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Hiscock H, Kabir A, Honisett S, Morris T, Constable L, Forell S, Woolfenden S, Goldfeld S, Jorm A. Identifying Service, Research and Policy priorities for preventing the impacts of family adversity on children's mental health: An Australian national resource allocation study with professional and lived experience experts. Aust N Z J Public Health 2024; 48:100184. [PMID: 39217838 DOI: 10.1016/j.anzjph.2024.100184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/08/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVES The objective of this study was to develop Service, Research and Policy priorities to prevent the impact of family adversity on child mental health and determine comparative priorities of diverse stakeholders to those with lived experience of adversity. METHODS Value-weighting approach conducted in a staged process: (i) professionals and experts with lived experience from health, education, justice and social care sectors attended a national symposium to identify priorities for family adversity and mental health and (ii) a subsequent resource allocation survey gathered views from participants and external experts on symposium priorities. RESULTS Consensus was reached on priorities. Service priorities included establishing intersectoral hubs for children and families and early childhood nurse home-visiting programs. Research priorities included scaling up evidence-based interventions and evaluating cross-sector, flexible funding models for services addressing childhood adversity. Policy priorities included developing evidence-based policies with evaluation and implementation plans and flexible funding models to support integrated care. CONCLUSIONS Our results provide detailed and actionable clarity on next steps to address family adversities. IMPLICATIONS FOR PUBLIC HEALTH The priorities call for a focus on cross-sectoral approaches to preventing or mitigating the effects of family adversity. The current Australian policy environment provides a timely opportunity to action the proposed interventions.
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Affiliation(s)
- Harriet Hiscock
- Health Services and Economics, Murdoch Children's Research Institute, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Ashraful Kabir
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Suzy Honisett
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Tamara Morris
- School of Clinical Medicine, University of New South Wales, Sydney, 2031, Australia
| | - Leanne Constable
- Centre for Community Child Health, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Suzie Forell
- Health Justice Australia, Sydney, NSW, 2000, Australia; School of Law, University of New South Wales, Australia
| | - Sue Woolfenden
- Community Paediatrics, Sydney Local Health District, Australia; Community Paediatrics, Central Clinical School, Sydney Medical School, The Faculty of Medicine and Health, University of Sydney, Sydney, 2006, Australia
| | - Sharon Goldfeld
- Policy and Equity, Centre for Community Child Health, Murdoch Children's Research Institute, Victoria, 3052, Australia; Royal Children's Hospital, Parkville, VIC, 3052, Australia
| | - Anthony Jorm
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, University of Melbourne, Victoria, 3010, Australia
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Novak A, Semenza D, Gutman C, Heard-Garris N, Testa A, Jackson DB. Adverse Childhood Experiences and Trajectories of Firearm Exposure in Childhood. J Pediatr 2024; 270:114008. [PMID: 38479639 PMCID: PMC11176024 DOI: 10.1016/j.jpeds.2024.114008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To examine the longitudinal relationship between exposure to adverse childhood experiences (ACEs) in early life and trajectories of firearm exposure from early to middle childhood (ages 5-9 years old). STUDY DESIGN Data from the Longitudinal Studies of Child Abuse and Neglect (LOGSCAN) study were used. The LONGSCAN study was a prospective study in the United States and contained data from 1354 children from age 4 to age 18 years old. Exposure to ACEs was measured through the wave 1 interview (age 5 years old) and trajectories of firearm exposure were created using data from waves 1 (age 5 years old) and two (age 9 years old). RESULTS Two trajectories of firearm exposure in childhood were identified: a low exposure group and a group with persistently-high firearm exposure from ages 5 to 9 years old. ACEs were associated with membership in the high exposure group and children with four or more ACEs had over twice the odds of membership in the high exposure group compared with children with zero ACEs. CONCLUSION ACEs exposure in early childhood is associated with persistently-high exposure to firearms from early to middle childhood. This finding highlights the need for pediatricians to consider screening for both ACEs and firearm exposure in routine examinations, as well as the need for future research to identify and evaluate interventions intended to address exposure to adversity and firearms.
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Affiliation(s)
- Abigail Novak
- Department of Criminal Justice & Legal Studies, University of Mississippi, University, MS.
| | - Daniel Semenza
- Camden College of Arts and Sciences, Rutgers University, Camden, NJ
| | - Colleen Gutman
- Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FL
| | - Nia Heard-Garris
- Division of Advanced General Pediatrics and Primary Care, Department of Pediatrics, Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Institute for Policy Research, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alexander Testa
- Department of Criminology and Criminal Justice, The University of Texas at San Antonio, San Antonio, TX
| | - Dylan B Jackson
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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Harding KB, Di Ruggiero E, Gonzalez E, Hicks A, Harrington DW, Carsley S. Supporting Ontario public health units to address adverse childhood experiences in pandemic recovery planning: A priority-setting exercise. Health Res Policy Syst 2024; 22:68. [PMID: 38872217 PMCID: PMC11170865 DOI: 10.1186/s12961-024-01156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/22/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are potentially traumatic exposures experienced during childhood, for example, neglect. There is growing evidence that the coronavirus disease 2019 (COVID-19) pandemic and related socioeconomic conditions contributed to an increased risk of ACEs. As public health programs/services are re-evaluated and restored following the state of emergency, it is important to plan using an ACEs-informed lens. The aim of this study was to identify and prioritize initiatives or activities that Public Health Ontario (PHO) could undertake to support Ontario public health units' work towards ACEs-informed pandemic recovery plans. METHODS The Child Health and Nutrition Research Initiative method was adapted to conduct a priority-setting exercise (May-October 2022). Two online surveys were administered with members of the Healthy Growth and Development (HGD) Evidence Network, comprised of public health unit staff working in child and family health/HGD from Ontario's 34 public health units. In the first survey, participants were asked to propose activities or initiatives that PHO could undertake to support Ontario public health units' work towards ACEs-informed planning. In the second survey, participants were asked to score the final list of options against pre-determined prioritization criteria (for example, relevance). Responses were numerically coded and used to calculate prioritization scores, which were used to rank the options. RESULTS In all, 76% of public health units (n = 26) responded to the first survey to identify options. The 168 proposed ideas were consolidated into a final list of 13 options, which fall under PHO's scientific and technical support mandate areas (data and surveillance, evidence synthesis, collaboration and networking, knowledge exchange and research). A total of 79% of public health units (n = 27) responded to the follow-up survey to prioritize options. Prioritization scores ranged from 76.4% to 88.6%. The top-ranked option was the establishment of a new provincial ACEs community of practice. CONCLUSIONS Over three quarters of public health units contributed to identifying and ranking 13 options for PHO to support public health units in considering and addressing ACEs through pandemic recovery planning. In consultation with the ACEs and Resilience Community of Practice, recently formed on the basis of this exercise, PHO will continue to use the ranked list of options to inform work-planning activities/priorities.
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Affiliation(s)
- Kimberly B Harding
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Erick Gonzalez
- Family Health Division, Niagara Region Public Health and Emergency Services, 1815 Sir Isaac Brock Way, Thorold, ON, L2V 4Y6, Canada
| | - Amanda Hicks
- Family Health Division, Niagara Region Public Health and Emergency Services, 1815 Sir Isaac Brock Way, Thorold, ON, L2V 4Y6, Canada
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Daniel W Harrington
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada
| | - Sarah Carsley
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada.
- Health Promotion, Chronic Disease and Injury Prevention, Public Health Ontario, 661 University Avenue, Suite 1701, Toronto, ON, M5G 1M1, Canada.
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Zhen-Duan J, Alvarez K, Zhang L, Cruz-Gonzalez M, Kuo J, Falgas-Bagué I, Bird H, Canino G, Duarte CS, Alegría M. Parental psychopathology and posttraumatic stress in Puerto Ricans: the role of childhood adversity and parenting practices. J Child Psychol Psychiatry 2024; 65:742-752. [PMID: 37850715 PMCID: PMC11024057 DOI: 10.1111/jcpp.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Parental psychopathology is associated with their children's posttraumatic stress symptoms (PTSS). However, the mechanisms through which this occurs remain unclear. We hypothesized that exposure to childhood adversities is the mechanism linking parental psychopathology to child PTSS and that parenting practices moderated these associations. METHODS Participants (N = 1,402) with an average age of 24.03 years old (SD = 2.20), were all Puerto Ricans (50% Male and 50% Female) from the Boricua Youth Study, which is a four-wave longitudinal study spanning almost 20 years, following individuals from childhood (ages 5-13 at Wave 1) to young adulthood. Measured variables include parental psychopathology at Wave 1, childhood adversities and parenting practices at Waves 2-3, and PTSS at Wave 4. A traditional mediation model estimated the association between parental psychopathology and child PTSS via childhood adversities. A moderated mediation model was used to examine whether parenting practices moderated this mediation model. RESULTS Results showed that the total effect of parental psychopathology at Wave 1 on PTSS at Wave 4 was fully mediated by childhood adversities at Waves 2-3 (direct effect b = 1.72, 95% CI = [-0.09, 3.83]; indirect effect b = 0.40, 95% CI = [0.15, 0.81]). In addition, the magnitude of this pathway varied by levels of parenting practices (i.e. parental monitoring and parent-child relationship quality). Specifically, the indirect effect of additional adversities in the psychopathology-PTSS link was stronger with higher levels of parental monitoring but weaker with higher parent-child relationship quality scores. CONCLUSIONS Intergenerational continuity of psychopathology may be mitigated through the prevention of additional childhood adversities via upstream interventions, emphasizing providing parents with mental health needs with parenting tools. Family-based interventions focused on providing families with the tools to improve parent-child relationships may reduce the negative impact of childhood adversities on mental health across the life course.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kiara Alvarez
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lulu Zhang
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Josephine Kuo
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Irene Falgas-Bagué
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Hector Bird
- Department of Psychiatry, Columbia University – New York State Psychiatric Institute, New York, NY, USA
| | - Glorisa Canino
- Department of Pediatrics, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Cristiane S. Duarte
- Department of Psychiatry, Columbia University – New York State Psychiatric Institute, New York, NY, USA
| | - Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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King WM, Fleischer NL, Operario D, Chatters LM, Gamarel KE. Inequities in the distribution of adverse childhood experiences and their association with health among transgender people of color. CHILD ABUSE & NEGLECT 2024; 149:106654. [PMID: 38350400 DOI: 10.1016/j.chiabu.2024.106654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND Racism and cisgenderism expose transgender people of color to adversity across the life course. However, little is known about the prevalence of adverse childhood experiences (ACEs) in this population or their association with health in comparison to other groups. OBJECTIVE Guided by the structural trauma framework, we examined race/ethnicity/gender group differences in the prevalence of ACEs and their association with adult mental and physical health. PARTICIPANTS AND SETTING 2019-2021 Behavioral Risk Factor Surveillance Survey. METHODS Transgender participants (n = 551) were matched with two cisgender men (n = 1102) and two cisgender women (n = 1102) on key covariates. We compared age-adjusted predicted probabilities of nine ACEs by race/ethnicity/gender group. We then fit adjusted logistic regression models predicting poor mental and physical health by each ACE and compared marginal effects between groups. RESULTS Transgender people of color had higher age-adjusted probabilities of six ACEs than at least one other group; for example, household incarceration was 0.16 (95 % CI: 0.11-0.22) compared to 0.09 (95 % CI: 0.06-0.13) for cisgender men of color (p = 0.032). The relationship between five ACEs and poor mental health was greater for transgender people of color than at least one other group. For instance, the marginal effect of household alcoholism on poor mental health was 0.28 (95 % CI: 0.11-0.45) compared to 0.07 (0.01-0.14) for White cisgender men (p = 0.031). There were no statistically significant differences regarding effects on poor physical health. CONCLUSIONS ACEs inequitably impact transgender people of color, reflecting the need to restructure the interlocking systems that drive adversity among transgender children of color and exacerbate ACEs' health effects among adults.
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Affiliation(s)
- Wesley M King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America.
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America.
| | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, 1525 Clifton Road, Atlanta, GA 30329, United States of America.
| | - Linda M Chatters
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America; University of Michigan School of Social Work, 1080 South University Avenue, Ann Arbor, MI 48109, United States of America.
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, United States of America.
