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Vázquez-Vázquez A, Smith A, Gibson F, Roberts H, Mathews G, Ward JL, Viner RM, Nicholls D, Cornaglia F, Roland D, Phillips K, Hudson LD. Admissions to paediatric medical wards with a primary mental health diagnosis: a systematic review of the literature. Arch Dis Child 2024:archdischild-2023-326593. [PMID: 38373777 DOI: 10.1136/archdischild-2023-326593] [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: 11/09/2023] [Accepted: 01/26/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVE To systematically review the literature describing children and young people (CYP) admissions to paediatric general wards because of primary mental health (MH) reasons, particularly in MH crisis. DESIGN PubMed, Embase, PsycINFO, Web of Science and Google Scholar were searched, with no restriction on country or language. We addressed five search questions to inform: trends and/or the number of admissions, the risk factors for adverse care, the experiences of CYP, families/carers and healthcare professionals (HCPs) and the evidence of interventions aimed at improving the care during admissions.Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality assessment. This review was registered with PROSPERO (CRD42022350655). RESULTS Thirty-two studies met the inclusion criteria. Eighteen addressed trends and/or numbers/proportions of admissions, 12 provided data about the views/experiences of HCPs, two provided data about CYP's experiences and four explored improving care. We were unable to identify studies examining risk factors for harm during admissions, but studies did report the length of stay in general paediatric/adult settings while waiting for specialised care, which could be considered a risk factor while caring for this group. CONCLUSIONS MH admissions to children's wards are a long-standing issue and are increasing. CYP will continue to need to be admitted in crisis, with paediatric wards a common location while waiting for assessment. For services to be delivered effectively and for CYP and their families/carers to feel supported and HCPs to feel confident, we need to facilitate more integrated physical and MH pathways of care. PROSPERO REGISTRATION NUMBER CRD42022350655.
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Affiliation(s)
- Adriana Vázquez-Vázquez
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Abigail Smith
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Faith Gibson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- University of Surrey, Guildford, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Helen Roberts
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Gabrielle Mathews
- CYP Transformation Team, NHS England and NHS Improvement London, London, UK
| | - Joseph Lloyd Ward
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
| | | | - Damian Roland
- SAPPHIRE Group, Population Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Kirsty Phillips
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lee D Hudson
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
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2
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Hudson LD, Vázquez-Vázquez A, Gibson F, Phillips K, Mathews G, Roberts H, Cornaglia F, Roland D, Ward J, Nicholls DE, Elphinstone H, Viner R. Mental Health Admissions to Paediatric Wards Study (MAPS): protocol of a prospective study of mental health admissions to paediatric wards in England using surveillance and qualitative methods. BMJ Paediatr Open 2024; 8:e002186. [PMID: 38272539 PMCID: PMC10824001 DOI: 10.1136/bmjpo-2023-002186] [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: 07/14/2023] [Accepted: 08/09/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Children and young people (CYP) presenting with a mental health (MH) crisis are frequently admitted to general acute paediatric wards as a place of safety. Prior to the pandemic, a survey in England showed that CYP occupied 6% of general paediatric inpatient beds due to an MH crisis, and there have been longstanding concerns about the quality of care to support these patients in this setting. MAPS aims to generate a Theory of Change (ToC) model to improve the quality of care for CYP admitted to acute paediatric services after presenting with an MH crisis. Here, we describe work packages (WPs) 2 and 3 of the study, which have been granted ethics approval. METHODS AND ANALYSIS We will undertake a national (England), sequential, mixed-methods study to inform a ToC framework alongside a stakeholder group consisting of patients, families/carers and healthcare professionals (HCPs). Our study consists of four WPs undertaken over 30 months. WP2 is limited to working with stakeholders to develop a data collection instrument and then use this in a prospective study of MH admissions over 6 months in 15 purposively recruited acute paediatric wards across England. WP3 consists of gathering the views of CYP, their families/carers and HCPs during admissions using semistructured interviews. ETHICS AND DISSEMINATION WP2 and WP3 received ethical approval (ref: 23/LO/0349). We will publish the overall synthesis of data and the final ToC to improve care of CYP with MH crisis admitted to general acute paediatric settings. As co-producers of the ToC, we will work with our stakeholder group to ensure wide dissemination of findings. Potential impacts will be upon service development, new models of care, training and workforce planning. PROSPERO REGISTRATION NUMBER CRD42022350655.
