréal, Montréal, Québec
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206
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Iturralde E, Adams RN, Barley RC, Bensen R, Christofferson M, Hanes SJ, Maahs DM, Milla C, Naranjo D, Shah AC, Tanenbaum ML, Veeravalli S, Park KT, Hood KK. Implementation of Depression Screening and Global Health Assessment in Pediatric Subspecialty Clinics. J Adolesc Health 2017; 61:591-598. [PMID: 28830798 PMCID: PMC7162556 DOI: 10.1016/j.jadohealth.2017.05.030] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/10/2017] [Accepted: 05/24/2017] [Indexed: 12/21/2022]
Abstract
PURPOSE Adolescents with chronic illness face greater risk of psychosocial difficulties, complicating disease management. Despite increased calls to screen for patient-reported outcomes, clinical implementation has lagged. Using quality improvement methods, this study aimed to investigate the feasibility of standardized screening for depression and assessment of global health and to determine recommended behavioral health follow-up, across three pediatric subspecialty clinics. METHODS A total of 109 patients aged 12-22 years (median = 16.6) who were attending outpatient visits for treatment of diabetes (80% type 1), inflammatory bowel disease, or cystic fibrosis completed the 9-item Patient Health Questionnaire (PHQ-9) depression and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health measures on electronic tablets. Patients screening positive on the PHQ-9 received same-day behavioral health assessment and regular phone check-ins to facilitate necessary follow-up care. RESULTS Overall, 89% of 122 identified patients completed screening during a 6-month window. Patients completed measures in a timely manner (within 3 minutes) without disruption to clinic flow, and they rated the process as easy, comfortable, and valuable. Depression scores varied across disease type. Patients rated lower global health relative to a previously assessed validation cohort. Depression and global health related significantly to certain medical outcomes. Fifteen percent of patients screened positive on the PHQ-9, of whom 50% confirmed attending behavioral health appointments within 6 months of screening. CONCLUSIONS A standardized depression and global health assessment protocol implemented across pediatric subspecialties was feasible and effective. Universal behavioral health screening for adolescents and young adults living with chronic disease is necessary to meet programmatic needs in pediatric subspecialty clinics.
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Affiliation(s)
- Esti Iturralde
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Rebecca N Adams
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Regan C Barley
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Rachel Bensen
- Division of Gastroenterology, Department of Pediatrics, Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Stanford, California
| | - Megan Christofferson
- Division of Gastroenterology, Department of Pediatrics, Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Stanford, California
| | - Sarah J Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - David M Maahs
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Carlos Milla
- Division of Pulmonary Medicine, Stanford Children's CysticFibrosis Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Diana Naranjo
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Avni C Shah
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Molly L Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Sruthi Veeravalli
- Division of Pulmonary Medicine, Stanford Children's CysticFibrosis Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - K T Park
- Division of Gastroenterology, Department of Pediatrics, Stanford Children's Inflammatory Bowel Disease Center, Stanford University School of Medicine, Stanford, California
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
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207
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Reinke WM, Thompson A, Herman KC, Holmes S, Owens S, Cohen D, Tanner-Jones LA, Henry L, Green A, Copeland C. The County Schools Mental Health Coalition: A Model for Community-Level Impact. SCHOOL MENTAL HEALTH 2017. [DOI: 10.1007/s12310-017-9227-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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208
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Abstract
A multidisciplinary team approach to care and robust care coordination services are primary components of almost all integrated care delivery systems. Given that these services have limited reimbursement in fee-for-service payment arrangements, integrating care in a fee-for-service environment is almost impossible. Capitated payment models hold promise for supporting integrated behavioral and physical health services. There are multiple national examples of integrated care delivery systems supported by capitated payment arrangements.
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Affiliation(s)
- Katherine Hobbs Knutson
- Department of Psychiatry, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA.
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209
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Maslow GR, Banny A, Pollock M, Stefureac K, Rosa K, Walter BK, Hobbs Knutson K, Lucas J, Heilbron N. Preliminary Outcomes from an Integrated Pediatric Mental Health Outpatient Clinic. Child Adolesc Psychiatr Clin N Am 2017; 26:761-770. [PMID: 28916012 DOI: 10.1016/j.chc.2017.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
An estimated 1 in 5 children in the United States meet criteria for a diagnosable mental disorder, yet fewer than 20% receive mental health services. Unmet need for psychiatric treatment may contribute to patterns of increasing use of the emergency department. This article describes an integrated pediatric evaluation center designed to prevent the need for treatment in emergency settings by increasing access to timely and appropriate care for emergent and critical mental health needs. Preliminary results showed that the center provided rapid access to assessment and treatment services for children and adolescents presenting with a wide range of psychiatric concerns.
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Affiliation(s)
- Gary R Maslow
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA.
| | - Adrienne Banny
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
| | - McLean Pollock
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
| | - Kristen Stefureac
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
| | - Kendra Rosa
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
| | - Barbara Keith Walter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
| | - Katherine Hobbs Knutson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
| | - Joseph Lucas
- Social Science Research Institute, Duke University, Erwin Mill Building, 2024 W. Main Street, Durham, NC 27705, USA
| | - Nicole Heilbron
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2608 Erwin Road, Suite 300, Durham, NC 27705, USA
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210
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Hawke LD, Cleverley K, Settipani C, Rice M, Henderson J. Youth friendliness in mental health and addiction services: protocol for a scoping review. BMJ Open 2017; 7:e017555. [PMID: 28947459 PMCID: PMC5623576 DOI: 10.1136/bmjopen-2017-017555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION To better reach youth in need of mental health and addiction (MHA) services, there is increasing emphasis on making MHA services 'youth friendly.' However, it is unclear what youth friendliness means on a practical level. This scoping review explores (1) how youth friendliness in mental health services is defined in the literature, (2) what characteristics make MHA services youth friendly and (3) how youth friendliness is expected to impact service use by young people. METHODS A search will be conducted of eight electronic bibliographic databases over the last 15 years (2002-2017) to identify literature on youth friendliness consistent with the modern youth experience. Grey literature will also be searched. The search and literature selection process will include all study designs, as well as non-research literature. Two independent raters will determine eligibility based on a review of the titles and abstracts of the identified literature, followed by full text reviews when required. Data will be extracted from the identified literature and then synthesised using qualitative and quantitative approaches. As a final step, we will conduct stakeholder consultations with youth, family members and service provider groups to validate the findings and identify any characteristics of youth friendliness that they deem important that were not reported in the findings. ETHICS AND DISSEMINATION Results will be disseminated through a peer-reviewed publication, as well as international, national and local conference presentations. Agency reports will be developed to present the findings in a user-friendly format, including a youth-friendliness checklist for youth-serving organisations. Research ethics approval has been obtained for the consultation component of this study.
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Affiliation(s)
- Lisa D Hawke
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kristin Cleverley
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Cara Settipani
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Maureen Rice
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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211
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Kaye DL, Fornari V, Scharf M, Fremont W, Zuckerbrot R, Foley C, Hargrave T, Smith BA, Wallace J, Blakeslee G, Petras J, Sengupta S, Singarayer J, Cogswell A, Bhatia I, Jensen P. Description of a multi-university education and collaborative care child psychiatry access program: New York State's CAP PC. Gen Hosp Psychiatry 2017; 48:32-36. [PMID: 28917392 DOI: 10.1016/j.genhosppsych.2017.06.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/06/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Although, child mental health problems are widespread, few get adequate treatment, and there is a severe shortage of child psychiatrists. To address this public health need many states have adopted collaborative care programs to assist primary care to better assess and manage pediatric mental health concerns. This report adds to the small literature on collaborative care programs and describes one large program that covers most of New York state. PROGRAM DESCRIPTION CAP PC, a component program of New York State's Office of Mental Health (OMH) Project TEACH, has provided education and consultation support to primary care providers covering most of New York state since 2010. The program is uniquely a five medical school collaboration with hubs at each that share one toll free number and work together to provide education and consultation support services to PCPs. METHODS The program developed a clinical communications record to track information about all consultations which forms the basis of much of this report. 2-week surveys following consultations, annual surveys, and pre- and post-educational program evaluations have also been used to measure the success of the program. RESULTS CAP PC has grown over the 6years of the program and has provided 8013 phone consultations to over 1500 PCPs. The program synergistically provided 17,523 CME credits of educational programming to 1200 PCPs. PCP users of the program report very high levels of satisfaction and self reported growth in confidence. CONCLUSIONS CAP PC demonstrates that large-scale collaborative consultation models for primary care are feasible to implement, popular with PCPs, and can be sustained. The program supports increased access to child mental health services in primary care and provides child psychiatric expertise for patients who would otherwise have none.