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Haddad E, Hayes LC, Price D, Vallery CG, Somers M, Borer JG. Ensuring our exstrophy-epispadias complex patients and families thrive. Pediatr Nephrol 2024; 39:371-382. [PMID: 37410166 DOI: 10.1007/s00467-023-06049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 05/17/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023]
Abstract
Individuals with bladder exstrophy-epispadias complex (EEC) need long-term integrated medical/surgical and psychosocial care. These individuals are at risk for medical and surgical complications and experience social and psychological obstacles related to their genitourinary anomaly. This care needs to be accessible, comprehensive, and coordinated. Multiple surgical interventions, reoccurring hospitalizations, urinary and fecal incontinence, extensive treatment regimens for continent diversions, genital differences, and sexual health implications affect the quality of life for the EEC patient. Interventions must include psychosocial support, medical literacy initiatives, behavioral health services, school and educational consultation, peer-to-peer opportunities, referrals to disease-specific camps, mitigation of adverse childhood events (ACEs), formal transition of care to adult providers, family and teen advisory opportunities, and clinical care coordination. The priority of long-term kidney health will necessitate strong collaboration among urology and nephrology teams. Given the rarity of these conditions, multi-center and global efforts are paramount in the trajectory of improving care for the EEC population. To achieve the highest standards of care and ensure that individuals with EEC can thrive in their environment, multidisciplinary and integrated medical/surgical and psychosocial services are imperative.
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Affiliation(s)
- Emily Haddad
- Cook Children's Health Care System, Fort Worth, TX, USA.
| | - Lillian C Hayes
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Diane Price
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christina G Vallery
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Somers
- Department of Nephrology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph G Borer
- Department of Urology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Mucignat-Caretta C, Soravia G. Positive or negative environmental modulations on human brain development: the morpho-functional outcomes of music training or stress. Front Neurosci 2023; 17:1266766. [PMID: 38027483 PMCID: PMC10657192 DOI: 10.3389/fnins.2023.1266766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
In the last couple of decades, the study of human living brain has benefitted of neuroimaging and non-invasive electrophysiological techniques, which are particularly valuable during development. A number of studies allowed to trace the usual stages leading from pregnancy to adult age, and relate them to functional and behavioral measurements. It was also possible to explore the effects of some interventions, behavioral or not, showing that the commonly followed pathway to adulthood may be steered by external interventions. These events may result in behavioral modifications but also in structural changes, in some cases limiting plasticity or extending/modifying critical periods. In this review, we outline the healthy human brain development in the absence of major issues or diseases. Then, the effects of negative (different stressors) and positive (music training) environmental stimuli on brain and behavioral development is depicted. Hence, it may be concluded that the typical development follows a course strictly dependent from environmental inputs, and that external intervention can be designed to positively counteract negative influences, particularly at young ages. We also focus on the social aspect of development, which starts in utero and continues after birth by building social relationships. This poses a great responsibility in handling children education and healthcare politics, pointing to social accountability for the responsible development of each child.
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Affiliation(s)
| | - Giulia Soravia
- Department of Mother and Child Health, University of Padova, Padova, Italy
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Ng AE, Salam Z, Tkach N, Alcalá HE. Adverse Childhood Experiences and Family-Centered Care. JOURNAL OF PREVENTION (2022) 2023; 44:561-578. [PMID: 37380896 DOI: 10.1007/s10935-023-00738-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 06/30/2023]
Abstract
Adverse Childhood Experiences (ACEs) include experiences of child maltreatment and household dysfunction. Prior work has shown that children with ACEs may have suboptimal utilization of preventive health care, including annual well-visits, however little is known about the relationship between ACEs and quality of patient care. Using data from the 2020 National Survey of Children's Health (N = 22,760) a series of logistic regression models estimated associations between ACEs, both individually and cumulatively, and five components of family-centered care. Most ACEs were consistently associated with lower odds of family-centered care (e.g. financial hardship was associated with doctors always spend enough time with children, AOR = 0.53; 95% CI = 0.47, 0.61), except for having a parent or guardian die, which was associated with higher odds. Cumulative ACE score was also associated with lower odds of family-centered care (e.g. doctors always listened carefully to the parent, AOR = 0.86; 95% CI = 0.81, 0.90). These findings emphasize the importance of the consideration of ACEs in the context of family-centered care, and support the need for ACEs screening in the clinical setting. Future work should focus on mechanisms explaining the observed associations.
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Affiliation(s)
- Amanda E Ng
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, 20742, USA
| | - Zoha Salam
- Department of Global Health, McMaster University , Hamilton, ON, L8S 4L8, Canada
| | - Nicholas Tkach
- New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, 11568, USA
| | - Héctor E Alcalá
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, 20742, USA.
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, 21201, USA.
- Program in Oncology, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, Baltimore, 21201, USA.
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Buchanan G, Sullivan E, Berkel C, Breitenstein S, Feinberg E, Valado T, Willis D. Implementing Parenting Programs in Primary Care: A Framework and a Call for Action. Acad Pediatr 2023; 23:1315-1325. [PMID: 37088132 DOI: 10.1016/j.acap.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
Healthy parent-child relationships are clearly critical to healthy child development. Parenting programs develop caregivers' skills to support the health and well-being of children. Rigorous evidence has demonstrated the efficacy of these programs. Rising rates of child and youth depression, anxiety, grief, and suicide, both prior to and compounded by the COVID-19 pandemic, provide further reasons to implement parenting programs that support all parents in their essential roles. Parents can act as a buffer to stressors and support for children's well-being when they have the knowledge and skills to do so. Pediatric primary care practices are a natural setting for parenting programs, but challenges, including stigma, technology, workflow issues, and funding, have prevented their broad dissemination, implementation, and sustainability. In this article, we develop a framework for implementing parenting programs in primary care and present key considerations for selecting programs that fit the needs of parents, providers, patients, and the practice. We offer lessons from our experiences in overcoming these challenges, using the updated Consolidated Framework for Implementation Research to structure our discussion. We also provide an initial stepwise process which readers may use to plan their own parenting program implementation. Pediatric clinicians and practices can use this article and associated resources to plan, implement, and evaluate parenting programs in their practices as a strategy to help address the growing youth mental health crisis. Improving parenting behaviors can reduce the need for current or future mental health interventions by supporting optimal child development, emotional regulation, and parent-child relationships.
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Affiliation(s)
- Gretchen Buchanan
- Center for Mental Health Services Research and Brown School of Social Work (G Buchanan), Washington University in St. Louis, MO.
| | | | - Cady Berkel
- College of Health Solutions (C Berkel), Arizona State University, Tempe
| | - Susie Breitenstein
- College of Nursing (S Breitenstein), The Ohio State University, Columbus
| | - Emily Feinberg
- Department of Pediatrics (E Feinberg), Chobanian and Avedisian School of Medicine and Department of Community Health Sciences, Boston University School of Public Health, Boston University School of Medicine, MA
| | - Trenna Valado
- ZERO TO THREE National Center for Infants, Toddlers, and Families (T Valado), Washington, D.C
| | - David Willis
- Center for the Study of Social Policy (D Willis), Washington, D.C
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Bethell CD, Wells N, Bergman D, Reuland C, Stumbo SP, Gombojav N, Simpson LA. Scaling Family Voices and Engagement to Measure and Improve Systems Performance and Whole Child Health: Progress and Lessons from the Child and Adolescent Health Measurement Initiative. Matern Child Health J 2023:10.1007/s10995-023-03755-9. [PMID: 37624473 DOI: 10.1007/s10995-023-03755-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND The 1997 legislation authorizing the United States Child Health Insurance Program sparked progress to measure and publicly report on children's healthcare services quality and system performance. To meet the moment, the national Child and Adolescent Health Measurement Initiative (CAHMI) public-private collaboration was launched to put families at the center of defining, measuring and using healthcare performance information to drive improved services quality and outcomes. METHODS Since 1996 the CAHMI followed an intentional path of collaborative action to (1) articulate shared goals for child health and advance a comprehensive, life-course and outcomes-based healthcare performance measurement and reporting framework; (2) collaborate with families, providers, payers and government agencies to specify, validate and support national, state and local use of dozens of framework aligned measures; (3) create novel public-facing digital data query, collection and reporting tools that liberate data findings for use by families, providers, advocates, policymakers, the media and researchers (Data Resource Center, Well Visit Planner); and (4) generate field building research and systems change agendas and frameworks (Prioritizing Possibilities, Engagement In Action) to catalyze prevention, flourishing and healing centered, trauma-informed, whole child and family engaged approaches, integrated systems and supportive financing and policies. CONCLUSIONS Lessons call for a restored, sustainable family and community engaged measurement infrastructure, public activation campaigns, and undeterred federal, state and systems leadership that implement policies to incentivize, resource, measure and remove barriers to integrated systems of care that scale family engagement to equitably promote whole child, youth and family well-being. Population health requires effective family engagement.
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Affiliation(s)
- Christina D Bethell
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E4152, Baltimore, MD, 21205, USA.
| | - Nora Wells
- Family Voices, 1250 I St NW #250, Washington, DC, 20005, USA
| | - David Bergman
- Department of Pediatrics, General Pediatrics, Stanford Medicine Children's Health, MSOB, 1265 Welch Road X240, Palo Alto, CA, 94305-5459, USA
| | - Colleen Reuland
- Oregon Pediatric Improvement Project, Department of Pediatrics, Division of General Pediatrics, Oregon Health and Sciences University, 707 SW Gaines St, Mail Code CDRC-P, Portland, OR, 97239, USA
| | - Scott P Stumbo
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E4152, Baltimore, MD, 21205, USA
| | - Narangerel Gombojav
- Child and Adolescent Health Measurement Initiative, Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Room E4152, Baltimore, MD, 21205, USA
| | - Lisa A Simpson
- AcademyHealth, 1666 K St NW #1100, Washington, DC, 20006, USA
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Sloboda Z, Johnson KA, Fishbein DH, Brown CH, Coatsworth JD, Fixsen DL, Kandel D, Paschall MJ, Silva FS, Sumnall H, Vanyukov M. Normalization of Prevention Principles and Practices to Reduce Substance Use Disorders Through an Integrated Dissemination and Implementation Framework. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:1078-1090. [PMID: 37052866 PMCID: PMC10476513 DOI: 10.1007/s11121-023-01532-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/14/2023]
Abstract
Major research breakthroughs over the past 30 years in the field of substance use prevention have served to: (1) enhance understanding of pharmacological effects on the central and peripheral nervous systems and the health and social consequences of use of psychoactive substances, particularly for children and adolescents; (2) delineate the processes that increase vulnerability to or protect from initiation of substance use and progression to substance use disorders (SUDs) and, based on this understanding, (3) develop effective strategies and practices to prevent the initiation and escalation of substance use. The challenge we now face as a field is to "normalize" what we have learned from this research so that it is incorporated into the work of those involved in supporting, planning, and delivering prevention programming to populations around the world, is integrated into health and social service systems, and helps to shape public policies. But we wish to go further, to incorporate these effective prevention practices into everyday life and the mind-sets of the public, particularly parents and educators. This paper reviews the advances that have been made in the field of prevention and presents a framework and recommendations to achieve these objectives generated during several meetings of prevention and implementation science researchers sponsored by the International Consortium of Universities for Drug Demand Reduction (ICUDDR) that guides a roadmap to achieve "normalization."
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Affiliation(s)
- Zili Sloboda
- Applied Prevention Science International, Ontario, OH, USA.
| | - Kimberly A Johnson
- Department of Mental Health Law and Policy, College of Community and Behavioral Sciences, University of South Florida, Tampa, FL, USA
- International Consortium of Universities of Drug Demand Reduction, Tampa, FL, USA
| | - Diana H Fishbein
- Frank Porter Graham Child Development Institute, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
- National Prevention Science, The Pennsylvania State University, State College, Harrisburg, PA, USA
| | | | | | - Dean L Fixsen
- Active Implementation Research Network, Inc, Chapel Hill, NC, USA
| | - Denise Kandel
- Department of Psychiatry and School of Public Health, Columbia University, New York, NY, USA
| | - Mallie J Paschall
- Prevention Research Center (PRC), Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | | | - Harry Sumnall
- Faculty of Health, Public Health Institute, Liverpool John Moores University, Liverpool, UK
| | - Michael Vanyukov
- Departments of Pharmaceutical Sciences, Psychiatry, and Human Genetics, University of Pittsburgh, Pittsburgh, PA, USA
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Manjarres MT, Duarte DPM, Navarro-Obeid J, Álvarez MLV, Martinez I, Cudris-Torres L, Hernández-Lalinde J, Bermúdez V. A bibliometric analysis and literature review on emotional skills. Front Psychol 2023; 14:1040110. [PMID: 37292504 PMCID: PMC10246769 DOI: 10.3389/fpsyg.2023.1040110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/17/2023] [Indexed: 06/10/2023] Open
Abstract
The content, management, and implementation of social skills have been developed since the end of the 20th century as a model of capabilities. Thus, as human beings develop and train their basic cognitive and perceptual-motor functions, they increase their ability to solve and cope with difficulties. This article aims to present a bibliometric and systematic review of social skills, using query sources in databases such as Web of Science (WoS) and Scopus between the years 2000 and 2022, with platforms such as Bibliometrix and Gephi. This search yielded a total of 233 records in WoS and 250 records in Scopus that were merged and, after eliminating 143 duplicate data, were consolidated into 340 records that enclose the academic production of 20 years. Through scientific mapping, the main authors, journals, and countries in this field were determined; similarly, the most relevant studies were classified into three categories, namely, classic, structural, and perspectives, which were represented by means of the metaphor of the tree of science. In addition, a program for further studies was planned, such as in-depth qualitative research measuring observationally and directly taking into account emotional expressiveness, emotional understanding, emotion regulation, and behavior, and the impact of social skills training on social problem-solving. Finally, another important aspect to mention is that this research work is useful for the scientific academic community in many areas of knowledge such as psychology, education, and managers of educational institutions.