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Affiliation(s)
- Lee Duncan Hudson
- University College London Great Ormond Street Institute of Child Health, London, UK
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Adriana Vázquez-Vázquez
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Faith Gibson
- University College London Great Ormond Street Institute of Child Health, London, UK
- Population, Policy and Practice, University College London Great Ormond Street Institute of Child Health, London, UK
- Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Kirsty Phillips
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Gabrielle Mathews
- CYP Transformation Team, NHS England and NHS Improvement London, London, UK
| | - Helen Roberts
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Damian Roland
- SAPPHIRE Group, Population Health Sciences, Leicester University, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Joseph Ward
- University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Holly Elphinstone
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Russell Viner
- University College London Great Ormond Street Institute of Child Health, London, UK
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3
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Golson ME, Brunson McClain M, O'Dell SM, Gormley MJ, Roanhorse TT, Yang NJ, Kettlewell P, Shahidullah JD. Assessment and Management of Attention-Deficit/Hyperactivity Disorder: Pediatric Resident Perspectives on Training and Practice. Clin Pediatr (Phila) 2023; 62:1513-1522. [PMID: 36995005 DOI: 10.1177/00099228231163687] [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] [Indexed: 03/31/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a common presenting concern in primary care. This study examined the relationship between pediatric residency training program characteristics and residents' ADHD knowledge, attitudes, and comfort in providing ADHD services. Given the familiarity that pediatric chief residents have with the training and experiences within their residency programs, a 30-item survey was mailed to pediatric chief residents. A total of 100 residents returned their surveys (response rate 49.5%) and were included in the descriptive quantitative and thematic qualitative analyses. The majority of participants rated their ADHD knowledge as at least average. However, approximately half of the participants were comfortable with screening, and less than half were comfortable with managing stimulant medication or behavioral treatments. Participants emphasized the importance of interprofessional collaboration, clinical experiences, and integrated ADHD education throughout training. These results emphasize the importance of improved training in screening, diagnosing, and managing ADHD to increase resident comfort regarding these practices.
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Affiliation(s)
- Megan E Golson
- Department of Psychology, Utah State University, Logan, UT, USA
| | | | | | | | | | - Nai-Jiin Yang
- Department of Psychology, Utah State University, Logan, UT, USA
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4
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Shahidullah JD, Roberts H, Parkhurst J, Ballard R, Mautone JA, Carlson JS. State of the Evidence for Use of Psychotropic Medications in School-Age Youth. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1454. [PMID: 37761415 PMCID: PMC10528957 DOI: 10.3390/children10091454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Psychotropic medications are commonly prescribed to school-aged youth for the management of mental health concerns. This paper describes the current state of evidence for psychotropic medications in school-aged youth. More specifically, the following sections summarize relevant medication research trials and practice parameters pertaining to psychotropic medication prescribing as well as the specific medications indicated for a range of commonly presenting disorders and symptom clusters in school-aged youth. For each of these disorders and symptom clusters, key findings pertaining to the current state of science and practice are highlighted for the purpose of offering patients, clinicians, researchers, and policymakers with nuanced considerations for the role of psychopharmacology within the context of a larger "whole-child" approach to care that relies on the collaboration of providers and services across systems of care to promote optimal child and family health and wellness. The paper concludes with a discussion about supporting the use of medication treatments in schools, including considerations for ensuring effective family-school-health system collaboration to best meet youth mental health needs.
