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Martinez-Donate A, Rangel MG, Lieberman JT, Gonzalez-Fagoaga JE, Amuedo-Dorantes C, Hassrick EM, Valdez C, Wagner K, Turcios Y, Gonzalez AA, Zhang X. Between the lines: A mixed-methods study on the impacts of parental deportation on the health and well-being of U.S. citizen children. J Migr Health 2024; 9:100233. [PMID: 38813455 PMCID: PMC11133918 DOI: 10.1016/j.jmh.2024.100233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/13/2023] [Accepted: 05/05/2024] [Indexed: 05/31/2024] Open
Abstract
Objective To explore the impacts of parental deportation on the health and well-being of U.S. citizen children of Mexican immigrants. Methods From 2019-2020, this ambi-directional cohort study recruited U.S.-based families with an undocumented Mexican immigrant parent and U.S.-citizen childrens (ages 13-17) recently exposed to parental deportation (N = 61), and similar families without a history of parental deportation (N = 51). Children health, behavioral, economic, and academic outcomes were measured via phone surveys upon enrollment and six months later. A subsample of "exposed" caregivers (N = 14) also completed in-depth semi-structured interviews. Data were analyzed using fixed-effects regression models and thematic analyses. Results Childrens exposed to parental deportation had significantly worse health status, behavioral problems, material hardship, and academic outcomes than children in the control arm (p<.05). Caregivers' interviews illustrated these health, behavioral, academic and family impacts. Conclusions Parental deportations have wide and potentially long-lasting health, behavioral, economic, and academic consequences for U.S. citizen youth. Changes in immigration policies and enforcement practices are urgently needed to protect the unity of mixed-legal status families in the U.S. and prevent the suffering of U.S. children in these families.
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Affiliation(s)
- Ana Martinez-Donate
- Department of Community Health & Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA, 1904, United States
| | - M. Gudelia Rangel
- Mexico Section of the U.S.-Mexico Border Health Commission, Paseo del Centenario #10851, Zona Río, C.P. 22010, Tijuana, B.C., Mexico
| | - Jamile Tellez Lieberman
- Department of Community Health & Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA, 1904, United States
| | - J. Eduardo Gonzalez-Fagoaga
- Mexico Section of the U.S.-Mexico Border Health Commission, Paseo del Centenario #10851, Zona Río, C.P. 22010, Tijuana, B.C., Mexico
| | - Catalina Amuedo-Dorantes
- Department of Economics & Business Management, University of California-Merced, 5200 North Lake Rd., Merced, CA, 95343, United States
| | - Elizabeth McGhee Hassrick
- A.J. Drexel Autism Institute, Drexel University, 3030 Market St., Suite 560, Philadelphia, PA, 19104, United States
| | - Carmen Valdez
- Steve Hicks School of Social Work and Dell Medical School, University of Texas-Austin, 1925 San Jacinto Blvd., Stop D3500, Austin, TX, 78712, United States
| | - Kevin Wagner
- Steve Hicks School of Social Work and Dell Medical School, University of Texas-Austin, 1925 San Jacinto Blvd., Stop D3500, Austin, TX, 78712, United States
| | - Yosselin Turcios
- Department of Community Health & Prevention, Dornsife School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA, 1904, United States
| | - Ahmed Asadi Gonzalez
- School of Medicine and Psychology, Universidad Autónoma de Baja California, Universidad 14418, UABC, Parque Internacional Industrial, Tijuana, 22390, B.C., Mexico
| | - Xiao Zhang
- School of Medicine & Public Health, University of Wisconsin-Madison, 750 Highland Ave., Madison, WI, 53726, United States
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Cooper J, Donovan K, Michel H, Peterson L, Todd-Thompson M, Gillette C, Hussaini SS. Screening for post-traumatic stress disorder among Latinx immigrant children. JAAPA 2023; 36:1-6. [PMID: 37884045 DOI: 10.1097/01.jaa.0000979516.10361.7d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
ABSTRACT Latinx children face psychosocial, linguistic, and economic challenges that put them at an increased risk of developing mental health conditions. Primary care providers should be equipped to recognize the complex mental health needs of this growing population. This article explores some of the barriers to mental health screenings in Latinx children and presents culturally sensitive, validated screening tools for primary care providers.
