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Pajer K, Gardner W, Ouellette C, Cheng M, Bissex S, MacKay R, MacLaurin T, Gandy H. Telementoring to Strengthen Child and Youth Mental Health Care Capacity in Primary Care Providers: Session Duration and Learning Outcomes. Clin Pediatr (Phila) 2024:99228241270035. [PMID: 39183567 DOI: 10.1177/00099228241270035] [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: 08/27/2024]
Abstract
Primary care providers (PCPs) report insufficient capacity for child and youth mental health care (CYMH). The telementoring program Project ECHO (Extension for Community Healthcare Outcomes) can build capacity, but 75- to 120-minute sessions are a participation barrier. Using a Lean health care paradigm, we designed a 60-minute session, and compared self-reported CYMH capacity strengthening (10 constructs) and satisfaction between 60- and 90-minute sessions. Pre-post (n = 139) and post-cycle (n = 146) survey data were analyzed using generalized linear mixed-effects logistic regression. Capacity strengthening was demonstrated when analyzing both groups together (all Ps ≤ .002). Session duration did not affect capacity strengthening for 9/10 constructs (all Ps > .05), but medication management development was higher with 90-minute sessions (P = .002). Satisfaction was high in both groups. The 60-minute ECHO CYMH sessions can be used without negative learning outcomes, but more mentoring may be needed to build capacity for psychopharmacologic treatment.
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Affiliation(s)
- Kathleen Pajer
- Department of Psychiatry, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - William Gardner
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Carley Ouellette
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - Michael Cheng
- Department of Psychiatry, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Roxanne MacKay
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Hazen Gandy
- Department of Psychiatry, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Minnis H. Abuse, neglect and neurodevelopment across the life course: what can paediatricians and child psychiatrists do about this together? The Illingworth-Rees keynote lecture 2023. Arch Dis Child 2024; 109:533-535. [PMID: 37788885 DOI: 10.1136/archdischild-2023-325942] [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: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023]
Abstract
Paediatricians and child psychiatrists share complex cases, often associated with abuse, neglect and other 'Adverse Childhood Experiences (ACEs)'. ACEs are associated in a dose-response relationship with both mental and physical health problems across the life span. We found that 9-year-old children who had been abused and neglected were much more likely to also have symptoms of heritable neurodevelopmental conditions (NDCs) such as ADHD, autism and intellectual disabilities. To our surprise, these were not caused by the abuse and neglect. Instead, both the NDCs and the abuse and neglect were being caused by additional genetic factors. We also found that children who have experienced abuse and neglect, and who also have NDCs, are at twice the risk of developing symptoms of severe mental illness in adolescence. This has caused us to develop our 'Double Jeopardy' hypothesis-that experiencing both abuse and neglect and NDCs in childhood might double the risk of a range of physical and mental health problems across the life span.Both paediatricians and child psychiatrists will be faced with children who have complex problems, and they will sometimes need to work together to solve these-whether or not abuse or neglect is in the mix.Dr Corinne Rees's words were prescient: 'The truth that psychological issues and behaviour are integral to all illness indicates the necessity for every doctor to feel competent in considering their relevance'. As paediatricians and child psychiatrists, let's move forward together to overcome the mind-body dichotomy for the benefit of our patients.
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Affiliation(s)
- Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8TB, UK
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3
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Terry MS, Brown C, Franklin L. Addressing Geographical Inequities and Barriers in Access to Mental Health Care among Youth in a Rural Western Kentucky County. Community Ment Health J 2024:10.1007/s10597-024-01294-3. [PMID: 38829469 DOI: 10.1007/s10597-024-01294-3] [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] [Received: 02/10/2024] [Accepted: 05/10/2024] [Indexed: 06/05/2024]
Abstract
A Community Health Assessment (CHA) was conducted among community members in a rural Western Kentucky county in 2022-2023 identified mental health as one of the top health issues in the county. The purpose of a CHA is to identify key health needs and issues through data and develop strategies for action. One of the objectives was to identify barriers to accessing mental health care, especially among youth. Secondary data analyses were performed from survey results conducted by the local health department and local public schools. Quantitative data were analyzed using SPSS software. Qualitative data were analyzed using a two-cycle coding process. Access to mental healthcare is an area of great need in this rural Western Kentucky county. Recommendations include working with healthcare providers, especially specialists, to accept Medicaid and it is recommended to cross-train other professionals to address mental health needs in this region.
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Affiliation(s)
- Miranda Sue Terry
- Department of Public Health, Health Administration, and Health Sciences, Tennessee State University, Nashville, TN, USA.
| | - Charles Brown
- Department of Public Health, Health Administration, and Health Sciences, Tennessee State University, Nashville, TN, USA
| | - Lauren Franklin
- Department of Public Health, Health Administration, and Health Sciences, Tennessee State University, Nashville, TN, USA
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4
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Foster AA, Saidinejad M, Li J. Approach to acute agitation in the pediatric emergency department. Curr Opin Pediatr 2024; 36:245-250. [PMID: 38299972 DOI: 10.1097/mop.0000000000001337] [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: 02/02/2024]
Abstract
PURPOSE OF REVIEW The complexity of pediatric mental and behavioral health (MBH) complaints presenting to emergency departments (EDs) is increasing at an alarming rate. Children may present with agitation or develop agitation during the ED visit. This causes significant distress and may lead to injury of the child, caregivers, or medical staff. This review will focus on providing safe, patient-centered care to children with acute agitation in the ED. RECENT FINDINGS Approaching a child with acute agitation in the ED requires elucidation on the cause and potential triggers of agitation for optimal management. The first step in a patient-centered approach is to use the least restrictive means with behavioral and environmental strategies. Restraint use (pharmacologic or physical restraint) should be reserved where these modifications do not result in adequate de-escalation. The provider should proceed with medications first, using the child's medication history as a guide. The use of physical restraint is a last resort to assure the safety concerns of the child, family, or staff, with a goal of minimizing restraint time. SUMMARY Children are increasingly presenting to EDs with acute agitation. By focusing primarily on behavioral de-escalation and medication strategies, clinicians can provide safe, patient-centered care around these events.
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Affiliation(s)
- Ashley A Foster
- Department of Emergency Medicine, University of California, San Francisco
| | - Mohsen Saidinejad
- The Lundquist Institute for Biomedical Innovation at Harbor UCLA, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Joyce Li
- Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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5
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Ouyang JX, Pustilnik S, Cotton A, Fallucco EM, Hopkins M. Building Integrated Mental Health Services in Pediatric Primary Care: User Guide from the Academic Trenches. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-01946-2. [PMID: 38448716 DOI: 10.1007/s40596-024-01946-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024]
Affiliation(s)
- Jessica X Ouyang
- Medstar Georgetown University Hospital, Georgetown University Medical Center, Washington, DC, USA.
| | - Sean Pustilnik
- Medstar Georgetown University Hospital, Georgetown University Medical Center, Washington, DC, USA
| | - Aronica Cotton
- Medstar Georgetown University Hospital, Georgetown University Medical Center, Washington, DC, USA
| | - Elise M Fallucco
- Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk, VA, USA
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Zhong Y, Chen Y, Su X, Wang M, Li Q, Shao Z, Sun L. Global, regional and national burdens of bipolar disorders in adolescents and young adults: a trend analysis from 1990 to 2019. Gen Psychiatr 2024; 37:e101255. [PMID: 38390238 PMCID: PMC10882284 DOI: 10.1136/gpsych-2023-101255] [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] [Received: 07/26/2023] [Accepted: 12/14/2023] [Indexed: 02/24/2024] Open
Abstract
Background Bipolar disorder is identified as a cause of severe damage to the physical, psychological and social functioning of adolescents and young adults. Aims The aim of this study is to ascertain the trends in the burden of bipolar disorder among individuals aged 10-24 years at global, regional and national levels from 1990 to 2019. Methods The data analysed in this study were from the Global Burden of Diseases 2019. The numbers, rates per 100 000 population, average annual percentage changes (AAPCs) of incidence, prevalence and years lived with disability (YLDs) of bipolar disorder are reported at the global, regional and national levels among individuals aged 10-24 years. Global trends by age, sex and Social Development Index (SDI) were further analysed. Results Globally, the incidence of bipolar disorder among adolescents and young adults increased from 79.21 per 100 000 population (95% uncertainty interval (UI): 58.13 to 105.15) in 1990 to 84.97 per 100 000 population (95% UI: 61.73 to 113.46) in 2019, AAPC 0.24 (95% confidence interval (CI): 0.22 to 0.26). In the past three decades, there has been an increase in incidence, prevalence and YLDs in both males and females. The largest increase in incidence between 1990 and 2019 was observed in those aged 20-24 years old (from 51.76 per 100 000 population (95% UI: 26.81 to 87.20) in 1990 to 58.37 per 100 000 population (95% UI: 30.39 to 98.55) in 2019; AAPC 0.42 (95% CI: 0.38 to 0.47)). By the SDI quintile, the largest increase in incidence was observed in the middle SDI; however, the high SDI countries had the highest incidence. Regionally, the largest increase in incidence was observed in southern Latin America. At the national level, the most pronounced increase in the incidence was in Greenland. Conclusions The global increase in incidence among adolescents and young adults between 1990 and 2019 indicates that strategies to improve their mental health still need to be emphasised.
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Affiliation(s)
- Yunxi Zhong
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
| | - Yifan Chen
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
| | - Xiaoying Su
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
| | - Meiqi Wang
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
| | - Qixiu Li
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
| | - Ziming Shao
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Long Sun
- Centre for Health Management and Policy Research,School of Public Health,Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- National Health Commission of China (NHC) Key Laboratory of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
- Institute of Health and Elderly Care, Shandong University, Jinan, Shandong, China
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Kim E, Gomez JP, Mutter E, Campion J, Kumar M, Ramasamy D. Retaining Interest in Child and Adolescent Psychiatry Among General Residency Trainees. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2024:10.1007/s40596-024-01941-7. [PMID: 38321353 DOI: 10.1007/s40596-024-01941-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/22/2024] [Indexed: 02/08/2024]
Abstract
OBJECTIVES This study aimed to identify factors affecting current general psychiatry residents' interest in child and adolescent psychiatry (CAP) at Lehigh Valley Health Network (LVHN). Furthermore, it aimed to identify areas for improvement in clinical education to address the shortage of child psychiatrists at the institution at the time of this study. METHODS An electronic anonymous pre-implementation survey was sent to all the current general psychiatry residents at LVHN. It assessed the most important factors for trainees in deciding their career paths into CAP, their comfort level with children and families, and overall CAP and related systems-based knowledge. Interventions based on the survey results were implemented in the LVHN psychiatry residency program. The residents then completed a post-intervention survey to assess the impact of these interventions on their perspectives toward CAP. RESULTS CAP rotation experience and work with families were strong influencers for general psychiatry residents at LVHN in pursing CAP. Systems-based knowledge was particularly lacking compared to overall CAP knowledge. Educational interventions that were implemented at LVHN led to improvements in residents' sense of competence working with children and families with no net loss of interest in CAP. CONCLUSIONS Educational modifications enhanced attitudes toward CAP among LVHN general psychiatry residents. Implementing such modifications at other residency programs may be likewise effective in retaining interest in CAP among their general psychiatry residents.