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Affiliation(s)
- Jeffrey D. Shahidullah
- Department of Psychiatry & Behavioral Sciences, Dell Medical School, The University of Texas at Austin, Austin, TX 78712, USA;
| | - Holly Roberts
- Department of Psychology, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - John Parkhurst
- Pritzker Department of Psychiatry & Behavioral Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (J.P.); (R.B.)
| | - Rachel Ballard
- Pritzker Department of Psychiatry & Behavioral Sciences, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA; (J.P.); (R.B.)
| | - Jennifer A. Mautone
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19146, USA;
| | - John S. Carlson
- Department of Counseling, Educational Psychology, & Special Education, Michigan State University, East Lansing, MI 48824, USA
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5
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Bennett RJ, Nickbakht M, Saulsman L, Pachana NA, Eikelboom RH, Bucks RS, Meyer CJ. Providing information on mental well-being during audiological consultations: exploring barriers and facilitators using the COM-B model. Int J Audiol 2023; 62:269-277. [PMID: 35175887 DOI: 10.1080/14992027.2022.2034997] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being. DESIGN A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change). STUDY SAMPLE Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3). RESULTS Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients' lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician's limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss. CONCLUSION Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.
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Affiliation(s)
- Rebecca J Bennett
- Ear Science Institute Australia, Subiaco, Australia.,Ear Sciences Centre, The University of Western Australia, Perth, Australia.,School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Mansoureh Nickbakht
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Lisa Saulsman
- School of Psychological Science, The University of Western Australia, Perth, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, St Lucia, Australia
| | - Robert H Eikelboom
- Ear Science Institute Australia, Subiaco, Australia.,Ear Sciences Centre, The University of Western Australia, Perth, Australia.,Department of Speech Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Romola S Bucks
- School of Psychological Science, The University of Western Australia, Perth, Australia.,The Raine Study, School of Population and Global Health, The University of Western Australia, Perth, Australia
| | - Carly J Meyer
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.,Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, London, UK
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6
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Scala M, Marchman VA, Dowtin LL, Givrad S, Nguyen T, Thomson A, Gao C, Sorrells K, Hall S. Evaluation of a course for neonatal fellows on providing psychosocial support to NICU families. PEC INNOVATION 2022; 1:100053. [PMID: 37213727 PMCID: PMC10194397 DOI: 10.1016/j.pecinn.2022.100053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/12/2022] [Accepted: 05/19/2022] [Indexed: 05/23/2023]
Abstract
Objectives Families in the Neonatal Intensive Care Unit (NICU) experience significant psychological distress. Fellowship training requires education on mental health issues. No standardized program exists. We evaluated the impact of an online course, combining research with family perspectives, on neonatology fellow knowledge and self-efficacy when emotionally supporting NICU families. Methods Fellows from 20 programs completed a course covering: (1) Parent Mental Health, (2) Infant Mental Health, (3) Communication, and (4) Comprehensive Mental Health (e.g., discharge, bereavement) with pre- and post-course knowledge and self-efficacy assessments. Results Fellows (n=91) completed the course and assessments. Pre-course knowledge was similar by year of training (1st: 66.9%; 2nd: 67.2%; 3rd: 67.4%). Mean knowledge and self-efficacy improved between pre- and post-course assessments regardless of training year or prior education for knowledge (d=1.2) (67.1% vs. 79.4%) and for self-efficacy (d=1.2) (4.7 vs 5.2 on 6-point Likert scale). Fellows who gained more knowledge had higher self-efficacy scores at post-test (r = .37). Conclusions Current neonatal fellowship training under-educates on mental health. An online course improved fellow knowledge and self-efficacy. Our course may be an exemplar for others creating similar curricula. Innovation An online course enriched by patient perspectives is an effective method of disseminating education around mental health.
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Affiliation(s)
- Melissa Scala
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
- Corresponding author at: Division of Neonatal and Developmental Medicine, Stanford University, MC5660, 453 Quarry Road, Palo Alto, CA 94304, USA.