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Affiliation(s)
| | | | | | | | | | | | | | - Valmore Bermúdez
- Centro de Investigaciones en Ciencias de la Vida, Universidad Simón Bolívar, Barranquilla, Colombia
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Merner B, Schonfeld L, Virgona A, Lowe D, Walsh L, Wardrope C, Graham-Wisener L, Xafis V, Colombo C, Refahi N, Bryden P, Chmielewski R, Martin F, Messino NM, Mussared A, Smith L, Biggar S, Gill M, Menzies D, Gaulden CM, Earnshaw L, Arnott L, Poole N, Ryan RE, Hill S. Consumers' and health providers' views and perceptions of partnering to improve health services design, delivery and evaluation: a co-produced qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 3:CD013274. [PMID: 36917094 PMCID: PMC10065807 DOI: 10.1002/14651858.cd013274.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Partnering with consumers in the planning, delivery and evaluation of health services is an essential component of person-centred care. There are many ways to partner with consumers to improve health services, including formal group partnerships (such as committees, boards or steering groups). However, consumers' and health providers' views and experiences of formal group partnerships remain unclear. In this qualitative evidence synthesis (QES), we focus specifically on formal group partnerships where health providers and consumers share decision-making about planning, delivering and/or evaluating health services. Formal group partnerships were selected because they are widely used throughout the world to improve person-centred care. For the purposes of this QES, the term 'consumer' refers to a person who is a patient, carer or community member who brings their perspective to health service partnerships. 'Health provider' refers to a person with a health policy, management, administrative or clinical role who participates in formal partnerships in an advisory or representative capacity. This QES was co-produced with a Stakeholder Panel of consumers and health providers. The QES was undertaken concurrently with a Cochrane intervention review entitled Effects of consumers and health providers working in partnership on health services planning, delivery and evaluation. OBJECTIVES 1. To synthesise the views and experiences of consumers and health providers of formal partnership approaches that aimed to improve planning, delivery or evaluation of health services. 2. To identify best practice principles for formal partnership approaches in health services by understanding consumers' and health providers' views and experiences. SEARCH METHODS We searched MEDLINE, Embase, PsycINFO and CINAHL for studies published between January 2000 and October 2018. We also searched grey literature sources including websites of relevant research and policy organisations involved in promoting person-centred care. SELECTION CRITERIA We included qualitative studies that explored consumers' and health providers' perceptions and experiences of partnering in formal group formats to improve the planning, delivery or evaluation of health services. DATA COLLECTION AND ANALYSIS Following completion of abstract and full-text screening, we used purposive sampling to select a sample of eligible studies that covered a range of pre-defined criteria, including rich data, range of countries and country income level, settings, participants, and types of partnership activities. A Framework Synthesis approach was used to synthesise the findings of the sample. We appraised the quality of each study using the CASP (Critical Appraisal Skill Program) tool. We assessed our confidence in the findings using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. The Stakeholder Panel was involved in each stage of the review from development of the protocol to development of the best practice principles. MAIN RESULTS We found 182 studies that were eligible for inclusion. From this group, we selected 33 studies to include in the final synthesis. These studies came from a wide range of countries including 28 from high-income countries and five from low- or middle-income countries (LMICs). Each of the studies included the experiences and views of consumers and/or health providers of partnering in formal group formats. The results were divided into the following categories. Contextual factors influencing partnerships: government policy, policy implementation processes and funding, as well as the organisational context of the health service, could facilitate or impede partnering (moderate level of confidence). Consumer recruitment: consumer recruitment occurred in different ways and consumers managed the recruitment process in a minority of studies only (high level of confidence). Recruiting a range of consumers who were reflective of the clinic's demographic population was considered desirable, particularly by health providers (high level of confidence). Some health providers perceived that individual consumers' experiences were not generalisable to the broader population whereas consumers perceived it could be problematic to aim to represent a broad range of community views (high level of confidence). Partnership dynamics and processes: positive interpersonal dynamics between health providers and consumers facilitated partnerships (high level of confidence). However, formal meeting formats and lack of clarity about the consumer role could constrain consumers' involvement (high level of confidence). Health providers' professional status, technical knowledge and use of jargon were intimidating for some consumers (high level of confidence) and consumers could feel their experiential knowledge was not valued (moderate level of confidence). Consumers could also become frustrated when health providers dominated the meeting agenda (moderate level of confidence) and when they experienced token involvement, such as a lack of decision-making power (high level of confidence) Perceived impacts on partnership participants: partnering could affect health provider and consumer participants in both positive and negative ways (high level of confidence). Perceived impacts on health service planning, delivery and evaluation: partnering was perceived to improve the person-centredness of health service culture (high level of confidence), improve the built environment of the health service (high level of confidence), improve health service design and delivery e.g. facilitate 'out of hours' services or treatment closer to home (high level of confidence), enhance community ownership of health services, particularly in LMICs (moderate level of confidence), and improve consumer involvement in strategic decision-making, under certain conditions (moderate level of confidence). There was limited evidence suggesting partnering may improve health service evaluation (very low level of confidence). Best practice principles for formal partnering to promote person-centred care were developed from these findings. The principles were developed collaboratively with the Stakeholder Panel and included leadership and health service culture; diversity; equity; mutual respect; shared vision and regular communication; shared agendas and decision-making; influence and sustainability. AUTHORS' CONCLUSIONS Successful formal group partnerships with consumers require health providers to continually reflect and address power imbalances that may constrain consumers' participation. Such imbalances may be particularly acute in recruitment procedures, meeting structure and content and decision-making processes. Formal group partnerships were perceived to improve the physical environment of health services, the person-centredness of health service culture and health service design and delivery. Implementing the best practice principles may help to address power imbalances, strengthen formal partnering, improve the experiences of consumers and health providers and positively affect partnership outcomes.
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Affiliation(s)
- Bronwen Merner
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Lina Schonfeld
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Ariane Virgona
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Dianne Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
- Child and Family Evidence, Australian Institute of Family Studies, Melbourne, Australia
| | - Louisa Walsh
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Cheryl Wardrope
- Clinical Governance, Metro South Hospital and Health Service, Eight Mile Plains, Australia
| | | | - Vicki Xafis
- The Sydney Children's Hospitals Network, Sydney, Australia
| | - Cinzia Colombo
- Laboratory for medical research and consumer involvement, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Nora Refahi
- Consumer Representative, Melbourne, Australia
| | - Paul Bryden
- Consumer Representative, Caboolture, Australia
| | - Renee Chmielewski
- Planning and Patient Experience, The Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | | | | | | | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Susan Biggar
- Consumer Representative, Melbourne, Australia
- Australian Health Practitioner Regulation Agency (AHPRA), Melbourne, Australia
| | - Marie Gill
- Gill and Wilcox Consultancy, Melbourne, Australia
| | - David Menzies
- Chronic Disease Programs, South Eastern Melbourne Primary Health Network, Heatherton, Australia
| | - Carolyn M Gaulden
- Detroit Wayne County Authority Health Residency Program, Michigan State University, Providence Hospital, Southfield, Michigan, USA
| | | | | | - Naomi Poole
- Strategy and Innovation, Australian Commission on Safety and Quality in Health Care, Sydney, Australia
| | - Rebecca E Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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14
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Webb L, Musci R, Mendelson T. Co-Occurring Mental Health Symptoms in Urban Adolescents: Comorbidity Profiles and Correlates. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:171-183. [PMID: 33819113 PMCID: PMC8490478 DOI: 10.1080/15374416.2021.1901228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify subgroups of urban youth based on their self- and teacher-reported mental health symptoms, and to explore characteristics of these subgroups. METHODS Cross-sectional data from 426 eighth-grade students (Mage = 13.22 years; 70.1% Black/African American; 58.7% female) across 20 Baltimore City public schools were analyzed using latent profile analysis and latent regressions. Variables for latent profile analysis included self-reported symptoms (i.e., anxiety, depression, trauma, interpersonal issues, social problems, and behavioral dysfunction) and teacher-reported symptoms (i.e., externalizing, internalizing, and problems in social and emotional competence). Regressions used profile membership to predict trauma exposure, coping mechanisms, and substance use. RESULTS A 3-profile solution was found from the latent profile analysis. The profile with high student- and teacher-reported symptoms had more trauma exposures, greater use of maladaptive coping mechanisms, and higher substance use. CONCLUSIONS The current study may help in the identification of urban youth who are at risk of developing multiple co-occurring psychological disorders to target for prevention efforts.
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Affiliation(s)
- Lindsey Webb
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Tamar Mendelson
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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15
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Purtle J, Nelson KL, Lê-Scherban F, Gollust SE. Unintended consequences of disseminating behavioral health evidence to policymakers: Results from a survey-based experiment. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231172807. [PMID: 37790180 PMCID: PMC10170598 DOI: 10.1177/26334895231172807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
Background Communication research demonstrates that messages often have unintended consequences, but this work has received limited attention in implementation science. This dissemination experiment sought to determine whether state-tailored policy briefs about the behavioral health consequences of adverse childhood experiences (ACEs), compared to national policy briefs on the topic, increased state legislators'/staffers' perceptions of the policy brief relevance and parental blame for the consequences of ACEs, and whether effects differed between Democrats and Republicans. Method A preregistered, web-based survey experiment with U.S. state legislators/staffers was conducted in 2021 (n = 133). Respondents were randomized to view a policy brief about the behavioral health consequences of ACEs that included state-tailored data (intervention condition) or national data (control condition) and then answered survey questions. Dependent variables were perceived policy brief relevance and parental blame for the consequences of ACEs. Results The mean policy brief relevance score was 4.1% higher in the intervention than in the control condition (p = .24), but the mean parental blame score was 16.5% higher (p = .02). When outcomes were dichotomized, 61.2% of respondents in the intervention condition rated parents as "very much to blame" for the consequences of ACEs compared to 37.1% in the control condition (p = .01). When the sample was stratified by political affiliation, the effect of the state-tailored policy brief on parental blame was larger in magnitude among Democrats and not significant among Republicans. The intervention policy brief increased the mean parental blame score by 22.8% among Democrats relative to the control policy brief (p = .007) and doubled the proportion rating parents as "very much to blame" (52.2% vs. 26.1%, p = .03). Conclusions Despite limited statistical power, state-tailored policy briefs significantly increased state legislators'/staffers' perceptions of parental blame for the behavioral health consequences of ACEs, relative to a policy brief with national data. Unintended messaging effects warrant greater attention in dissemination research and practice.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, New York University School of Global Public Health, Global Center for Implementation Science, New York, NY, USA
| | | | - Félice Lê-Scherban
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Sarah E. Gollust
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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16
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Skouteris H, Green R, Chung A, Bergmeier H, Amir LH, Baidwan SK, Chater A, Chamberlain C, Emond R, Gibbons K, Gooey M, Hatzikiriakidis K, Haycraft E, Hills AP, Higgins DJ, Hooper O, Hunter S, Kappelides P, Kleve S, Krakouer J, Lumeng JC, Manios Y, Mansoor A, Marmot M, Mâsse LC, Matvienko‐Sikar K, Mchiza ZJ, Meyer C, Moschonis G, Munro ER, O'Connor TM, O'Neil A, Quarmby T, Sandford R, Schneiderman JU, Sherriff S, Simkiss D, Spence A, Sturgiss E, Vicary D, Wickes R, Wolfenden L, Story M, Black MM. Nurturing children's development through healthy eating and active living: Time for policies to support effective interventions in the context of responsive emotional support and early learning. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6719-e6729. [PMID: 36401560 PMCID: PMC10946933 DOI: 10.1111/hsc.14106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/19/2022] [Accepted: 10/31/2022] [Indexed: 06/16/2023]
Abstract
Fostering the growth, development, health, and wellbeing of children is a global priority. The early childhood period presents a critical window to influence lifelong trajectories, however urgent multisectoral action is needed to ensure that families are adequately supported to nurture their children's growth and development. With a shared vision to give every child the best start in life, thus helping them reach their full developmental potential, we have formed the International Healthy Eating Active Living Matters (HEALing Matters) Alliance. Together, we form a global network of academics and practitioners working across child health and development, and who are dedicated to improving health equity for children and their families. Our goal is to ensure that all families are free from structural inequality and oppression and are empowered to nurture their children's growth and development through healthy eating and physical activity within the context of responsive emotional support, safety and security, and opportunities for early learning. To date, there have been disparate approaches to promoting these objectives across the health, community service, and education sectors. The crucial importance of our collective work is to bring these priorities for early childhood together through multisectoral interventions, and in so doing tackle head on siloed approaches. In this Policy paper, we draw upon extensive research and call for collective action to promote equity and foster positive developmental trajectories for all children. We call for the delivery of evidence-based programs, policies, and services that are co-designed to meet the needs of all children and families and address structural and systemic inequalities. Moving beyond the "what" is needed to foster the best start to life for all children, we provide recommendations of "how" we can do this. Such collective impact will facilitate intergenerational progression that builds human capital in future generations.