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Affiliation(s)
| | | | | | - John Campion
- Lehigh Valley Health Network, Bethlehem, PA, USA
| | - Maanvi Kumar
- Lehigh Valley Health Network, Bethlehem, PA, USA
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8
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Mora Ringle VA, Sung JY, Roulston CA, Schleider JL. Mixed-Methods Examination of Adolescent-Reported Barriers to Accessing Mental Health Services. J Adolesc Health 2024; 74:268-276. [PMID: 37804301 PMCID: PMC10842491 DOI: 10.1016/j.jadohealth.2023.08.034] [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: 12/20/2022] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Many adolescents struggle to access the mental healthcare they need. To increase access to mental health services, we must have a clear understanding of the barriers adolescents face from their own perspectives. This online mixed-methods study aimed to enhance understanding of access barriers by centering the perspectives of diverse adolescents who had recently tried and failed to access mental health support. METHODS In this convergent parallel mixed-methods study, adolescents responded to a preintervention, open-ended question about barriers they have faced to accessing mental health services when they needed them and shared information about their background and depressive symptoms. Barriers were assessed using inductive, conventional content analysis. Quantitative analyses examined barrier differences across sociodemographic groups. RESULTS All adolescents (aged 11-17 years, 50% racially minoritized youth, 15% gender diverse youth, 64% LGBTQ + youth; 78% with clinically elevated depressive symptoms) reported at least one barrier to accessing mental health support, and 20% reported multiple barriers. Content analysis revealed 13 barrier categories, with parent-related barriers (three different categories) accounting for 32% of all barriers. The most common barrier categories related to personal and financial constraints. Asian adolescents, adolescents who were aged 17 years or more, and adolescents who reported uncertainty of their gender identity endorsed the numerically highest mean number of barriers to accessing mental health support. DISCUSSION High-symptom adolescents reported myriad barriers to accessing mental health support, with 32% of all barriers related to parents.
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Affiliation(s)
- Vanesa A Mora Ringle
- Counseling Psychology Program, Department of Education and Human Services, Lehigh University, Bethlehem, Pennsylvania.
| | - Jenna Y Sung
- Department of Psychology, Stony Brook University, Stony Brook, New York
| | - Chantelle A Roulston
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Jessica L Schleider
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
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9
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Lee CM, Jeung J, Yonek JC, Farghal M, Steinbuchel P. Using human-centered design to develop and implement a pediatric mental health care access program. Front Psychiatry 2024; 14:1283346. [PMID: 38260798 PMCID: PMC10802988 DOI: 10.3389/fpsyt.2023.1283346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024] Open
Abstract
In 2019, the University of California at San Francisco (UCSF) launched the Child and Adolescent Psychiatry Portal (CAPP), a pediatric mental health care access (PMHCA) program providing remote mental health consultation services to pediatric primary care providers (PCPs) throughout Northern and Central California. The development and implementation of CAPP was guided by Human-Centered Design (HCD), an iterative, rapid-paced innovation process focusing on stakeholders' needs and experiences, which shaped the development of CAPP's programs. The resulting key programmatic elements are designed for pediatric workforce development: (1) PCP consultation with a child and adolescent psychiatrist via a telephone warmline; and (2) training and education for providers. CAPP has grown rapidly since its launch, having enrolled 1,714 providers from 257 practices spread across 36 counties and provided 3,288 consults on 2,703 unique lives as of August 2023. Preliminary evaluation findings indicate high PCP satisfaction with CAPP's services, despite continued challenges of integrating behavioral health into primary care. Throughout the HCD and implementation process, multidisciplinary partnerships have proven critical in providing end-user input to inform and improve program design. This growing network of partnerships, developed through the cultivation of personal relationships and trust over time, has also proven essential for CAPP's rapid growth and sustainability. Overall, this Community Case Study highlights the critical role of partnerships and the importance of taking a people-centered approach, as captured in CAPP's motto, "Connecting for Care."
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Affiliation(s)
- Chuan Mei Lee
- Child and Adolescent Psychiatry Portal, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Clinical Excellence Research Center, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Joan Jeung
- Child and Adolescent Psychiatry Portal, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Juliet C. Yonek
- Child and Adolescent Psychiatry Portal, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Mahmoud Farghal
- Child and Adolescent Psychiatry Portal, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Petra Steinbuchel
- Child and Adolescent Psychiatry Portal, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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10
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Currie J, Kurdyak P, Zhang J. Socioeconomic status and access to mental health care: The case of psychiatric medications for children in Ontario Canada. JOURNAL OF HEALTH ECONOMICS 2024; 93:102841. [PMID: 38113755 DOI: 10.1016/j.jhealeco.2023.102841] [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: 06/29/2023] [Revised: 10/27/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023]
Abstract
We examine differences in the prescribing of psychiatric medications to lower-income and higher-income children in the Canadian province of Ontario using rich administrative data that includes diagnosis codes and physician identifiers. Our most striking finding is that conditional on diagnosis and medical history, low-income children are more likely to be prescribed antipsychotics and benzodiazepines than higher-income children who see the same doctors. These are drugs with potentially dangerous side effects that ideally should be prescribed to children only under narrowly proscribed circumstances. Lower-income children are also less likely to be prescribed SSRIs, the first-line treatment for depression and anxiety conditional on diagnosis. Hence, socioeconomic differences in the prescribing of psychotropic medications to children persist even in the context of universal public health insurance and universal drug coverage.
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Affiliation(s)
- Janet Currie
- Princeton University and Center for Health and Wellbeing, United States of America.
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11
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Lu W, Keyes KM. Major depression with co-occurring suicidal thoughts, plans, and attempts: An increasing mental health crisis in US adolescents, 2011-2020. Psychiatry Res 2023; 327:115352. [PMID: 37506585 DOI: 10.1016/j.psychres.2023.115352] [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: 04/24/2022] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
This study aimed to examine national trends and disparities in the prevalence and treatment of adolescent 12-month major depressive episode (MDE) with co-occurring suicidal thoughts, plans, and attempts. Publicly available data for adolescents aged 12-17 in the 2011-2020 National Survey on Drug Use and Health were analyzed. Bivariate and multivariable logistic regression analyses were conducted. In 2011, 4.6%, 2.1%, and 1.7% of adolescents had 12-month MDE with co-occurring suicidal thoughts, plans, and attempts, and the prevalence increased steadily to 9.8%, 5.3%, and 3.5% in 2019, respectively. In 2011, 45% of adolescents with MDE and suicidal thoughts received any mental health treatment, and the prevalence increased slightly to 46.6% in 2019. Meanwhile, the prevalence of treatment use among adolescents with MDE and suicidal plans remained stable at below 54%. Lastly, the prevalence of treatment use increased significantly from 53.6% in 2011 to 60.8% in 2019 among those with MDE and suicidal attempts. Continued high prevalence and low treatment use were observed in 2020. Disparities in treatment use were found in older adolescents, adolescents without insurance, Hispanics, and Asians. Concerted efforts are needed to prioritize evidence-based interventions, enhance outreach to high-risk groups, and expand service provisions to underserved adolescents.
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Affiliation(s)
- Wenhua Lu
- Department of Community Health and Social Medicine, School of Medicine, The City University of New York, New York, United States.
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, United States
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Shenoi S, Edison SE, Haynes S, Patten J. Implementation of an embedded behavioral health care model in a pediatric rheumatology subspecialty juvenile myositis clinic. Front Psychiatry 2023; 14:1192711. [PMID: 37636819 PMCID: PMC10447969 DOI: 10.3389/fpsyt.2023.1192711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Youth with chronic medical illness, such as juvenile myositis (JM), require specialized behavioral health care. However, access to such care is challenging due to the youth mental health crisis, which impacts accessibility of mental health services in the community, as well as challenges accessing behavioral health care above and beyond the demands of care related to their JM management. In this paper we describe an embedded behavioral health care model, including the establishment and implementation of such a model, at a pediatric hospital where youth with JM receive medical care in a Center of Excellence (CoE). We describe a unique partnership with a philanthropic organization; the challenges and benefits of delivering care within this model; as well as recommendations for maximizing its effectiveness. Ultimately, we provide an example of a successful embedded behavioral health care program for youth with rare disease, which may be applied to other institutions providing similar care.
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Affiliation(s)
- Susan Shenoi
- Seattle Children’s Hospital and Research Center, University of Washington, Seattle, WA, United States
| | - Suzanne E. Edison
- Mental Health Coordinator, Cure JM Foundation, Leesburg, VA, United States
| | - Stacey Haynes
- Seattle Children’s Hospital and Research Center, University of Washington, Seattle, WA, United States
| | - Joanna Patten
- Seattle Children’s Hospital and Research Center, University of Washington, Seattle, WA, United States
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13
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Eyllon M, Dalal M, Jans L, Sotomayor I, Peloquin G, Yon J, Fritz R, Schleider J. Referring Adolescent Primary Care Patients to Single-Session Interventions for Anxiety and Depression: Protocol for a Feasibility Study. JMIR Res Protoc 2023; 12:e45666. [PMID: 37556202 PMCID: PMC10448284 DOI: 10.2196/45666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Despite the growing prevalence of depression and anxiety among adolescents, fewer than half access appropriate mental health care. Single-session interventions (SSIs) for depression and anxiety offered in primary care are a promising approach to bridging the treatment gap. OBJECTIVE We aimed to implement a clinical workflow for primary care and behavioral health providers to refer patients aged 13 to 17 years with mild to moderate depression and anxiety symptoms to Project YES (Youth Empowerment and Support), an open-access SSI platform, in a large group medical practice with an integrated behavioral health department. METHODS Pediatric primary care and integrated behavioral health providers will be educated on the benefits of Project YES for adolescent anxiety and depression and trained in a workflow integrated within the electronic health record system, Epic, to refer patients during well-child visits and pediatric behavioral health visits. Patients with mild to moderate internalizing symptoms based on the 17-item Pediatric Symptom Checklist or youth Pediatric Symptom Checklist will be invited to try an SSI through Project YES. We will examine provider uptake and perceptions of acceptability, feasibility, and appropriateness over time. RESULTS The rollout will take place between November 2022 and May 2023, when outcomes will be evaluated. Data analysis and manuscript writing are anticipated to be completed during the summer of 2023. CONCLUSIONS SSIs such as those available through Project YES have the potential to provide low-cost, evidence-based mental health treatment to adolescents with mild to moderate depression and anxiety. If deemed feasible and acceptable, providing SSIs in primary care settings could significantly improve access to mental health care without taxing pediatric primary care and behavioral health providers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45666.