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Affiliation(s)
- D L Kaye
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States.
| | - V Fornari
- Hofstra/Northwell Health School of Medicine, Glen Oaks, NY, United States
| | - M Scharf
- University of Rochester School of Medicine, Rochester, NY, United States
| | - W Fremont
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - R Zuckerbrot
- Columbia University Medical Center/NY State Psychiatric Institute, New York, NY, United States
| | - C Foley
- Hofstra/Northwell Health School of Medicine, Glen Oaks, NY, United States
| | - T Hargrave
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - B A Smith
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - J Wallace
- University of Rochester School of Medicine, Rochester, NY, United States
| | - G Blakeslee
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - J Petras
- Columbia University Medical Center/NY State Psychiatric Institute, New York, NY, United States
| | - S Sengupta
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - J Singarayer
- SUNY Upstate Medical University, Syracuse, NY, United States
| | - A Cogswell
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - I Bhatia
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, United States
| | - P Jensen
- REACH Institute, University of Arkansas for Medical Sciences, Little Rock, AK, United States
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Mental health issues in children and adolescents with chronic illness. INTERNATIONAL JOURNAL OF HUMAN RIGHTS IN HEALTH CARE 2017. [DOI: 10.1108/ijhrh-05-2017-0020] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Purpose
The purpose of this paper is to consider mental health issues in children and adolescents with chronic illness or health conditions, including their treatment, and issues related to delivery of services.
Design/methodology/approach
A selective review of the literature was conducted to highlight significant mental health issues and their treatment in youth with various types of chronic illness.
Findings
A significant portion of youth experience mental health problems related to their chronic health conditions. While evidence-based treatments are available to address these problems, significant barriers exist that impede the delivery of psychological and behavioral interventions for many youth.
Research limitations/implications
More controlled studies are needed to demonstrate the effectiveness and cost offset of delivering psychological and behavioral interventions for the population of youth with various types of chronic health conditions, particularly in clinical and community settings.
Social implications
Policy reform can ensure that mental health issues are effectively addressed for children with chronic illness. Policy is needed that promotes integrated health care, whereby psychological and behavioral interventions are delivered in health care settings along with medical interventions to reduce barriers to care.
Originality/value
Significant numbers of children and adolescents have chronic health conditions and many experience mental health problems related to their conditions. While evidence-based treatments are available to address these problems, significant barriers impede the delivery of psychological and behavioral interventions for many youth. Health care policy promoting integrated health care to deliver psychological and behavioral interventions in health care settings along with medical interventions should reduce barriers to care and improve both physical and mental health outcomes for youth.
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Adapting and Implementing a School-Based Resilience-Building Curriculum Among Low-Income Racial and Ethnic Minority Students. ACTA ACUST UNITED AC 2017; 21:223-239. [DOI: 10.1007/s40688-017-0134-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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214
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Treating the Child or Syndrome: Does Context Matter for Treatment Decisions for Antisocially Behaving Youth? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9599-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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215
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Price JH, Khubchandani J. Adolescent Homicides, Suicides, and the Role of Firearms: A Narrative Review. AMERICAN JOURNAL OF HEALTH EDUCATION 2017. [DOI: 10.1080/19325037.2016.1272507] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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216
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Demissie Z, Brener N. Mental Health and Social Services in Schools: Variations by School Characteristics-United States, 2014. MENTAL HEALTH & PREVENTION 2017; 5:5-11. [PMID: 38616928 PMCID: PMC11010460 DOI: 10.1016/j.mhp.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Schools serve as a mental health service provider for students with related disorders. This study reported on specific mental health and social services practices overall and by school demographics in U.S. schools using data from the 2014 School Health Policies and Practices Study, a cross-sectional study of a nationally representative sample of schools with any of grades kindergarten through twelve, and an extant source of school demographics. Differences in mental health and social services staffing, facilities/equipment, and services were observed across school demographics. These data will help identify service gaps, which can guide efforts to better serve students and families.
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Affiliation(s)
- Zewditu Demissie
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Rd. NE; Mailstop E-75, Atlanta, GA 30329 USA
- U.S. Public Health Service Commissioned Corps, 1101 Wootton Parkway, Plaza Level, Rockville, MD 20852 USA
| | - Nancy Brener
- Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Rd. NE; Mailstop E-75, Atlanta, GA 30329 USA
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Vigerland S, Serlachius E, Thulin U, Andersson G, Larsson JO, Ljótsson B. Long-term outcomes and predictors of internet-delivered cognitive behavioral therapy for childhood anxiety disorders. Behav Res Ther 2017; 90:67-75. [DOI: 10.1016/j.brat.2016.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 11/09/2016] [Accepted: 12/12/2016] [Indexed: 12/17/2022]
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218
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Henderson JL, Chaim G, Hawke LD. Screening for substance use and mental health problems in a cross-sectoral sample of Canadian youth. Int J Ment Health Syst 2017; 11:21. [PMID: 28261324 PMCID: PMC5331633 DOI: 10.1186/s13033-017-0128-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/22/2017] [Indexed: 01/08/2023] Open
Abstract
Background This project examines the substance use and mental health concerns of a cross-sectoral, national, service-seeking sample of adolescents and emerging adults using an extended version of the Global Appraisal of Individual Needs-Short Screener (GSS). It also aims to provide incremental evidence of the psychometric properties of the GSS. Methods A sample of 2313 youth aged 12–24 years who presented for service participated in the project. Youth were recruited from 89 participating services across Canada representing eight major clinical and non-clinical sectors. Participants completed the GSS and provided sociodemographic data. Results The majority of youth presenting for services endorsed concerns on the GSS and would be likely to meet diagnostic criteria for a disorder in a full diagnostic assessment according to the norms for the scale, while many endorsed multiple concerns. This was true in both clinical and non-clinical settings. Externalizing concerns and suicidality were significantly more common in younger participants, while substance use was significantly more common in older youth. Females were more likely to endorse internalizing and suicidality concerns, while males endorsed more substance use and crime/violence concerns. Internalizing and suicidality concerns were also more common in Canada’s northerly regions. The reliability of the GSS was confirmed, however the factor structure revealed problems. Conclusions Youth presenting across clinical and non-clinical service sectors endorse high levels of need, supporting the importance of universal, cross-sectoral screening. The GSS is a practical tool that service providers across sectors can employ to identify the addiction and mental health service needs of youth, although further psychometric work is warranted. Implications for screening and treatment in community contexts are discussed.