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Affiliation(s)
- Josseline Cooper
- At the time this article was written, Josseline Cooper, Kelsey Donovan, Halee Michel, Lindsey Peterson , and Megan Todd-Thompson were students in the PA program at Wake Forest School of Medicine in Winston-Salem, N.C. Josseline Cooper now practices in internal medicine palliative care at Cone Health in Greensboro, N.C. Kelsey Donovan practices in hospital medicine at Atrium Health Wake Forest Baptist in Winston-Salem, N.C. Halee Michel practices in internal medicine with Scripps Clinic Medical Group in San Diego, Calif. Lindsey Peterson practices at Legacy Meridian Park Medical Center in Portland, Ore. Megan Todd-Thompson practices at Randolph Health Medical Group in Asheboro, N.C. Chris Gillette is an associate professor and director of scholarship and research at Wake Forest University School of Medicine in Winston-Salem, N.C. Sobia Shariff Hussaini is an assistant professor and director of admissions and academic practice partnerships in the PA program at Wake Forest University School of Medicine. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Burrell TD, Kim S, Mohadikar K, Jonas C, Ortiz N, Horberg MA. Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic. J Adolesc Health 2023; 73:693-700. [PMID: 37032208 PMCID: PMC10081921 DOI: 10.1016/j.jadohealth.2023.01.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 11/19/2022] [Accepted: 01/21/2023] [Indexed: 04/11/2023]
Abstract
PURPOSE This study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization. METHODS Our retrospective cohort study analyzed adolescents aged 12-17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition (= physical illness lasting > 12 months), mental health condition, race, sex, and state of residence. RESULTS Among 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year (McNemar's χ2 = 9.24, p < .01); however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19 (odds ratio 1.12, 95% confidence interval [CI]: 1.02-1.22, p < .01). Higher odds of using MHS was associated with chronic medical condition (adjusted odds ratio = 1.15; 95% CI: 1.05-1.26, p < .01) and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% (ratio of adjusted odds ratio = 1.63; 95% CI: 1.39-1.91, p < .01) during the COVID-19 pandemic. DISCUSSION Individual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.
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Affiliation(s)
- Tierra D Burrell
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland; Department of Pediatrics, MAPMG, Rockville, Maryland.
| | - Seohyun Kim
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Karishma Mohadikar
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Cabell Jonas
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Nancy Ortiz
- Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
| | - Michael A Horberg
- Kaiser Permanente Mid-Atlantic Permanente Research Institute, Rockville, Maryland; Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland
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4
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Martin KJ, Polk S, Young J, DeCamp LR. Health Care for Children in Immigrant Families: Key Considerations and Addressing Barriers. Pediatr Clin North Am 2023; 70:791-811. [PMID: 37422315 DOI: 10.1016/j.pcl.2023.03.011] [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: 07/10/2023]
Abstract
One in four US children is a child in an immigrant family. Children in immigrant families (CIF) have distinct health and health care needs that vary by documentation status, countries of origin, and health care and community experience caring for immigrant populations. Health insurance access and language services are fundamental to providing health care to CIF. Promoting health equity for CIF requires a comprehensive approach to both the health and social determinants of health needs of CIF. Child health providers can promote health equity for this population through tailored primary care services and partnerships with immigrant-serving community organizations.
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Affiliation(s)
- Keith J Martin
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Centro SOL-Center for Salud/Health and Opportunity for Latinos, Johns Hopkins University School of Medicine
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Centro SOL-Center for Salud/Health and Opportunity for Latinos, Johns Hopkins University School of Medicine
| | - Janine Young
- Department of Pediatrics University of California San Diego School of Medicine; Rady Children's Hospital San Diego
| | - Lisa Ross DeCamp
- Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA; Adult and Child Center for Outcomes Research and Delivery Science, Aurora, CO, USA; Latino Research and Policy Center, Denver, CO, USA.
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5
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Lieberman JT, Valdez CR, Pintor JK, Weisz P, Carroll-Scott A, Wagner K, Martinez-Donate AP. "It felt like hitting rock bottom": A qualitative exploration of the mental health impacts of immigration enforcement and discrimination on US-citizen, Mexican children. LATINO STUDIES 2023:1-25. [PMID: 37358960 PMCID: PMC10184077 DOI: 10.1057/s41276-023-00415-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 06/28/2023]
Abstract
Latino immigrant families in the United States were disproportionately affected by intensified interior immigration enforcement under the Trump administration. US-citizen children are victimized by policies targeting their immigrant parents; research is sparse regarding how these polices affect children who experience parental deportation and children who are at risk for parental deportation. Additionally, anti-immigrant rhetoric can result in increased discrimination that also threatens children's psychological health. This qualitative study (N = 22) explores children's lived experiences of discrimination, parental deportation or threat of parental deportation, and perceived impacts on mental health. Interviews conducted from 2019 to 2020 revealed that children who are directly affected by or at risk for parental deportation experience detrimental impacts to their psychological well-being. Children experience discrimination as Latinos and children of immigrants, which is also detrimental to their mental/emotional health. Incorporating children's perspectives is critical to informing public health interventions. Findings demonstrate the need for family-friendly immigration reform.