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Affiliation(s)
- Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
- Warwick Business SchoolUniversity of WarwickCoventryUK
| | - Rachael Green
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Alexandra Chung
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Heidi Bergmeier
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Lisa H. Amir
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityVictoriaBundooraAustralia
| | | | - Angel Marie Chater
- Centre for Health, Wellbeing and Behaviour ChangeUniversity of BedfordshireLutonUK
| | - Catherine Chamberlain
- Judith Lumley Centre, School of Nursing and MidwiferyLa Trobe UniversityVictoriaBundooraAustralia
- Centre for Health EquityThe University of MelbourneVictoriaMelbourneAustralia
- Ngangk Yira Research Centre for Aboriginal Health and Social EquityMurdoch UniversityMurdochAustralia
- The Lowitja InstituteCollingwoodVictoriaAustralia
| | | | - Kay Gibbons
- Institute for Health & SportVictoria UniversityVictoriaMelbourneAustralia
| | - Michelle Gooey
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | - Emma Haycraft
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Andrew P. Hills
- School of Health SciencesUniversity of TasmaniaTasmaniaLauncestonAustralia
| | | | - Oliver Hooper
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | | | - Pam Kappelides
- Department of ManagementLa Trobe UniversityVictoriaBundooraAustralia
| | - Sue Kleve
- Department of Nutrition, Dietetics and Food, School of Clinical SciencesMonash UniversityVictoriaClaytonAustralia
| | - Jacynta Krakouer
- Health and Social Care Unit, School of Public Health and Preventive MedicineMonash UniversityVictoriaMelbourneAustralia
| | | | - Yannis Manios
- Department of Nutrition and DieteticsHarokopio University of AthensAthensGreece
- Institute of Agri‐food and Life SciencesHellenic Mediterranean University Research CentreHeraklionGreece
| | - Athar Mansoor
- The Hong Kong University of Science and TechnologyHong KongHong Kong
| | | | - Louise C. Mâsse
- BC Children's Hospital Research Institute/School of Population and Public HealthUniversity of British ColumbiaBritish ColumbiaVancouverCanada
| | | | - Zandile June‐Rose Mchiza
- Non‐communicable Disease Research Unit, South African Medical Research Council & School of Public Health, Faculty of Community and Health SciencesUniversity of the Western CapeBellvilleSouth Africa
| | - Caroline Meyer
- Executive Office, Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - George Moschonis
- Department of Food, Nutrition and Dietetics, School of Allied Health, Human Services and SportLa Trobe UniversityVictoriaBundooraAustralia
| | - Emily R. Munro
- Tilda Goldberg Centre for Social Work and Social CareUniversity of BedfordshireLutonUK
| | - Teresia Margareta O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of PediatricsBaylor College of MedicineTexasHoustonUSA
| | - Adrienne O'Neil
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food & Mood Centre, School of MedicineDeakin UniversityVictoriaGeelongAustralia
| | | | - Rachel Sandford
- School of Sport, Exercise and Health SciencesLoughborough UniversityLoughboroughUK
| | - Janet U. Schneiderman
- Department of Nursing, Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaCaliforniaLos AngelesUSA
| | | | - Doug Simkiss
- Executive Office, Warwick Medical SchoolUniversity of WarwickCoventryUK
- Birmingham Community Healthcare NHS Foundation TrustBirminghamUK
- Aston UniversityBirminghamUK
| | - Alison Spence
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | - Elizabeth Sturgiss
- School of Primary and Allied Health CareMonash UniversityFrankstonVictoriaAustralia
| | | | - Rebecca Wickes
- Griffith Criminology InstituteGriffith UniversityBrisbaneQueenslandAustralia
| | - Luke Wolfenden
- School of Medicine and Public Health, College of Health, Medicine and WellbeingThe University of NewcastleCallaghanNew South WalesAustralia
| | - Mary Story
- Duke Global Health InstituteDurhamNorth CarolinaUSA
| | - Maureen M. Black
- School of MedicineUniversity of MarylandCollege ParkMarylandUSA
- Research Triangle Institute InternationalResearch Triangle ParkNorth CarolinaUSA
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17
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Moonen X, Festen D, Bakker-van Gijsel E, Vervoort-Schel J. A Dutch Perspective on Two Health Related Issues Regarding Children and Adolescents with Intellectual Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11698. [PMID: 36141966 PMCID: PMC9517279 DOI: 10.3390/ijerph191811698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
In this opinion article, we want to inspire readers by highlighting recent Dutch developments about two important health related issues regarding the quality of life of children and adolescents with intellectual disabilities. Firstly we focus on the prevention, treatment and reduction of (disability-related) somatic and psychological problems by specialized physicians for people with intellectual disabilities. Secondly, we emphasize the importance of the prevention of adverse childhood experiences and the promotion of protective and compensatory experiences. Subsequently, we stress the need for trauma informed care to support children and adolescents with intellectual disabilities who encounter adverse events. A specialized and multidisciplinary approach is advised as is the need for promoting healthy (family) relations with a focus on (co)regulation and connection as a basis for recovery.
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Affiliation(s)
- Xavier Moonen
- Ben Sajet Center, Zwanenburgwal 206, 1011 JH Amsterdam, The Netherlands
- Department of Child Development and Education, University of Amsterdam, 1018 WS Amsterdam, The Netherlands
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands
| | - Dederieke Festen
- Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | | | - Jessica Vervoort-Schel
- Ben Sajet Center, Zwanenburgwal 206, 1011 JH Amsterdam, The Netherlands
- Department of Child Development and Education, University of Amsterdam, 1018 WS Amsterdam, The Netherlands
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands
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18
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Purtle J, Nelson KL, Gollust SE. Public Opinion About Adverse Childhood Experiences: Social Stigma, Attribution of Blame, and Government Intervention. CHILD MALTREATMENT 2022; 27:344-355. [PMID: 33769126 DOI: 10.1177/10775595211004783] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Adverse childhood experiences (ACEs) are receiving increasing attention in academic, policy, and media discourses. However, no public opinion research has focused on ACEs. We conducted a nationally representative survey of U.S. adults to address this knowledge gap. A web-based survey was conducted using the Ipsos KnowledgePanel (N = 503, completion rate = 60.5%) in fall 2019. We found that inter-personal stigma and parental blame related to ACEs were prevalent, with 25.0% of respondents unwilling to have a person with "a lot of ACEs" as a close co-worker and 65.2% believing that parents were very much to blame for the consequences of ACEs. Fifty percent of respondents believed that government intervention to prevent ACEs was very important. After adjustment for demographic characteristics, inter-personal stigma toward people with ACEs and conservative ideology were significantly associated with lower perceived importance of government intervention to prevent ACEs. Black race, Hispanic ethnicity, and female gender were significantly associated with higher perceived importance of government intervention. These findings provide an empirical foundation to inform strategies to communicate ACE science to public and policymaker audiences.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Katherine L Nelson
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Dembo RS, LaFleur J, Akobirshoev I, Dooley DP, Batra N, Mitra M. Racial/ethnic health disparities among children with special health care needs in Boston, Massachusetts. Disabil Health J 2022; 15:101316. [PMID: 35387761 DOI: 10.1016/j.dhjo.2022.101316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/28/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the factors that contribute to racial/ethnic disparities among children with special health care needs (CSHCN). OBJECTIVE To quantify the contributions of determinants of racial/ethnic disparities in health and health care among CSHCN in Boston, Massachusetts. METHODS A sample of 326 Black, Latino, and white CSHCN was drawn from the Boston Survey of Children's Health, a city-wide representative sample of children. The study implemented Oaxaca-Blinder-style decomposition techniques to examine the relative contributions of health resources and child-, family-, and neighborhood-level factors to disparities in four outcomes: health status, barriers to medical care, oral health status, and utilization of preventive dental care. RESULTS White CSHCN had a greater likelihood of having very good/excellent health and oral health and were less likely to experience barriers to care than Black CSHCN. Compositional differences on predictors explained 63%, 98%, and 80% of these gradients, respectively. Group variation in household income, family structure, neighborhood support, and exposure to adverse childhood experiences accounted for significant portions of the Black-white gaps in health and access. White CSHCN were also more likely to have very good/excellent health and oral health compared to Latino CSHCN. Differences on predictors accounted for about 86% and 80% of these gaps, respectively. Household income, adverse childhood experiences, and household language emerged as significant determinants of Latino-white disparities. CONCLUSIONS Racial/ethnic health disparities among CSHCN are explained by relatively few determinants. Several of the contributing factors that emerged from the analysis and could be targeted by public health and policy interventions.
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Affiliation(s)
- Robert S Dembo
- Waisman Center, University of Wisconsin-Madison, 1500 Highland Ave, Madison, WI, 53705, USA
| | - Jennifer LaFleur
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, MS 035, Waltham, MA, 02453, USA.
| | - Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, MS 035, Waltham, MA, 02453, USA
| | - Daniel P Dooley
- Research and Evaluation Office, Boston Public Health Commission, 1010 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Neelesh Batra
- Research and Evaluation Office, Boston Public Health Commission, 1010 Massachusetts Avenue, Boston, MA, 02118, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, 415 South Street, MS 035, Waltham, MA, 02453, USA
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20
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Joseph-Lemon L, Thompson H, Verostick L, Shizuka Oura H, Jolles DR. Outcomes of Cannabis Use During Pregnancy Within the American Association of Birth Centers Perinatal Data Registry 2007-2020: Opportunities Within Midwifery-Led Care. J Perinat Neonatal Nurs 2022; 36:264-273. [PMID: 35894723 DOI: 10.1097/jpn.0000000000000668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Healthcare providers require data on associations between perinatal cannabis use and birth outcomes. METHODS This observational secondary analysis come from the largest perinatal data registry in the United States related to the midwifery-led birth center model care (American Association of Birth Centers Perinatal Data Registry; N = 19 286). Births are planned across all birth settings (home, birth center, hospital); care is provided by midwives and physicians. RESULTS Population data show that both early and persistent self-reports of cannabis use were associated with higher rates of preterm birth, low-birth-weight, lower 1-minute Apgar score, gestational weight gain, and postpartum hemorrhage. Once controlled for medical and social risk factors using logistic regression, differences for childbearing people disappeared except that the persistent use group was less likely to experience "no intrapartum complications" (adjusted odds ratio [aOR] = 0.49; 95% confidence interval [CI], 0.32-0.76; P < .01), more likely to experience an indeterminate fetal heart rate in labor (aOR = 3.218; 95% CI, 2.23-4.65; P < .05), chorioamnionitis (aOR = 2.8; 95% CI, 1.58-5.0; P < .01), low-birth-weight (aOR = 1.8; 95% CI, 1.08-3.05; P < .01), and neonatal intensive care unit (NICU) admission (aOR = 2.4; 95% CI, 1.30-4.69; P < .05). CONCLUSIONS Well-controlled data demonstrate that self-reports of persistent cannabis use through the third trimester are associated with an increased risk of low-birth-weight and NICU admission.