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Affiliation(s)
- Joanna L Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada.,University of Toronto, 250 College Street, Toronto, ON M5T 1R8 USA
| | - Gloria Chaim
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada.,University of Toronto, 250 College Street, Toronto, ON M5T 1R8 USA
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON M6J 1H4 Canada
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219
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Neufeld SAS, Dunn VJ, Jones PB, Croudace TJ, Goodyer IM. Reduction in adolescent depression after contact with mental health services: a longitudinal cohort study in the UK. Lancet Psychiatry 2017; 4:120-127. [PMID: 28087201 PMCID: PMC5285445 DOI: 10.1016/s2215-0366(17)30002-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 11/04/2016] [Accepted: 11/11/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Evidence regarding the association between service contact and subsequent mental health in adolescents is scarce, and previous findings are mixed. We aimed to longitudinally assess the extent to which depressive symptoms in adolescents change after contact with mental health services. METHODS As part of a longitudinal cohort study, between April 28, 2005, and March 17, 2010, we recruited 1238 14-year-old adolescents and their primary caregivers from 18 secondary schools in Cambridgeshire, UK. Participants underwent follow-up assessment at months 18 and 36. Trained researchers assessed the adolescents for current mental disorder using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS-PL). Caregivers and adolescents reported contact with mental health services in the year before baseline. Adolescents self-reported depressive symptoms (Mood and Feelings Questionnaire [MFQ]) at each timepoint. We assessed change in MFQ sum scores from baseline contact with mental health services using multilevel mixed-effects regression adjusted for sociodemographic, environmental, individual, and mental health confounders, with multiple imputation of missing data. We used propensity score weighting to balance confounders between treatment (users of mental health services) and control (non-users of mental health services) groups. We implemented an MFQ clinical cutoff following the results of receiver operating characteristic analysis. FINDINGS 14-year-old adolescents who had contact with mental health services in the past year had a greater decrease in depressive symptoms than those without contact (adjusted coefficient -1·68, 95% CI -3·22 to -0·14; p=0·033). By age 17 years, the odds of reporting clinical depression were more than seven times higher in individuals without contact than in service users who had been similarly depressed at baseline (adjusted odds ratio 7·38, 1·73-31·50; p=0·0069). INTERPRETATION Our findings show that contact with mental health services at age 14 years by adolescents with a mental disorder reduced the likelihood of depression by age 17 years. This finding supports the improvement of access to adolescent mental health services. FUNDING Wellcome Trust, National Institute for Health Research.
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Affiliation(s)
| | - Valerie J Dunn
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Tim J Croudace
- School of Nursing and Midwifery and Social Dimensions of Health Institute, University of Dundee, Dundee, UK
| | - Ian M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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220
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Hargreaves DS, Struijs JN, Schuster MA. US Children And Adolescents Had Fewer Annual Doctor And Dentist Contacts Than Their Dutch Counterparts, 2010-12. Health Aff (Millwood) 2017; 34:2113-20. [PMID: 26643632 DOI: 10.1377/hlthaff.2015.0709] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Children and adolescents in the United States have been found to be less healthy than their counterparts in other high-income countries. The contribution of pediatric health care use to health outcomes--either as an independent determinant or as a mediator of wider social factors--is not well understood. We found that, compared to their peers in the Netherlands, US children and adolescents had fewer annual doctor and dental contacts in 2012. In both countries, poorer health status was reported among low-income compared to high-income children; however, this status was accompanied by greater or equal number of doctor and dental contacts among low-income Dutch children compared to their higher-income Dutch peers. By contrast, low-income US children had 28-65 percent fewer care episodes than high-income US children. Further research is needed to investigate the potential impact of greater equity and use of pediatric services on US health outcomes. Possible policy responses might include a focus on improving the quality, coverage, and benefits of health insurance, as well as on the workforce implications of providing high-quality pediatric care to all.
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Affiliation(s)
- Dougal S Hargreaves
- Dougal S. Hargreaves is an associate professor in the Population, Policy, and Practice program at the Institute of Child Health, University College London, in England
| | - Jeroen N Struijs
- Jeroen N. Struijs is a senior researcher in the Department of Quality of Care and Health Economics at the National Institute of Public Health and the Environment (RIVM), in Bilthoven, the Netherlands
| | - Mark A Schuster
- Mark A. Schuster is the William Berenberg Professor of Pediatrics at Harvard Medical School and chief of the Division of General Pediatrics and vice chair for health policy in the Department of Medicine at Boston Children's Hospital, in Massachusetts
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221
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Siceloff ER, Bradley WJ, Flory K. Universal Behavioral/Emotional Health Screening in Schools: Overview and Feasibility. REPORT ON EMOTIONAL & BEHAVIORAL DISORDERS IN YOUTH 2017; 17:32-38. [PMID: 30705612 PMCID: PMC6350819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Affiliation(s)
- E Rebekah Siceloff
- E. Rebekah Siceloff, Ph.D., is a research coordinator in the Department of Psychology at the University of South Carolina (USC). W. Joshua Bradley, B.A., is a research assistant in the Department of Psychology at USC. Kate Flory, Ph.D., is a professor in the Department of Psychology at USC
| | - W Joshua Bradley
- E. Rebekah Siceloff, Ph.D., is a research coordinator in the Department of Psychology at the University of South Carolina (USC). W. Joshua Bradley, B.A., is a research assistant in the Department of Psychology at USC. Kate Flory, Ph.D., is a professor in the Department of Psychology at USC
| | - Kate Flory
- E. Rebekah Siceloff, Ph.D., is a research coordinator in the Department of Psychology at the University of South Carolina (USC). W. Joshua Bradley, B.A., is a research assistant in the Department of Psychology at USC. Kate Flory, Ph.D., is a professor in the Department of Psychology at USC
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222
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DeFosset AR, Gase LN, Ijadi-Maghsoodi R, Kuo T. Youth Descriptions of Mental Health Needs and Experiences with School-based Services: Identifying Ways to Meet the Needs of Underserved Adolescents. J Health Care Poor Underserved 2017; 28:1191-1207. [PMID: 28804086 PMCID: PMC5886017 DOI: 10.1353/hpu.2017.0105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
While schools serve as a common entry point into mental health services for underserved youth, engagement of students in need of care remains a problem. Little is known about the ways schools can best address students' mental health needs, especially from the perspective of youth who struggle to attend school, a vulnerable group with a high burden of mental health problems. A qualitative descriptive approach was used to analyze data from in-depth interviews with a sample of 18 youth with a history of school truancy and mental health problems. Analyses explored how youth expressed mental health symptoms, and their trajectories through, and perceptions of, school-based mental health services. Results suggest that participants experienced multiple, overlapping symptoms; only a portion had their needs addressed. The quality of relationships with school staff and the perceived efficacy of treatment affected service trajectories. Promising school-based approaches to address students' mental health needs are discussed.
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Affiliation(s)
- Amelia R DeFosset
- Los Angeles County Department of Public Health, Division of Chronic
Disease and Injury Prevention, 3530 Wilshire Blvd, 8 Floor, Los
Angeles, CA 90026, USA
| | - Lauren N Gase
- Los Angeles County Department of Public Health, Division of Chronic
Disease and Injury Prevention, 3530 Wilshire Blvd, 8 Floor, Los
Angeles, CA 90026, USA
| | - Roya Ijadi-Maghsoodi
- VA Greater Los Angeles Healthcare System, Health Services Research
& Development, Center for the Study of Healthcare Innovation,
Implementation, & Policy, 11301 Wilshire Blvd, Los Angeles, CA 90073,
USA
- University of California Los Angeles, Department of Psychiatry and
Biobehavioral Sciences, Semel Institute, Los Angeles, CA 90095, USA
| | - Tony Kuo
- Los Angeles County Department of Public Health, Division of Chronic
Disease and Injury Prevention, 3530 Wilshire Blvd, 8 Floor, Los
Angeles, CA 90026, USA
- University of California Los Angeles, Jonathan and Karin Fielding
School of Public Health, Department of Epidemiology, 71-254 CHS, Box 951772, Los
Angeles, CA 90095, USA
- University of California Los Angeles, David Geffen School of
Medicine, Department of Family Medicine, 10880 Wilshire Blvd, Suite 1800, Los
Angeles, CA 90024, USA
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223
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Vigerland S, Lenhard F, Bonnert M, Lalouni M, Hedman E, Ahlen J, Olén O, Serlachius E, Ljótsson B. Internet-delivered cognitive behavior therapy for children and adolescents: A systematic review and meta-analysis. Clin Psychol Rev 2016; 50:1-10. [DOI: 10.1016/j.cpr.2016.09.005] [Citation(s) in RCA: 169] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 09/16/2016] [Accepted: 09/18/2016] [Indexed: 11/29/2022]
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224
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Doupnik SK, Lawlor J, Zima BT, Coker TR, Bardach NS, Hall M, Berry JG. Mental Health Conditions and Medical and Surgical Hospital Utilization. Pediatrics 2016; 138:peds.2016-2416. [PMID: 27940716 PMCID: PMC5127076 DOI: 10.1542/peds.2016-2416] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Mental health conditions are prevalent among children hospitalized for medical conditions and surgical procedures, but little is known about their influence on hospital resource use. The objectives of this study were to examine how hospitalization characteristics vary by presence of a comorbid mental health condition and estimate the association of a comorbid mental health condition with hospital length of stay (LOS) and costs. METHODS Using the 2012 Kids' Inpatient Database, we conducted a retrospective, nationally representative, cross-sectional study of 670 161 hospitalizations for 10 common medical and 10 common surgical conditions among 3- to 20-year-old patients. Associations between mental health conditions and hospital LOS were examined using adjusted generalized linear models. Costs of additional hospital days associated with mental health conditions were estimated using hospital cost-to-charge ratios. RESULTS A comorbid mental health condition was present in 13.2% of hospitalizations. A comorbid mental health condition was associated with a LOS increase of 8.8% (from 2.5 to 2.7 days, P < .001) for medical hospitalizations and a 16.9% increase (from 3.6 to 4.2 days, P < .001) for surgical hospitalizations. For hospitalizations in this sample, comorbid mental health conditions were associated with an additional 31 729 (95% confidence interval: 29 085 to 33 492) hospital days and $90 million (95% confidence interval: $81 to $101 million) in hospital costs. CONCLUSIONS Medical and surgical hospitalizations with comorbid mental health conditions were associated with longer hospital stay and higher hospital costs. Knowledge about the influence of mental health conditions on pediatric hospital utilization can inform clinical innovation and case-mix adjustment.