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Palley E, White C, Newransky C, Abram M. Interdisciplinary Children's Behavioral Health Workforce Development for Social Work and Nursing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085601. [PMID: 37107883 PMCID: PMC10139134 DOI: 10.3390/ijerph20085601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023]
Abstract
This paper will begin with a review of child health inequities globally, in the United States and in the State of New York. It will then describe a model training program that was designed to educate social workers and nurse practitioners to create a workforce able to address child behavioral health inequities in the United States (US), specifically New York State. Behavioral health care refers to prevention, care and treatment for mental health and substance abuse conditions as well as physical conditions caused by stress and life crises. This project uses an interdisciplinary training program for nurse practitioner and Master of Social Work students to address workforce shortages in underserved communities in New York State. It will present process evaluation findings to highlight the program's initial success and will conclude with a discussion of the data that are still needed and the challenges of obtaining this data.
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Affiliation(s)
- Elizabeth Palley
- School of Social Work, Adelphi University, Garden City, NY 11530, USA
- Correspondence:
| | - Chireau White
- School of Social Work, Adelphi University, Garden City, NY 11530, USA
| | | | - Marissa Abram
- College of Nursing and Public Health, Adelphi University, Garden City, NY 11530, USA
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Forcén FE, Vélez Flórez MC, Bido Medina R, Zambrano J, Pérez JH, Rodríguez AM, Santos LH. Deconstructing Cultural Aspects of Mental Health Care in Hispanic/Latinx People. Psychiatr Ann 2023; 53:127-132. [PMID: 37781171 PMCID: PMC10540642 DOI: 10.3928/00485713-20230215-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
In the United States, 18.9% of the population identifies as Hispanic or Latin. The culture of these communities is as diverse, heterogenous, and rich as the history of this population. Culture shapes the perception of symptoms and psychiatric disorders. To provide culturally sensitive care, it is relevant to understand the history of these communities in the US, recognize cultural humility, and acknowledge aspects and values (eg, culturally bound syndromes, familism, paternalism, stigma of mental illness, machismo, immigration) inherent to the cultural experience and unique barriers to care. Incorporating these aspects into clinical practice is essential for positive outcomes. The purpose of this article is to give a brief historical context, encourage cultural humility, and describe cultural aspects that are essential when providing culturally sensitive care to the Hispanic and Latinx community in the US.
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Affiliation(s)
- Fernando Espí Forcén
- Massachusetts General Hospital, Hispanic Psychiatry Group, Department of Psychiatry, and Harvard Medical School, Boston, Massachusetts
| | - María Camila Vélez Flórez
- Massachusetts General Hospital, Hispanic Psychiatry Group, Department of Psychiatry, and Harvard Medical School, Boston, Massachusetts
| | - Richard Bido Medina
- Massachusetts General Hospital, Hispanic Psychiatry Group, Department of Psychiatry, and Harvard Medical School, Boston, Massachusetts
| | - Juliana Zambrano
- Massachusetts General Hospital, Hispanic Psychiatry Group, Department of Psychiatry, and Harvard Medical School, Boston, Massachusetts
| | - José Hermina Pérez
- Massachusetts General Hospital, Hispanic Psychiatry Group, Department of Psychiatry, and Harvard Medical School, Boston, Massachusetts
| | - Alejandra Morfín Rodríguez
- Massachusetts General Hospital, Hispanic Psychiatry Group, Department of Psychiatry, and Harvard Medical School, Boston, Massachusetts
| | - Linda Herrera Santos
- Massachusetts General Hospital, Hispanic Psychiatry Group, Department of Psychiatry, and Harvard Medical School, Boston, Massachusetts
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8
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Patel SG, Bouche V, Thomas I, Martinez W. Mental health and adaptation among newcomer immigrant youth in United States educational settings. Curr Opin Psychol 2023; 49:101459. [PMID: 36502587 DOI: 10.1016/j.copsyc.2022.101459] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/17/2022] [Indexed: 12/15/2022]
Abstract
Schools play a vital role in the acculturation process of newly migrated youth. Social and academic factors within school settings predict a wide variety of adaptation outcomes. Age and grade also impact the ways that school experiences can shape the post-migration adjustment trajectories of migrant youth. Negative school experiences can exacerbate migration trauma, whereas positive school experiences play an important protective role in overcoming migration-related challenges and adjusting to a new cultural context. Emerging research also suggests that the school environment presents a valuable opportunity for service delivery, as students are readily accessible during the school day which reduces systemic barriers to engagement. Socio-emotional prevention and intervention can address migration trauma, foster resiliency, and help lead the way to acculturative and academic success. Teachers, counselors, coaches and mentors who engage with newcomer immigrant youth in schools can play a pivotal role in easing migration-related challenges by encouraging positive emotional attachments, linking to resources, and helping to navigate new systems. These professionals benefit from specialized training on the unique needs and best practices for supporting the learning, engagement, development, and adaptation of newcomer youth.