| | | | | | - Soudabeh Givrad
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Tuan Nguyen
- Department of Pediatrics, Stanford University, Palo Alto, CA, USA
| | - Alexa Thomson
- Human Biology, Stanford University, Stanford, CA, USA
| | - Courtney Gao
- Human Biology, Stanford University, Stanford, CA, USA
| | | | - Sue Hall
- St John’s Regional Medical Center (retired), Oxnard, CA, USA
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7
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Bonnin R, Gralnik LM, Rothe E, Obeso V, von Harscher H, Shoua-Desmarais N, Creel L, Castellanos D. Overcoming Stigma: A Novel Curriculum for Teaching Medical Students about Suicide. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2021; 45:751-756. [PMID: 34080134 DOI: 10.1007/s40596-021-01485-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/10/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Rodolfo Bonnin
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
| | - Leonard M Gralnik
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Eugenio Rothe
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Vivian Obeso
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Heidi von Harscher
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | | | - Laura Creel
- Florida International University, Miami, FL, USA
| | - Daniel Castellanos
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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8
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Psychotropic Medication Prescribing in Primary Care: Pediatric Chief Resident Perspectives. Acad Pediatr 2021; 21:750-758. [PMID: 33359584 DOI: 10.1016/j.acap.2020.12.001] [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: 06/06/2019] [Revised: 11/29/2020] [Accepted: 12/13/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Evidence-based treatments for mental health concerns include psychopharmacological and psychosocial approaches. Pediatrics organizations indicate psychopharmacology needs to be a component of training. This study investigated the status of training in psychotropic medication prescribing through a national survey of pediatric chief residents. METHOD Pediatric chief residents (one per residency program) completed a survey (response rate = 60.2%, 127/211) about their attitudes, knowledge, comfort, practice, and training around prescribing psychotropic medication in primary care. Quantitative data included descriptive statistics and correlational analyses to explore relationships between variables; qualitative data were examined through classical content analysis. RESULTS Almost half of respondents reported prescribing sometimes or often. Frequency of prescribing varied by mental health condition, with highest frequency for attention-deficit/hyperactivity disorder. About two-thirds of respondents reported having at least some/average knowledge. About half of respondents reported being uncomfortable with prescribing; respondents were most uncomfortable with prescribing antianxiety, mood stabilizing, and antipsychotic medications, and with discontinuing medication; about half indicated their competence in progress-monitoring needed improvement. Concurrent psychosocial treatment was perceived as very useful, although often inaccessible to patients. Prescribing frequency was related to knowledge, comfort, progress-monitoring competence, and training quality; training quality was related to knowledge and comfort. Over 60% rated their training as not at all or only somewhat adequate. CONCLUSIONS Pediatric chief residents reported having knowledge of psychotropic medication issues, but experience a general discomfort, especially with discontinuing medication, and with medications other than stimulants. Most thought their training needed improvement in terms of comprehensiveness and clinical practice experiences.
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Hilgenberg SL, Frintner MP, Blankenburg RL, Haftel HM, Gellin CE. Categorical Pediatric Residency Program Curriculum Needs: A Study of Graduating Residents and Residency Program Leadership. Acad Pediatr 2021; 21:589-593. [PMID: 33011294 DOI: 10.1016/j.acap.2020.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pediatric residency programs must adapt their curriculum to meet evolving patient needs yet face limited resources to implement changes resulting in gaps. We performed a categorical pediatric residency program curriculum needs assessment to inform curriculum development efforts. METHODS We analyzed data from the 2017 American Academy of Pediatrics Annual Survey of Graduating Residents and pediatric program and associate program director polls conducted at a 2019 pediatric residency program director national meeting. We used conventional content analysis to code and categorize. RESULTS Participants included 528 (53%) graduating residents representing 88% of programs, 89 program directors, and 177 associate program directors representing at minimum 45% of programs. Participants demonstrated concordance on the top 4 needs-additional clinical experiences, career development, business of medicine, and health systems. Program leaders also identified wellness and resiliency; disparities; diversity, equity, and inclusion; and communication. CONCLUSIONS This is the first categorical pediatric program general curriculum needs assessment conducted of pediatric leadership and graduating residents in over a decade. While program leadership and resident data were collected 2 years apart, we found concordance on the top 4 categories and consistency with prior national needs assessments with the exception of career development. New curriculum development efforts are underway.