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Affiliation(s)
- Stephanie K. Doupnik
- Division of General Pediatrics, Center for Pediatric Clinical Effectiveness, and PolicyLab, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Lawlor
- Children’s Hospital Association, Washington, District of Columbia;,Children's Hospital Association, Overland Park, Kansas
| | - Bonnie T. Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
| | - Tumaini R. Coker
- Department of Pediatrics, UCLA Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Naomi S. Bardach
- Department of Pediatrics, Philip R. Lee Institute for Health Policy Studies, UCSF School of Medicine, University of California at San Francisco, San Francisco, California; and
| | - Matt Hall
- Children’s Hospital Association, Washington, District of Columbia;,Children's Hospital Association, Overland Park, Kansas
| | - Jay G. Berry
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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225
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Costello EJ. Early Detection and Prevention of Mental Health Problems: Developmental Epidemiology and Systems of Support. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 45:710-717. [DOI: 10.1080/15374416.2016.1236728] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- E. Jane Costello
- Department of Psychiatry and Behavioral Sciences, Duke University
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226
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Kverno K, Kozeniewski K. Expanding rural access to mental health care through online postgraduate nurse practitioner education. J Am Assoc Nurse Pract 2016; 28:646-651. [PMID: 27613374 DOI: 10.1002/2327-6924.12397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/05/2016] [Accepted: 06/28/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Workforce shortages in mental health care are especially relevant to rural communities. People often turn to their primary care providers for mental healthcare services, yet primary care providers indicate that more education is needed to fill this role. Rural primary care nurse practitioners (NPs) are ideal candidates for educational enhancement. Online programs allow NPs to continue living and working in their communities while developing the competencies to provide comprehensive and integrated mental healthcare services. This article presents a review of current online postgraduate psychiatric mental health NP (PMHNP) options. METHODS Website descriptions of online PMHNP programs were located using keywords: PMHNP or psychiatric nurse practitioner, postgraduate or post-master's, and distance or online. CONCLUSIONS Across the United States, 15 online postgraduate certificate programs were located that are designed for primary care NPs seeking additional PMHNP specialization. IMPLICATIONS FOR PRACTICE For rural primary care NPs who are ready, willing, and able, a postgraduate PMHNP specialty certificate can be obtained online in as few as three to four semesters. The expected outcome is a cadre of dually credentialed NPs capable of functioning in an integrated role and of increasing rural access to comprehensive mental healthcare services.
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Affiliation(s)
- Karan Kverno
- Department of Acute and Chronic Care, Johns Hopkins University School of Nursing, Baltimore, Maryland
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227
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Kang-Yi CD, Locke J, Pellecchia M, Marcus SC, Hadley T, Mansell DS. Decline in Medicaid-Funded One-to-One Behavioral Support Use in School as Children Age. SCHOOL MENTAL HEALTH 2016; 8:344-353. [PMID: 27818714 PMCID: PMC5094805 DOI: 10.1007/s12310-015-9172-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Christina D Kang-Yi
- University of Pennsylvania Center for Mental Health Policy and Services Research, 3535 Market Street, 3 Floor, Philadelphia, PA 19104, USA
| | - Jill Locke
- Speech and Hearing Sciences, University of Washington, University of Washington Autism Center, Box 357920, Seattle, WA 98195, USA, ,
| | - Melanie Pellecchia
- University of Pennsylvania Center for Mental Health Policy and Services Research, 3535 Market Street, 3 Floor, Philadelphia, PA 19104, USA, ,
| | - Steve C Marcus
- University of Pennsylvania School of Social Policy and Practice, 3701 Locust Walk, Caster Building Room C16, Philadelphia, PA 19104, ,
| | - Trevor Hadley
- University of Pennsylvania Center for Mental Health Policy and Services Research, 3535 Market Street, 3 Floor, Philadelphia, PA 19104, USA, ,
| | - David S Mansell
- University of Pennsylvania Center for Mental Health Policy and Services Research, The Children's Hospital of Philadelphia Center for Autism Research, 3535 Market Street, 3 floor, Philadelphia, PA 19104, ,
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228
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Maalouf FT, Ghandour LA, Halabi F, Zeinoun P, Shehab AAS, Tavitian L. Psychiatric disorders among adolescents from Lebanon: prevalence, correlates, and treatment gap. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1105-16. [PMID: 27246607 DOI: 10.1007/s00127-016-1241-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 05/12/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE Adolescence is a critical age for the development of psychiatric disorders. Although Lebanon, a low-to-middle income country, has suffered from decades of war and political instability, the burden of psychiatric disorders among adolescents in Lebanon remains unclear. This study aims to estimate the prevalence of psychiatric disorders among adolescents in the Lebanese capital, Beirut, and to study the correlates and treatment seeking behavior associated with these disorders. METHODS Through a multistage cluster sampling design, 510 adolescents, aged 11-17 years were recruited from a household sample in Beirut in 2012. Parents and adolescents completed a battery of self-reported questionnaires and interviews including the Development and Well-being Assessment (DAWBA), the Peer-Relations Questionnaire (PRQ), and a demographic/clinical information questionnaire. Logistic regression models were used to study the correlates of psychiatric disorders. RESULTS The 30-day prevalence of psychiatric disorders was 26.1 %, with anxiety disorders (13.1 %) and ADHD (10.2 %) being the most prevalent disorders. Only 6 % of those with disorders reported seeking professional help. Parental marital status, not attending school, having a chronic medical condition, having a family history of psychiatric disorders, as well as propensity to bullying and to being victimized by peers emerged as correlates of having psychiatric disorders. CONCLUSIONS A clear treatment gap is evident with a high 30-day prevalence of psychiatric disorders among adolescents in Beirut coupled with a very low percentage seeking treatment. Scaling up mental health services and addressing potential barriers to seeking care would be important to close this gap.
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Affiliation(s)
- Fadi T Maalouf
- Child and Adolescent Psychiatry Program, Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 11072020, Lebanon.
| | - Lilian A Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fadi Halabi
- Child and Adolescent Psychiatry Program, Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 11072020, Lebanon
| | - Pia Zeinoun
- Child and Adolescent Psychiatry Program, Department of Psychiatry, Faculty of Medicine, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 11072020, Lebanon
| | - Al Amira Safa Shehab
- Department of Psychology, Queens College, City University of New York, New York, USA
| | - Lucy Tavitian
- Department of Cross-Cultural Studies, Tilburg University, Tilburg, The Netherlands
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229
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Abstract
This update of the 2008 statement from the American Academy of Pediatrics redirects the discussion of quality health care from the theoretical to the practical within the medical home. This statement reviews the evolution of the medical home concept and challenges the provision of quality adolescent health care within the patient-centered medical home. Areas of attention for quality adolescent health care are reviewed, including developmentally appropriate care, confidentiality, location of adolescent care, providers who offer such care, the role of research in advancing care, and the transition to adult care.