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Affiliation(s)
- Sita G Patel
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA.
| | - Vicky Bouche
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA; Children's Hospital of Orange County, 1201 West La Veta Avenue, Orange, CA, 92868, USA
| | - Irene Thomas
- Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, USA
| | - William Martinez
- University of California, San Francisco/Zuckerberg San Francisco General Hospital, 1001 Potrero Ave. Building 5, Suite 6B, San Francisco, CA 94110, USA
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Espinoza-Kulick MAV, Cerdeña JP. "We Need Health for All": Mental Health and Barriers to Care among Latinxs in California and Connecticut. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12817. [PMID: 36232112 PMCID: PMC9565216 DOI: 10.3390/ijerph191912817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/26/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Latinx (im)migrant groups remain underserved by existing mental health resources. Past research has illuminated the complex factors contributing to this problem, including migration-related trauma, discrimination, anti-immigrant policies, and structural vulnerability. This paper uses decolonial-inspired methods to present and analyze results from two studies of Latinx (im)migrant communities in central California and southern Connecticut in the United States. Using mixed quantitative and qualitative analysis, we demonstrate the intersectional complexities to be addressed in formulating effective mental health services. Relevant social and structural factors including knowledge of mental health, access to insurance, and experiencing discrimination were significantly associated with anxiety symptoms, based on linear regression analysis. Ethnographic interviews demonstrate how complex trauma informs mental health needs, especially through the gendered experiences of women. Overlapping aspects of gender, language barriers, fear of authorities, and immigration status contoured the lived experiences of Latinx (im)migrants. Thematic analyses of open-ended survey responses also provide recommendations for solutions based on the experiences of those directly affected by these health disparities, particularly relating to healthcare access, affordability, and capacity. Building from these findings and past research, we recommend the adoption of a comprehensive model of mental health service provision for Latinx (im)migrants that takes into account Indigenous language access, structural competency, expanded health insurance, and resources for community health workers.
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Affiliation(s)
| | - Jessica P. Cerdeña
- Yale School of Medicine, Yale University, New Haven, CT 06520, USA
- Institute for Collaboration on Health, Implementation, and Policy (InCHIP), University of Connecticut, Storrs, CT 06269, USA
- Department of Anthropology, University of Connecticut, Storrs, CT 06269, USA
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10
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El-Banna G, Higuera K, Mendoza FS. The Intergenerational Health Effects of the Deferred Action for Childhood Arrivals Program on Families With Mixed Immigration Status. Acad Pediatr 2022; 22:729-735. [PMID: 34320415 PMCID: PMC8786974 DOI: 10.1016/j.acap.2021.07.016] [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: 11/18/2020] [Revised: 06/09/2021] [Accepted: 07/20/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Children of undocumented mothers with Deferred Action for Childhood Arrivals (DACA) have better mental health outcomes than children of DACA-ineligible mothers. This study explored the intergenerational health effects of DACA on undocumented parents and their children in families with mixed immigration status. METHODS Forty-eight semistructured interviews were selected from a study on life transitions of 50 undocumented immigrants. Prevalent themes related to the intergenerational health effects of DACA on undocumented immigrants were identified through thematic analysis of the transcripts, and quotes were selected to illustrate themes in the participants' own words. RESULTS Thirty-three of the 48 respondents were DACA recipients. Twenty-six respondents were parents with a total of 61 children, 73.8% of whom were US-born. Four themes were identified: 1) DACA recipients reported decreased familial stress because of protection from deportation and increased access to health care, 2) both DACA and DACA-ineligible parents prioritized regular pediatrician visits for their children, but DACA-ineligible parents suffered from poor health because of decreased access to health care, 3) adults with DACA mirror the health behaviors of their DACA-ineligible parents, and 4) the poor health access of DACA-ineligible family members appeared to stress DACA recipients and US-born children in these families. CONCLUSIONS DACA decreases children's fear of parental deportation and loss. However, the suffering of DACA-ineligible parents and family members may stress their children and influence their health-seeking behavior in adulthood. Health care access for all members of immigrant families needs to be examined, since their well-being impacts the well-being of their children.