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Affiliation(s)
- Sarah L Hilgenberg
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford School of Medicine (SL Hilgenberg and RL Blankenburg), Stanford, Calif.
| | - Mary Pat Frintner
- Health Services Research, American Academy of Pediatrics (MP Frintner), Itasca, Ill
| | - Rebecca L Blankenburg
- Department of Pediatrics, Lucile Packard Children's Hospital, Stanford School of Medicine (SL Hilgenberg and RL Blankenburg), Stanford, Calif
| | - Hilary M Haftel
- Education, American Academy of Pediatrics (HM Haftel), Itasca, Ill
| | - Caren E Gellin
- Department of Pediatrics, University of Rochester (CE Gellin), Rochester, NY
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10
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Sullivan K, George P, Horowitz K. Addressing National Workforce Shortages by Funding Child Psychiatry Access Programs. Pediatrics 2021; 147:peds.2019-4012. [PMID: 33277350 DOI: 10.1542/peds.2019-4012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kathryn Sullivan
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Paul George
- Departments of Family Medicine and.,Office of Medical Education
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11
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Green C, Walkup JT, Bostwick S, Trochim W. Advancing the Agenda in Pediatric Mental Health Education. Pediatrics 2019; 144:peds.2018-2596. [PMID: 31383816 PMCID: PMC6856785 DOI: 10.1542/peds.2018-2596] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is an urgent need to advance mental health (MH) education and/or training in pediatric residency programs, yet no consensus on how to achieve this. We created an operational framework from ideas provided by a diverse group of stakeholders on how to advance MH education. METHODS Concept-mapping methodology was used, which involves brainstorming ideas by completing a focus prompt, sorting ideas into groups, and rating them for importance and feasibility. Multidimensional scaling and hierarchical cluster analysis grouped ideas into clusters. Average importance and feasibility were calculated for each statement and cluster and compared statistically in each cluster and between subgroups. RESULTS Ninety-nine ideas were generated. Sorted ideas yielded a 7-cluster concept map: (1) modalities for MH training, (2) prioritization of MH, (3) systems-based practice, (4) self-awareness and/or relationship building, (5) training in clinical assessment of patients, (6) training in treatment, and (7) diagnosis-specific skills. Two hundred and sixteen participants rated ideas for importance and 209 for feasibility. Four clusters had a statistically significant difference between their importance and feasibility ratings (P < .001). Suburban and rural area respondents (versus urban) rated clusters higher in importance and feasibility (P < .004), trainees rated all clusters higher in feasibility than practicing clinicians, and MH professionals rated prioritization of MH higher in feasibility (3.42 vs 2.98; P < .001). CONCLUSIONS This comprehensive set of ideas, especially those rated highly in both importance and feasibility, should inform curricular and policy initiatives. Differences between importance and feasibility may explain why there has been little progress in this field.
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Affiliation(s)
- Cori Green
- Department of Pediatrics, Weill Cornell Medicine, New York, New York;
| | - John T. Walkup
- Department of Psychiatry and Behavioral Health, Ann
& Robert H. Lurie Children’s Hospital of Chicago and Feinberg School
of Medicine, Northwestern University, Chicago, Illinois
| | - Susan Bostwick
- Department of Pediatrics, Weill Cornell Medicine, New
York, New York
| | - William Trochim
- Department of Policy Analysis and Management, Cornell
University, Ithaca, New York; and
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12
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Harris E, Bowden J, Greiner E, Duby JC. Mental Health Training in Pediatric Residency: Where Can We Go? J Pediatr 2019; 211:4-6. [PMID: 31349919 DOI: 10.1016/j.jpeds.2019.05.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Emily Harris
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Emily Greiner
- Wright State University Boonshoft School of Medicine
| | - John C Duby
- Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, OH.
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13
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Bultas MW, McMillin SE, Broom MA, Zand DH. Brief, Rapid Response, Parenting Interventions Within Primary Care Settings. J Behav Health Serv Res 2018; 44:695-699. [PMID: 26289564 DOI: 10.1007/s11414-015-9479-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Opportunities created by the Patient Protection and Affordable Care Act along with the increased prevalence of pediatric behavioral and mental health concerns provide new challenges for pediatric health care providers. To address these matters, providers need to change the manner by which they provide health care to families. A novel approach is providing brief, rapid response, evidence-based parenting interventions within the pediatric primary care setting. Family-focused parenting programs support the American Academy of Pediatrics recommendations of improving mental health via supports in pediatric primary care to maximize the social and psychological well-being of families. A considerable body of research indicates that parenting interventions reduce the severity and frequency of disruptive behavior disorders in children and provide support to parent by bolstering parental resilience and improving overall family functioning. Providing these services within the pediatric primary care setting addresses the need for fully integrated health services that are family-centered and easily accessible.