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230
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Abstract
Given the long-term negative outcomes associated with depression in adolescence, there is a pressing need to develop brief, evidence-based treatments that are accessible to more young people experiencing low mood. Behavioral Activation (BA) is an effective treatment for adult depression; however, little research has focused on the use of BA with depressed adolescents, particularly with briefer forms of BA. In this article, we outline an adaptation of brief Behavioral Activation Treatment of Depression (BATD) designed for adolescents and delivered in eight sessions (Brief BA). This case example illustrates how a structured, brief intervention was useful for a depressed young person with a number of complicating and risk factors.
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231
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Haughwout SP, Harford TC, Castle IJP, Grant BF. Treatment Utilization Among Adolescent Substance Users: Findings from the 2002 to 2013 National Survey on Drug Use and Health. Alcohol Clin Exp Res 2016; 40:1717-27. [PMID: 27427179 DOI: 10.1111/acer.13137] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 05/20/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Adolescent substance users face serious health and social consequences and benefit from early diagnosis and treatment. The objectives of this study were to observe trends in treatment utilization; examine correlates of treatment utilization and treatment types/settings among adolescent substance users with and without substance use disorder (SUD); and assess gender differences. METHODS National Survey on Drug Use and Health data were pooled across 2002 to 2013, with a combined sample of 79,885 past-year substance users ages 12 to 17 (17,510 with SUD and 62,375 without SUD). Treatment was defined as receiving treatment or counseling for use of alcohol or any drug, not counting cigarettes. Trends were assessed by joinpoint linear regression, and multivariable logistic regression assessed odds ratios of treatment utilization. RESULTS Percentages of past-year treatment use did not change in 2002 to 2013. Treatment utilization was more prevalent among adolescents with SUD than without (11.4% vs. 1.4%) and among males than females. Among adolescents with and without SUD, criminal justice involvement and perceiving a need for treatment increased adolescent treatment utilization, while SUDs other than alcohol abuse, older age, and talking to parents increased treatment use among adolescents with SUD, and polysubstance use and male gender increased treatment among those without SUD. Treatment gaps persisted among non-Hispanic Blacks for both groups with and without SUD, male Hispanics with SUD, female non-Hispanic Asians without SUD, and private insurance coverages. Gender differences were observed in SUD, race/ethnicity, and insurance coverage. Most adolescents received treatment for both alcohol and drug use, and self-help group and outpatient rehabilitation facility were the most used treatment settings. CONCLUSIONS Treatment utilization among adolescents with past-year substance use remained low and unimproved in 2002 to 2013. Treatment gaps among minority populations, insurance coverage, and in educating adolescents on seeking relevant treatment must be addressed. Using screening processes such as Screening, Brief Intervention, and Referral to Treatment, health professionals can help prevent lifelong SUD by recognizing and addressing substance misuse early.
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Affiliation(s)
| | | | | | - Bridget F Grant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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232
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Poirier M, Déry M, Temcheff CE, Toupin J, Verlaan P, Lemelin JP. Longitudinal associations between conduct problems and depressive symptoms among girls and boys with early conduct problems. Eur Child Adolesc Psychiatry 2016; 25:743-54. [PMID: 26564019 DOI: 10.1007/s00787-015-0796-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/02/2015] [Indexed: 11/28/2022]
Abstract
Youth with conduct problems (CP) may experience high rates of depressive symptoms (DS). However, little is known about the direction of the longitudinal associations between CP and DS in this specific population. Although girls with CP appear at greater risk than boys for presenting comorbid depression, empirical research on gender differences in these associations is even sparser. The current study used autoregressive latent trajectory models to compare four perspectives with hypotheses regarding the longitudinal associations between CP and DS, while taking into account the evolution of both problems. We also examined gender differences in the longitudinal associations. A total of 345 children (40.6 % female) presenting with a high level of CP in early elementary school (mean age at study inception = 8.52; SD = .94) were evaluated annually over a four-year period (5 measurement time points). The results revealed that CP and DS were quite stable over time. Moreover, CP and DS showed strong covariation at each measurement time point, but only one significant positive cross-lagged association between the two processes, indicating that higher levels of DS at time 3 were associated with higher levels of CP 1 year later. No differences were observed in the longitudinal associations between CP and DS in boys and girls. Given the comorbidity and stability of CP and DS, these findings suggest that DS should be systematically evaluated among children with early clinically significant CP, and treatment plans should include interventions aimed at both CP and DS among children who present with both types of problems.
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Affiliation(s)
- Martine Poirier
- Department of Education, Université du Québec à Rimouski, 300, allée des Ursulines, C. P. 3300, succ. A, Rimouski, QC, G5L 3A1, Canada.
| | - Michèle Déry
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Jean Toupin
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Canada
| | - Pierrette Verlaan
- Department of Psychoeducation, Université de Sherbrooke, Sherbrooke, Canada
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233
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Mason MJ, Aplasca A, Morales-Theodore R, Zaharakis N, Linker J. Psychiatric Comorbidity and Complications. Child Adolesc Psychiatr Clin N Am 2016; 25:521-32. [PMID: 27338972 DOI: 10.1016/j.chc.2016.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This article highlights the prevalence of co-occurring disorders among adolescents and underscores the complexity and opportunities of treating these patients in a systematic, comprehensive approach. As evidenced by this review, the need exists to develop and test models of care that integrate co-occurring disorders into both psychiatric and substance abuse treatment settings. The challenge for pediatric practitioners is to provide detailed assessments linked to evidence-based treatment plans to account for the variations in adolescent development and the unique risk factor profile of each patient. The issues related to co-morbidity are vast and continue to grow with rapidly increasing research literature.
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Affiliation(s)
- Michael J Mason
- Department of Psychiatry, Commonwealth Institute for Child & Family Studies, Virginia Commonwealth University, 515 North 10th Street, P.O.Box 980489, Richmond, VA 23298-0489, USA.
| | - Alexis Aplasca
- Department of Psychiatry, Commonwealth Institute for Child & Family Studies, Virginia Commonwealth University, 515 North 10th Street, P.O.Box 980489, Richmond, VA 23298-0489, USA
| | - Rosa Morales-Theodore
- Department of Psychiatry, Commonwealth Institute for Child & Family Studies, Virginia Commonwealth University, 515 North 10th Street, P.O.Box 980489, Richmond, VA 23298-0489, USA
| | - Nikola Zaharakis
- Department of Psychiatry, Commonwealth Institute for Child & Family Studies, Virginia Commonwealth University, 515 North 10th Street, P.O.Box 980489, Richmond, VA 23298-0489, USA
| | - Julie Linker
- Department of Psychiatry, Commonwealth Institute for Child & Family Studies, Virginia Commonwealth University, 515 North 10th Street, P.O.Box 980489, Richmond, VA 23298-0489, USA
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Ringeisen H, Miller S, Munoz B, Rohloff H, Hedden SL, Colpe LJ. Mental Health Service Use in Adolescence: Findings From the National Survey on Drug Use and Health. Psychiatr Serv 2016; 67:787-9. [PMID: 27032654 PMCID: PMC5951613 DOI: 10.1176/appi.ps.201400196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study examined mental health service use, by service type, of adolescents ages 12-17. METHODS Data were from approximately 113,000 adolescents who participated in the 2008-2012 National Survey on Drug Use and Health, an annual nationally representative survey of the civilian, noninstitutionalized U.S. POPULATION Polynomial contrasts tested for linear and quadratic changes across age in the use of three types of past-year mental health services: school-based services, outpatient therapist or clinic, and overnight hospital stay. RESULTS Although mental health service use increased from age 12 to age 14 across all service types, it decreased or stabilized from age 15 to 17. School-based services were the most commonly used service and showed the steepest decline in use from age 12 to 17. CONCLUSIONS Although adolescence can be marked by an increasing prevalence of mental disorders, mental health service use declined or leveled off for many service types by age 14 or 15.