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Affiliation(s)
- Mara Eyllon
- Practice Research Network, Reliant Medical Group, Worcester, MA, United States
| | - Michelle Dalal
- Northeastern University, Northeastern University Health and Counseling Services, Boston, MA, United States
- Department of Pediatrics, Chan School of Medicine, University of Massachusetts, Worcester, MA, United States
| | - Laura Jans
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Ian Sotomayor
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
| | - Gabrielle Peloquin
- Practice Research Network, Reliant Medical Group, Worcester, MA, United States
| | - James Yon
- Behavioral Health Department, Reliant Medical Group, Worcester, MA, United States
| | - Rochelle Fritz
- Behavioral Health Department, Reliant Medical Group, Worcester, MA, United States
| | - Jessica Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, United States
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14
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Butler W, Kim H, Keuroghlian AS. Psychiatric Boarding of Transgender and Gender Diverse Youth Awaiting Treatment. LGBT Health 2023; 10:412-415. [PMID: 36971585 DOI: 10.1089/lgbt.2022.0267] [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] [Indexed: 03/29/2023] Open
Abstract
With increased prevalence and duration of pediatric mental health boarding that disparately impacts transgender and gender diverse (TGD) youth, it is critical to consider disparities that TGD youth experience in accessing mental health care. Although mental health care for TGD youth has long been considered specialty care, frontline, primary medical, and mental health clinicians must be equipped to serve TGD patients' psychiatric needs. Inequities that TGD youth face require examination and intervention at multiple levels, including societal discrimination, lack of culturally responsive primary mental health care, and barriers to gender-affirming care in emergency departments and psychiatric inpatient units.
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Affiliation(s)
| | - Heather Kim
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- National LGBTQIA+ Health Education Center, The Fenway Institute, Boston, Massachusetts, USA
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15
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Saidinejad M, Barata I, Foster A, Ruttan TK, Waseem M, Holtzman DK, Benjamin LS, Shahid S, Berg K, Wallin D, Atabaki SM, Joseph MM. The role of telehealth in pediatric emergency care. J Am Coll Emerg Physicians Open 2023; 4:e12952. [PMID: 37124475 PMCID: PMC10131292 DOI: 10.1002/emp2.12952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 03/27/2023] [Accepted: 03/31/2023] [Indexed: 05/02/2023] Open
Abstract
In 2006, the Institute of Medicine published a report titled "Emergency Care for Children: Growing Pains," in which it described pediatric emergency care as uneven at best. Since then, telehealth has emerged as one of the great equalizers in care of children, particularly for those in rural and underresourced communities. Clinicians in these settings may lack pediatric-specific specialization or experience in caring for critically ill or injured children. Telehealth consultation can provide timely and safe management for many medical problems in children and can prevent many unnecessary and often long transport to a pediatric center while avoiding delays in care, especially for time-sensitive and acute interventions. Telehealth is an important component of pediatric readiness of hospitals and is a valuable tool in facilitating health care access in low resourced and critical access areas. This paper provides an overview of meaningful applications of telehealth programs in pediatric emergency medicine, discusses the impact of the COVID-19 pandemic on these services, and highlights challenges in setting up, adopting, and maintaining telehealth services.
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Affiliation(s)
- Mohsen Saidinejad
- The Lundquist Institute for Biomedical Innovation at Harbor UCLATorranceCaliforniaUSA
- David Geffen School of Medicine at UCLALos AngelesCaliforniaUSA
| | - Isabel Barata
- Donald and Barbara Zucker School of Medicine at Hofstra/NorthwellNorthwell HealthManhassetNew YorkUSA
| | - Ashley Foster
- Harvard Medical SchoolMassachusetts General HospitalBostonMassachusettsUSA
| | | | - Muhammad Waseem
- Lincoln Medical CenterBronxNew YorkUSA
- Weill Cornell MedicineNew YorkUSA
| | | | - Lee S. Benjamin
- Trinity Health St. Joseph Medical CenterAnn ArborMichiganUSA
| | - Sam Shahid
- American College of Emergency PhysiciansIrvingTexasUSA
| | - Kathleen Berg
- Dell Medical School at the University of TexasAustinTexasUSA
| | - Dina Wallin
- University of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Shireen M. Atabaki
- The George Washington University, School of MedicineChildren's National HospitalWashingtonDistrict of ColumbiaUSA
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Olfson M, Wall MM, Wang S, Laje G, Blanco C. Treatment of US Children With Attention-Deficit/Hyperactivity Disorder in the Adolescent Brain Cognitive Development Study. JAMA Netw Open 2023; 6:e2310999. [PMID: 37115542 PMCID: PMC10148191 DOI: 10.1001/jamanetworkopen.2023.10999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Importance Characterizing the extent and pattern of unmet needs for treatment of children with attention-deficit/hyperactivity disorder (ADHD) could help target efforts to improve access to ADHD medications and outpatient mental health care. Objective To describe current ADHD medication use and lifetime outpatient mental health care among a large national sample of children with ADHD. Design, Setting, and Participants This study uses cross-sectional survey data from the first wave of the Adolescent Brain and Cognitive Development Study (n = 11 723), conducted from June 1, 2016, to October 15, 2018, among 1206 school children aged 9 and 10 years who met parent-reported Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for current ADHD. Statistical analysis was performed from March 23, 2022, to March 10, 2023. Main Outcomes and Measures Current ADHD medications including stimulants and nonstimulants, lifetime outpatient mental health care, or either treatment. Weighted results are reported. Results Among a sample of 11 723 children, 1206 had parent-reported ADHD (aged 9-10 years; 826 boys [68.2%]; 759 White, non-Hispanic children [62.2%]), 149 (12.9%) were currently receiving ADHD medications. Children receiving ADHD medications included a significantly higher percentage of boys (15.7% [121 of 826]) than girls (7.0% [28 of 108]), White children (14.8% [104 of 759]) than Black children (9.4% [22 of 206]), children of parents without a high school education (32.2% [9 of 36]) than of parents with a bachelor's degree or higher (11.5% [84 of 715]), and children with the combined subtype of ADHD (17.0% [83 of 505]) than with the inattentive subtype (9.5% [49 of 523]). Approximately 26.2% of children (301 of 1206) with parent-reported ADHD had ever received outpatient mental health care. Children receiving outpatient mental health care included a significantly higher percentage of children whose parents had a high school education (36.2% [29 of 90]) or some college (31.0% [109 of 364]) than a bachelor's degree or higher (21.3% [153 of 715]), children with family incomes of less than $25 000 (36.5% [66 of 176]) or $25 000 to $49 999 (27.7% [47 of 174]) than $75 000 or more (20.1% [125 of 599]), and children with the combined subtype of ADHD (33.6% [166 of 505]) than with the predominantly inattentive subtype (20.0% [101 of 523]) or the hyperactive-impulsive subtype (22.4% [34 of 178]) of ADHD. Conclusions and Relevance This cross-sectional study of children with parent-reported ADHD suggests that most were not receiving ADHD medications and had never received outpatient mental health care. Gaps in treatment, which were not directly associated with socioeconomic disadvantage, underscore the challenges of improving communication and access to outpatient mental health care for children with ADHD.
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Affiliation(s)
- Mark Olfson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York
| | - Melanie M Wall
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, New York
| | - Shuai Wang
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
| | - Gonzalo Laje
- Maryland Institute for Neuroscience and Development Inc, Chevy Chase
- Washington Behavioral Medicine Associates, LLC, Chevy Chase, Maryland
- Department of Psychiatry, Texas Tech University Health Science Center, Lubbock
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Rockville, Maryland
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17
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Kishore A, DiGiovanni M, Sun KL, Kolevzon A, Benoit L, Martin A. Enhancing Child and Adolescent Psychiatry Recruitment Through a Medical Student Mentorship Network: A Qualitative Study. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:124-133. [PMID: 36123518 PMCID: PMC9484713 DOI: 10.1007/s40596-022-01700-6] [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: 12/22/2021] [Accepted: 08/15/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVE There is a shortage of psychiatrists necessary to meet the clinical needs of children and adolescents. Efforts over the past decade to enhance the workforce have had a limited impact. This study sought to identify the critical components of a medical student mentorship network designed to increase recruitment into the subspecialty. METHODS The authors conducted interviews via synchronized videoconferencing of network site leaders and medical students at 14 schools throughout the USA. In addition, they analyzed verbatim transcripts using a thematic-phenomenological qualitative approach. RESULTS The authors interviewed thirty-eight program participants during seven focus group sessions: nine program directors and 29 medical students or graduates, a median of five participants per session. They constructed a framework consisting of two overarching domains, comprised of three themes each: (1) life cycle of a subspecialty mentorship network (Origins, Initiation, and Continuity); and (2) next steps to improve the program (Refining goals, Increasing accessibility, and Defining a path forward). CONCLUSION Preliminary data have already documented the positive impact of participation in this mentorship program on medical student match rates into psychiatry. The qualitative model of this study provides a blueprint to develop, maintain, and optimize this and similar efforts aimed at increasing the child and adolescent psychiatry workforce.