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Bitsko RH, Claussen AH, Lichstein J, Black LI, Jones SE, Danielson ML, Hoenig JM, Davis Jack SP, Brody DJ, Gyawali S, Maenner MJ, Warner M, Holland KM, Perou R, Crosby AE, Blumberg SJ, Avenevoli S, Kaminski JW, Ghandour RM. Mental Health Surveillance Among Children - United States, 2013-2019. MMWR Suppl 2022; 71:1-42. [PMID: 35202359 PMCID: PMC8890771 DOI: 10.15585/mmwr.su7102a1] [Citation(s) in RCA: 229] [Impact Index Per Article: 114.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Mental health encompasses a range of mental, emotional, social, and behavioral functioning and occurs along a continuum from good to poor. Previous research has documented that mental health among children and adolescents is associated with immediate and long-term physical health and chronic disease, health risk behaviors, social relationships, education, and employment. Public health surveillance of children's mental health can be used to monitor trends in prevalence across populations, increase knowledge about demographic and geographic differences, and support decision-making about prevention and intervention. Numerous federal data systems collect data on various indicators of children's mental health, particularly mental disorders. The 2013-2019 data from these data systems show that mental disorders begin in early childhood and affect children with a range of sociodemographic characteristics. During this period, the most prevalent disorders diagnosed among U.S. children and adolescents aged 3-17 years were attention-deficit/hyperactivity disorder and anxiety, each affecting approximately one in 11 (9.4%-9.8%) children. Among children and adolescents aged 12-17 years, one fifth (20.9%) had ever experienced a major depressive episode. Among high school students in 2019, 36.7% reported persistently feeling sad or hopeless in the past year, and 18.8% had seriously considered attempting suicide. Approximately seven in 100,000 persons aged 10-19 years died by suicide in 2018 and 2019. Among children and adolescents aged 3-17 years, 9.6%-10.1% had received mental health services, and 7.8% of all children and adolescents aged 3-17 years had taken medication for mental health problems during the past year, based on parent report. Approximately one in four children and adolescents aged 12-17 years reported having received mental health services during the past year. In federal data systems, data on positive indicators of mental health (e.g., resilience) are limited. Although no comprehensive surveillance system for children's mental health exists and no single indicator can be used to define the mental health of children or to identify the overall number of children with mental disorders, these data confirm that mental disorders among children continue to be a substantial public health concern. These findings can be used by public health professionals, health care providers, state health officials, policymakers, and educators to understand the prevalence of specific mental disorders and other indicators of mental health and the challenges related to mental health surveillance.
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Jeffrey JK, Venegas-Murillo AL, Krishna R, Hajal NJ. Rating Scales for Behavioral Health Screening System Within Pediatric Primary Care. Child Adolesc Psychiatr Clin N Am 2021; 30:777-795. [PMID: 34538448 DOI: 10.1016/j.chc.2021.06.003] [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: 10/20/2022]
Abstract
Barriers to conducting standardized behavioral health screening within pediatric primary care settings include engaging youth and families, limited time available for this activity, and difficulties related to obtaining behavioral health consultation and treatment from specialists. Child and adolescent psychiatrists may assist pediatric primary care practices with engaging youth and families around screening by assisting with identifying rating scales that have good psychometric characteristics across multiple languages and are validated in diverse samples and available within the public domain. Additionally, they may partner with pediatric primary care professionals to assist with optimizing screening workflows and linkage to specialized services.
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Affiliation(s)
- Jessica K Jeffrey
- Department of Psychiatry & Biobehavioral Sciences, Division of Population Behavioral Health, Semel Institute for Neuroscience and Human Behavior, UCLA, 760 Westwood Plaza, A7-372A, Los Angeles, CA 90095, USA.