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Affiliation(s)
- Heather Ringeisen
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| | - Shari Miller
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| | - Breda Munoz
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| | - Harley Rohloff
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| | - Sarra L Hedden
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
| | - Lisa J Colpe
- Dr. Ringeisen, Dr. Miller, Dr. Munoz, and Mr. Rohloff are with RTI International, Research Triangle Park, North Carolina (e-mail: ). Dr. Hedden is with the Substance Abuse and Mental Health Services Administration (SAMHSA), Rockville, Maryland. Dr. Colpe is with the Division of Services and Intervention Research, National Institute of Mental Health (NIMH), Bethesda, Maryland
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Abstract
Depression is the most common mental health disorder in children and adolescents, and primary care is often the first point of contact for children and adolescents with depression. Depression impacts all areas of life, impairing academics and interactions with family and friends. The purpose of this article is to help NPs identify and treat children and adolescents presenting with depression in the primary care setting.
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Affiliation(s)
- Judy Haefner
- Judy Haefner is an assistant professor at the University of Michigan, Flint, Mich
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236
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Elkin TD, Sarver DE, Wong Sarver N, Young J, Buttross S. Future Directions for the Implementation and Dissemination of Statewide Developmental-Behavioral Pediatric Integrated Health Care. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 46:619-630. [PMID: 27210591 DOI: 10.1080/15374416.2016.1152551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The integration of mental health and pediatric health care services has long been a goal for both research and practice. With the advent of federal policies developed to mandate clinical efficiency across the health care spectrum, this issue is becoming more salient. Applied literature on this topic is only recently emerging, however, and there are limited contextual examples to guide program development, research, and refinement. This article presents background information relevant to the development of such a program (the Center for Advancement of Youth). The cultural and organizational contexts for the project are discussed, with particular emphasis on models for cooperation among several institutions of varying size and scope. The implications for the future of tangible research in this area are also discussed, with attention to extending lessons learned to diverse settings motivated to integrate various aspects of health care service provision.
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Affiliation(s)
- T David Elkin
- a Department of Psychiatry and Human Behavior , University of Mississippi Medical Center
| | - Dustin E Sarver
- b Department of Pediatrics , University of Mississippi Medical Center
| | - Nina Wong Sarver
- b Department of Pediatrics , University of Mississippi Medical Center
| | - John Young
- c Department of Psychology , University of Mississippi
| | - Susan Buttross
- b Department of Pediatrics , University of Mississippi Medical Center
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237
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Cornacchio D, Crum KI, Coxe S, Pincus DB, Comer JS. Irritability and Severity of Anxious Symptomatology Among Youth With Anxiety Disorders. J Am Acad Child Adolesc Psychiatry 2016; 55:54-61. [PMID: 26703910 PMCID: PMC5340317 DOI: 10.1016/j.jaac.2015.10.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Most research on irritability and child psychopathology has focused on depressive disorders, bipolar disorder, and/or oppositional defiant disorder (ODD). Less is known about relationships between child anxiety and irritability and moderators of such associations. METHOD Structural equation modeling (SEM) was used to examine associations between anxiety severity and irritability in a large sample of treatment-seeking youth with anxiety disorders (N = 663, aged 7-19 years, mean = 12.25 years), after accounting for comorbid depressive disorders and ODD. Additional analyses examined whether associations were moderated by child gender, age, and generalized anxiety disorder (GAD) status. RESULTS There was a direct link between child anxiety and irritability even after accounting for comorbid depressive disorders and ODD. Links between child anxiety and irritability were robust across child gender and age. Furthermore, relationships between child anxiety and irritability were comparable across youth with and without GAD, suggesting that the anxiety-irritability link is relevant across child anxiety disorders and not confined to youth with GAD. CONCLUSION Findings add to an increasing body of evidence linking child irritability to a range of internalizing and externalizing psychopathologies, and suggest that child anxiety assessment should systematically incorporate irritability evaluations. Moreover, youth in clinical settings displaying irritability should be assessed for the presence of anxiety. Treatments for childhood anxiety may do well to incorporate new treatment modules as needed that specifically target problems of irritability.
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Affiliation(s)
- Danielle Cornacchio
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami
| | - Kathleen I. Crum
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami
| | - Stefany Coxe
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami
| | - Donna B. Pincus
- Center for Anxiety and Related Disorders (CARD), Boston University, Boston
| | - Jonathan S. Comer
- Mental Health Interventions and Technology (MINT) Program, Center for Children and Families, Florida International University, Miami
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238
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Brookman-Frazee L, Stahmer A, Stadnick N, Chlebowski C, Herschell A, Garland AF. Characterizing the Use of Research-Community Partnerships in Studies of Evidence-Based Interventions in Children's Community Services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 43:93-104. [PMID: 25578512 PMCID: PMC4500757 DOI: 10.1007/s10488-014-0622-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study characterized the use of research community partnerships (RCPs) to tailor evidence-based intervention, training, and implementation models for delivery across different childhood problems and service contexts using a survey completed by project principal investigators and community partners. To build on previous RCP research and to explicate the tacit knowledge gained through collaborative efforts, the following were examined: (1) characteristics of studies using RCP models; (2) RCP functioning, processes, and products; (3) processes of tailoring evidence-based practices for community implementation; and (4) perceptions of the benefits and challenges of collaborating with community providers and consumers. Results indicated that researchers were solely or jointly involved in the formation of almost all of the RCPs; interpersonal and operational processes were perceived as primary challenges; community partners' roles included greater involvement in implementation and participant recruitment than more traditional research activities; and the partnership process was perceived to increase the relevance and "fit" of interventions and research.
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Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, Child and Adolescent Services Research Center, 3020 Children's Way (MC 5033), San Diego, CA, 92123, USA.
| | - Aubyn Stahmer
- Department of Psychiatry and Behavioral Sciences, M.I.N.D. Institute, U.C. Davis Medical Center, Sacramento, CA, USA
| | - Nicole Stadnick
- Department of Psychiatry, University of California, San Diego, Child and Adolescent Services Research Center, 3020 Children's Way (MC 5033), San Diego, CA, 92123, USA
| | - Colby Chlebowski
- Department of Psychiatry, University of California, San Diego, Child and Adolescent Services Research Center, 3020 Children's Way (MC 5033), San Diego, CA, 92123, USA
| | - Amy Herschell
- University of Pittsburgh School of Medicine, Western Psychiatric Institute & Clinic, Pittsburgh, PA, USA
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239
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Dissemination of Child Anxiety Psychotherapy: The Next Frontier. J Cogn Psychother 2016; 30:149-153. [PMID: 32755920 DOI: 10.1891/0889-8391.30.3.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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240
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Vigerland S, Ljótsson B, Thulin U, Öst LG, Andersson G, Serlachius E. Internet-delivered cognitive behavioural therapy for children with anxiety disorders: A randomised controlled trial. Behav Res Ther 2015; 76:47-56. [PMID: 26649465 DOI: 10.1016/j.brat.2015.11.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cognitive behaviour therapy (CBT) has been shown to be an effective treatment for anxiety disorders in children, but few affected seek or receive treatment. Internet-delivered CBT (ICBT) could be a way to increase the availability of empirically supported treatments. AIMS A randomised controlled trial was conducted to evaluate ICBT for children with anxiety disorders. METHOD Families (N = 93) with a child aged 8-12 years with a principal diagnosis of generalised anxiety disorder, panic disorder, separation anxiety, social phobia or specific phobia were recruited through media advertisement. Participants were randomised to 10 weeks of ICBT with therapist support, or to a waitlist control condition. The primary outcome measure was the Clinician Severity Rating (CSR) and secondary measures included child- and parent-reported anxiety. Assessments were made at pre-treatment, post-treatment and at three-month follow-up. RESULTS At post-treatment, there were significant reductions on CSR in the treatment group, with a large between-group effect size (Cohen's d = 1.66). Twenty per cent of children in the treatment group no longer met criteria for their principal diagnosis at post-treatment and at follow-up this number had increased to 50%. Parent-reported child anxiety was significantly lower in the treatment group than in the waitlist group at post-treatment, with a small between-group effect size (Cohen's d = 0.45). There were no significant differences between the groups regarding child-ratings of anxiety at post-treatment. Improvements were maintained at three-month follow-up, although this should be interpreted cautiously due to missing data. CONCLUSIONS Within the limitations of this study, results suggest that ICBT with therapist support for children with anxiety disorders can reduce clinician- and parent-rated anxiety symptoms. TRIAL REGISTRATION Clinicaltrials.gov: NCT01533402.