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Affiliation(s)
| | | | | | | | - Laelia Benoit
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA
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18
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Fortuna LR, Brown IC, Lewis Woods GG, Porche MV. The Impact of COVID-19 on Anxiety Disorders in Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:531-542. [PMCID: PMC9894765 DOI: 10.1016/j.chc.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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19
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Choi SY, Rusch A, Lane A, Liebrecht C, Bilek EL, Eisenberg D, Andrews C, Perry M, Smith SN. Individual and organizational factors as predictors of early evidence-based practice adoption in Michigan high schools: Baseline data from an implementation trial. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231159429. [PMID: 37091540 PMCID: PMC10052498 DOI: 10.1177/26334895231159429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background Adolescents increasingly access mental health services in schools. School mental health professionals (SPs; school counselors, social workers, etc.) can offer evidence-based mental health practices (EBPs) in schools, which may address access gaps and improve clinical outcomes. Although some studies have assessed factors associated with EBP adoption in schools, additional research focusing on SP- and school-level factors is warranted to support EBP implementation as SPs’ mental health delivery grows. Methods Baseline data were collected from SPs at Michigan high schools participating in a statewide trial to implement SP-delivered cognitive behavioral therapy (CBT) to students. Models examined factors associated with attitudes about EBPs, implementation climate, and implementation leadership, and their associations with CBT knowledge, training attendance, and pre-training CBT delivery. Results One hundred ninety-eight SPs at 107 schools (87%) completed a baseline survey. The mean Evidence-Based Practice Attitude Scale (EBPAS) total score was 2.9, and school-aggregated mean scores of the Implementation Climate Scale (ICS) and Implementation Leadership Scale (ILS) were 1.83 and 1.77, respectively, all on a scale ranging from 0 ( low) to 4 ( high). ICS and ILS scores were lower than typically reported in clinical settings, while EBPAS scores were higher. School characteristics were not significantly associated with EBPAS, ICS, or ILS scores, but scores did differ by SP role. Higher EBPAS scores were associated with more CBT knowledge (average marginal effect for 1 SD change [AME] = 0.15 points) and a higher probability of training completion (AME = 8 percentage points). Higher ICS scores were associated with a higher probability of pre-training CBT delivery (AME = 6 percentage points), and higher ILS scores were associated with higher probability of training completion (AME = 10 percentage points). Conclusions Our findings suggest that SPs’ attitudes toward EBPs and organizational support were positively associated with early signs of implementation success. As schools increasingly fill the adolescent mental healthcare access gap, efforts to strengthen both provider attitudes toward EBP and strategic organizational factors supporting EBP delivery will be key to encouraging EBP uptake in schools. Plain Language Summary Schools are an important setting in which adolescents receive mental healthcare. We need to better understand how to implement evidence-based practices (EBPs) in this setting to improve student mental health. This study examined the attitudes and perceptions of school professionals (SPs) as key contributors to the implementation of a particular EBP, the delivery of cognitive behavioral therapy (CBT) in schools. The study found that implementation climate and leadership scores in participating schools were lower than scores typically reported in clinical settings, while scores for SP attitudes about EBP adoption were higher than typical scores in clinical settings. Results further suggest that SPs with more positive attitudes toward EBPs are more knowledgeable of CBT and more likely to complete a 1-day CBT training. We also found that higher implementation climate scores were associated with SPs reporting pre-training CBT delivery (although this association was not statistically significant), and more implementation leadership was associated with SPs completing the CBT training. These findings suggest that SP attitudes toward EBPs and organizational support in schools are positively associated with early signs of implementation success. Early, low-intensity efforts to (1) improve SP attitudes about mental health EBPs, and (2) increase schools’ support for implementation may scaffold more intensive implementation efforts in schools down the road.
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Affiliation(s)
- Seo Youn Choi
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Amy Rusch
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Annalise Lane
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Celeste Liebrecht
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily L. Bilek
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Carolyn Andrews
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Morgan Perry
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Shawna N. Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
- Seo Youn Choi, Department of Health Management and Policy, University of Michigan, SPH II, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
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Harris BA, Huntington N, Sideridis G, Chan E. Referring Attention-Deficit/Hyperactivity Disorder: Gaining Perspective From Advanced Practice Providers in Primary Care. Clin Pediatr (Phila) 2022:99228221143916. [PMID: 36495191 DOI: 10.1177/00099228221143916] [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: 12/14/2022]
Abstract
The objective of the current study is to identify provider, patient, and family characteristics associated with pediatric advanced practice provider (APP) decisions to refer to a subspecialist for diagnosis and management of attention-deficit/hyperactivity disorder (ADHD). We conducted a cross-sectional electronic survey of pediatric primary care APPs using member lists of professional organizations. T tests and chi-square analysis were conducted to identify group differences. Most respondents rated themselves as comfortable diagnosing and managing ADHD. We found no significant difference between groups based on comfort level or likelihood to refer. APPs working in suburban settings report significantly lower levels of comfort. Self-designation as the practice's primary provider for behavioral/mental health concerns had significantly higher levels of comfort and were less likely to refer. In a limited sample, most APPs reported comfort diagnosing and managing ADHD. Activities to identify and ameliorate gaps in ADHD knowledge and care need to consider this growing part of the workforce.
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Affiliation(s)
- Brian A Harris
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.,Orlando Health Arnold Palmer Hospital Pediatric Behavioral Health and Development Center, Orlando, FL, USA
| | - Noelle Huntington
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Georgios Sideridis
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Eugenia Chan
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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21
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Chew KK, Temples HS. Adolescent Eating Disorders: Early Identification and Management in Primary Care. J Pediatr Health Care 2022; 36:618-627. [PMID: 37855407 DOI: 10.1016/j.pedhc.2022.06.004] [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: 11/03/2021] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 11/24/2022]
Abstract
Eating disorders are complex, potentially life-threatening conditions characterized by disruptive eating behaviors that significantly impact physical and psychosocial functioning. The adolescent population is at an increased risk of developing eating disorders because of developmental changes affecting their perception. Eating disorders are associated with devastating medical complications and high mortality rates if left untreated. As the prevalence of eating disorders among adolescents continues to increase, it is important that clinicians are knowledgeable about early signs of disordered eating and facilitate timely evaluation and care coordination. Newly released clinical guidelines from the American Academy of Pediatrics are reviewed for early identification and management of eating disorders in children and adolescents. The epidemiology, risk factors, and medical complications for common eating disorders in primary care such as anorexia nervosa, bulimia nervosa, and binge eating disorder, are presented. An approach to screening for eating disorders, clinical assessment, and treatment options are outlined.
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22
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McLeigh JD, Malthaner L, Winebrenner C, Stone KE. Paediatric integrated care in the primary care setting: A scoping review of populations served, models used and outcomes measured. Child Care Health Dev 2022; 48:869-879. [PMID: 35288973 DOI: 10.1111/cch.13000] [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: 09/08/2021] [Revised: 02/17/2022] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Paediatric integrated care (PIC), which involves primary care and behavioural health clinicians working together with patients and families, has been promoted as a best practice in the provision of care. In this context, behavioural health includes behavioural elements in the care of mental health and substance abuse conditions, chronic illness and physical symptoms associated with stress, and addressing health behaviours. Models of and contexts in which PIC has been applied vary, as do the outcomes and measures used to determine its value. Thus, this study seeks to better understand (1) what paediatric subpopulations are receiving integrated care, (2) which models of PIC are being studied, (3) what PIC outcomes are being explored and what measures and strategies are being used to assess those outcomes, and (4) whether the various models are resulting in positive outcomes. These questions have significant policy and clinical implications, given current national- and state-level efforts aimed at promoting integrated health care. METHODS This study utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews to identify relevant articles published between January 1994 and 30 June 2020. The search utilized three databases: PubMed, PsycInfo and CINAHL. A total of 28 articles met the eligibility criteria for inclusion. RESULTS Overall, acceptability of PIC appears to be high for patients and providers, with access, screening and engagement generally increasing. However, several gaps in the knowledge base on PIC were uncovered, and for some studies, ascertaining which models of integrated care were being implemented proved difficult. CONCLUSION PIC has the potential to improve access to and quality of behavioural health care, but more research is needed to understand what models of PIC prove most beneficial and which policies and conditions promote cost efficiency. Rigorous evaluation of patient outcomes, provider training, institutional buy-in and system-level changes are needed.
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Affiliation(s)
- Jill D McLeigh
- Children's Health, Rees-Jones Center for Foster Care Excellence, Dallas, Texas, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UT Health School of Public Health, Dallas Campus, Dallas, Texas, USA
| | - Lauren Malthaner
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UT Health School of Public Health, Dallas Campus, Dallas, Texas, USA
| | | | - Kimberly E Stone
- Children's Health, Rees-Jones Center for Foster Care Excellence, Dallas, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
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23
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Riehm KE, Brignone E, Stuart EA, Gallo JJ, Mojtabai R. Diagnoses and Treatment After Depression Screening in Primary Care Among Youth. Am J Prev Med 2022; 62:511-518. [PMID: 34801332 PMCID: PMC8940608 DOI: 10.1016/j.amepre.2021.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Depression screening is universally recommended for adolescents presenting in primary care settings in the U.S. However, little is known about how depression screening affects the likelihood of being diagnosed with a mental disorder or accessing mental health care over time. METHODS This longitudinal cohort study used insurance claims data from adolescents who attended a well-visit between 2014 and 2017. Propensity score matching was used to compare adolescents who were screened for depression with similar unscreened adolescents. Diagnoses and treatment uptake were examined over a 6-month follow-up and included depression diagnoses, mood-related diagnoses, antidepressant medications, any mental health medication, and psychotherapy. Heterogeneity of associations by sex was also examined. Analyses were conducted from December 2020 to June 2021. RESULTS The sample included 57,732 adolescents (mean age, 14.26 years; 48.9% female). Compared with adolescents who were not screened for depression, adolescents screened for depression were 30% more likely to be diagnosed with depression (risk ratio=1.30, 95% CI=1.11, 1.52) and 17% more likely to receive a mood-related diagnosis (risk ratio=1.17, 95% CI=1.08, 1.27) but were not more likely to be treated with an antidepressant medication (risk ratio=1.11, 95% CI=0.82, 1.51), any mental health medication (risk ratio=1.15, 95% CI=0.87, 1.53), or psychotherapy (risk ratio=1.13, 95% CI=0.98, 1.31). Associations were generally stronger among female adolescents. CONCLUSIONS Adolescents who were screened for depression during a well-visit were more likely to receive a diagnosis of depression or a mood-related disorder in the 6 months after screening. Future research should explore methods for increasing treatment uptake after screening.
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Affiliation(s)
- Kira E Riehm
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
| | - Emily Brignone
- Data Science Research and Development, Highmark Health, Pittsburgh, Pennsylvania
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Joseph J Gallo
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, Maryland
| | - Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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Sherman SJ, Tanaka R, Qaddoumi I. Psychiatric symptoms in children with low-grade glioma and craniopharyngioma: A systematic review. J Psychiatr Res 2022; 148:240-249. [PMID: 35149436 DOI: 10.1016/j.jpsychires.2022.01.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/11/2022] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
The presentation of psychiatric symptoms in pediatric low-grade brain tumors is challenging because this can delay proper diagnosis and treatment. We performed a systematic review of psychiatric presenting symptoms of low-grade brain tumors in pediatric patients. We searched the PubMed and Web of Science databases of studies published in English from 1977 until 2019 reporting patients aged ≤21 years at the time of tumor diagnosis who exhibited psychiatric/behavioral symptoms before diagnosis of low-grade glioma (LGG), pilocytic astrocytoma (PA), or craniopharyngioma (CP). Our systematic search strategy coupled each tumor type with patient age and presenting symptoms by using different variations of the search terms "childhood" and "psychiatric symptoms" or "behavioral symptoms." We identified six unique articles that met our inclusion criteria in the LGG search, 27 in the PA search, and 32 in the CP search. Six patients were included in the LGG articles (age range, 3-16 years), 75 in the PA articles (age range, 0.5-21 years), and 87 in the CP articles (age range, 0.67-21 years). The most common presenting symptoms included eating disorders (n = 64) and behavioral changes (n = 49). Our findings demonstrate the need to establish clear criteria for neuroimaging indications for pediatric patients exhibiting eating disorders.