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Affiliation(s)
- Margaret W Bultas
- School of Nursing, Saint Louis University, 3525 Caroline Street, St. Louis, MO, 63104, USA.
| | | | - Matthew A Broom
- Department of Pediatrics, School of Medicine, Saint Louis University, 1465 S Grand Blvd, St. Louis, MO, 63104, USA
| | - Debra H Zand
- Department of Pediatrics, School of Medicine, Saint Louis University, 1465 S Grand Blvd, St. Louis, MO, 63104, USA
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14
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Pasold TL, Woods JL, Portilla MG, Nesmith JD, Boateng BA. An examination of eating disorder education and experience in a 1-month adolescent medicine rotation: what is sufficient to foster adequate self-efficacy? Int J Adolesc Med Health 2018; 32:ijamh-2017-0212. [PMID: 29953405 DOI: 10.1515/ijamh-2017-0212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 05/25/2018] [Indexed: 11/15/2022]
Abstract
Objective Medical students and professionals report receiving limited education/training related to treating eating disorders. Because medical professionals are the point of initial contact for these patients and are involved necessarily in their treatment, sufficient knowledge on identification and intervention are imperative. This research set out to examine the impact of the eating disorder education and experience offered through a 1-month Adolescent Medicine rotation at a medical university on medical student/resident self-efficacy. Methods The 1-month rotation includes a standardized patient (SP) simulation, 1.5 h of didactic education, and 1 day observing the MD, nutritionist and psychologist within the outpatient Multidisciplinary Child/Adolescent Eating Disorders Clinic. All residents' (n = 132) eating disorder self-efficacy was assessed before (PRE) completing simulation and didactic session and again at the end of the 1-month rotation (END). Self-efficacy was also assessed after simulation and before the didactic session for group 1 (n = 92) and after simulation and didactic session for group 2 (n = 40). Results For group 1, self-efficacy was not significantly impacted PRE to POST. For group 2, self-efficacy significantly improved PRE to POST. POST to END changes were significant for both groups; however, group 2 scored significantly better across all self-efficacy areas at END. Conclusion Resident training in eating disorders requires more than is offered in many residency programs. SP simulation is strengthened as an effective training tool in assessing and promoting resident self-efficacy if it is followed by didactic education. Clinical observation and extended practice that includes ongoing guidance/feedback on performance is recommended in fostering self-efficacy.
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Affiliation(s)
- Tracie L Pasold
- Marywood University, 2300 Adams Avenue, Scranton, PA 18509, USA, Phone: +570-348-6211, Ext: 2265; Fax: +570-340-6040
| | - Jennifer L Woods
- Department of Pediatrics, Children's Hospital Colorado, Aurora Anschutz Outpatient Pavilion, Aurora, CO, USA
| | - Maria G Portilla
- Eating Disorder Clinic, Department Student Health, University of Virginia, Charlottesville, VA, USA
| | - James D Nesmith
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Beatrice A Boateng
- Office of Education and Evaluation, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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15
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Petts RA, Shahidullah JD, Kettlewell PW, Dehart K. Trainee perceptions of a group-based standardized patient training for challenging behavioral health scenarios in the United States. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2018; 15:15. [PMID: 29886706 PMCID: PMC6062672 DOI: 10.3352/jeehp.2018.15.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/11/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Rachel A. Petts
- Department of Psychiatry, Geisinger Health System, Danville, PA, USA
| | - Jeffrey D. Shahidullah
- Graduate School of Applied and Professional Psychology, Rutgers University, Piscataway, NJ, USA
| | | | - Kathryn Dehart
- Department of Pediatrics, Geisinger Health System, Danville, PA, USA
