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Sarkar A, Rahaman SM, Das DK, Banerjee N. Mental Health Disorders among Children and Associated Parental Stress: A Cross-Sectional Study in Pediatric OPD of Burdwan Medical College, West Bengal. Indian J Community Med 2024; 49:417-423. [PMID: 38665434 PMCID: PMC11042142 DOI: 10.4103/ijcm.ijcm_49_23] [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: 01/29/2023] [Accepted: 12/29/2023] [Indexed: 04/28/2024] Open
Abstract
Background Identification of mental health disorders during childhood is crucial for healthy 'adult roles' in the society, so this study aimed to estimate the magnitude of 'any mental health disorder' and to find out its correlates among children attending the pediatric out-patient department (OPD) of a medical college in West Bengal and to estimate parental stress among their parents. Materials and Methods It was a descriptive cross-sectional study done in the pediatric OPD of Burdwan Medical College, West Bengal, during July-December, 2021. The calculated size of 288 children aged between 4 and 12 years and attending with either of their parents was selected through systematic random sampling. One of their parents (preferably mother) was interviewed using a schedule, containing a pre-validated pediatric symptom checklist and parental stress scale. Ethical clearance was obtained from the Institutional Ethics Committee. Data were analyzed using SPSS-v23. Results The median age of the children was 7 years (5-8 y.). The majority of them were male (57.6%), lived in urban areas (59.0%), and lived in joint families (57.6%). One-fifth (20.5%) of the children were found to have any mental health disorder (AMHD). Living in an urban area (aOR = 2.5, 95% CI: 1.1-5.7), belonging to a nuclear family (aOR = 3.6, 95% CI: 1.7-8.1), and belonging to a family with social problems (aOR = 7.8, 95% CI: 2.3-27.2) were significant correlates of AMHD. Parental stress [median: 60 (55-63)] was found significantly higher (P < 0.001) among parents of children with AMHD as compared to the parents of others. Conclusion The magnitude of AMHD was high in this study, indicating toward the necessity of implementing opportunistic screening and appropriate public health action.
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Affiliation(s)
- Anisha Sarkar
- Department of Community Medicine, Burdwan Medical College, West Bengal, India
| | | | - Dilip K. Das
- Department of Community Medicine, Murshidabad Medical College, West Bengal, India
| | - Niladri Banerjee
- Department of Community Medicine, Nil Ratan Sircar Medical College, West Bengal, India
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2
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Arora BK, Klein MJ, Yousif C, Khacheryan A, Walter HJ. Virtual Collaborative Behavioral Health Model in a Community Pediatric Network: Two-Year Outcomes. Clin Pediatr (Phila) 2023; 62:1414-1425. [PMID: 36988180 DOI: 10.1177/00099228231164478] [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: 03/30/2023]
Abstract
Due to the pervasive shortage of behavioral health (BH) specialists, collaborative partnerships between pediatric primary care practitioners (PPCPs) and BH specialists can enhance provision of BH services by PPCPs. We aimed to create a new model of collaborative care that was mostly virtual, affordable, and scalable. The pilot program was implemented in 18 practices (48 PPCPs serving approximately 150 000 patients) in 2 consecutive cohorts. Outcomes were assessed by administering pre-program and post-program surveys. Across the 18 practices, PPCPs reported significantly increased confidence in their BH knowledge and skills, and significantly increased their provision of target BH services. Barriers to BH service provision (resources, time, and staff) were unchanged. This compact, mostly virtual model of BH collaboration appears to be beneficial to PPCPs while also offering convenience to patients and affordability and scalability to the practice network.
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Affiliation(s)
- Bhavana Kumar Arora
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Margaret J Klein
- Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Anesthesiology Critical Care Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | | | - Heather J Walter
- Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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3
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Gao R, Raygoza A, Distefano C, Greer F, Dowdy E. Assessing measurement equivalence of PSC-17 across teacher and parent respondents. SCHOOL PSYCHOLOGY INTERNATIONAL 2022. [DOI: 10.1177/01430343221108874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Pediatric Symptom Checklist-17 (PSC-17) is a popular screening instrument used by parents and clinicians to assess children's behavioral functioning. However, more schools are examining the potential of the PSC-17 as part of a Multi-Tier System of Support framework. To investigate the potential of the PSC-17 in the schools, a sample of 1,779 U.S. preschool and kindergarten-aged children rated by parents (n = 667) and teachers (n = 1,112) was used to assess the measurement invariance of the PSC-17 across respondent groups. Multiple-group Confirmatory Factor Analysis supported partial scalar invariance for the PSC-17, indicating functional equivalence across teacher and parent respondents. Latent mean testing revealed teachers rated children as exhibiting a lower level of Externalizing Problems relative to parents; however, no significant differences in children's Internalizing Problems and Attention Problems were found between teacher and parent ratings.