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Affiliation(s)
- Sarah J Sherman
- St. Jude Children's Research Hospital Graduate School of Biomedical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Ryuma Tanaka
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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Kwon S, O’Neill ME, Foster CC. The Associations of Child's Clinical Conditions and Behavioral Problems with Parenting Stress among Families of Preschool-Aged Children: 2018-2019 National Survey of Child Health. CHILDREN (BASEL, SWITZERLAND) 2022; 9:241. [PMID: 35204961 PMCID: PMC8869988 DOI: 10.3390/children9020241] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/03/2022] [Accepted: 02/09/2022] [Indexed: 11/17/2022]
Abstract
To understand parental stress resulting from parenting young children, the current literature has primarily focused on families of children with clinical conditions, but has placed far less attention on the general population. The aim of this study was to examine parenting stress related to children's clinical conditions and behavioral problems in a nationally representative sample of US children aged 3 to 5 years. The study sample included 8454 children aged 3 to 5 years and their parents who participated in the 2018-2019 US National Survey of Child Health (NSCH). Using online/paper NSCH questionnaires, parents reported their children's special health care needs (SHCN), clinically diagnosed mental, emotional, developmental, and behavioral (MEDB) problems (e.g., anxiety problem, developmental delay), and externalizing behaviors. Parents also reported the frequency of feeling aggravated from parenting the participating child as an indicator of elevated parenting stress. In the sample, the prevalence of elevated parenting stress was 5.1% overall (95% CI = 4.2, 6.0); however, it was significantly higher among parents of children with SHCN (20.8%; 95% CI = 16.7, 24.9), with MEDB problems (24.8%; 95% CI = 19.9, 29.8), and with externalizing behavior problems (14.7%; 95% CI = 11.8, 17.6). A multivariable logistic regression model showed that elevated parenting stress was associated with the child's SHCN (adjusted odds ratio [AOR] = 2.3; 1.3, 3.9), MEDB problems (AOR = 4.8; 95% CI = 2.5, 9.1), and externalizing behavior problems (AOR = 5.4; 95% CI = 3.1, 9.4). Even in children without SHCN or MEDB problems, externalizing behavior problems were associated with elevated parenting stress (AOR = 6.4; 95% CI = 3.3, 12.7). The findings call for greater attention to subclinical or yet to be diagnosed externalizing behavior problems among the general preschool-aged child population and their underestimated impact on parenting stress.
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Affiliation(s)
- Soyang Kwon
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA; (M.E.O.); (C.C.F.)
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Budimirovic DB, Province HS. Increasing Interest in Child and Adolescent Psychiatry Through a Structured Tutorial Program. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:91-92. [PMID: 32399836 DOI: 10.1007/s40596-020-01241-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Dejan B Budimirovic
- Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Haley S Province
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
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Himmelstein R, Guth S, Enenbach M, Gleason MM, Stevens H, Glowinski A, Kolevzon A, Martin A. Psychiatry Match Rates Increase After Exposure to a Medical Student Mentorship Program: A Multisite Retrospective Cohort Analysis. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:40-44. [PMID: 32100255 PMCID: PMC7483187 DOI: 10.1007/s40596-020-01210-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/12/2020] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Since 2002, the Klingenstein Third Generation Foundation (KTGF) has supported a network of medical student mentorship programs (MSMPs) across the USA with the explicit aim of enhancing interest in, and eventual recruitment into the field of child and adolescent psychiatry (CAP). The authors conducted a multisite, retrospective cohort analysis to examine the impact of the program on career selection, as reflected by graduation match rates into psychiatry or pediatrics. METHODS The authors collected graduating match information (2008-2019) from fourteen participating medical schools (Exposed) and thirteen non-participating schools (Control). Control schools were selected based on region, comparable student body and faculty size, national standing, and rank in NIH funding. Match rates into psychiatry and pediatrics were compared between Exposed and Control groups. RESULTS Exposed schools had significantly higher match rates into psychiatry as compared to unexposed schools (6.1% and 4.8%, respectively; OR [95%CI] = 1.29 [1.18, 1.40]; X2 = 32.036, p < 0.001). In contrast, during the same time period, exposed schools had significantly lower match rates into pediatrics than unexposed ones (11.6 and 10.5%, respectively; OR [95%CI] = 0.89 (0.83, 0.95); X2 = 12.127, p < 0.001). These findings persisted even after adjustment for secular trends in match rates. CONCLUSIONS Seventeen years after its inception, the KTGF medical student mentorship program network has had a positive impact on match rates into general psychiatry. Future studies will address whether these results translate to trainees' eventual selection of careers in CAP.
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Affiliation(s)
- Russell Himmelstein
- Robert Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Sarah Guth
- Robert Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Michael Enenbach
- University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | - Anne Glowinski
- Washington University in Saint Louis, Saint Louis, MO, USA
| | - Alex Kolevzon
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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Sengupta S, Jacobson S, Williamson E. Straight on Through: the Current State of Child Tracks in Psychiatry Residency. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:65-69. [PMID: 31823305 DOI: 10.1007/s40596-019-01151-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The authors explore the advantages and disadvantages of 5-year integrated child and adolescent psychiatry tracks from the perspective of program directors. METHODS The authors surveyed via email the program directors of the 134 child and adolescent psychiatry training programs accredited by the Accreditation Council for Graduate Medical Education in the USA on their experiences with and perceptions of a formal child track. RESULTS The authors received 79 responses (60% response rate), including 13 (16%) with a child track, an increase from 7 programs in a survey completed 13 years ago. Of programs with a child track, a majority were created within the last 5 years. Out of an average postgraduate year 1 class size of nine, the most common child track size was two positions per year. Benefits cited for child tracks included improved recruitment, longitudinal retention, potential flexibility, scholarly productivity, and clinical benefits such as the foundation of a developmental perspective and improved integration of pediatrics and mental health. Of programs that do not have a track, more than half were strongly or very strongly considering one. CONCLUSIONS Child tracks have potential benefits for individual trainees, general psychiatry residency programs, and child and adolescent psychiatry fellowships. Additionally, long-term benefits to child mental health workforce recruitment and expansion are likely. The number of programs offering a child track has risen significantly over the last decade since the field was last surveyed, and this trend is likely to continue over the next decade.
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Affiliation(s)
- Sourav Sengupta
- University at Buffalo Jacobs School of Medicine, Buffalo, NY, USA.
| | - Sansea Jacobson
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Shaligram D, Bernstein B, DeJong SM, Guerrero APS, Hunt J, Jadhav M, Ong SH, Robertson P, Seker A, Skokauskas N. "Building" the Twenty-First Century Child and Adolescent Psychiatrist. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:75-81. [PMID: 35119681 PMCID: PMC8815291 DOI: 10.1007/s40596-022-01594-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Affiliation(s)
| | | | - Sandra M DeJong
- Cambridge Health Alliance/Harvard Medical School, Cambridge, MA, USA
| | | | - Jeffrey Hunt
- Alpert Medical School of Brown University, Providence, RI, USA
| | - Mandar Jadhav
- American Psychiatric Association Foundation, Washington, DC, USA
| | - Say How Ong
- Institute of Mental Health, Singapore, Singapore
| | | | - Asilay Seker
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Adolescent dropout from brief digital mental health interventions within and beyond randomized trials. Internet Interv 2022; 27:100496. [PMID: 35257001 PMCID: PMC8897204 DOI: 10.1016/j.invent.2022.100496] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/09/2022] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Many adolescents struggle to access appropriate mental health care due to structural or psychological barriers. Although traditional barriers to participation (e.g., location, cost) are hypothetically reduced or removed in internet interventions, low retention reduces the likelihood that adolescents will receive the intervention dosage intended to produce beneficial effects. It is therefore key to determine what factors are associated with dropout in digital mental health interventions with adolescents both within and beyond the context of research studies. METHODS We compare completion rates from two projects evaluating self-guided, online single-session mental health interventions (SSIs) for adolescents. One was a randomized controlled trial (RCT) in which participants were paid for participation. The other was a program evaluation project in which participants were not paid for participation. We additionally compare SSI completion rates across various demographic groups and across baseline hopelessness levels. RESULTS There was a statistically significant difference in SSI completion status between the RCT (84.75% full-completers) and the program evaluation (36.86% full-completers), X 2 (2, N = 2436) = 583.5, p < 0.05. There were no significant differences in the baseline hopelessness scores across completion statuses in either study. There were no significant differences in full-completion rates across demographic groups in either project. CONCLUSION Adolescents may be more likely to complete a brief digital mental health intervention in a paid, research-based context than in an unpaid, naturalistic context. Additionally, it is possible that the brevity of SSIs reduces demographic disparities related to retention by minimizing the time required to complete an intervention.
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Suk JW, Soltis-Vaughan B, Mahato K, Hwang S. Practical and Ethical Issues in Pediatric Psychopharmacology: Introductory Considerations. Psychiatr Ann 2021. [DOI: 10.3928/00485713-20210913-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cotton A, Riddle MA, Reinblatt SP, Bettencourt AF. Characteristics of Providers Using a Child Psychiatry Access Program. Psychiatr Serv 2021; 72:1213-1217. [PMID: 33957762 DOI: 10.1176/appi.ps.202000292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Child psychiatry access programs (CPAPs) help increase access to mental health services. This study aimed to provide information on the types of pediatric primary care clinicians (PPCCs) who call Maryland's CPAP. METHODS Descriptive statistics and multinomial logistic regressions were conducted with data from 676 PPCCs who called Maryland's CPAP at least once between October 2012 and June 2019. RESULTS On average, PPCCs contacted Maryland's CPAP 6.8 times. Providers who called seven or more times were more likely to have an allopathic or osteopathic medicine degree and to specialize in pediatrics. Providers calling from rural regions were less likely to call only for referrals. CONCLUSIONS Most PPCCs contacted the CPAP for consultation or referrals but not both. PPCCs in rural areas were more likely to call for consultation, suggesting that they may be more likely to manage the care of patients with mental health conditions themselves, because of a lack of resources in their locations.
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Affiliation(s)
- Aronica Cotton
- University of MarylandSchool of Medicine (Cotton, Reinblatt) and Johns Hopkins University School of Medicine (Riddle, Bettencourt), Baltimore
| | - Mark A Riddle
- University of MarylandSchool of Medicine (Cotton, Reinblatt) and Johns Hopkins University School of Medicine (Riddle, Bettencourt), Baltimore
| | - Shauna P Reinblatt
- University of MarylandSchool of Medicine (Cotton, Reinblatt) and Johns Hopkins University School of Medicine (Riddle, Bettencourt), Baltimore
| | - Amie F Bettencourt
- University of MarylandSchool of Medicine (Cotton, Reinblatt) and Johns Hopkins University School of Medicine (Riddle, Bettencourt), Baltimore
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Braunberger P, McLennan JD. Arguments for Keeping Child & Adolescent Psychiatry Focused on Persons Under 18 Years of Age. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:217-222. [PMID: 34381517 PMCID: PMC8315220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Child and adolescent psychiatrists and their associations are grappling with the idea of restructuring their subspecialty to including transitional age youth (TAY), sometimes operationalized as persons 18-25 years of age. This consideration is currently before the Canadian Academy of Child and Adolescent Psychiatry (CACAP). This essay identifies several concerning and potentially harmful consequences of widening the age range of child and adolescent psychiatry. A key concern is the consequential and substantial increase in the population mandate which will significantly dilute already strained and limited child and adolescent psychiatry resources. Furthermore, the nature of some of the needs of TAY may preferentially divert resources away from younger patients. The change in age range will also disrupt existing partnerships which facilitate multidisciplinary care and needed efficiencies for the child and adolescent population, such as close working ties with pediatrics and schools. This is not to say that there may not be merit in child and adolescent psychiatrists contributing to the care of TAY, just as our members already contribute to other areas of mental health outside our immediate mandate. However, to advance such a mandate change, a threshold of evidence of a net beneficial impact including a systematic evaluation of potential harms and opportunity costs is needed. Unfortunately, such an assessment has not yet occurred and therefore a mandate and name change is premature. We recommend a much more deliberate evaluation of the role child and adolescent psychiatrists and their associations might play in contributing to the needs of TAY.