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Affiliation(s)
- Lodz Joseph-Lemon
- El Rio Health, Tucson, Arizona (Ms Joseph-Lemon); Elephant Circle, Palisade, Colorado (Dr Thompson); Conemaugh OB/Gyne Associates, Duke Life Point Conemaugh, Johnstown, Pennsylvania (Dr Verostick); Mel and Enid Zuckerman College of Public Health, the University of Arizona, Tucson (Ms Shizuka Oura); and Frontier Nursing University, Versailles, Kentucky (Dr Jolles)
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21
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Purtle J, Nelson KL, Gebrekristos L, Lê-Scherban F, Gollust SE. Partisan differences in the effects of economic evidence and local data on legislator engagement with dissemination materials about behavioral health: a dissemination trial. Implement Sci 2022; 17:38. [PMID: 35729630 PMCID: PMC9213102 DOI: 10.1186/s13012-022-01214-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND State legislators make policy decisions that influence children's exposure to adverse childhood experiences (ACEs), such as child maltreatment, and their effects on behavioral health. Effective dissemination of scientific research can increase the likelihood that legislators' decisions are aligned with evidence to prevent ACEs and their consequences, and effective dissemination requires legislators to engage with dissemination materials. Informed by the elaboration likelihood model of persuasive communication and Brownson's Model of Dissemination Research, we tested the hypothesis that inclusion of economic evidence and local data would increase legislator engagement with dissemination materials about evidence-supported policies related to ACEs and behavioral health. METHODS A three-arm randomized dissemination trial was conducted. A university researcher e-mailed dissemination materials which contained evidence about ACEs and behavioral health problems to state legislators (two e-mails sent 2 weeks apart, 12,662 e-mails delivered to 6509 legislators). The e-mail subject lines, text, and policy brief content were manipulated across the study arms. The intervention condition received state-tailored data about rates of ACEs and state-tailored economic evidence about the costs of ACEs for public systems, the enhanced control condition received state-tailored data and not economic evidence, and the control condition received national data and not economic evidence. Outcomes were rates of e-mail views, policy brief link clicks, requests for researcher consultation, and mentions of child maltreatment terms in legislators' social media posts. RESULTS For the first e-mail, the e-mail view rate was 42.6% higher in the intervention than in the enhanced control condition (22.8% vs. 14.8%) and 20.8% higher than in the control condition (22.8% vs. 18.5%) (both p < .0001). Similar results were observed for the second e-mail. These differences remained significant after adjustment for demographic differences across study conditions in individual-level models, but not multilevel models. There was a significant interaction between the experimental condition and political party (p < .0001) in which the intervention increased e-mail view rates among Democrats but not Republicans. The intervention had no effect on policy brief link clicks or requests for consultation and a mixed effect on social media posts. CONCLUSIONS Inclusion of state-tailored economic evidence in dissemination materials can increase engagement with research evidence among Democrat, but not Republican, legislators. Dissemination strategies tailored for legislators' political party affiliation may be needed.
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Affiliation(s)
- Jonathan Purtle
- New York University School of Global Public Health, New York City, USA.
| | | | | | | | - Sarah E Gollust
- University of Minnesota School of Public Health, Minneapolis, USA
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22
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Emotional Wellbeing in Adolescents Living With Chronic Conditions: A Metasynthesis of the Qualitative Literature. J Adolesc Health 2022; 70:864-876. [PMID: 35168883 DOI: 10.1016/j.jadohealth.2021.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/22/2022]
Abstract
Adolescents living with chronic conditions (ALWCCs) are at a higher risk of suicide (odds ratio: 4.3) than their peers. No consensus exists in the scientific community on a definition or conceptual elements of emotional well-being in this vulnerable population, hindering informed interventional research. This study investigated the meaning of emotional well-being in ALWCCs. A systematic metasynthesis of the qualitative literature was performed and structured using ENTREQ guidelines for reporting qualitative metasynthesis. A final sample of 11 primary qualitative studies met inclusion criteria and was critically analyzed using a team-based thematic synthesis and reciprocal translation approach. The meaning of emotional well-being in ALWCCs is having positive relationships that ease loss, foster hope and resilience, and promote self-efficacy and self-actualization. The role of healthcare providers as a safe, stable nurturing relationship which promotes hope and positive body image emerges an area for future research. Spirituality as it relates to emotional well-being in this population is scarce in the qualitative literature and should be further explored.
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23
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Thomas K. Early relational health - A promising approach for equitable systems change in pediatrics: A commentary. Infant Ment Health J 2022; 43:507-514. [PMID: 35579363 DOI: 10.1002/imhj.21984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 11/11/2022]
Abstract
Pediatric primary care plays a critical role in supporting the healthy development of young children. Wisdom and research suggest that every developmental domain is shaped by the quality of close relationships, particularly the caregiver-child relationship. Therefore, pediatric primary care has a unique opportunity to support and nurture early relationships using the Early Relational Health (ERH) framework and its applications Early Relational Health Screen, and Early Relational Health Conversations. ERH and its applications recognize years of innovation focused on the promotion of the wellbeing of caregiver-child relationships, and children's long-term development. Central to enhancing and elevating pediatric practice is intentional effort in using diversity-informed, anti-racist, equitable systems of care frameworks. This Commentary offers a call to action for pediatric primary care to create more equitable and inclusive practice via ERH. The call to action includes deepening self and institutional awareness; allocating resources for systems change, including infusing greater equity into departmental structures; and, building authentic relationships with patients, families, and communities. This will result in intentional systems change centered on equitable practice.
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24
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Ignacio DA, Emick-Seibert J, Serpas DG, Fernandez YS, Bargotra S, Bush J. Individual, family, and social correlates of flourishing outcomes among youth: Findings from the 2016-2017 National Survey of Children's Health. CHILD ABUSE & NEGLECT 2022; 127:105560. [PMID: 35180647 DOI: 10.1016/j.chiabu.2022.105560] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 01/25/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Flourishing is considered an optimal state of well-being and is associated with positive psychological outcomes. Although, individual, family, and social factors may either facilitate or impede flourishing, their unique influence on flourishing outcomes is not well-understood among youth. OBJECTIVE Using data from the 2016-2017 National Survey of Children's Health (NSCH), this study investigated cross-sectional associations among adverse family experiences (AFE), community safety, family resilience, parental aggravation, and flourishing among youth. PARTICIPANTS AND SETTING Data from the 2016-2017 NSCH (N = 51,156) were analyzed. Participants included males (n = 26,124) and females (n = 25,032) whose ages ranged from 6 to 17 years old (M = 12.14, SD = 3.45). METHODS After controlling for relevant demographics, adjusted odds ratios (AORs) using a single-block logistic regression determined the relative likelihood of flourishing. RESULTS Youth who experienced zero to one AFE (AOR = 2.10; 95% CI [1.95, 2.26]) and two to three AFEs (1.32 [1.20, 1.45]) were more likely to flourish than youth with four or more AFEs. Youth whose parents endorsed low parental aggravation (6.80 [6.41, 7.22]) and moderate parental aggravation (3.70 [3.51, 3.89]) were more likely to be flourishing than youth whose parents endorsed high parental aggravation. CONCLUSIONS Findings suggest that high parental aggravation is related to poorer flourishing outcomes, after considering community safety, family adversity, family resilience, and demographic characteristics. Providers should consider interventions to support the emotional regulation of parental systems as a means of maximizing developmental outcomes among youth.
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Affiliation(s)
- Daniel Andre Ignacio
- St. Jude Brain Injury Network: HI-CARES, United States of America; Department of Psychology, Fielding Graduate University, United States of America; Department of Psychology, California State University, Fullerton, United States of America.
| | | | - Dylan G Serpas
- St. Jude Brain Injury Network: HI-CARES, United States of America; Department of Psychology, California State University, Fullerton, United States of America
| | - Yuliana Stacy Fernandez
- St. Jude Brain Injury Network: HI-CARES, United States of America; Department of Psychology, California State University, Fullerton, United States of America
| | - Sonali Bargotra
- St. Jude Brain Injury Network: HI-CARES, United States of America; Department of Psychology, California State University, Fullerton, United States of America
| | - Joe Bush
- Department of Psychology, Fielding Graduate University, United States of America
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25
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Dubowitz H, Finkelhor D, Zolotor A, Kleven J, Davis N. Addressing Adverse Childhood Experiences in Primary Care: Challenges and Considerations. Pediatrics 2022; 149:e2021052641. [PMID: 35362065 PMCID: PMC9405315 DOI: 10.1542/peds.2021-052641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/24/2022] Open
Abstract
This article draws attention to the overlapping literature on social determinants of health and adverse childhood experiences, and the growing clinical interest in addressing them to promote children's and parents' health and well-being. We address important considerations and suggest solutions for leaders and practitioners in primary care to address social determinants of health/adverse childhood experiences. Priorities include: begin with a few prevalent conditions for which there are helpful resources; focus on conditions that are current or recent and where parents may be more apt to engage in services; focus initially on families with children aged <6 given the frequency of well-child visits and the especially strong relationships between primary care professionals and parents during this period; ensure training of primary care professionals and staff to help them play this role competently and comfortably; and have good referral processes to facilitate additional evaluation or help.
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Affiliation(s)
- Howard Dubowitz
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - David Finkelhor
- Department of Sociology, University of New Hampshire, Durham, New Hampshire
| | - Adam Zolotor
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Jennifer Kleven
- Department of Pediatrics, Gundersen Health System, La Crosse, Wisconsin
| | - Neal Davis
- Pediatric Community Based Care, Intermountain Primary Children’s Hospital, Salt Lake City, Utah
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26
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NASN Position Statement: The Behavioral Health and Wellness of Students. NASN Sch Nurse 2022; 37:103-105. [PMID: 35086374 DOI: 10.1177/1942602x211066656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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27
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A Qualitative Study of Pediatricians' Adverse Childhood Experiences Screening Workflows. Acad Pediatr 2022; 22:1346-1352. [PMID: 35462065 PMCID: PMC9587130 DOI: 10.1016/j.acap.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND & OBJECTIVE Adverse childhood experiences (ACEs) are associated with poor health outcomes over the life course. Interest in ACEs screening is growing, but standard ACEs screening workflows have yet to be established. We aimed to describe common workflow processes and variation among pediatricians who have successfully implemented ACEs screening and response protocols. METHODS We conducted semi-structured interviews with members of the American Academy of Pediatrics who practiced in clinical pediatric settings that implemented standardized ACEs screening (n = 18 physicians). Interviews were coded and analyzed using thematic content analysis and clinical processes were examined for differences across ACEs screening workflow processes. RESULTS ACEs screening workflows varied considerably, hinging primarily on determination of a positive screen, the type of interventions recommended in response, and protocolization of the workflow. We identified 5 major theme domains related to ACEs screening workflows: 1) degree of protocolization of the workflow, 2) screening tool(s) used, 3) timing of screening, 4) clinic staff involvement, and 5) interventions recommended and/or initiated by the physician. Common workflow processes were identified and grouped based on determination of and thresholds for response to a positive screen. Clinicians used symptoms, ACE score, or a combination of the 2 as criteria for deciding when to intervene and to what degree, though protocolization of this approach varied. CONCLUSIONS ACEs screening workflow variability was largely driven by clinical feasibility and availability of ACEs intervention resources. This variability demonstrates that a one-size-fits-all standardized screening protocol may not be universally feasible or appropriate across practices.
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28
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Piper KN, Elder A, Renfro T, Iwan A, Ramirez M, Woods-Jaeger B. The Importance of Anti-Racism in Trauma-Informed Family Engagement. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:125-138. [PMID: 34195916 PMCID: PMC9729020 DOI: 10.1007/s10488-021-01147-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 01/03/2023]
Abstract
Students of color are disproportionately affected by exposure to adverse childhood experiences (ACEs), racial trauma, and traumatic stress. Trauma-informed interventions in schools can promote healing among ACE-impacted students of color. These interventions require collaboration with family members to decide upon services and referrals; however, educators commonly face challenges with engaging families. The study purpose is to understand barriers and facilitators to engaging families in trauma-informed mental health interventions for ACE-impacted students of color. As part of a larger school-based trauma-informed trial (Link for Equity), 6 focus groups were conducted with parents/guardians of color and school staff (n = 39) across 3 Midwestern school districts. Participants were asked open-ended questions about trauma, discrimination, school supports, and family engagement. Transcripts were coded by two team members, and thematic analysis was used to identify barriers/facilitators to family involvement. Results indicated that families of ACE-impacted students of color commonly experienced racism including microaggressions and stereotypes from the school community, which deterred engagement and prevented trusting relationships between families and school staff. Parents highlighted feeling excluded from decisions related to their child's education and that their voices were not heard or understood. Participants discussed the need for schools to consider how family obstacles (such as mental health and trauma) may prevent families from engaging with staff, and they recommended structural changes, such as anti-racism trainings for educators. Findings highlight the need for anti-racist work that addresses interpersonal and structural racism in schools, in order to promote family engagement in trauma-informed mental health interventions.