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Affiliation(s)
- Ruiqin Gao
- College of Education, University of South Carolina, United States
| | - Alyssa Raygoza
- College of Education, University of South Carolina, United States
| | | | - Fred Greer
- College of Education, University of South Carolina, United States
| | - Erin Dowdy
- Department of Counseling, Clinical, and school psychology, University of California at Santa Barbara, United States
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4
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Radovic A, Anderson N, Hamm M, George-Milford B, Fascetti C, Engster S, Lindhiem O. Perceived Facilitators of and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: Focus Group and Interview Study. JMIR Ment Health 2021; 8:e26035. [PMID: 34524090 PMCID: PMC8482166 DOI: 10.2196/26035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/27/2021] [Accepted: 04/29/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents' and parents' reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments. OBJECTIVE This qualitative study aims to describe multi-stakeholder perspectives of adolescents, parents, and providers to understand the potential barriers to the implementation of SW. METHODS We interviewed 11 parents and 11 adolescents and conducted two focus groups with 18 health care providers (PCPs, nurses, therapists, and staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks were inductively developed based on content. Transcripts were double coded, and disagreements were adjudicated to full agreement. Completed coding was used to produce thematic analyses of the interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; SW is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents are all concerned with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. Although SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead, SW focuses on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve the future implementation of SW.
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Affiliation(s)
- Ana Radovic
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Nathan Anderson
- University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Megan Hamm
- Center for Research on Healthcare's Data Center, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Carrie Fascetti
- Clinical and Translational Science Institute Pediatric PittNet, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stacey Engster
- Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.,Clinical and Translational Science Institute Pediatric PittNet, University of Pittsburgh, Pittsburgh, PA, United States
| | - Oliver Lindhiem
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
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5
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Walter HJ, Vernacchio L, Correa ET, Bromberg J, Goodman E, Barton J, Young GJ, DeMaso DR, Focht G. Five-Phase Replication of Behavioral Health Integration in Pediatric Primary Care. Pediatrics 2021; 148:peds.2020-001073. [PMID: 34210739 DOI: 10.1542/peds.2020-001073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Because of severe and protracted shortages of pediatric behavioral health (BH) specialists, collaboration between pediatric primary care practitioners (PCPs) and BH specialists has the potential to increase access to BH services by expanding the BH workforce. In a previous study, we demonstrated that phase 1 of a behavioral health integration program (BHIP) enrolling 13 independently owned, community-based pediatric practices was associated with increased access to BH services while averting substantial cost increases and achieving high provider self-efficacy and professional satisfaction. The current study was undertaken to assess whether the initial access findings were replicated over 4 subsequent implementation phases and to explore the practicality of broad dissemination of the BHIP model. METHODS After phase 1, BHIP was extended over 4 subsequent phases in a stepped-wedge design to 46 additional pediatric practices, for a total cohort of 59 practices (354 PCPs serving >300 000 patients). Program components comprised BH education and consultation and support for integrated practice transformation; these components facilitated on-site BH services by an interprofessional BH team. Outcomes were assessed quarterly, preprogram and postprogram launch. RESULTS Across combined phases 1 to 5, BHIP was associated with increased primary care access to BH services (screening, psychotherapy, PCP BH visits, psychotropic prescribing) and performed well across 7 standard implementation outcome domains (acceptability, appropriateness, feasibility, fidelity, adoption, penetration, and sustainability). Emergency BH visits and attention-deficit/hyperactivity disorder prescribing were unchanged. CONCLUSIONS These findings provide further support for the potential of integrated care to increase access to BH services in pediatric primary care.