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Affiliation(s)
- Peter Braunberger
- St Joseph's Care Group Thunder Bay, Northern Ontario School of Medicine, and Telemental Health, The Hospital for Sick Children, Toronto, Ontario
| | - John D McLennan
- Departments of Psychiatry & Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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34
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Gill PJ, Anwar MR, Thavam T, Hall M, Rodean J, Kaiser SV, Srivastava R, Keren R, Mahant S. Identifying Conditions With High Prevalence, Cost, and Variation in Cost in US Children's Hospitals. JAMA Netw Open 2021; 4:e2117816. [PMID: 34309667 PMCID: PMC8314139 DOI: 10.1001/jamanetworkopen.2021.17816] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Identifying high priority pediatric conditions is important for setting a research agenda in hospital pediatrics that will benefit families, clinicians, and the health care system. However, the last such prioritization study was conducted more than a decade ago and used International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. OBJECTIVES To identify conditions that should be prioritized for comparative effectiveness research based on prevalence, cost, and variation in cost of hospitalizations using contemporary data at US children's hospitals. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study of children with hospital encounters used data from the Pediatric Health Information System database. Children younger than 18 years with inpatient hospital encounters at 45 tertiary care US children's hospitals between January 1, 2016, and December 31, 2019, were included. Data were analyzed from March 2020 to April 2021. MAIN OUTCOMES AND MEASURES The condition-specific prevalence and total standardized cost, the corresponding prevalence and cost ranks, and the variation in standardized cost per encounter across hospitals were analyzed. The variation in cost was assessed using the number of outlier hospitals and intraclass correlation coefficient. RESULTS There were 2 882 490 inpatient hospital encounters (median [interquartile range] age, 4 [1-12] years; 1 554 024 [53.9%] boys) included. Among the 50 most prevalent and 50 most costly conditions (total, 74 conditions), 49 (66.2%) were medical, 15 (20.3%) were surgical, and 10 (13.5%) were medical/surgical. The top 10 conditions by cost accounted for $12.4 billion of $33.4 billion total costs (37.4%) and 592 815 encounters (33.8% of all encounters). Of 74 conditions, 4 conditions had an intraclass correlation coefficient (ICC) of 0.30 or higher (ie, major depressive disorder: ICC, 0.49; type 1 diabetes with complications: ICC, 0.36; diabetic ketoacidosis: ICC, 0.33; acute appendicitis without peritonitis: ICC, 0.30), and 9 conditions had an ICC higher than 0.20 (scoliosis: ICC, 0.27; hypertrophy of tonsils and adenoids: ICC, 0.26; supracondylar fracture of humerus: ICC, 0.25; cleft lip and palate: ICC, 0.24; acute appendicitis with peritonitis: ICC, 0.21). Examples of conditions high in prevalence, cost, and variation in cost included major depressive disorder (cost rank, 19; prevalence rank, 10; ICC, 0.49), scoliosis (cost rank, 6; prevalence rank, 38; ICC, 0.27), acute appendicitis with peritonitis (cost rank, 13; prevalence rank, 11; ICC, 0.21), asthma (cost rank, 10; prevalence rank, 2; ICC, 0.17), and dehydration (cost rank, 24; prevalence rank, 8; ICC, 0.18). CONCLUSIONS AND RELEVANCE This cohort study found that major depressive disorder, scoliosis, acute appendicitis with peritonitis, asthma, and dehydration were high in prevalence, costs, and variation in cost. These results could help identify where future comparative effectiveness research in hospital pediatrics should be targeted to improve the care and outcomes of hospitalized children.
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Affiliation(s)
- Peter J. Gill
- Department of Pediatrics, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Mohammed Rashidul Anwar
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Thaksha Thavam
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | | | - Sunitha V. Kaiser
- Department of Pediatrics and Department of Epidemiology and Biostatistics, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, San Francisco, California
| | - Rajendu Srivastava
- Department of Pediatrics, University of Utah, Primary Children’s Hospital, Salt Lake City
- Healthcare Delivery Institute, Intermountain Healthcare, Salt Lake City, Utah
| | - Ron Keren
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sanjay Mahant
- Department of Pediatrics, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Canada
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DiGiovanni M, Weller I, Martin A. Pivoting in the pandemic: a qualitative study of child and adolescent psychiatrists in the times of COVID-19. Child Adolesc Psychiatry Ment Health 2021; 15:32. [PMID: 34154612 PMCID: PMC8216090 DOI: 10.1186/s13034-021-00382-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/07/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES We examined the personal and professional impacts of the COVID-19 pandemic on the development, practice, and shifting values of child and adolescent psychiatrists (CAP), in order to inform how the field may move forward post-pandemic. METHODS We conducted individual semi-structured interviews of child and adolescent psychiatrists (n = 24) practicing in the United States. Participants were selected as a diverse purposive sample of active members of the American Academy of Child and Adolescent Psychiatry (AACAP). We analyzed anonymized transcripts through iterative coding using thematic analysis aided by NVivo software. RESULTS We identified three main thematic domains within participants' response to the pandemic, which have engendered a reevaluation of and a recommitment to the aims of each clinician and the field of CAP more broadly. These domains, paired with representative questions, include: (1) Unsettling, or "who have we been?" (identifying discontents such as daily inefficiencies and intraprofessional loss of trust); (2) Adaptation, or "who are we now?" (exploring affordances and limitations of virtual work, and the evolution of personal and professional identity); and (3) Reimagination, or "who will we become?" (renewing a commitment to psychiatry as advocacy). Even as we identified a collective agreement toward the need for implementing change, just what needs to change, and how that change will be realized, remain contested. CONCLUSION These three thematic domains, augmented by a national confrontation with race and equity, have engendered a field-wide reckoning with known inequities. They have reinvigorated collective responses and calls to action. The divergent mindsets to change and leadership have provided an aperture for what values and practices the field might instill in its next generation of practitioners.
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Affiliation(s)
| | - Indigo Weller
- Bioethics Program, Harvard University, Cambridge, MA, USA
| | - Andrés Martin
- Child Study Center, Yale School of Medicine, New Haven, CT, USA.
- Center for Educational Development and Research in Health Sciences (CEDAR), University Medical Center Groningen, Groningen, The Netherlands.
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Sullivan AW, Lozowski-Sullivan S. The Continuum of Intervention Models in Integrated Behavioral Health. Pediatr Clin North Am 2021; 68:551-561. [PMID: 34044984 DOI: 10.1016/j.pcl.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current models of clinical collaboration between physicians and psychologists/social workers in the pediatric outpatient primary care setting fall along a continuum of integration of services and philosophies of care. Domains of integration include physical office location, the targeted patient population, the level of professional adaptation to other professions' model of training, and the influence of current models of reimbursement. Included here is an analysis of those models based on each continuum of integration. Each model is discussed with respect to where it falls on each continuum.
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Affiliation(s)
- Alexander W Sullivan
- Department of Social Work, Wayne State University, 5447 Woodward Avenue, Detroit, MI 48202, USA
| | - Sheryl Lozowski-Sullivan
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8071, USA.
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37
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Masciale M, Dongarwar D, Salihu HM. Predictors of Prolonged Length of Stay in Suicidal Children Transferred to Psychiatric Facilities. Hosp Pediatr 2021; 11:366-373. [PMID: 33782014 DOI: 10.1542/hpeds.2020-001230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To determine if sociodemographic factors or underlying mental health conditions serve as predictors for prolonged length of stay (pLOS) in children hospitalized for suicidal ideation (SI) or suicide attempt (SA) requiring transfer to psychiatric facilities. We hypothesized an association between certain patient and hospital characteristics and pLOS. METHODS For this retrospective cross-sectional study, we used the National Inpatient Sample. We included children <18 years old hospitalized with a primary or secondary International Classification of Diseases, 10th Edition, Clinical Modification diagnosis of SI or SA who were dispositioned to psychiatric facilities from 2016 to 2017. Exposures were patient sociodemographics, underlying mental health diagnoses, and hospital characteristics. Our outcome was pLOS. Adjusted prevalence ratios with 95% confidence intervals (CIs) were generated with log binomial regression. RESULTS Of 12 715 hospitalizations meeting inclusion criteria, 5475 had pLOS. After adjusting for sociodemographics and hospital characteristics, predictive factors for pLOS were public insurance use (prevalence ratio: 1.40; CI: 1.12-1.78), urban nonteaching hospital location (prevalence ratio: 4.61; CI: 2.33-9.12), urban teaching hospital location (prevalence ratio: 3.26; CI: 1.84-5.76), and underlying diagnosis of mood disorder (prevalence ratio: 1.98; CI: 1.63-3.42). Hispanic patients had decreased probability of pLOS (prevalence ratio: 0.69; CI: 0.52-0.93). Otherwise, age, zip income, sex, and hospital region were not predictive of pLOS. CONCLUSIONS Among children hospitalized for SI or SA requiring transfer to psychiatric facilities, public insurance, urban hospital location, and diagnoses of mood disorder, depression, and bipolar disorder were predictive of pLOS. Further research is needed on how to decrease disparities in length of stay among this vulnerable population.
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Affiliation(s)
- Marina Masciale
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; and
| | - Deepa Dongarwar
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
| | - Hamisu M Salihu
- Center of Excellence in Health Equity, Training, and Research, Baylor College of Medicine, Houston, Texas
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38
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LaVille Thoren K, Vista-Wayne J. The collaborative care model: Improving access to children's mental health care. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 34:83-87. [PMID: 33625764 DOI: 10.1111/jcap.12309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/12/2021] [Accepted: 02/14/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Current accessibility to child and adolescent mental health services is negatively affected by the shortage of mental health providers. The primary care provider or pediatrician is in a key position to identify behavioral health concerns, coordinate services, and provide treatment to the patient. AIM This project aimed to improve access to children's mental health care by creating and implementing an educational course on the collaborative care model (CoCM), a model of integrated care that embeds mental health professionals into the primary care setting. METHODS Pre- and post-surveys were embedded in the online CoCM course to track course completion, identify clinical staff knowledge, and identify clinical staff interest in implementing the CoCM in practice. RESULTS Following project implementation, clinical staffs' responses from the pre- and post-surveys represented an increase in knowledge and interest in implementing the CoCM in practice after taking the online course. CONCLUSION This project suggests further exploration of funding and planning to implement a pilot of the CoCM in a primary care practice setting.