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Affiliation(s)
- Sarah Vigerland
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Gävlegatan 22, 113 30 Stockholm, Sweden.
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden.
| | - Ulrika Thulin
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Gävlegatan 22, 113 30 Stockholm, Sweden.
| | - Lars-Göran Öst
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden; Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden.
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Nobels väg 9, 171 77 Stockholm, Sweden; Department of Behavioral Sciences and Learning, Linköping University, 581 83 Linköping, Sweden.
| | - Eva Serlachius
- Department of Clinical Neuroscience, Centre for Psychiatric Research and Education, Karolinska Institutet, Gävlegatan 22, 113 30 Stockholm, Sweden.
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241
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Mellin EA, Taylor L, Weist MD, Lockhart NC. The Expanded School Mental Health Collaboration Instrument [Community Version]: Development and Initial Psychometrics. SCHOOL MENTAL HEALTH 2015. [DOI: 10.1007/s12310-015-9164-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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242
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Hargreaves DS, Elliott MN, Viner RM, Richmond TK, Schuster MA. Unmet Health Care Need in US Adolescents and Adult Health Outcomes. Pediatrics 2015; 136:513-20. [PMID: 26283778 DOI: 10.1542/peds.2015-0237] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adolescence is a formative period when health care services have a unique opportunity to influence later health outcomes. Unmet health care need in adolescence is known to be associated with poor contemporaneous health outcomes; it is unknown whether it predicts poor adult health outcomes. METHODS We used nationally representative data from 14 800 subjects who participated in Wave I (mean age: 15.9 years [1994/1995]) and Wave IV (mean age: 29.6 years [2008]) of the National Longitudinal Study of Adolescent to Adult Health. Logistic regression models were used to estimate the association between unmet health care need in adolescence and 5 self-reported measures of adult health (fair/poor general health, functional impairment, time off work/school, depressive symptoms, and suicidal ideation). Models were adjusted for baseline health, insurance category, age, gender, race/ethnicity, household income, and parental education. RESULTS Unmet health care need was reported by 19.2% of adolescents and predicted worse adult health: fair/poor general health (adjusted odds ratio [aOR]: 1.27 [95% confidence interval (CI): 1.00-1.60]); functional impairment (aOR: 1.52 [95% CI: 1.23-1.87]); depressive symptoms (aOR: 1.36 [95% CI: 1.13-1.64]); and suicidal ideation (aOR: 1.30 [95% CI: 1.03-1.68]). There was no significant association between unmet health care need and time off work/school (aOR: 1.13 [95% CI: 0.93-1.36]). Cost barriers accounted for only 14.8% of unmet health care need. The reason for unmet need was not significantly related to the likelihood of poor adult health outcomes. CONCLUSIONS Reported unmet health care need in adolescence is common and is an independent predictor of poor adult health. Strategies to reduce unmet adolescent need should address health engagement and care quality, as well as cost barriers to accessing services.
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Affiliation(s)
- Dougal S Hargreaves
- Division of General Pediatrics, Department of Medicine, and Population, Policy and Practice Programme, UCL Institute of Child Health, London, United Kingdom;
| | | | - Russell M Viner
- Population, Policy and Practice Programme, UCL Institute of Child Health, London, United Kingdom
| | - Tracy K Richmond
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Mark A Schuster
- Division of General Pediatrics, Department of Medicine, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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243
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Scudder A, Herschell AD. Building an evidence-base for the training of evidence-based treatments in community settings: Use of an expert-informed approach. CHILDREN AND YOUTH SERVICES REVIEW 2015; 55:84-92. [PMID: 26504259 PMCID: PMC4617599 DOI: 10.1016/j.childyouth.2015.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In order to make EBTs available to a large number of children and families, developers and expert therapists have used their experience and expertise to train community-based therapists in EBTs. Understanding current training practices of treatment experts may be one method for establishing best practices for training community-based therapists prior to comprehensive empirical examinations of training practices. A qualitative study was conducted using surveys and phone interviews to identify the specific procedures used by treatment experts to train and implement an evidence-based treatment in community settings. Twenty-three doctoral-level, clinical psychologists were identified to participate because of their expertise in conducting and training Parent-Child Interaction Therapy. Semi-structured qualitative interviews were completed by phone, later transcribed verbatim, and analyzed using thematic coding. The de-identified data were coded by two independent qualitative data researchers and then compared for consistency of interpretation. The themes that emerged following the final coding were used to construct a training protocol to be empirically tested. The goal of this paper is to not only understand the current state of training practices for training therapists in a particular EBT, Parent-Child Interaction Therapy, but to illustrate the use of expert opinion as the best available evidence in preparation for empirical evaluation.
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Affiliation(s)
- Ashley Scudder
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Amy D Herschell
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
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244
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Abstract
PURPOSE OF REVIEW There has been increased attention towards the burden imposed by mental disorders on children and adolescents. The present overview explores the current state of child and adolescent mental healthcare provision around the globe. RECENT FINDINGS Current research indicates a concerning gap in the provision of care for the child and adolescent population. The disparities between need, demand and access to youth mental healthcare are likely to be even greater in low and- middle-income countries (LAMIC), where the proportion of children and adolescents in the population is higher. The scarcity of available resources for youth mental healthcare, especially in LAMIC, represents a major obstacle to decreasing the impact of mental disorders across the lifespan. SUMMARY Our review highlights the discrepancy between demands and availability of mental healthcare for youth populations throughout the world. We describe some of the potential contributors to the current state of youth mental healthcare, such as problematic access to services, implementation deficiencies and inadequacy of policies. Recent innovative strategies to reduce these barriers are also presented.
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245
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Grudnikoff E, Taneli T, Correll CU. Characteristics and disposition of youth referred from schools for emergency psychiatric evaluation. Eur Child Adolesc Psychiatry 2015; 24:731-43. [PMID: 25260234 DOI: 10.1007/s00787-014-0618-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/16/2014] [Indexed: 10/24/2022]
Abstract
We aimed to describe the characteristics and disposition of youth referred from schools to the emergency department (ED) for psychiatric evaluations. Consecutive 12-month records of ED psychiatric consultations at a large urban hospital from 07.01.2009 to 06.30.2010 were retrospectively analyzed. School-initiated referrals were deemed inappropriate if youth were discharged from the ED without any recommended mental health follow-up. Of the 551 psychiatric ED evaluations, 243 (44.1%) were initiated by schools. Of all school referrals, only 19 (7.8%) children were psychiatrically hospitalized, 108 (44.4%) were discharged from the ED with a follow-up appointment; and 116 (47.7%) were discharged without arranged follow-up. Those with a chief complaint of "suicidality" (n = 109, 44.9%) were more likely to be discharged without arranged follow-up than youth with other presenting complaints (56.0 vs. 41.0%, p = 0.021). Altogether, only 37 (18.5%) of 200 school-referred youth with information were evaluated by a school nurse, social worker, or other professional before being sent to the ED. Students without in-school screening were significantly more frequently discharged without follow-up than students with in-school evaluations prior to the ED referral (51.5 vs. 27.0%, p = 0.0070; odds ratio = 2.87 (95% CI 1.30-6.31). Multivariate predictors of inappropriate school referrals of youth discharged without any outpatient follow-up were higher Children's Global Assessment Scale score (p < 0.0001), absent in-school evaluation (p = 0.0069), absent prior psychiatric history (p = 0.011) and absent current psychotropic medication treatment (p = 0.012) (r(2) = 0.264%, p < 0.0001). Altogether 44.1% of ED consultations were school referred, of which 47.7% were potentially inappropriate for the emergency setting. In-school screening, which occurred infrequently, reduced unnecessary evaluations by 52%.