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Affiliation(s)
- Heather J Walter
- Departments of Psychiatry .,Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | - Louis Vernacchio
- Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts.,Pediatric Physicians' Organization at Children's, Boston, Massachusetts
| | | | - Jonas Bromberg
- Departments of Psychiatry.,Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | | | - Jessica Barton
- Social Work, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Gregory J Young
- Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts.,Pediatric Physicians' Organization at Children's, Boston, Massachusetts
| | | | - Glenn Focht
- Connecticut Children's Medical Center, Hartford, Connecticut
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6
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Richardson L, Parker EO, Zhou C, Kientz J, Ozer E, McCarty C. Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial. J Med Internet Res 2021; 23:e24135. [PMID: 33709942 PMCID: PMC7998326 DOI: 10.2196/24135] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/30/2020] [Accepted: 01/16/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Health risk behaviors are the most common sources of morbidity among adolescents. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent. OBJECTIVE This study aims to test the efficacy of electronic risk behavior screening with integrated patient-facing feedback on the delivery of adolescent-reported clinician counseling and risk behaviors over time. METHODS This was a randomized controlled trial comparing an electronic tool to usual care in five pediatric clinics in the Pacific Northwest. A total of 300 participants aged 13-18 years who attended a well-care visit between September 30, 2016, and January 12, 2018, were included. Adolescents were randomized after consent by employing a 1:1 balanced age, sex, and clinic stratified schema with 150 adolescents in the intervention group and 150 in the control group. Intervention adolescents received electronic screening with integrated feedback, and the clinicians received a summary report of the results. Control adolescents received usual care. Outcomes, assessed via online survey methods, included adolescent-reported receipt of counseling during the visit (measured a day after the visit) and health risk behavior change (measured at 3 and 6 months after the visit). RESULTS Of the original 300 participants, 94% (n=282), 94.3% (n=283), and 94.6% (n=284) completed follow-up surveys at 1 day, 3 months, and 6 months, respectively, with similar levels of attrition across study arms. The mean risk behavior score at baseline was 2.86 (SD 2.33) for intervention adolescents and 3.10 (SD 2.52) for control adolescents (score potential range 0-21). After adjusting for age, gender, and random effect of the clinic, intervention adolescents were 36% more likely to report having received counseling for endorsed risk behaviors than control adolescents (adjusted rate ratio 1.36, 95% CI 1.04 to 1.78) 1 day after the well-care visit. Both the intervention and control groups reported decreased risk behaviors at the 3- and 6-month follow-up assessments, with no significant group differences in risk behavior scores at either time point (3-month group difference: β=-.15, 95% CI -0.57 to -0.01, P=.05; 6-month group difference: β=-.12, 95% CI -0.29 to 0.52, P=.57). CONCLUSIONS Although electronic health screening with integrated feedback improves the delivery of counseling by clinicians, the impact on risk behaviors is modest and, in this study, not significantly different from usual care. More research is needed to identify effective strategies to reduce risk in the context of well-care. TRIAL REGISTRATION ClinicalTrials.gov NCT02882919; https://clinicaltrials.gov/ct2/show/NCT02882919.
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Affiliation(s)
- Laura Richardson
- Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | | | - Chuan Zhou
- Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Julie Kientz
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, United States
| | - Elizabeth Ozer
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States.,Office of Diversity & Outreach, University of California, San Francisco, San Francisco, CA, United States
| | - Carolyn McCarty
- Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
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7
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Terry JD, Weist MD, Strait GG, Miller M. Motivational Interviewing to Promote the Effectiveness of Selective Prevention: an Integrated School-Based Approach. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:799-810. [PMID: 32451788 DOI: 10.1007/s11121-020-01124-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
School Mental Health prevention approaches that use multi-tiered systems are advancing rapidly. However, there is a relative shortage of effective selective prevention programs feasible to implement within the school context. To optimize the effectiveness of selective prevention in this context, a Motivational Interviewing (MI)-based prevention program for an adolescent student population was developed and tested. Footprints utilizes MI to increase engagement in modular Cognitive-Behavioral Therapy and to promote academic protective factors. In this study, forty-three adolescents were randomly assigned to Footprints or a treatment-as-usual waitlist control. Participants in the experimental condition demonstrated significant increases in behavioral and emotional functioning, self-efficacy to regulate behaviors, positive expectations for success, academic motivation, and grades in mathematics. Simultaneously, Footprints received high ratings for feasibility and acceptability within a dynamic school context. This exploratory efficacy evaluation provides initial support for MI's potential to promote the effectiveness of school-based prevention programs and warrants further study.
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Affiliation(s)
- John D Terry
- Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA.
| | - Mark D Weist
- Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA
| | | | - Marissa Miller
- Department of Psychology, University of South Carolina, Columbia, SC, 29208, USA
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8
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Pittman LD, Cutright NL, McNeela L, Awada S, Pabis JM, Kochanova K, Shelleby E. Coping Strategies and Psychological Symptoms Among Children on St. Thomas in the Aftermath of Hurricanes Irma and Maria. J Trauma Stress 2020; 33:151-160. [PMID: 31800137 DOI: 10.1002/jts.22471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/25/2019] [Accepted: 07/28/2019] [Indexed: 11/10/2022]
Abstract
Research has shown that experiencing a hurricane can lead to internalizing, externalizing, and posttraumatic stress (PTS) symptoms in children. However, the effects of experiencing two hurricanes within a short time frame have not been examined. Moreover, there is limited research examining how children's coping is linked to their psychological functioning and no research using the empirically supported conceptualization of coping that includes primary control coping (i.e., attempts to control the stressor) and secondary control coping (i.e., attempts to adapt to the stressor). This study examined the psychological functioning of 108 children and adolescents (69.7% Black, Non-Hispanic; 56.5% female; M age = 11.59 years, SD = 2.43) in Grades 3-12 as measured 3 months after experiencing Hurricanes Irma and Maria on the island of St. Thomas. Participants completed electronic questionnaires about their demographic characteristics, hurricane exposure (i.e., perceived life-threat, life-threatening events, loss/disruption after hurricanes), coping strategies utilized, and their psychological functioning (i.e., PTS, internalizing, and externalizing symptoms). A principal component analysis of the coping items determined four coping factors: primary control, secondary control, disengagement, and negative coping. Linear regressions, including children's age and aspects of hurricane exposure, found primary control coping was positively associated with PTS symptoms, β = .18, whereas secondary control coping was negatively associated with PTS and externalizing symptoms, βs = -.17 and -.19, respectively. Negative coping, but not disengagement coping, was positively associated with all three outcomes, βs = .31-.42. These findings suggest positive ways children can cope after experiencing a hurricane, informing possible early intervention efforts.