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Affiliation(s)
- Kaitlin N. Piper
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amy Elder
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Tiffaney Renfro
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Allison Iwan
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Marizen Ramirez
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Briana Woods-Jaeger
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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29
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Perez Jolles M, Mack WJ, Reaves C, Saldana L, Stadnick NA, Fernandez ME, Aarons GA. Using a participatory method to test a strategy supporting the implementation of a state policy on screening children for adverse childhood experiences (ACEs) in a Federally Qualified Health Center system: a stepped-wedge cluster randomized trial. Implement Sci Commun 2021; 2:143. [PMID: 34930500 PMCID: PMC8685798 DOI: 10.1186/s43058-021-00244-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are potentially traumatic events occurring before age 18, such as maltreatment or exposure to violence. ACE screening is increasingly recommended to prevent and address physical and mental health conditions associated with ACEs. To promote ACE screening uptake, the state of California issued the "ACEs Aware" policy that provides Medicaid reimbursement for ACE screening annually for child primary care visits. However, policy directives alone often do not translate into effective screening efforts and greater access to care. Few rigorous studies have developed and tested implementation strategies for ACE pediatric screening policies. This study will fill this gap by testing a multifaceted implementation strategy in partnership with a Federally Qualified Health Center (FQHC) system serving low-income families in Southern California to support the ACE Aware policy. METHODS We will use Implementation Mapping, with study process and consideration of determinants and mechanisms guided by the EPIS framework, to co-create and refine an implementation strategy. The proposed strategy is comprised of online training videos, a customized algorithm and use of technology to improve workflow efficiency, implementation training to internal FQHC personnel, clinic support and coaching, and written implementation protocols. A hybrid type 2, stepped-wedge cluster randomized trial design with five primary care clinics will test whether a multifaceted implementation strategy improves (a) fidelity to the ACE screening protocol, (b) reach defined as the proportion of eligible children screened for ACEs, and (c) the impact of the ACE policy on child-level mental health referrals and symptom outcomes. The study will use mixed methods with data to include electronic health records, surveys, and interviews with clinic personnel and caregivers. DISCUSSION This study is designed to increase the capacity of FQHCs' inner context to successfully implement an outer context-initiated ACE policy designed to benefit pediatric patients. It capitalizes on a rare opportunity to use a co-creation approach to develop, adapt, refine, and pilot test an implementation strategy to maximize the impact of a new state-wide policy intended to improve ACE assessment and subsequent care to improve child health, particularly those from underserved communities. TRIAL REGISTRATION Trial # NCT04916587 registered at ClinicalTrials.gov on June 4, 2021.
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Affiliation(s)
- Monica Perez Jolles
- Suzanne Dworak-Peck School of Social Work, Affiliate Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles, CA, USA.
| | - Wendy J Mack
- Department of Population and Public Health Sciences, Keck School of Medicine, University of University of Southern California, Los Angeles, CA, USA
| | | | | | - Nicole A Stadnick
- Child and Adolescent Services Research Center, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, San Diego, CA, USA.,Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.,Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
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30
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Hillis SD, Blenkinsop A, Villaveces A, Annor FB, Liburd L, Massetti GM, Demissie Z, Mercy JA, Nelson Iii CA, Cluver L, Flaxman S, Sherr L, Donnelly CA, Ratmann O, Unwin HJT. COVID-19-Associated Orphanhood and Caregiver Death in the United States. Pediatrics 2021; 148:e2021053760. [PMID: 34620728 PMCID: PMC10896160 DOI: 10.1542/peds.2021-053760] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most coronavirus disease 2019 (COVID-19) deaths occur among adults, not children, and attention has focused on mitigating COVID-19 burden among adults. However, a tragic consequence of adult deaths is that high numbers of children might lose their parents and caregivers to COVID-19-associated deaths. METHODS We quantified COVID-19-associated caregiver loss and orphanhood in the United States and for each state using fertility and excess and COVID-19 mortality data. We assessed burden and rates of COVID-19-associated orphanhood and deaths of custodial and coresiding grandparents, overall and by race and ethnicity. We further examined variations in COVID-19-associated orphanhood by race and ethnicity for each state. RESULTS We found that from April 1, 2020, through June 30, 2021, >140 000 children in the United States experienced the death of a parent or grandparent caregiver. The risk of such loss was 1.1 to 4.5 times higher among children of racial and ethnic minority groups compared with non-Hispanic White children. The highest burden of COVID-19-associated death of parents and caregivers occurred in Southern border states for Hispanic children, in Southeastern states for Black children, and in states with tribal areas for American Indian and/or Alaska Native populations. CONCLUSIONS We found substantial disparities in distributions of COVID-19-associated death of parents and caregivers across racial and ethnic groups. Children losing caregivers to COVID-19 need care and safe, stable, and nurturing families with economic support, quality child care, and evidence-based parenting support programs. There is an urgent need to mount an evidence-based comprehensive response focused on those children at greatest risk in the states most affected.
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Affiliation(s)
- Susan D Hillis
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Francis B Annor
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leandris Liburd
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - James A Mercy
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles A Nelson Iii
- Department of Pediatrics, Harvard Medical School, Harvard Graduate School of Education, Harvard University and Boston Children's Hospital, Cambridge, Massachusetts
| | - Lucie Cluver
- Departments of Social Policy and Intervention
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Lorraine Sherr
- Institute for Global Health, University College London, London, United Kingdom
| | - Christl A Donnelly
- Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
- Statistics, University of Oxford, Oxford, United Kingdom
| | | | - H Juliette T Unwin
- Medical Research Council (MRC) Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
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31
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Lo SL, Riley HO, Sturza J, Vazquez DM, Rosenblum K, Kaciroti N, Lumeng JC, Miller AL. Cortisol in early childhood moderates the association between family routines and observed affective balance in children from low-income backgrounds. Dev Psychobiol 2021; 63:e22204. [PMID: 34813102 DOI: 10.1002/dev.22204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022]
Abstract
The study of emotion regulation often addresses control of negative emotion. Researchers have proposed that affective balance is an indicator of emotion regulation that incorporates the role of positive emotion in the context of negative emotional experiences. Environmental and individual factors, such as family processes and biological stress regulation, are known to shape emotion regulation. The present study investigated whether child diurnal cortisol, an indicator of biological stress regulation, moderated the association between family routines and observed affective balance. Children (N = 222; M age = 4.70 years, SD = 0.60) from low-income households provided saliva samples to measure diurnal cortisol and completed a behavioral task designed to elicit negative emotions. Affective balance was defined as the difference score between the proportion of positive and negative emotional expressions displayed during the task. A higher affective balance score indicated greater positive compared with negative emotional displays. Simple slope analyses indicated that for children with a low morning cortisol intercept, more frequent family routines were associated with more affective balance. This pattern was not observed in children with average or high morning cortisol. Positive family routines may play an important role in shaping affective balance among children with disrupted cortisol levels from low-income backgrounds.
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Affiliation(s)
- Sharon L Lo
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Hurley O Riley
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Julie Sturza
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Delia M Vazquez
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Katherine Rosenblum
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Niko Kaciroti
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Julie C Lumeng
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
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Velez ML, Jordan C, Jansson LM. Reconceptualizing non-pharmacologic approaches to Neonatal Abstinence Syndrome (NAS) and Neonatal Opioid Withdrawal Syndrome (NOWS): A theoretical and evidence-based approach. Part II: The clinical application of nonpharmacologic care for NAS/NOWS. Neurotoxicol Teratol 2021; 88:107032. [PMID: 34600100 DOI: 10.1016/j.ntt.2021.107032] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/20/2022]
Abstract
There has been increasing emphasis on the importance of the development of self-regulatory capacities of the individual as the cornerstone of development. The caregivers' abilities to manage their own attention, emotions, physiology and behaviors influence the development of the child's self-regulatory and interactive capacities, and thereby their overall development. Newborns prenatally exposed to psychoactive substances and/or to other prenatal stressors such as maternal poor nutrition, increased maternal stress, trauma, difficult and/or impoverished environments, in tandem with genetic predispositions, can result in alterations to their neurodevelopment that predispose them to self-regulatory problems that can be expressed at any stage of life. The care of infants with Neonatal Abstinence Syndrome (NAS)/Neonatal Opioid Withdrawal Syndrome (NOWS) and their mother/caregiver is a window of opportunity to assess the regulatory and co-regulatory capacities of both, and to provide holistic interventions with the goal of empowering the mother/caregiver in their own self-knowledge/self-regulation capacities and their crucial role in promoting the healthy development of their children. Non-pharmacologic care for the infant with NAS/NOWS is the first line of treatment and of paramount importance. Yet, current approaches are based on a limited scope of infant functioning, and the scoring systems in current use do not result in individualized and specific non-pharmacologic care of the infant, which can result in excessive or insufficient medication and a lack of caregiver appreciation for the infant's strengths, difficulties and early development. The interventions described here are based on the infant's signs of dysregulation in four neurobehavioral subsystems that can be dysregulated by NAS/NOWS, the infant's adaptive or maladaptive responses to return to a regulated functioning, and the co-regulatory behaviors of the infant and the mother/caregiver. In Part I of this two-part series on re-conceptualizing non-pharmacologic care for NAS/NOWS we laid the foundation for a new treatment approach, one grounded in developmental theory and evidence-based observations of infant and interpersonal neurobiology. Here, in Part II, we outline actionable, individually tailored evaluations and approaches to non-pharmacologic NAS/NOWS treatment based on strategies to support the regulatory capacities and development of 4 key domains: 1) autonomic; 2) motor/tone; 3) sleep/awake state control; and 4) sensory modulation subsystems.
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Affiliation(s)
- Martha L Velez
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
| | - Chloe Jordan
- Division of Alcohol, Drugs and Addiction, Department of Psychiatry, McLean Hospital/Harvard Medical School, Belmont, MA, USA.
| | - Lauren M Jansson
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA.
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Rehmus W, Zarbafian M, Alobaida S, Bland C, Hanson D, McIntosh G, Pikksalu K, Loock C. Integrating dermatology services into a social pediatrics network: 8 years of experience in the RICHER (Responsive, Interdisciplinary/Intersectoral, Child/Community, Health, Education and Research) program. Pediatr Dermatol 2021; 38 Suppl 2:174-178. [PMID: 34398992 DOI: 10.1111/pde.14762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Social pediatric initiatives aim to improve health outcomes for vulnerable children by working in the community to empower families, to enhance protective factors that mitigate adverse childhood experiences (ACEs), and to deliver place-based health care. In 2012, pediatric dermatology was added as a component of the Responsive, Interdisciplinary Intersectoral Child and Community Health Education and Research (RICHER) social pediatric program in Vancouver, BC. We share our experience with inclusion of pediatric dermatology in a well-established social pediatric program as well as lessons we have learned in the first 8 years of our partnership. Partnership, bridging trust, knowledge sharing, empowerment, consistency, and flexibility were found to be central elements in the success of this endeavor.
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Affiliation(s)
- Wingfield Rehmus
- Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital, RICHER Program, Vancouver, BC, Canada
| | - Misha Zarbafian
- Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Saud Alobaida
- Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Clea Bland
- BC Children's Hospital, RICHER Program, Vancouver, BC, Canada
| | - Denise Hanson
- BC Children's Hospital, RICHER Program, Vancouver, BC, Canada
| | - Gwyn McIntosh
- BC Children's Hospital, RICHER Program, Vancouver, BC, Canada
| | | | - Christine Loock
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital, RICHER Program, Vancouver, BC, Canada
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Malti T, Cheah CSL. Toward complementarity: Specificity and commonality in social-emotional development: Introduction to the special section. Child Dev 2021; 92:e1085-e1094. [PMID: 34658013 DOI: 10.1111/cdev.13690] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
What are the roles of specificity and commonality in social-emotional development? We begin by highlighting the conceptual context for this timely and timeless question and explain how responses to it can inform novel lines of theoretical and empirical inquiry, as well as sociocultural generalizability. Next, we describe how the selection of papers included in this special section contributes to our understanding of specificity and commonality in social-emotional development. We then explain how applying the complementarity principle to social-emotional development can inform a future research agenda in this domain. Lastly, we discuss how specificity and commonality fundamentally impact the way we conceptualize and implement interventions aimed at nurturing social-emotional development in every child.