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Plemmons G, Hall M, Doupnik S, Gay J, Brown C, Browning W, Casey R, Freundlich K, Johnson DP, Lind C, Rehm K, Thomas S, Williams D. Hospitalization for Suicide Ideation or Attempt: 2008-2015. Pediatrics 2018; 141:peds.2017-2426. [PMID: 29769243 DOI: 10.1542/peds.2017-2426] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Suicide ideation (SI) and suicide attempts (SAs) have been reported as increasing among US children over the last decade. We examined trends in emergency and inpatient encounters for SI and SA at US children's hospitals from 2008 to 2015. METHODS We used retrospective analysis of administrative billing data from the Pediatric Health Information System database. RESULTS There were 115 856 SI and SA encounters during the study period. Annual percentage of all visits for SI and SA almost doubled, increasing from 0.66% in 2008 to 1.82% in 2015 (average annual increase 0.16 percentage points [95% confidence intervals (CIs) 0.15 to 0.17]). Significant increases were noted in all age groups but were higher in adolescents 15 to 17 years old (average annual increase 0.27 percentage points [95% CI 0.23 to 0.30]) and adolescents 12 to 14 years old (average annual increase 0.25 percentage points [95% CI 0.21 to 0.27]). Increases were noted in girls (average annual increase 0.14 percentage points [95% CI 0.13 to 0.15]) and boys (average annual increase 0.10 percentage points [95% CI 0.09 to 0.11]), but were higher for girls. Seasonal variation was also observed, with the lowest percentage of cases occurring during the summer and the highest during spring and fall. CONCLUSIONS Encounters for SI and SA at US children's hospitals increased steadily from 2008 to 2015 and accounted for an increasing percentage of all hospital encounters. Increases were noted across all age groups, with consistent seasonal patterns that persisted over the study period. The growing impact of pediatric mental health disorders has important implications for children's hospitals and health care delivery systems.
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Affiliation(s)
- Gregory Plemmons
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee;
| | - Matthew Hall
- Children's Hospital Association, Lenexa, Kansas; and
| | | | - James Gay
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Charlotte Brown
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Whitney Browning
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Casey
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Katherine Freundlich
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David P Johnson
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carrie Lind
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kris Rehm
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Susan Thomas
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Derek Williams
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
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Ragunanthan B, Frosch EJ, Solomon BS. On-site Mental Health Professionals and Pediatric Residents in Continuity Clinic. Clin Pediatr (Phila) 2017; 56:1219-1226. [PMID: 28081620 DOI: 10.1177/0009922816681136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of the study was to examine differences in pediatric resident perceptions and practices related to child mental health conditions in continuity clinic settings with versus without on-site mental health professionals (MHPs). A 20-item questionnaire, based on the American Academy of Pediatrics Periodic Survey Number 59, was administered to pediatric residents in a medium-sized program from 2008 to 2011. Of 130 residents surveyed, compared with their peers, those practicing with the on-site MHPs were more likely to report mental health services as very available in their clinic (odds ratio [OR] = 39.7; P = .000). Residents with on-site MHPs inquired more frequently about attention-deficit/hyperactivity disorder (ADHD; OR = 2.96; P = .029) and referred more frequently for ADHD (OR = 3.68; P = .006), depression (OR = 2.82; P = .030), and behavioral problems (OR = 3.04; P = .012). On-site MHPs in continuity clinics offer great potential to improve resident education and patient care. Additional research is necessary to further understand their impact.
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Affiliation(s)
| | - Emily J Frosch
- 2 Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barry S Solomon
- 2 Johns Hopkins University School of Medicine, Baltimore, MD, USA
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18
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Kelsay K, Bunik M, Buchholz M, Burnett B, Talmi A. Incorporating Trainees' Development into a Multidisciplinary Training Model for Integrated Behavioral Health Within a Pediatric Continuity Clinic. Child Adolesc Psychiatr Clin N Am 2017; 26:703-715. [PMID: 28916009 DOI: 10.1016/j.chc.2017.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Integrated behavioral and mental health systems of care for children require multidisciplinary team members to have specific competencies and knowledge of the other disciplines' strengths and practice needs. Training models for multidisciplinary professionals should consider the developmental level of trainees. The authors describe a model of flexible scaffolding, increasing intensity, and depth of experience as trainees gain skills and knowledge.