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Affiliation(s)
- Laura D Pittman
- Psychology Department, Northern Illinois University, DeKalb, Illinois, USA
| | | | - Lauren McNeela
- Psychology Department, Northern Illinois University, DeKalb, Illinois, USA
| | - Samantha Awada
- Psychology Department, Northern Illinois University, DeKalb, Illinois, USA
| | - Jacqueline M Pabis
- Psychology Department, Northern Illinois University, DeKalb, Illinois, USA
| | - Kristina Kochanova
- Psychology Department, Northern Illinois University, DeKalb, Illinois, USA
| | - Elizabeth Shelleby
- Psychology Department, Northern Illinois University, DeKalb, Illinois, USA
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9
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Liu J, Guo S, Gao R, DiStefano C. Investigating school children’s behavioral and emotional problems using pediatric symptoms checklist-17 in a structural equation modeling framework. SCHOOL PSYCHOLOGY INTERNATIONAL 2020. [DOI: 10.1177/0143034320912301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Pediatric Symptom Checklist-17 was originally used in primary care settings with parents to identify their children’s behavioral and emotional problems, but there has been some research supporting use of this scale in school settings. This study examined: (a) the factor structure and measurement invariance of the teacher-rated Pediatric Symptom Checklist-17 and (b) complex relationships among demographic characteristics, behavioral and emotional problems, and learning outcomes using structural equation modeling in elementary schools. A sample of 508 children in grades one and two were rated by their teachers with the Pediatric Symptom Checklist-17. Measures of Academic Progress test was utilized to measure participants’ learning outcomes in reading and math. The results confirmed a three-factor structure of the Pediatric Symptom Checklist-17 (internalizing problems, externalizing problems, and attention problems) and attested the measurement invariance across different demographic groups (i.e. gender, ethnicity, and grade levels). Boys were more likely to have severe attention problems which were associated with lower learning outcomes as seen by Measures of Academic Progress reading and math scores. Attention problems mediated the relationship between gender and learning outcomes. This study has implications for the use of the Pediatric Symptom Checklist-17 in school-based settings. Additionally, it highlights the potential relationships among gender, attention problems, and learning outcomes.
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Affiliation(s)
- Jin Liu
- University of South Carolina, USA
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10
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Adolescent-Reported Sleep/Wake Patterns in the Relationships Between Inhibitory Control and Internalizing and Externalizing Problems. J Dev Behav Pediatr 2019; 40:679-685. [PMID: 31299032 DOI: 10.1097/dbp.0000000000000707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Youth with poorer inhibitory control are more likely to experience internalizing and externalizing problems, placing them at risk for poorer psychological, academic, and social functioning. Modifying inhibitory control is challenging; therefore, research is needed to identify alternative targets to reduce internalizing and externalizing problems in youth. Sleep/wake patterns may serve as alternative targets, given their relationships with poorer inhibitory control and greater internalizing and externalizing problems. This study examines the mediating role of sleep/wake patterns in the relationships between youth inhibitory control and internalizing and externalizing problems. METHOD One hundred fifty-five adolescent (ages 12-15 years) and parent dyads completed the Behavioral Rating Inventory of Executive Function, Pediatric Symptom Checklist, and Adolescent Sleep-Wake Scale, short version. Bootstrapped mediations examined indirect relationships between inhibitory control and internalizing and externalizing through sleep/wake patterns. RESULTS Analyses revealed that problematic sleep/wake patterns partially mediated the relationship between poorer inhibitory control and greater internalizing, explaining 19% of the variance in internalizing problems. In addition, problematic sleep/wake patterns partially mediated the relationship between poorer inhibitory control and greater externalizing, explaining 58% of the variance in externalizing problems. CONCLUSION The results suggest that sleep/wake patterns may be a mechanism through which deficits in inhibitory control increase youth risk for internalizing and externalizing problems. Because sleep/wake patterns are frequently modified through adoption of health behaviors conducive to good sleep, assessing for problematic patterns in adolescents who present with internalizing and externalizing problems may offer providers a relatively modifiable target to reduce the emotional and behavioral problems of youth with poorer inhibitory control abilities.