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Affiliation(s)
- Kennedy LaVille Thoren
- Eyerly Ball Outpatient Community Mental Health Center-UnityPoint Des Moines, Des Moines, Iowa, USA.,MercyOne Des Moines-Mercy College of Health Sciences, Des Moines, Iowa, USA
| | - Joyce Vista-Wayne
- MercyOne Des Moines-Pediatric Psychiatry Center, Des Moines, Iowa, USA
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Chang D, Carlo AD, Khor S, Drake L, Lee ES, Avery M, Unützer J, Flum DR. Transforming Population-Based Depression Care: a Quality Improvement Initiative Using Remote, Centralized Care Management. J Gen Intern Med 2021; 36:333-340. [PMID: 32869208 PMCID: PMC7878605 DOI: 10.1007/s11606-020-06136-y] [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] [Received: 08/31/2019] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION With the growing prevalence of value-based contracts, health systems are incentivized to consider population approaches to service delivery, particularly for chronic conditions like depression. To this end, UW Medicine implemented the Depression-Population Approach to Health (PATH) program in primary care (PC) as part of a system-wide Center for Medicare and Medicaid Innovation (CMMI) quality improvement (QI) initiative. AIM To examine the feasibility of a pilot PATH program and its impact on clinical and process-of-care outcomes. SETTING A large, diverse, geographically disparate academic health system in Western Washington State including 28 PC clinics across five networks. PROGRAM DESCRIPTION The PATH program was a population-level, centralized, measurement-based care intervention that utilized a clinician to provide remote monitoring of treatment progress via chart review and facilitate patient engagement when appropriate. The primary goals of the program were to improve care engagement and increase follow-up PHQ-9 assessments for patients with depression and elevated initial PHQ-9 scores. PROGRAM EVALUATION We employed a prospective, observational study design, including commercially insured adult patients with new depression diagnoses and elevated initial PHQ-9 scores. The pilot intervention group, consisting of accountable care network (ACN) self-enrollees (N = 262), was compared with a similar commercially insured cohort (N = 2527) using difference-in-differences analyses adjusted for patient comorbidities, initial PHQ-9 score, and time trends. The PATH program was associated with three times the odds of PHQ-9 follow-up (OR 3.28, 95% CI 1.79-5.99), twice the odds of a follow-up PC clinic visit (OR 1.74, 95% CI 0.99-3.08), and twice the odds of treatment response, defined as reduction in PHQ-9 score by ≥ 50% (OR 2.02, 95% CI 0.97-4.21). DISCUSSION Our results demonstrate that a centralized, remote care management initiative is both feasible and effective for large academic health systems aiming to improve depression outcome ascertainment, treatment engagement, and clinical care.
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Affiliation(s)
- Denise Chang
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, USA.
| | - Andrew D Carlo
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, USA
| | - Sara Khor
- Department of Surgery, University of Washington, Seattle, WA, USA.,The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, WA, USA
| | - Lauren Drake
- UW Medicine Population Health Management, Seattle, WA, USA
| | - E Sally Lee
- UW Medicine, Population Health Analytics, Seattle, WA, USA
| | - Marc Avery
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, USA.,Health Management Associates, Seattle, WA, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle, WA, USA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA, USA
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Hoffnung G, Feigenbaum E, Schechter A, Guttman D, Zemon V, Schechter I. Children and Telehealth in Mental Healthcare: What We Have Learned From COVID-19 and 40,000+ Sessions. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2021; 3:106-114. [PMID: 33821240 PMCID: PMC8014257 DOI: 10.1176/appi.prcp.20200035] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 12/01/2022] Open
Abstract
Objective Of the many impacts of COVID-19 on contemporary healthcare is the rapid and overwhelming shift to remote telehealth (TH) service. The precise effect of TH on treatment is yet unknown, and the possible child/adult differences are an essential point of clarification for the utility of TH services and efforts to improve upon them. Methods The current study considers data reflecting pre-, during-, and post-COVID-19 lockdown over the first six months of 2020. Data comprise records of N = 43,294 services delivered to N = 2520 unique clients across multiple outpatient mental health sites at a Certified Community Based Mental Health Clinic (CCBHC) in Rockland County, NY, an area hard hit by COVID-19. Results Results demonstrate significant differences between child and adult sessions with a relative decrease in the number of child mental health services with the switch to TH in March 2020 (onset of lockdown) and a relatively rapid shift back to face-to-face among child services when in-person services resumed in May and June 2020. Results further highlight significant differences between child age and service type, with psychiatry less affected by TH than psychotherapy. Conclusions Implicit in the data is the ability to offer remotely, a high volume of ongoing behavioral intervention. Findings support TH as less preferred for children than adults while indicating that child TH is favored for psychiatry and support services, less so for psychotherapy. Implications for enhancing child TH delivery and directions for continued research include relational factors, platform (phone/video) and screen salience.
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Affiliation(s)
| | | | | | | | - Vance Zemon
- Ferkauf Graduate School of Psychology Yeshiva University Bronx NY
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Boyer J, Cautenet A, Ligier F. [The evolution of child psychiatry emergencies: Results and reflections from a Nancy University Hospital study]. Encephale 2021; 47:348-355. [PMID: 33455741 DOI: 10.1016/j.encep.2020.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Mental illness is one of the most common causes of disability, morbidity and mortality in childhood. According to the scientific literature, the prevalence of mental health disorders is an estimated 10% to 20% in the USA and similar results are found in France. Although primordial, outpatient care often appears insufficient with inequalities in its geographical distribution and its accessibility. These past decades have been marked by an increase in consultations for mental disorders in pediatric emergency departments. Is this trend indicative of a "defect" in the healthcare organization? Identifying the root causes of this inflation in psychiatric consultations seems of paramount importance in the improvement of healthcare policies. In France and worldwide, only a few studies deal with this subject. That is why we proposed to observe the evolution of the number of consultations for mental health reasons in the pediatric emergency department of Nancy University Hospital and to detail their characteristics. MATERIALS AND METHODS Ancillary comparative and retrospective study (2003-2013) on minors having received a child psychiatry consultation within the pediatric emergency department of Nancy University Hospital. RESULTS The number of consultations for mental health reasons increased by 119% (97 in 2003; 212 in 2013), while consultations for pediatrics reasons remained stable over the period studied. Consultations mainly dealt with females representing 55.6% of consultations in 2003 and 63.7% in 2013. Mean age of consultants was stable: 13.9 years (standard deviation=3.3 years) in 2003; 14.1 (2.5) years in 2013. Family structure witnessed a three-fold increase in the single-parent model. Regarding consultation motives, behavioral disorders were significantly more represented in 2013: 27.7% (RR=1.7; 95% CI 1.0-2.8; P<0.05) versus 16.5%. As far as diagnosis is concerned (ICD-10), emotional and behavioral disorders increased to 35.9% from 12.6% (RR=2.8; IC95% 1.6-5.1; P=0.0001). CONCLUSIONS In France, as well as in other western countries, the number of visits in pediatric emergency departments for mental health reasons more than doubled over a 10-year span. This growth mostly concerned externalizing disorders as a motive for consultation. Causes for this increase are multifactorial and closely related to the prevalence of psychiatric disorders in children. Some studies showed that economic factors played a major role on mental illness during such a downturn as the financial crisis of 2007-2008. Unemployment caused by economic crises can weaken pediatric caregivers and therefore their patients. Evolution of family structure and value also explains this trend. These past decades, the two-parent model, relevant till the 1960s, has evolved to a point where single parents are more quickly overwhelmed. Family values are now focused on consensus rather than duty and hedonism has become a central value. Women are more involved in the working world which became for all a performance field. Several studies have shown that social settings where competitiveness is the norm breed externalized disorders in children by advocating short-term efficiency. Moreover, the widespread use of screens in households as well as early exposure impact the psychomotor development, decrease the amount of sleep and may be responsible for the occurrence of many psychiatric disorders. There are some epidemiological reasons too. In 1971, Omran introduced a concept called "epidemiological transition" explaining how mental health issues appeared in the limelight through to the decline of infectious and cardiovascular diseases. This phenomenon has already occurred in western countries which could explain the increase in the prevalence of psychiatric disorders. In Africa, there is evidence it may have already started. Beyond all these considerations, the increase in consultations for mental disorders in pediatric emergency departments can be explained by a change in care consumption habits. Going straight to the local emergency department, accessible on a 24/7 basis, is easier than waiting for an outpatient appointment and is also free for the have-nots lacking proper insurance coverage. Scarce resources in ambulatory care may also explain the increased recourse to emergency services. Several reports have shown a lack of child psychiatrists and their uneven geographical distribution. For example, in the US only a third of children with mental disorders receive proper care, a lack which doubled between 1997 and 2010. Despite the reason for this trend, it is important to propose a better fitting of the healthcare system to the population needs, and to improve prevention and early identification. All these changes require further collective reflection.
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Affiliation(s)
- J Boyer
- Pôle universitaire de psychiatrie de l'enfant et de l'adolescent, centre psychothérapique de Nancy, 1, rue du Docteur-Archambault BP 11010, 54521 Laxou cedex, France.
| | - A Cautenet
- Pôle universitaire de psychiatrie de l'enfant et de l'adolescent, centre psychothérapique de Nancy, 1, rue du Docteur-Archambault BP 11010, 54521 Laxou cedex, France
| | - F Ligier
- Pôle universitaire de psychiatrie de l'enfant et de l'adolescent, centre psychothérapique de Nancy, 1, rue du Docteur-Archambault BP 11010, 54521 Laxou cedex, France; EA 4360 APEMAC, Université de Lorraine, Nancy, France
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Quinlan K, Auerbach S, Bearl DW, Dodd DA, Thurm CW, Hall M, Fuchs DC, Lambert AN, Godown J. The impact of psychiatric disorders on outcomes following heart transplantation in children. Pediatr Transplant 2020; 24:e13847. [PMID: 32997873 DOI: 10.1111/petr.13847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 07/31/2020] [Accepted: 08/29/2020] [Indexed: 12/31/2022]
Abstract
Psychiatric disorders are common in pediatric HTx recipients. However, the impact of psychiatric comorbidities on patient outcomes is unknown. We aimed to assess the impact of disorders of adjustment, depression, and anxiety on HTx outcomes in children; hypothesizing that the presence of psychiatric disorders during or preceding HTx would negatively impact outcomes. All pediatric HTx recipients ≥8 years of age who survived to hospital discharge were identified from a novel linkage between the PHIS and SRTR databases (2002-2016). Psychiatric disorders were identified using ICD codes during or preceding the HTx admission. Post-transplant graft survival, freedom from readmission, and freedom from rejection were analyzed using the Kaplan-Meier method. Multivariable Cox proportional hazard models were used to adjust for covariates. A total of 1192 patients were included, of which 133 (11.2%) had depression, 197 (16.5%) had anxiety, and 218 (18.3%) had adjustment disorders. The presence of depression was independently associated with higher rates of readmission (60.9% vs 54.1% at 6 months) (AHR 1.63, 95% CI 1.22-2.18, P = .001) and inferior graft survival (70.2% vs 83.4% at 5 years) (AHR 1.62, 95% CI 1.14-2.3, P = .007). Anxiety was independently associated with higher rates of readmission (60.4% vs 53.9% at 6 months) (AHR 1.46, 95% CI 1.09-1.94, P = .01). Anxiety and depression in the pretransplant period are independently associated with outcomes following HTx in children. Evaluation and management of psychiatric comorbidities represents an important component of care in this vulnerable population.