| | - Angela L Venegas-Murillo
- Department of Pediatrics, College of Medicine, Charles R. Drew University of Medicine & Science, 1748 East 118th Street, Room N147, Los Angeles, CA 90059, USA; Department of General Internal Medicine and Health Service Research, UCLA Health, Los Angeles, CA, USA
| | - Rajeev Krishna
- Behavioral Health, Department of Psychiatry, Nationwide Children's Hospital, 444 Butterfly Garden's Drive, Columbus, OH 43215, USA
| | - Nastassia J Hajal
- Department of Psychiatry & Biobehavioral Sciences, Division of Population Behavioral Health, UCLA-Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, A8-153, Los Angeles, CA 90095, USA
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Roby E, Da Rosa Piccolo L, Gutierrez J, Kesoglides N, Raak CD, Mendelsohn AL, Canfield CF. Father involvement in infancy predicts behavior and response to chronic stress in middle childhood in a low-income Latinx sample. Dev Psychobiol 2021; 63:1449-1465. [PMID: 33398881 PMCID: PMC8254829 DOI: 10.1002/dev.22081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/27/2020] [Accepted: 12/03/2020] [Indexed: 11/06/2022]
Abstract
Fathers' involvement in early childhood is important for children's physical, emotional, and cognitive development, particularly in low-income families. However, little is known about the longitudinal relations between early father involvement and children's later physiological responses to chronic stress and behaviors impacted by stress in the context of poverty. These issues are particularly important among Latinx immigrant families who face significant psychosocial and poverty-related risk. In the current study, we examined the relationship between father involvement in infancy and physiological chronic stress in the middle childhood period, as measured through hair cortisol concentration (HCC), and several behavioral measures (attention problems, working memory) in a Latinx immigrant sample with low income. Father involvement in infancy predicted children's later HCC, and working memory in second to third grade. Father involvement also moderated the effect of HCC on working memory, such that increased HCC predicted better working memory when fathers were not involved. These findings suggest that the fathers' involvement in infancy has lasting impacts on health and behavior and that associations between physiological and behavioral measures of stress may be moderated by differences in early father involvement.
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Affiliation(s)
- Erin Roby
- Department of Pediatrics, NYU Grossman School of Medicine
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Nash KA, Zima BT, Rothenberg C, Hoffmann J, Moreno C, Rosenthal MS, Venkatesh A. Prolonged Emergency Department Length of Stay for US Pediatric Mental Health Visits (2005-2015). Pediatrics 2021; 147:peds.2020-030692. [PMID: 33820850 PMCID: PMC8086002 DOI: 10.1542/peds.2020-030692] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. Our objectives were to (1) compare LOS trends for pediatric mental health versus non-mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits. METHODS We conducted an observational analysis of ED visits among children 6 to 17 years of age using the National Hospital Ambulatory Medical Care Survey (2005-2015). We assessed trends in rates of prolonged LOS and the association between prolonged LOS and demographic and clinical characteristics (race and ethnicity, payer type, and presence of a concurrent physical health diagnosis) using descriptive statistics and survey-weighted logistic regression. RESULTS From 2005 to 2015, rates of prolonged LOS for pediatric mental health ED visits increased over time from 16.3% to 24.6% (LOS >6 hours) and 5.3% to 12.7% (LOS >12 hours), in contrast to non-mental health visits for which LOS remained stable. For mental health visits, Hispanic ethnicity was associated with an almost threefold odds of LOS >12 hours (odds ratio 2.74; 95% confidence interval 1.69-4.44); there was no difference in LOS by payer type. CONCLUSIONS The substantial rise in prolonged LOS for mental health ED visits and disparity for Hispanic children suggest worsening and inequitable access to definitive pediatric mental health care. Policy makers and health systems should work to provide equitable and timely access to pediatric mental health care.
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Affiliation(s)
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | | | - Jennifer Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Claudia Moreno
- Yale Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | | | - Arjun Venkatesh
- Emergency Medicine, and,Center for Outcomes Research & Evaluation, New Haven, Connecticut
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15
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Spain AK, Monahan EK, Alvarez K, Finno-Velasquez M. Latinx Family Perspectives on Social Needs Screening and Referral during Well-Child Visits. MCN Am J Matern Child Nurs 2021; 46:143-149. [PMID: 38019058 DOI: 10.1097/nmc.0000000000000710] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To understand Latinx parent perspectives on screening and referral approaches to identify social determinants of health and address social and material needs during well-child visits and to identify techniques that promote their engagement with these approaches. STUDY DESIGN We investigated parent perspectives and engagement with social needs screening and referral practices during well-child visits using focus group methodology. RESULTS We conducted 17 focus groups (n = 134 parents and other primary caregivers) with families receiving care at sites operated by eight pediatric primary care clinics. Adding social needs screening and referral shifted the social context of well-child visits for Latinx parents. Participants reported greater engagement with the practices where they perceived an emotional connection with nurses and other clinicians and cultural brokering to ensure their screening responses accurately reflected family needs and priorities. Participants highlighted the importance of having a personal patient-provider relationship as many preferred to discuss social needs outside of the exam room. CLINICAL IMPLICATIONS Nurses and other clinicians play a critical role in establishing systems needed to systematically screen and refer families for social needs. Future policy development should consider implications for nursing practice and leadership in adopting these approaches.