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11
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Buchbinder D, Patel SK, Casillas JN, Nugent DJ, Neudorf S, Sender LS, Torno L, Huszti H, Zeltzer LK, Parsons SK. Parent proxy assessment of sibling quality of life following pediatric hematopoietic cell transplantation. Health Qual Life Outcomes 2019; 17:162. [PMID: 31665035 PMCID: PMC6819636 DOI: 10.1186/s12955-019-1231-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/02/2019] [Indexed: 12/11/2022] Open
Abstract
Background When a child undergoes hematopoietic cell transplantation (HCT), the impact extends to the entire family, including siblings. Assessment of the quality of life (QoL) of siblings is challenged by their general lack of availability for regular assessment by clinical providers. Thus, the use of parent proxy reporting may be useful. Our aim was to describe the QoL of siblings of HCT survivors, as reported by their parents, as well as to identify parent and family factors associated with lower sibling QoL. Methods A cross-sectional study was utilized to assess parent-reported QoL of the HCT recipient’s sibling (Short Form (SF)-10 Health Survey for Children and the Pediatric Symptom Checklist (PSC)-17). Parent QoL was assessed using the SF-12. Multivariable linear regression was used to explore hypothesized predictors of sibling QoL, including parent QoL, family impact/function (Impact on Family Scale, Family Adaptability and Cohesion Evaluation Scales, IV, and a question asking about financial problems) while adjusting for demographic and HCT characteristics. Results Ninety-seven siblings (55% males) with a mean age of 12 years (standard deviation [SD] 4 years) were assessed, representing HCT survivors, who were an average of 5 years (SD 4 years) post-HCT. Neither sibling psychosocial (mean 49.84, SD 10.70, p = 0.87) nor physical health scores (mean 51.54, SD 8.42, p = 0.08) differed from norms. Parent proxies reported behavioral/emotional problems (PSC-17 total score > 15) in 24% of siblings. While parental ratings of their own physical health (SF-12 were higher than norms (mean 53.04, SD 8.17, p = 0.0005), mental health scores were lower (mean 45.48, SD 10.45, p < 0.0001). In multivariable analysis, lower parent emotional functioning and adverse family function were associated with lower sibling QoL, as reported by parents. Conclusions While proxy-reported QoL of siblings did not differ significantly from normative data, both parent QoL and family function were associated with sibling QoL. Future research is needed to understand how siblings themselves perceive their QoL following HCT.
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Affiliation(s)
- David Buchbinder
- Department of Pediatrics and Division of Pediatric Hematology, CHOC Children's Hospital and University of California at Irvine's Chao Family Comprehensive Cancer Center, Irvine, California, USA. .,CHOC Children's Hospital, 1201 W. La Veta Avenue, Orange, CA, 92868, USA.
| | - Sunita K Patel
- Department of Cancer Control and Population Sciences, City of Hope, Duarte, California, USA
| | - Jacqueline N Casillas
- Department of Pediatrics and Division of Pediatric Hematology and Oncology, David Geffen School of Medicine at University of California at Los Angeles and University of California at Los Angeles's Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Diane J Nugent
- Department of Pediatrics and Division of Hematology at CHOC Children's Hospital, Orange, California, USA
| | - Steven Neudorf
- Department of Pediatrics and Division of Oncology at CHOC Children's Hospital, Orange, California, USA
| | - Leonard S Sender
- Department of Pediatrics and Division of Oncology at CHOC Children's Hospital, Orange, California, USA
| | - Lilibeth Torno
- Department of Pediatrics and Division of Oncology at CHOC Children's Hospital, Orange, California, USA
| | - Heather Huszti
- Department of Pediatrics and Division of Psychology at CHOC Children's Hospital, Orange, California, USA
| | - Lonnie K Zeltzer
- Psychiatry / Biobehavioral Science, and Division of Cancer Prevention and Control Research, David Geffen School of Medicine at University of California at Los Angeles and University of California at Los Angeles's Jonsson Comprehensive Cancer Center, Los Angeles, California, USA
| | - Susan K Parsons
- Institute of Clinical Research and Health Policy Studies at Tufts Medical Center and Departments of Medicine and Pediatrics, at Tufts University School of Medicine, Boston, Massachusetts, USA
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12
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Suku S, Soni J, Martin MA, Mirza MP, Glassgow AE, Gerges M, Van Voorhees BW, Caskey R. A multivariable analysis of childhood psychosocial behaviour and household functionality. Child Care Health Dev 2019; 45:551-558. [PMID: 30897231 DOI: 10.1111/cch.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Social determinants of health play a vital role in population health. Awareness of household social factors and their impact on health can help health professionals to provide effective strategies in health promotion, especially for children and adolescents showing signs of psychosocial dysfunction. The objective of this study was to explore the association between parents' perceptions of the psychosocial behaviour of their children and the functionality of their household. METHODS This cohort study analysed data from the Coordinated Health Care for Complex Kids programme. The sample included 293 parents of children aged 4-17 years with chronic conditions, and from urban, low-income families. Psychosocial behaviour of the child was measured using the Pediatric Symptom Checklist (PSC-17), which included subscales for internal, external, and attention symptoms. Household functionality was measured using the Confusion, Hubbub, and Order Scale. Responses to both assessments were scored in a standard manner. RESULTS There was a significant association between parents' perceptions of the psychosocial behaviour of their children and the functionality of the home environment. The mean Confusion, Hubbub, and Order Scale scores in the home environment improved from baseline to the first reassessment (the period between the two assessments ranged from 4 to 8 months). Additionally, positive PSC-17 screening results of the children decreased by 11% in the first reassessment. The odds of having a positive PSC-17 screening result also decreased in the first reassessment after receiving interventions. CONCLUSION The association between psychosocial dysfunction and household functionality indicates the importance of family-centred care and taking the home environment into consideration when administering health services to low-income children with chronic conditions. This study brings attention to the more hidden factors that influence child mental health, which must be addressed to improve care delivery and child health outcomes.