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Affiliation(s)
- Tina Malti
- Department of Psychology, University of Toronto, Mississauga, Ontario, Canada.,Centre for Child Development, Mental Health, and Policy, University of Toronto, Mississauga, Ontario, Canada
| | - Charissa S L Cheah
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, USA
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Morgart K, Harrison JN, Hoon AH, Wilms Floet AM. Adverse childhood experiences and developmental disabilities: risks, resiliency, and policy. Dev Med Child Neurol 2021; 63:1149-1154. [PMID: 33938573 DOI: 10.1111/dmcn.14911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 01/11/2023]
Abstract
Thanks to the seminal work of Robert Anda and Vincent Felitti, it is now widely accepted that adverse childhood experiences (ACEs) can have lifelong effects on physical, behavioral, and mental health and that many adult diseases can be considered developmental disorders that began early in life. Genomics has advanced the neurobiological understanding that underpins ACEs, wellness, and disease, which are modulated through stress pathways and epigenetic modifications. While data are currently limited, children with developmental disabilities have an increased ACE risk compared to typically developing peers. This recognition has important ramifications for health and policy interventions that address the root causes of ACEs, especially in this vulnerable population. With increased societal recognition, advances in policy will lead to medical, financial, and public benefits in years to come, hopefully changing healthcare models from 'sick care' to 'well care'. What this paper adds Adverse childhood experience (ACE) research has refocused medicine from the question 'What is wrong with you?' to 'What happened to you?'. Adopting ACE research into public policy can redirect healthcare models from providing 'sick care' to promoting 'well care'. Not exploring the role of ACEs in children with developmental disabilities leads to further vulnerability and morbidity. ACEs can be mitigated by early identification and implementation of evidence-based interventions.
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Affiliation(s)
| | - Joyce Nolan Harrison
- Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander H Hoon
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Phelps Center for Cerebral Palsy and Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Anna Maria Wilms Floet
- Kennedy Krieger Institute, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Ross MK, Romero T, Szilagyi PG. Adverse Childhood Experiences and Association With Pediatric Asthma Severity in the 2016-2017 National Survey of Children's Health. Acad Pediatr 2021; 21:1025-1030. [PMID: 33940207 PMCID: PMC8947844 DOI: 10.1016/j.acap.2021.04.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/14/2021] [Accepted: 04/23/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Prior studies have found that adverse childhood experiences (ACEs) are associated with asthma prevalence and onset, presumably related to stress and increased inflammation. We hypothesized that ACEs may be associated with asthma severity as well. We studied the 2016-2017 US National Survey of Children's Health dataset to explore the relationship between ACEs and pediatric asthma severity. METHODS We analyzed children ages 0 to 17 years old who had current caregiver-reported asthma diagnosed by a healthcare provider. We reported descriptive characteristics using chi-square analysis of variance (ANOVA) and used multivariable regression analysis to assess the relationship of cumulative and individual ACEs with asthma severity. Survey sampling weights and SAS survey procedures were implemented to produce nationally representative results. RESULTS Our analysis included 3691 children, representing a population of 5,465,926. Unadjusted analysis demonstrated that ACEs - particularly household economic hardship, parent/guardian served time in jail, witnessed household violence, or victim/witness of neighborhood violence - were each associated with higher odds of moderate/severe caregiver-reported asthma. After controlling for confounders possibly associated with both exposure (ACEs) and outcome (asthma severity), children who witnessed parent/adult violence had higher adjusted odds of caregiver-reported moderate/severe asthma. (1.67, confidence interval 1.05-2.64, P = .03) CONCLUSIONS: Intrafamilial witnessed household violence is significantly associated with caregiver-reported moderate/severe asthma.
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Affiliation(s)
- Mindy K. Ross
- University of California Los Angeles, Department of Pediatrics, Pediatric Pulmonology and Sleep Medicine, Los Angeles, Calif
| | - Tahmineh Romero
- University of California Los Angeles, Department of Medicine, Statistical Core, Los Angeles, Calif
| | - Peter G Szilagyi
- University of California Los Angeles, Department of Pediatrics, General Pediatrics, Los Angeles, Calif
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Norris G, Norris H. Building Resilience Through Sport in Young People With Adverse Childhood Experiences. Front Sports Act Living 2021; 3:663587. [PMID: 34337400 PMCID: PMC8319951 DOI: 10.3389/fspor.2021.663587] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022] Open
Abstract
Interventions focused on young people at risk of anti-social and criminal behaviour frequently involve physical exercise and/or participation in sporting activities as a primary vehicle to bring about behavioural change in both the short to medium term. Anecdotal evidence suggests that sporting activities positively influence individual well-being alongside a sense of purpose and belonging centred around sporting clubs and activities. Empirically, participation in sport has been identified as a key resilience factor for young people with numerous Adverse Childhood Experiences (ACEs) and investment and policy initiatives target investment in these opportunities. However, the psychological mechanisms which underpin these improvements in well-being and building of resilience are less clearly articulated. This article will review current and developing research in this field to synthesise future applications of sport-related interventions with young people, with a particular emphasis on furthering understanding of the pathways to capacity building at individual and community level which sport and exercise can generate.
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Affiliation(s)
- Gareth Norris
- Department of Psychology, Faculty of Earth and Life Sciences, Aberystwyth University, Aberystwyth, United Kingdom
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Ghandour RM, Hirai AH, Moore KA, Robinson LR, Kaminski JW, Murphy K, Lu MC, Kogan MD. Healthy and Ready to Learn: Prevalence and Correlates of School Readiness among United States Preschoolers. Acad Pediatr 2021; 21:818-829. [PMID: 33667721 PMCID: PMC10947794 DOI: 10.1016/j.acap.2021.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the national and state prevalence of being "Healthy and Ready to Learn" (HRL) and associated sociodemographic, health, family and neighborhood factors. METHODS Cross-sectional analysis of the 2016 National Survey of Children's Health, a nationally representative parent-reported survey administered by web and paper June 2016 to February 2017. Four domains were constructed from 18 items through confirmatory factor analyses: "Early Learning Skills", "Social-Emotional Development", "Self-Regulation", and "Physical Well-being and Motor Development." Each item and domain were scored according to age-specific standards as "On-Track", "Needs Support", and "At Risk" with overall HRL defined as "On-Track" in all domains for 7565 randomly selected children ages 3 to 5 years. RESULTS In 2016, 42.2% of children ages 3 to 5 years were considered HRL with the proportion considered "On-Track" ranging from 58.4% for Early Learning Skills to 85.5% for Physical Well-being and Motor Development"; approximately 80% of children were considered "On-Track" in Social-Emotional Development and Self-Regulation, respectively. Sociodemographic differences were mostly non-significant in multivariable analyses. Health, family, and neighborhood factors (ie, special health care needs status/type, parental mental health, reading, singing and storytelling, screen time, adverse childhood experiences, and neighborhood amenities) were associated with HRL. HRL prevalence ranged from 25.5% (NV) to 58.7% (NY), but only 4 states were significantly different from the U.S. overall. CONCLUSIONS Based on this pilot measure, only about 4 in 10 US children ages 3 to 5 years may be considered "Healthy and Ready to Learn." Improvement opportunities exist for multiple, modifiable factors to affect young children's readiness to start school.
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Affiliation(s)
- Reem M Ghandour
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (RM Ghandour, AH Hirai, and MD Kogan), Rockville, Md.
| | - Ashley H Hirai
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (RM Ghandour, AH Hirai, and MD Kogan), Rockville, Md
| | | | - Lara R Robinson
- U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities (LR Robinson and JW Kaminski), Atlanta, Ga
| | - Jennifer W Kaminski
- U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities (LR Robinson and JW Kaminski), Atlanta, Ga
| | - Kelly Murphy
- Child Trends (KA Moore and K Murphy), Bethesda, Md
| | - Michael C Lu
- University of California Berkeley, School of Public Health (MC Lu), Berkeley, Calif
| | - Michael D Kogan
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (RM Ghandour, AH Hirai, and MD Kogan), Rockville, Md
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Affiliation(s)
- Robert D Sege
- Center for Community-Engaged Medicine, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts
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Perceived Persuasiveness of Evidence About Adverse Childhood Experiences: Results From a National Survey. Acad Pediatr 2021; 21:529-533. [PMID: 32553780 DOI: 10.1016/j.acap.2020.05.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/25/2020] [Accepted: 05/31/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Advocates must make decisions about the types of evidence they emphasize when communicating to cultivate support for adverse childhood experience (ACE) prevention policies. This study sought to characterize public perceptions of the persuasiveness of 12 ACE evidence statements and assess differences by ideology in the strength of these evidence messages as rationales for ACE prevention policies. METHODS A web-based survey of a nationally representative sample of US adults was conducted using the KnowledgePanel (N = 503, completion rate = 60.5%). Respondents read ACE evidence statements and answered questions about the extent to which each was perceived as persuasive. Data were collected and analyzed in 2019. RESULTS The evidence statements perceived as most persuasive (scoring range 3-17) were those about ACEs as risk factors for mental health and substance use conditions (mean = 12.39) and suicide (mean = 12.14); ACEs generating financial costs for society (mean = 12.03); and the consequences of ACEs being preventable by a supportive adult (mean = 11.97). The evidence statements perceived as least persuasive were about ACEs generating health care costs for individuals (mean = 9.42) and ACEs as risk factors for physical health conditions (mean = 9.47). A larger proportion of liberals than conservatives rated every statement as providing a "strong reason" for ACE prevention policies. These differences were largest for evidence about ACEs generating financial costs for society (84.6% vs 42.8%, P < .0001) and socioeconomic disparities in ACEs (65.1% vs 32.9%, P < .0001). CONCLUSIONS Many ACE evidence statements commonly used in policy advocacy differ from those perceived as most persuasive among a nationally representative sample of US adults.
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Narayan AJ, Lieberman AF, Masten AS. Intergenerational transmission and prevention of adverse childhood experiences (ACEs). Clin Psychol Rev 2021; 85:101997. [PMID: 33689982 DOI: 10.1016/j.cpr.2021.101997] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/05/2021] [Accepted: 02/23/2021] [Indexed: 12/29/2022]
Abstract
In recent years, research and practice on adverse childhood experiences (ACEs) have shifted from delineating effects of ACEs on adulthood health problems to preventing ACEs in children. Nonetheless, little attention has focused on how parents' own childhood experiences, adverse or positive, may influence the transmission of ACEs across generations. Children's risk for ACEs and potential for resilience may be linked to the early child-rearing experiences of their parents carried forward into parenting practices. Additionally, parents with multiple ACEs may have PTSD symptoms, an under-recognized mediator of risk in the intergenerational transmission of ACEs. Guided by developmental psychopathology and attachment theory with an emphasis on risk and resilience, we argue that a more comprehensive understanding of parents' childhood experiences is needed to inform prevention of ACEs in their children. Part I of this review applies risk and resilience concepts to pathways of intergenerational ACEs, highlighting parental PTSD symptoms as a key mediator, and promotive or protective processes that buffer children against intergenerational risk. Part II examines empirical findings indicating that parents' positive childhood experiences counteract intergenerational ACEs. Part III recommends clinically-sensitive screening of ACEs and positive childhood experiences in parents and children. Part IV addresses tertiary prevention strategies that mitigate intergenerational ACEs and promote positive parent-child relationships.
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Affiliation(s)
- Angela J Narayan
- Department of Psychology, University of Denver, United States of America; Department of Psychiatry and Child Trauma Research Program, University of California, San Francisco, United States of America.
| | - Alicia F Lieberman
- Department of Psychiatry and Child Trauma Research Program, University of California, San Francisco, United States of America
| | - Ann S Masten
- Institute of Child Development, University of Minnesota, Twin Cities, United States of America
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Barnett M, Sheldrick RC, Liu SR, Kia-Keating M, Negriff S. Implications of adverse childhood experiences screening on behavioral health services: A scoping review and systems modeling analysis. AMERICAN PSYCHOLOGIST 2021; 76:364-378. [PMID: 33734801 PMCID: PMC8161946 DOI: 10.1037/amp0000756] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Widespread implementation of adverse childhood experiences (ACEs) screening is occurring in the United States in response to policies and practice recommendations. However, limited research has established how these screening efforts impact the health care system and ultimately health outcomes. This article examines the current knowledge base on screening in medical settings. A scoping review of articles reporting on ACEs screening and prevalence in the United States was conducted. Of the 1,643 unique studies across two decades, 12 articles meeting criteria included nine on routine screening in medical settings and three on population-based surveys. A Monte Carlo simulation model was designed to synthesize evidence, identify key areas of uncertainty, and explore service system implications. Results indicated significant heterogeneity in the proportion of respondents who reported ACEs, with 6% to 64% of patients reporting 1+ ACEs and .01% to 40.7% reporting 4+ ACEs. Gaps in the literature were identified regarding cut-scores for referrals and referral completion rates. Three scenarios, modeled based on these data and past research on behavioral health screenings in pediatric primary care, demonstrated how ACEs screening may differentially impact behavioral health care systems. Priorities for future research were highlighted to refine estimates of the likely impact of ACEs screening on health care delivery. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Miya Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical, and School Psychology
| | | | - Sabrina R. Liu
- University of California, Santa Barbara, Department of Counseling, Clinical, and School Psychology
| | - Maryam Kia-Keating
- University of California, Santa Barbara, Department of Counseling, Clinical, and School Psychology
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A Community Partnered Approach for Defining Child and Youth Thriving. Acad Pediatr 2021; 21:53-62. [PMID: 32445827 DOI: 10.1016/j.acap.2020.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/18/2020] [Accepted: 04/23/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To develop a community-informed definition of child and youth thriving and identify community priorities for child/youth thriving. METHODS Through concept mapping, a mixed-methods community-based participatory research method, this study examined community and health professionals' conceptualizations of child and youth thriving. We conducted brainstorming, sorting and rating, and interpretation sessions in 3 geographically distinct neighborhoods with concentrated disadvantage; simultaneously, researchers and health professionals participated in online sessions. RESULTS Participants included 91 community members, health care and social service professionals, and researchers who identified 104 items related to child and youth thriving and grouped these items into 7 distinct clusters. Two clusters focused on child-level factors (Strong Minds and Bodies; Positive Identity and Self-Worth), 2 focused on place-based factors (Healthy Environments; Vibrant Communities), and 3 focused on relationships and interactions between children and their environments (Caring Families and Relationships; Safety; and Fun and Happiness). The community-informed conceptualization of child thriving builds on previous models, adding dimensions of physical health and safety. Participants ranked having "someone to talk to," being "comfortable in their own skin," having "pride in themselves," and having a "strong sense of self and self-worth" as most important to child and youth thriving. CONCLUSIONS By integrating perspectives of community members from diverse neighborhoods with those of researchers and health professionals, this study captures novel domains to inform a conceptual model of thriving that focuses on stakeholder priorities. Findings will guide development, implementation, and evaluation of community-based interventions and their impact on child and adolescent health and thriving.