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Affiliation(s)
- Eugene Grudnikoff
- Department of Psychiatry, The Zucker Hillside Hospital, 75-59 263rd Street Glen Oaks, Glen Oaks, NY, 11004, USA,
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246
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Hintzpeter B, Klasen F, Schön G, Voss C, Hölling H, Ravens-Sieberer U. Mental health care use among children and adolescents in Germany: results of the longitudinal BELLA study. Eur Child Adolesc Psychiatry 2015; 24:705-13. [PMID: 25651821 DOI: 10.1007/s00787-015-0676-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
Abstract
Data on mental health care use of children and adolescents in Germany is scarce. This study investigates the degree of mental health care use, its trajectories and influencing factors among children and adolescents in Germany, using longitudinal data of the BELLA study. The BELLA study is the mental health module of the representative German National Health Interview and Examination Survey for children and adolescents (KiGGS). Baseline data of N = 2,863 participants aged 7-17 years were collected between 2003 and 2006. The study sample was followed up in three additional measurement points, assessing general mental health problems and impairment, specific mental health problems, and mental health care use. In the current study, we analysed data from the first three measurement points. At baseline, 5.9 % of all participants used mental health care in the past 12 months. Among those with general mental health problems, 29.5 % sought professional help. Only a minority of participants reporting mental health care use at baseline also sought help at the following two measurement points. Analysing a random intercept only model, mental health care use was found to be more likely among participants living in larger communities as well as in the Eastern part of Germany, among those participants with impairment of mental health problems, and signs of externalizing problems. Our results indicate a temporary character of mental health care use. Participants' impairment was identified to be the strongest predictor of mental health care use.
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Affiliation(s)
- Birte Hintzpeter
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany,
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247
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Shanahan L, Zucker N, Copeland WE, Bondy CL, Egger HL, Costello EJ. Childhood somatic complaints predict generalized anxiety and depressive disorders during young adulthood in a community sample. Psychol Med 2015; 45:1721-1730. [PMID: 25518872 PMCID: PMC4691537 DOI: 10.1017/s0033291714002840] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with somatic complaints are at increased risk for emotional disorders during childhood. Whether this elevated risk extends into young adulthood - and to which specific disorders - has rarely been tested with long-term prospective-longitudinal community samples. Here we test whether frequent and recurring stomach aches, headaches, and muscle aches during childhood predict emotional disorders in adulthood after accounting for childhood psychiatric and physical health status and psychosocial adversity. METHOD The Great Smoky Mountains Study is a community representative sample with 1420 participants. Children/adolescents were assessed 4-7 times between ages 9-16 years. They were assessed again up to three times between ages 19-26 years. Childhood somatic complaints were coded when subjects or their parents reported frequent and recurrent headaches, stomach aches, or muscular/joint aches at some point when children were aged 9-16 years. Psychiatric disorders were assessed with the Child and Adolescent Psychiatric Assessment and the Young Adult Psychiatric Assessment. RESULTS Frequent and recurrent somatic complaints in childhood predicted adulthood emotional disorders. After controlling for potential confounders, predictions from childhood somatic complaints were specific to later depression and generalized anxiety disorder. Long-term predictions did not differ by sex. Somatic complaints that persisted across developmental periods were associated with the highest risk for young adult emotional distress disorders. CONCLUSIONS Children from the community with frequent and recurrent physical distress are at substantially increased risk for emotional distress disorders during young adulthood. Preventions and interventions for somatic complaints could help alleviate this risk.
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Affiliation(s)
- L Shanahan
- Department of Psychology,University of North Carolina at Chapel Hill,Chapel Hill,NC,USA
| | - N Zucker
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - W E Copeland
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - C L Bondy
- Department of Psychology,University of North Carolina at Chapel Hill,Chapel Hill,NC,USA
| | - H L Egger
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
| | - E J Costello
- Department of Psychiatry and Behavioral Sciences,Duke University Medical Center,Durham,NC,USA
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Copeland WE, Shanahan L, Davis M, Burns BJ, Angold A, Costello EJ. Increase in untreated cases of psychiatric disorders during the transition to adulthood. Psychiatr Serv 2015; 66:397-403. [PMID: 25554854 PMCID: PMC4399490 DOI: 10.1176/appi.ps.201300541] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE During the transition to adulthood, youths face challenges that may limit their likelihood of obtaining services for psychiatric problems. The goal of this analysis was to estimate changes in rates of service use and untreated psychiatric disorders during the transition from adolescence to adulthood. METHODS In a prospective, population-based study, participants were assessed up to four times in adolescence (ages 13-16; 3,983 observations of 1,297 participants, 1993-2000) and three times in young adulthood (ages 19, 21, and 24-26; 3,215 observations of 1,273 participants, 1999-2010). Structured diagnostic interviews were used to assess service need (participants meeting DSM-IV diagnostic criteria for a psychiatric disorder) and use of behavioral services in 21 service settings in the past three months. RESULTS During young adulthood, 28.9% of cases of psychiatric disorders were associated with some treatment, compared with a rate of 50.9% for the same participants during adolescence. This decrease included a near-complete drop in use of educational and vocational services as well as declines in use of specialty behavioral services. Young adults most frequently accessed services in specialty behavioral or general medical settings. Males, African Americans, participants with substance dependence, and participants living independently were least likely to get treatment. For cases of psychiatric disorders among young adults, insurance and poverty status were unrelated to likelihood of service use. CONCLUSIONS Young adults were much less likely to receive treatment for psychiatric problems than they were as adolescents. Public policy must address gaps in service use during the transition to adulthood.
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Affiliation(s)
- William E Copeland
- Dr. Copeland, Dr. Burns, Dr. Angold, and Dr. Costello are with the Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina (e-mail: ). Dr. Shanahan is with the Department of Psychology, University of North Carolina, Chapel Hill. Dr. Davis is with the Department of Psychiatry, Systems and Psychosocial Advances Research Center, Transitions Research and Training Center, University of Massachusetts Medical School, Worcester
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Abstract
BACKGROUND Adolescent males have a low rate of seeking help for mental health problems. The onset for many psychiatric disorders occur during the adolescence. Previous studies have identified previous help seeking, parental opinion, parental divorce and suicidal thoughts as factors associated with contacting mental health services. Yet studies on the rate of use of mental health services remain few, as do studies concerning factors associated with use of mental health services. AIMS To study prevalence and risk factors of use of mental health services among Finnish adolescent males. METHODS Factors associated with use of mental health services during the preceding 12 months were studied in a general population sample of 4309 men attending military call-up in 2009. The mean age was 18.3 ± 0.45 years. RESULTS Within the previous 12 months, 3.2% of men had used mental health services and an additional 2.3% had considered contacting mental health services. Factors associated with service use were living alone, having a poor paternal relationship, having no contact with father, death of father, high internalizing symptoms, suicidal thoughts, regular smoking and use of illicit drugs. Frequent drunkenness was associated with mental health service use, whereas occasional use of alcohol was inversely associated with use of mental health services. CONCLUSIONS The rate of mental health service use among males in late adolescence is very low. The inability of young people to contact service providers should be addressed more efficiently. CLINICAL IMPLICATIONS A majority of the troubled men did not contact professionals for help, although approximately a quarter of the men had a self-perceived mental health problem. A major challenge is to find ways for mental health services to be made more accessible to adolescent males.
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Affiliation(s)
- Lassi Kaskeala
- a Lassi Kaskeala, B.M., Department of Child Psychiatry , University of Turku and Turku University Hospital , Turku , Finland
| | - Lauri Sillanmäki
- b Lauri Sillanmäki, Department of Child Psychiatry , University of Turku and Turku University Hospital , Turku , Finland
| | - Andre Sourander
- c Andre Sourander, M.D., Ph.D., Department of Child Psychiatry , University of Turku and Turku University Hospital , Turku , Finland
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250
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Polanczyk GV. Identifying the gaps between science, policies, services, and the needs of youths affected by mental disorders. Eur Child Adolesc Psychiatry 2014; 23:1119-21. [PMID: 25416962 DOI: 10.1007/s00787-014-0650-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Guilherme V Polanczyk
- Department of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil,
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