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Affiliation(s)
- Sangeeta Suku
- Community Health Sciences - Maternal and Child Health, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jinal Soni
- Epidemiology/Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Molly A Martin
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mansha Parven Mirza
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Anne Elizabeth Glassgow
- Department of Pediatrics, University of Illinois Hospital & Health Sciences System, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael Gerges
- CHECK Program - Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Benjamin W Van Voorhees
- Department of Pediatrics, University of Illinois at Chicago, Children's Hospital, University of Illinois Hospital & Health Sciences System, Chicago, Illinois, USA
| | - Rachel Caskey
- Pediatrics and Internal Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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13
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Stadnick NA, Brookman-Frazee L, Mandell DS, Kuelbs CL, Coleman KJ, Sahms T, Aarons GA. A mixed methods study to adapt and implement integrated mental healthcare for children with autism spectrum disorder. Pilot Feasibility Stud 2019; 5:51. [PMID: 30976456 PMCID: PMC6438023 DOI: 10.1186/s40814-019-0434-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 03/15/2019] [Indexed: 01/12/2023] Open
Abstract
Background There is a critical need for effective implementation of integrated healthcare systems for children with autism spectrum disorder (ASD). Children with ASD have many service needs, including the need to access effective mental healthcare, given high rates of co-occurring psychiatric conditions. Pediatric primary care is an ongoing point of healthcare that is well positioned to identify mental health concerns and facilitate linkage to mental health services for children with ASD. However, identifying mental health problems in children with ASD by primary care providers is complex, subject to being overlooked and may significantly vary based on primary care organizational characteristics. Efforts targeting integrated primary-mental healthcare implementation require a tailored approach for children with ASD. Methods This mixed methods, community-partnered study will apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011; Moullin et al., in press) to adapt and implement an integrated care model, “Access to Tailored Autism INtegrated Care” (ATTAIN), in pediatric practices within three diverse healthcare settings for children ages 4–18 years. Key inner context factors from the Exploration, Preparation, and Implementation phases of the EPIS framework will guide three objectives of this study: (1) to identify targets to improve mental health screening and linkage to mental health services in primary care for children with ASD, (2) to adapt integrated care procedures to facilitate identification of mental health problems and linkage to evidence-based care for children with ASD, and (3) to examine feasibility, acceptability, and uptake of the adapted integrated mental healthcare model through a pilot study in pediatric primary care. Discussion Improving integrated mental healthcare for children with ASD could have a significant public health impact on mental healthcare access, child clinical outcomes, and reduction in healthcare costs. Results from this mixed methods study will inform selection of implementation strategies to conduct larger-scale implementation of tailored integrated mental healthcare for children with ASD that will ultimately help to address the high unmet mental health needs for these children.