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Affiliation(s)
- Kia Quinlan
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Scott Auerbach
- Pediatrics, Division of Cardiology, Denver Anschutz Medical Campus Children's Hospital of Colorado, University of Colorado, Aurora, CO, USA
| | - David W Bearl
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN, USA
| | - Debra A Dodd
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN, USA
| | - Cary W Thurm
- Children's Hospital Association, Lenexa, KS, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS, USA
| | - Dickey Catherine Fuchs
- Child and Adolescent Psychiatry, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Justin Godown
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN, USA
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Randall MM, Parlette K, Reibling E, Chen B, Chen M, Randall F, Brown L. Young children with psychiatric complaints in the pediatric emergency department. Am J Emerg Med 2020; 46:344-348. [PMID: 33059988 DOI: 10.1016/j.ajem.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Children are increasingly diagnosed with mental illnesses and self-harm behaviors. They present frequently to the emergency department (ED) for evaluation. The aim of this study is to describe the youngest children in the ED with psychiatric issues. METHODS This is a retrospective chart review of all consecutive children less than 10 years of age with a psychiatric complaint who received a psychiatric consultation in the pediatric emergency department in the last four years. RESULTS The number of children with psychiatric issues increased over the study period. The ED length of stay also increased. Violent behavior and aggression were the most common chief complaints, and some children required chemical or physical restraint in the ED. Many children had pre-existing psychiatric issues and a history of adverse childhood experiences. Half of patients were deemed safe for discharge home by psychiatric consultation. CONCLUSION The number of young children with psychiatric complaints presenting to the ED has increased. However, a large number are found to be stable for discharge home. Increase in urgent outpatient psychiatric resources could help decrease ED utilization.
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Affiliation(s)
- Melanie M Randall
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Karli Parlette
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Ellen Reibling
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Brian Chen
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Miryah Chen
- Pediatrics Department, Kaiser Permanente Medical Group Moreno Valley, 12815 Heacock St, Moreno Valley, CA 92553, USA
| | - Frank Randall
- Psychiatry Department, Kaiser Permanente Medical Group Fontana, 1301 California St, Redlands, CA 92374, USA
| | - Lance Brown
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
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Cuddy E, Currie J. Treatment of mental illness in American adolescents varies widely within and across areas. Proc Natl Acad Sci U S A 2020; 117:24039-24046. [PMID: 32958646 PMCID: PMC7533674 DOI: 10.1073/pnas.2007484117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Many mental health disorders first manifest in adolescence, and early treatment may affect the course of the disease. Using a large national database of insurance claims, this study focuses on variations in the type of care that adolescent patients receive when they are treated for an initial episode of mental illness. We found large variations in the probability that children receive follow-up care and in the type of follow-up care received across zip codes. We also found large variations in the probability that children receive drug treatments that raise a red flag when viewed through the lens of treatment guidelines: Overall, in the first 3 mo after their initial claim for mental illness, 44.85% of children who receive drug treatment receive benzodiazepines, tricyclic antidepressants, or a drug that is not Food and Drug Administration-approved for their age. On average, these children are 12 y old. While the supply of mental health professionals impacts treatment choices, little of the overall variation is explained by supply-side variables, and at least half of the variation in treatment outcomes occurs within zip codes. These results suggest that other factors, such as physician practice style, may play an important role in the types of treatment that children receive.
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Affiliation(s)
- Emily Cuddy
- Department of Economics, Princeton University, Princeton, NJ 08540
| | - Janet Currie
- Center for Health and Wellbeing, Princeton University, Princeton, NJ 08540
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Abstract
Suicide is the second leading cause of death among adolescents worldwide, yet adequate mental health services for children and adolescents are lacking across the globe. Likewise, youth who engage in non-suicidal self-injury (NSSI) are at heightened risk for suicide, but few pediatric settings have established protocols for screening and responding to youth who engage in NSSI and/or endorse thoughts of suicide. In this article, we highlight similarities and differences of managing suicide and NSSI across cultures, including persisting stigma associated with youth at risk for self-harm. We summarize current guidelines for screening youth at risk for suicide and NSSI across services, consider the use of online and telehealth services, and offer recommendations for a multidisciplinary approach to treating youth who engage in self-harming behaviors as well as how healthcare professionals can communicate with each other using common, non-stigmatizing language. We conclude with a discussion of future policy recommendations and areas for research.
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Affiliation(s)
- Nicholas J Westers
- Department of Psychiatry, Children's Medical Center of Dallas, University of Texas Southwestern Medical Center, USA
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Austria
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Hoffmann JA, Grupp-Phelan J. Advocacy Opportunities for Pediatricians and Emergency Physicians to Prevent Youth Suicide. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Saito E, Eng S, Grosso C, Ozinci Z, Van Meter A. Pro Re Nata Medication Use in Acute Care Adolescent Psychiatric Unit. J Child Adolesc Psychopharmacol 2020; 30:250-260. [PMID: 31800304 DOI: 10.1089/cap.2019.0131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective: Evidence to support the use of pro re nata (PRN) medication is limited, and the details of PRN use (indication, frequency of administration, patient characteristics) are rarely reported, particularly in youth populations. The goal of this study was to report on the pattern of PRN use over 6 years in an acute care psychiatric unit for adolescents. Methods: A retrospective chart review of patients' records from November 2012 to October 2018 was conducted. Variables extracted from electronic medical records included age, gender, race/ethnicity, clinical rating scores at admission (on a subset of patients), length of stay, psychotropic and nonpsychotropic PRN medication administration, timing of administration, discharge diagnosis, and discharge medication. Results: Records from 2961 individuals with a total 3937 admissions were analyzed. A total of 62% of admissions had at least one PRN medication administration. Severity of symptoms, as indicated by higher scores on clinical rating scales at admission, longer length of stay, and readmission were related to high PRN use. Patients with bipolar spectrum disorders received more psychotropic and nonpsychotropic PRN medications than other patients. Patients who were high psychotropic PRN users were also high nonpsychotropic PRN users. Conclusion: Despite the lack of clear evidence in support of the efficacy of PRN medications, they commonly used to control symptoms in acute care inpatient settings. Youth with severe symptoms utilized not only psychotropic PRN medication but also nonpsychotropic PRN more frequently, suggesting a possible role of systemic disorder among youth with serious mental illness. More research is necessary to examine the efficacy of PRN medications for managing targeted symptoms.
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Affiliation(s)
- Ema Saito
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Stephanie Eng
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Christine Grosso
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Zeynep Ozinci
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA
| | - Anna Van Meter
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Feinstein Institutes of Medical Research, Glen Oaks, New York, USA
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Kronsberg H, Bettencourt A. Patterns of Student Treatment Attendance and Dropout in an Urban School-Based Mental Health Program. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09370-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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“Fighting Tooth and Nail”: Barriers to Accessing Adolescent Mental Health Treatment from Mothers Perspectives. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:935-945. [DOI: 10.1007/s10488-020-01026-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Diaz I, Thurm C, Hall M, Auerbach S, Bearl DW, Dodd DA, Mettler BA, Smith AH, Fuchs DC, Godown J. Disorders of Adjustment, Mood, and Anxiety in Children and Adolescents Undergoing Heart Transplantation and the Association of Ventricular Assist Device Support. J Pediatr 2020; 217:20-24.e1. [PMID: 31732131 DOI: 10.1016/j.jpeds.2019.10.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/06/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the prevalence of psychiatric disorders and associated therapies in children during their heart transplantation admission. STUDY DESIGN All pediatric heart transplant recipients (1999-2016) were included from a linked administrative and clinical registry database. Psychiatric disorders and associated therapies were identified using International Classification of Diseases or billing codes during the transplant admission. Data were analyzed using standard descriptive statistics. Multivariable logistic regression assessed factors independently associated with psychiatric disorders or therapies. RESULTS A total of 3073 pediatric heart transplant recipients were included. Psychiatric disorders were present in 434 (14.1%) patients during the heart transplant admission, with adjustment disorders being the most common. Antidepressant therapy was prescribed to 212 patients (6.9%) and selective serotonin reuptake inhibitors were most commonly used. Psychiatric diagnoses (8.4% vs 18.1%; P < .001) and the use of antidepressants (4.5% vs 8.9%; P < .001) increased over time (era 1, 1999-2009 vs era 2, 2010-2016). Psychiatric disorders were present in 39.8% of patients ≥8 years of age requiring ventricular assist device support at heart transplantation. The need for ventricular assist device support was independently associated with psychiatric diagnoses (aOR, 1.57; 95% CI, 1.18-2.1; P = .002) and antidepressant therapy (aOR, 2.11; 95% CI. 1.43-3.12; P < .001). CONCLUSIONS Psychiatric disorders are common in pediatric heart transplant recipients, especially among those bridged with ventricular assist device support. Psychiatric diagnoses and the use of antidepressants has increased over time, likely representing improved recognition of psychiatric comorbidities in this vulnerable population. Access to psychiatric services represents an important component of the multidisciplinary team caring for pediatric heart transplant recipients.
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Affiliation(s)
- Isaura Diaz
- Pediatric Critical Care, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Cary Thurm
- Children's Hospital Association, Lenexa, KS
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Scott Auerbach
- Pediatric Cardiology, Children's Hospital of Colorado, Aurora, CO
| | - David W Bearl
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Debra A Dodd
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Bret A Mettler
- Pediatric Cardiothoracic Surgery, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - Andrew H Smith
- Pediatric Critical Care, Monroe Carell Jr. Children's Hospital, Nashville, TN
| | - D Catherine Fuchs
- Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Vanderbilt University Medical Center, Nashville, TN
| | - Justin Godown
- Pediatric Cardiology, Monroe Carell Jr. Children's Hospital, Nashville, TN.
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