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Whitley MA, Smith AL, Dorsch TE, Bowers MT, Centeio EE. Reenvisioning Postpandemic Youth Sport to Meet Young People’s Mental, Emotional, and Social Needs. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2021. [DOI: 10.1249/tjx.0000000000000177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Burgette JM. Family Resilience and Connection Is Associated with Dental Caries in US Children. JDR Clin Trans Res 2020; 7:61-70. [PMID: 33353476 DOI: 10.1177/2380084420982250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The impact of family resilience and connection on children's oral health has not been well-documented in the published literature. OBJECTIVES This study examined the association between family resilience and connection and the probability of a child having caregiver-reported dental caries using a nationally representative sample. METHODS A cross-sectional analysis of the 2016 National Survey of Children's Health was performed on US children ages 6 to 17 y. Family resilience and connection was assessed using a 6-point index and analyzed as a 3-level categorical variable. Caregivers reported whether their child had "decayed teeth or cavities" during the past 12 mo. Logistic regression was performed controlling for child (age, gender, race/ethnicity, insurance, preventive dental use) and family (education and federal poverty level) characteristics. RESULTS Among the 35,167 children in the sample, 10.4% children had caregiver-reported dental caries. The prevalence of dental caries decreased in a graded fashion with increasing levels of family resilience and connection (12.5%, 10.5%, and 8.8%, respectively; P < 0.001). As compared with children with the lowest level of family resilience and connection, those with the highest level had lower odds of caregiver-reported dental caries after adjusting for child and family covariates (adjusted odds ratio = 0.63; 95% confidence interval = 0.58, 0.69). CONCLUSION Using a nationally representative sample, children living in families with higher levels of resilience and connection had a significantly lower odds of caregiver-reported dental caries. Policies and programs that increase family resilience and connection have the potential to decrease dental caries in school-aged children. KNOWLEDGE TRANSFER STATEMENT This work suggests an association between family resilience/connection and dental caries in school-aged children. Further work is required to determine the degree to which addressing these constructs might impact child dental caries.
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Affiliation(s)
- J M Burgette
- Departments of Dental Public Health and Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Purtle J. Systematic Review of Evaluations of Trauma-Informed Organizational Interventions That Include Staff Trainings. TRAUMA, VIOLENCE & ABUSE 2020; 21:725-740. [PMID: 30079827 DOI: 10.1177/1524838018791304] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Enthusiasm for trauma-informed practice has increased dramatically. Organizational interventions that train staff about trauma-informed practice are frequently used to promote trauma-informed systems change, but evidence about these interventions' effects has not been integrated. A systematic review was conducted of studies that evaluated the effects of organizational interventions that included a "trauma-informed" staff training component. A search was conducted in July 2017 and studies were identified in PubMed, PsycINFO, and the Published International Literature on Traumatic Stress database, limited to articles published in English after 2000. Six hundred and thirty-two articles were screened and 23 met inclusion criteria. Seventeen studies used a single group pretest/posttest design, five used a randomized controlled design, and one used a quasi-experimental design with a nonrandomized control group. The duration of trauma-informed trainings ranged from 1 hr to multiple days. Staff knowledge, attitudes, and behaviors related to trauma-informed practice improved significantly pre-/posttraining in 12 studies and 7 studies found that these improvements were retained at ≥1month follow-up. Eight studies assessed the effects of a trauma-informed organizational intervention on client outcomes, five of which found statistically significantly improvements. The strength of evidence about trauma-informed organization intervention effects is limited by an abundance of single group, pretest/posttest designs with short follow-up periods, unsophisticated analytic approaches, and inconsistent use of assessment instruments. In addition to addressing these methodological limitations, priorities for future research include understanding intervention effects on clients' perceptions of care and the mechanisms through which changes in staff knowledge and attitudes about trauma-informed practice influence client outcomes.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
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Value-Driven Care in Developmental-Behavioral Pediatrics, Part 1: The Value Proposition of Developmental-Behavioral Pediatrics. J Dev Behav Pediatr 2020; 40:472-478. [PMID: 31107762 DOI: 10.1097/dbp.0000000000000685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The drive to improve quality and reduce cost of health care is leading to a value-driven transformation of the US health care landscape. This is the first of a 2-part series on value-driven care and its implications for developmental-behavioral pediatrics (DBP). Tools derived from business/manufacturing models have been applied with some success to health care to better understand and enhance value. Value can be defined most simply as health outcomes achieved per dollar spent, but there are challenges in accounting for the full cost of a cycle or episode of care. When taking into account the "five Ds"-Development, Dependency, Differential Epidemiology, Demographics, and Dollars-the potential value of pediatric care is brought into sharper focus. The field of DBP in particular has the potential to add value through prevention, integration, efficiency, standardization, and innovation. The value proposition of DBP is illustrated by focusing on particular conditions or cycles of care commonly encountered in DBP practice: (1) children 0 to 3 years of age identified as having global developmental delay, (2) recent diagnosis of complex attention-deficit hyperactivity disorder (ADHD) (ADHD plus comorbid conditions), and (3) children with autism spectrum disorder and disruptive behavior. The second part of the series focuses on quality of care, emphasizing the important challenges that lie ahead for the field of DBP in measuring outcomes of care. With a discussion of national trends and a local example of a DBP program's response to these trends, the series is intended to provoke discussion and action in the field, contribute to the demonstration of value of a DBP approach to care, and help to chart a course toward growth and sustainability of DBP in an era of value-based care.
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Baumont M, Wandasari W, Agastya NLPM, Findley S, Kusumaningrum S. Understanding childhood adversity in West Sulawesi, Indonesia. CHILD ABUSE & NEGLECT 2020; 107:104533. [PMID: 32570186 DOI: 10.1016/j.chiabu.2020.104533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Despite research indicating the long-term impact of adverse childhood experiences (ACE), few studies identify cultural variations in perceptions of ACE in low-resource settings. OBJECTIVE This study explores culturally-rooted notions of ACE and sources of vulnerability in two culturally distinct districts in West Sulawesi, Indonesia. METHODS Data from 50 stakeholders were collected from four focus group discussions and nine semi-structured key informant interviews in Mamasa and Mamuju districts in West Sulawesi. All interviews were conducted in Bahasa Indonesia, recorded, transcribed verbatim, and translated into English. Constant comparative analysis was used to identify key themes. RESULTS Primary ACE were violence, abandonment due to parents migrating for work, and malnourishment. While individual child characteristics appeared to play a minimal role in vulnerability to ACE, factors at the community and familial levels such as widespread poverty and low levels of parental education led to early transitions to adulthood through child marriage and employment. Cultural norms, particularly adherence to customary law, impacted both vulnerability and responses to violence against children. CONCLUSIONS ACE interventions should expand beyond individual and family-level interventions to address these structural and cultural barriers to resilience.
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Affiliation(s)
- Monique Baumont
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B2, New York, NY, 10032, USA.
| | - Wenny Wandasari
- Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA), School of Social and Political Sciences, Gedung FISIP UI Nusantara II Lantai 1, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, Jawa Barat 16424, Indonesia.
| | - Ni Luh Putu Maitra Agastya
- Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA), School of Social and Political Sciences, Gedung FISIP UI Nusantara II Lantai 1, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, Jawa Barat 16424, Indonesia; Department of Social Welfare, Faculty of Social and Political Sciences, Universitas Indonesia, Gedung Nusantara II Laintai 2 FISIP, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, Jawa Barat 16424, Indonesia.
| | - Sally Findley
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, 60 Haven Ave B2, New York, NY, 10032, USA.
| | - Santi Kusumaningrum
- Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA), School of Social and Political Sciences, Gedung FISIP UI Nusantara II Lantai 1, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, Jawa Barat 16424, Indonesia.
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Flower KB, Massie S, Janies K, Bassewitz JB, Coker TR, Gillespie RJ, Macias MM, Whitaker TM, Zubler J, Steinberg D, DeStigter L, Earls MF. Increasing Early Childhood Screening in Primary Care Through a Quality Improvement Collaborative. Pediatrics 2020; 146:peds.2019-2328. [PMID: 32769199 DOI: 10.1542/peds.2019-2328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Multiple early childhood screenings are recommended, but gaps persist in implementation. Our aim for this project was to improve screening, discussion, referral, and follow-up of development, autism spectrum disorder (ASD), maternal depression, and social determinants of health (SDoH) to 90% by July 2018. METHODS This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes. RESULTS Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening. CONCLUSIONS Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.
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Affiliation(s)
- Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; .,Population Health Improvement Partners, Cary, North Carolina
| | - Sara Massie
- Population Health Improvement Partners, Cary, North Carolina
| | | | | | - Tumaini R Coker
- Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Research Institute, Seattle, Washington
| | | | - Michelle M Macias
- Division of Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Toni M Whitaker
- Division of Developmental Pediatrics, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jennifer Zubler
- Learn the Signs. Act Early Program, Division of Birth Defects, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | | | | | - Marian F Earls
- Community Care of North Carolina, Raleigh, North Carolina
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Elmore AL, Crouch E, Kabir Chowdhury MA. The Interaction of Adverse Childhood Experiences and Resiliency on the Outcome of Depression Among Children and Youth, 8-17 year olds. CHILD ABUSE & NEGLECT 2020; 107:104616. [PMID: 32645587 PMCID: PMC7494539 DOI: 10.1016/j.chiabu.2020.104616] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are common among children. Little is known on how resilience factors and positive childhood experiences (PCEs) may moderate the relationship between ACEs and childhood depression. OBJECTIVE Our study fills this gap by providing recent, nationally representative estimates of ACE and PCE exposure for ages 8-17 and examines the associations between ACE exposure and PCEs on the outcome of depression. PARTICIPANTS AND SETTING Data were drawn from the nationally representative 2016-2017 National Survey of Children's Health (NSCH) and included a total sample of 40,302 children and adolescents. METHODS Chi square analysis and multivariate logistic regressions were performed to assess associations of depression with 9 ACE and 6 PCE exposures. Additive and multiplicative interactions were examined between ACE exposure and PCEs (resiliency measures) on depression. Survey sampling weights and SAS survey procedures were used. RESULTS Our study found that 4% of children had current depression and those with an ACE count greater than four had increased odds (aOR: 2.29; CI: 1.74-3.02). Multivariate regressions demonstrated associations between depression and low resiliency as well as significant interactions between ACE exposure and three PCEs. Children who were exposed to greater than four ACEs and did not exhibit resilience had 8.75 higher odds of depression (CI: 5.23-14.65) compared to those with less than four ACEs and some resilience. CONCLUSIONS These findings illustrate the need for the promotion of PCEs and the building of resiliency for combatting depression and reducing the impact of trauma in children and adolescents.
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Affiliation(s)
- Amanda L Elmore
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA.
| | - Elizabeth Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC 29210, USA
| | - Mohiuddin Ahsanul Kabir Chowdhury
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
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