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Affiliation(s)
- Nicole A Stadnick
- 1Department of Psychiatry, University of California, San Diego, La Jolla USA.,Child and Adolescent Services Research Center, San Diego, USA
| | - Lauren Brookman-Frazee
- 1Department of Psychiatry, University of California, San Diego, La Jolla USA.,Child and Adolescent Services Research Center, San Diego, USA.,6Rady Children's Hospital, San Diego, USA
| | - David S Mandell
- 3Department of Psychiatry, Center for Mental Health, University of Pennsylvania, Philadelphia, USA
| | - Cynthia L Kuelbs
- 5Department of Pediatrics, University of California, San Diego, La Jolla USA.,6Rady Children's Hospital, San Diego, USA
| | - Karen J Coleman
- 4Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, USA
| | - Timothy Sahms
- 5Department of Pediatrics, University of California, San Diego, La Jolla USA.,7San Ysidro Health Center, San Ysidro, USA
| | - Gregory A Aarons
- 1Department of Psychiatry, University of California, San Diego, La Jolla USA.,Child and Adolescent Services Research Center, San Diego, USA
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Marsac ML, Sprang G, Guller L, Kohser KL, Draus JM, Kassam-Adams N. A parent-led intervention to promote recovery following pediatric injury: study protocol for a randomized controlled trial. Trials 2019; 20:137. [PMID: 30777113 PMCID: PMC6380044 DOI: 10.1186/s13063-019-3207-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Injury is one of the most prevalent potentially emotionally traumatic events that children experience and can lead to persistent impaired physical and emotional health. There is a need for interventions that promote full physical and emotional recovery and that can be easily accessed by all injured children. Based on research evidence regarding post-injury recovery, we created the Cellie Coping Kit for Children with Injury intervention to target key mechanisms of action and refined the intervention based on feedback from children, families, and experts in the field. The Cellie Coping Kit intervention is parent-guided and includes a toy (for engagement), coping cards for children, and a book for parents with evidence-based strategies to promote injury recovery. This pilot research trial aims to provide an initial evaluation of the impact of the Cellie Coping Kit for Children with Injury on proximal targets (coping, appraisals) and later child health outcomes (physical recovery, emotional health, health-related quality of life). METHOD / DESIGN Eighty children (aged 8-12 years) and their parents will complete a baseline assessment (T1) and then will be randomly assigned to an immediate intervention group or waitlist group. The Cellie Coping Kit for Injury Intervention will be introduced to the immediate intervention group after the T1 assessment and to the waitlist group following the T3 assessment. Follow-up assessments of physical and emotional health will be completed at 6 weeks (T2), 12 weeks (T3), and 18 weeks (T4). DISCUSSION This will be one of the first randomized controlled trials to examine an intervention tool intended to promote full recovery after pediatric injury and be primarily implemented by children and parents. Results will provide data on the feasibility of the implementation of the Cellie Coping Intervention for Injury as well as estimations of efficacy. Potential strengths and limitations of this design are discussed. TRIAL REGISTRATION Clinicaltrials.gov, NCT03153696 . Registered on 15 May 2017.
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Affiliation(s)
- Meghan L Marsac
- Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY, USA. .,College of Medicine, Kentucky Children's Hospital, University of Kentucky, 800 Rose St, MN 472, Lexington, KY, 40536, USA.
| | - Ginny Sprang
- College of Medicine, Kentucky Children's Hospital, University of Kentucky, 800 Rose St, MN 472, Lexington, KY, 40536, USA.,Center on Trauma and Children, University of Kentucky, Lexington, KY, USA
| | - Leila Guller
- Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY, USA.,College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Kristen L Kohser
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John M Draus
- College of Medicine, Kentucky Children's Hospital, University of Kentucky, 800 Rose St, MN 472, Lexington, KY, 40536, USA.,Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - Nancy Kassam-Adams
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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15
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Zima BT, McCreary M, Kenan K, Churchey-Mims M, Chi H, Brady M, Davies J, Rompala V, Leventhal B. Development and Evaluation of Two Integrated Care Models for Children Using a Partnered Formative Evaluation Approach. Ethn Dis 2018; 28:445-456. [PMID: 30202198 DOI: 10.18865/ed.28.s2.445] [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] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the development and evaluation of two integrated care models using a partnered formative evaluation approach across a private foundation, clinic leaders, providers and staff, and a university-based research center. Design Retrospective cohort study using multiple data sources. Setting Two federal qualified health care centers serving low-income children and families in Chicago. Participants Private foundation, clinic and academic partners. Interventions Development of two integrated care models and partnered evaluation design. Main Outcome Measures Accomplishments and early lessons learned. Results Together, the foundation-clinic-academic partners worked to include best practices in two integrated care models for children while developing the evaluation design. A shared data collection approach, which empowered the clinic partners to collect data using a web-based tool for a prospective longitudinal cohort study, was also created. Conclusion Across three formative evaluation stages, the foundation, clinic, and academic partners continued to reach beyond their respective traditional roles of project oversight, clinical service, and research as adjustments were collectively made to accommodate barriers and unanticipated events. Together, an innovative shared data collection approach was developed that extends partnered research to include data collection being led by the clinic partners and supported by the technical resources of a university-based research center.