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16
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Walker J, Venta A, Galicia B. Who is Taking Care of Central American Immigrant Youth? Preliminary Data on Caregiving Arrangements and Emotional-Behavioral Symptoms Post-Migration. Child Psychiatry Hum Dev 2021; 52:217-224. [PMID: 32399585 DOI: 10.1007/s10578-020-01002-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Migrant youth are at increased risk for mental health problems. Given increases in families migrating to the U.S. and family separations at the U.S.-Mexico border, understanding migrant youth home environments and impacts of family disruption are growing concerns. This study assessed caregiver arrangements and reports of youth emotional and behavioral symptoms from recently immigrated adolescents (N = 111) and respective caregivers (n = 64). 47.7% of youth indicated living with their mother, father, or both; 24.3% another relative, 2.7% a non-relative, and 25.2% reported no caregiver. 25% indicated caretaking responsibilities of their own. Caregiving arrangements were related to emotional and behavioral symptoms. Caregiver documentation status was related to caregiver-reported conduct problems, prosocial behavior, and total symptoms. The migration process is disruptive for youth and home environments. Many youth experience disrupted caregiving post-migration and caregiver features are significant to youth emotional and behavioral symptoms-which were elevated in this sample. The study provides novel insight into effects of family disruption on migrant youth post-migration.
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Affiliation(s)
- Jesse Walker
- Department of Psychology, Sam Houston State University, Huntsville, TX, CHSS 32577341, USA
| | - Amanda Venta
- Department of Psychology, Sam Houston State University, Huntsville, TX, CHSS 32577341, USA.
| | - Betsy Galicia
- Department of Psychology, Sam Houston State University, Huntsville, TX, CHSS 32577341, USA
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17
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DeCamp LR, Showell N, Godage SK, Leifheit KM, Valenzuela-Araujo D, Shah H, Polk S. Parent activation and pediatric primary care outcomes for vulnerable children: A mixed methods study. PATIENT EDUCATION AND COUNSELING 2019; 102:2254-2262. [PMID: 31288957 PMCID: PMC7266441 DOI: 10.1016/j.pec.2019.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 06/25/2019] [Accepted: 07/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Among children in low-income families 1) examine associations between parent activation and pediatric primary care outcomes and 2) explore parent perspectives on Parent-Patient Activation Measure (P-PAM) questions in relation to pediatric primary care experiences. METHODS We examined associations between P-PAM score via Spanish- or English-language survey and healthcare outcomes abstracted from electronic medical records for parent/child dyads at an urban general pediatrics clinic. Parent perspectives were elicited via qualitative interviews with a subsample of parents who "thought aloud" during P-PAM completion. RESULTS Among 316 Spanish (68%) and English-language parent/child dyads, we found associations between parent activation and primary care outcomes only among Spanish-language dyads and only for weight and health status. Findings from 21 interviews provided possible explanations for quantitative findings including question limitations in assessing knowledge, skills, and confidence in pediatric primary care and P-PAM cultural and linguistic appropriateness for low-income Latino populations. CONCLUSIONS Pairing quantitative and qualitative methods provided insight on P-PAM measurement limitations and raised questions about its use in patient engagement interventions to reduce health disparities. PRACTICE IMPLICATIONS Practices serving vulnerable children and families should consider the limitations of the P-PAM for measuring parent healthcare engagement before utilizing the P-PAM in patient engagement interventions.
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Affiliation(s)
- Lisa Ross DeCamp
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Nakiya Showell
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Sashini K Godage
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | | | | | - Harita Shah
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD USA
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18
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Triemstra JD, Monterrey AC. The Health of Children Who Are Immigrants and Refugees: A Review for the General Pediatrician. Pediatr Ann 2019; 48:e455-e460. [PMID: 31710365 DOI: 10.3928/19382359-20191016-01] [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: 11/20/2022]
Abstract
The United States is home to many immigrants and refugees; therefore, pediatricians who care for these vulnerable patients must be familiar with their unique medical, developmental, and psychosocial needs. Thankfully, there are resources that describe the recommended components of the medical visit for newly arrived immigrants and refugees. In this article, we review these resources while focusing on the resettlement process, mental health, trauma-informed care resources, and other important psychosocial needs such as legal and educational resources that are available for this patient population. [Pediatr Ann. 2019;48(11):e455-e460.].