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Affiliation(s)
- Kimberly Kelsay
- Department of Psychiatry, Pediatric Mental Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 130, Aurora, CO 80045, USA.
| | - Maya Bunik
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Melissa Buchholz
- Department of Psychiatry, Pediatric Mental Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 130, Aurora, CO 80045, USA
| | - Bridget Burnett
- Department of Psychiatry, Pediatric Mental Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 130, Aurora, CO 80045, USA
| | - Ayelet Talmi
- Department of Psychiatry, Pediatric Mental Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 130, Aurora, CO 80045, USA; Department of Pediatrics, Pediatric Mental Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA
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19
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Does Length of Developmental Behavioral Pediatrics Training Matter? Acad Pediatr 2017; 17:61-67. [PMID: 27476496 DOI: 10.1016/j.acap.2016.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/19/2016] [Accepted: 07/24/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Since 1997 pediatric residencies have been required to provide a 4-week block rotation in developmental and behavioral pediatrics (DBP), but it is not known whether this has altered the care and management of children by practicing pediatricians. The objective of this study was to compare the self-reported practice patterns of pediatricians who were trained with 4 or more weeks of DBP with the practice patterns of those who were trained for <4 weeks. METHODS We used self-reported practices from the American Academy of Pediatrics Periodic Survey 85. Pediatricians were asked whether they never, sometimes, or usually inquired about and screened for, and whether they treated/managed/comanaged attention deficit hyperactivity disorder, depression, anxiety, behavior problems and learning problems. They were also asked about a series of barriers to care. Analyses were weighted to account for low response rates. RESULTS Those with more DBP training were significantly more likely to treat/manage/co-manage depression, anxiety, behavior problems and learning problems, but were still doing so less than one third of the time. There were no differences in the care of patients with attention deficit hyperactivity disorder or in screening or inquiring about mental health conditions. Those with more training were more likely to perceive somewhat fewer barriers and to report more specific familiarity with some Diagnostic and Statistical Manual of Mental Disorders criteria and some treatment modalities. CONCLUSIONS Longer length of training is associated with more treatment, but significant deficits in self-reported practice remain, leaving much room for additional improvement in the training of clinicians in DBP.
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20
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Raval GR, Doupnik SK. Closing the Gap: Improving Access to Mental Health Care Through Enhanced Training in Residency. Pediatrics 2017; 139:peds.2016-3181. [PMID: 27940515 PMCID: PMC5192092 DOI: 10.1542/peds.2016-3181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gauri R. Raval
- Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, New York;,Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia;,Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York
| | - Stephanie K. Doupnik
- PolicyLab, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and,Center for Pediatric Clinical Effectiveness, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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21
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Harrison J, Wasserman K, Steinberg J, Platt R, Coble K, Bower K. The Five S's: A Communication Tool for Child Psychiatric Access Projects. Curr Probl Pediatr Adolesc Health Care 2016; 46:411-419. [PMID: 27919566 PMCID: PMC5480313 DOI: 10.1016/j.cppeds.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Given the gap in child psychiatric services available to meet existing pediatric behavioral health needs, children and families are increasingly seeking behavioral health services from their primary care clinicians (PCCs). However, many pediatricians report not feeling adequately trained to meet these needs. As a result, child psychiatric access projects (CPAPs) are being developed around the country to support the integration of care for children. Despite the promise and success of these programs, there are barriers, including the challenge of effective communication between PCCs and child psychiatrists. Consultants from the Maryland CPAP, the Behavioral Health Integration in Pediatric Primary Care (BHIPP) project, have developed a framework called the Five S's. The Five S's are Safety, Specific Behaviors, Setting, Scary Things, and Screening/Services. It is a tool that can be used to help PCCs and child psychiatrists communicate and collaborate to formulate pediatric behavioral health cases for consultation or referral requests. Each of these components and its importance to the case consultation are described. Two case studies are presented that illustrate how the Five S's tool can be used in clinical consultation between PCC and child psychiatrist. We also describe the utility of the tool beyond its use in behavioral health consultation.
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Affiliation(s)
- Joyce Harrison
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Kennedy Krieger Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kate Wasserman
- Division of Child & Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Janna Steinberg
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Rheanna Platt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kelly Coble
- Division of Child & Adolescent Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Kelly Bower
- Department of Community/Public Health, Johns Hopkins University School of Nursing, Baltimore, MD
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22
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Adams CD, Hinojosa S, Armstrong K, Takagishi J, Dabrow S. An innovative model of integrated behavioral health: school psychologists in pediatric primary care settings. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/1754730x.2016.1215927] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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