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19
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Linton JM, Green A, Chilton LA, Duffee JH, Dilley KJ, Gutierrez JR, Keane VA, Krugman SD, McKelvey CD, Nelson JL. Providing Care for Children in Immigrant Families. Pediatrics 2019; 144:peds.2019-2077. [PMID: 31427460 DOI: 10.1542/peds.2019-2077] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Children in immigrant families (CIF), who represent 1 in 4 children in the United States, represent a growing and ever more diverse US demographic that pediatric medical providers nationwide will increasingly encounter in clinical care. Immigrant children are those born outside the United States to non-US citizen parents, and CIF are defined as those who are either foreign born or have at least 1 parent who is foreign born. Some families immigrate for economic or educational reasons, and others come fleeing persecution and seeking safe haven. Some US-born children with a foreign-born parent may share vulnerabilities with children who themselves are foreign born, particularly regarding access to care and other social determinants of health. Therefore, the larger umbrella term of CIF is used in this statement. CIF, like all children, have diverse experiences that interact with their biopsychosocial development. CIF may face inequities that can threaten their health and well-being, and CIF also offer strengths and embody resilience that can surpass challenges experienced before and during integration. This policy statement describes the evolving population of CIF in the United States, briefly introduces core competencies to enhance care within a framework of cultural humility and safety, and discusses barriers and opportunities at the practice and systems levels. Practice-level recommendations describe how pediatricians can promote health equity for CIF through careful attention to core competencies in clinical care, thoughtful community engagement, and system-level support. Advocacy and policy recommendations offer ways pediatricians can advocate for policies that promote health equity for CIF.
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Affiliation(s)
- Julie M. Linton
- Departments of Pediatrics and Public Health, School of Medicine Greenville, University of South Carolina, Greenville, South Carolina
- Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina; and
| | - Andrea Green
- Larner College of Medicine, The University of Vermont, Burlington, Vermont
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20
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Abstract
At a time of evolving demographics and turbulent policy changes, pediatric providers have a critical role in the care of all children, regardless of where the child or parent was born. Pediatric providers can facilitate access to high-quality care and critical community-based resources for immigrant children and families. In this article, we delineate the primary domains for clinical care and offer clinical tools to achieve the provision of accessible, comprehensive, high-quality care within a family-centered medical home.
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Affiliation(s)
- Chloe Turner
- Unity Health Care, Inc., 3020 14th Street Northwest, Washington, DC 20009, USA; A.T. Still University of Health Sciences, Mesa, AZ, USA
| | - Anisa Ibrahim
- Department of Pediatrics, University of Washington, Harborview Medical Center, 325 9th Avenue Box 359774, Seattle, WA 98104, USA
| | - Julie M Linton
- University of South Carolina School of Medicine Greenville, Prisma Health Upstate Children's Hospital, 20 Medical Ridge Drive, Greenville, SC 29605, USA; Wake Forest School of Medicine, Winston-Salem, NC, USA.
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21
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Hainmueller J, Lawrence D, Martén L, Black B, Figueroa L, Hotard M, Jiménez TR, Mendoza F, Rodriguez MI, Swartz JJ, Laitin DD. Protecting unauthorized immigrant mothers improves their children's mental health. Science 2017; 357:1041-1044. [PMID: 28860206 DOI: 10.1126/science.aan5893] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/01/2017] [Indexed: 12/11/2022]
Abstract
The United States is embroiled in a debate about whether to protect or deport its estimated 11 million unauthorized immigrants, but the fact that these immigrants are also parents to more than 4 million U.S.-born children is often overlooked. We provide causal evidence of the impact of parents' unauthorized immigration status on the health of their U.S. citizen children. The Deferred Action for Childhood Arrivals (DACA) program granted temporary protection from deportation to more than 780,000 unauthorized immigrants. We used Medicaid claims data from Oregon and exploited the quasi-random assignment of DACA eligibility among mothers with birthdates close to the DACA age qualification cutoff. Mothers' DACA eligibility significantly decreased adjustment and anxiety disorder diagnoses among their children. Parents' unauthorized status is thus a substantial barrier to normal child development and perpetuates health inequalities through the intergenerational transmission of disadvantage.
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Affiliation(s)
- Jens Hainmueller
- Department of Political Science, Stanford University, Stanford, CA 94305, USA. .,Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA.,Graduate School of Business, Stanford University, Stanford, CA 94305, USA
| | - Duncan Lawrence
- Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA
| | - Linna Martén
- Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA.,Uppsala Center for Labor Studies, Uppsala University, Uppsala 75120, Sweden
| | - Bernard Black
- Pritzker Law School and Kellogg School of Management, Northwestern University, Chicago, IL 60611, USA
| | - Lucila Figueroa
- Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA.,Department of Politics, University of Virginia, Charlottesville, VA 22903, USA
| | - Michael Hotard
- Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA
| | - Tomás R Jiménez
- Department of Sociology, Stanford University, Stanford, CA 94305, USA
| | - Fernando Mendoza
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Maria I Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jonas J Swartz
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR 97239, USA
| | - David D Laitin
- Department of Political Science, Stanford University, Stanford, CA 94305, USA.,Immigration Policy Lab, Stanford University, Stanford, CA 94305, USA
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