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Affiliation(s)
- Bonnie T Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Kristen Kenan
- Department of Pediatrics, University of Illinois at Chicago, IL
| | | | - Hannah Chi
- Erie West Town Family Health Center, Chicago, IL
| | | | | | | | - Bennett Leventhal
- Department of Psychiatry, University of California at San Francisco, CA
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16
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Webb MJ, Wadley G, Sanci LA. Experiences of General Practitioners and Practice Support Staff Using a Health and Lifestyle Screening App in Primary Health Care: Implementation Case Study. JMIR Mhealth Uhealth 2018; 6:e105. [PMID: 29691209 PMCID: PMC5941099 DOI: 10.2196/mhealth.8778] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/27/2018] [Accepted: 02/18/2018] [Indexed: 01/13/2023] Open
Abstract
Background Technology-based screening of young people for mental health disorders and health compromising behaviors in general practice increases the disclosure of sensitive health issues and improves patient-centered care. However, few studies investigate how general practitioners (GPs) and practice support staff (receptionists and practice managers) integrate screening technology into their routine work, including the problems that arise and how the staff surmount them. Objective The aim of this study was to investigate the implementation of a health and lifestyle screening app, Check Up GP, for young people aged 14 to 25 years attending an Australian general practice. Methods We conducted an in-depth implementation case study of Check Up GP in one general practice clinic, with methodology informed by action research. Semistructured interviews and focus groups were conducted with GPs and support staff at the end of the implementation period. Data were thematically analyzed and mapped to normalization process theory constructs. We also analyzed the number of times we supported staff, the location where young people completed Check Up GP, and whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of taking their appointment. Results A total of 4 GPs and 10 support staff at the clinic participated in the study, with all except 3 receptionists participating in the final interviews and focus groups. During the 2-month implementation period, the technology and administration of Check Up GP was iterated through 4 major quality improvement cycles in response to the needs of the staff. This resulted in a reduction in the average time taken to complete Check Up GP from 14 min to 10 min, improved SMS text messaging for young people, and a more consistent description of the app by receptionists to young people. In the first weeks of implementation, researchers needed to regularly support staff with the app’s administration; however, this support decreased over time, even as usage rose slightly. The majority of young people (73/87, 84%) completed Check Up GP in the waiting room, with less than half (35/80, 44%) having received an SMS from the clinic with a link to the tool. Participating staff valued Check Up GP, particularly its facilitation of youth-friendly practice. However, there was at first a lack of organizational systems and capacity to implement the app and also initially a reliance on researchers to facilitate the process. Conclusions The implementation of a screening app in the dynamic and time-restricted general practice setting presents a range of technical and administrative challenges. Successful implementation of a screening app is possible but requires adequate time and intensive facilitation. More resources, external to staff, are needed to drive and support sustainable technology innovation and implementation in general practice settings.
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Affiliation(s)
- Marianne Julie Webb
- Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Greg Wadley
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Lena Amanda Sanci
- Department of General Practice, Melbourne Medical School, University of Melbourne, Parkville, Australia
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17
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Ratcliff MB, Catlin PA, Peugh JL, Siegel RM, Kirk S, Tamm L. Psychosocial Screening Among Youth Seeking Weight Management Treatment. Clin Pediatr (Phila) 2018; 57:277-284. [PMID: 28695753 DOI: 10.1177/0009922817715936] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The objectives of this study were to identify rates of, and factors associated with, "at-risk" scores on a brief psychosocial screener among overweight/obese youth seeking weight management treatment, as well as concordance between youth and caregiver reports. A retrospective chart review of 1443 consecutive patients ages 4 to 18 years and their caregivers was conducted. Almost 1 in 4 youth with overweight/obesity presented with psychosocial symptoms in the at-risk range for significant mental health issues based on caregiver report on the Pediatric Symptom Checklist (PSC) and 1 in 6 based on youth self-report on the Youth Pediatric Symptom Checklist (Y-PSC). Concordance between caregiver and youth was fair (agreement 24% to 40%). Higher scores were associated with male sex and older age on the PSC and with indication of depressive disorder in the electronic medical record on the Y-PSC. Conducting a brief psychosocial screen in comprehensive weight management programs is feasible and clinically indicated.
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Affiliation(s)
- Megan B Ratcliff
- 1 Center for Weight Management at Gwinnett Medical Center, Duluth, GA, USA
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - James L Peugh
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Robert M Siegel
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shelley Kirk
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Leanne Tamm
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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18
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Abstract
BACKGROUND It is well known that pediatric psychiatric patients frequent emergency department (ED), but the number of patients with undiagnosed psychiatric illness presenting to an ED is not well known. Identification and referral of these patients may provide an opportunity for improved patient care. The primary study objective was to identify a tool that can screen for unsuspected psychiatric illness in pediatric patients who present to the ED with non-psychiatric-related complaints. METHODS The MINI International Neuropsychiatric Interview for Children and Adolescents screening tool was administered to 200 pediatric consenting patients and guardians. The inclusion criteria were English-speaking patients who presented in the ED with a nonpsychiatric complaint who were stable and able to communicate. The study was conducted in a level 1 trauma center ED of an inner-city hospital that serves a predominantly African American and Hispanic population. This study was institutional review board approved. RESULTS The study populations consisted of 53% African American (107), 45% Hispanic (90), 1% white (2), and 0.5% Asian (1). Their age range was divided, with 49% between 12 and 14 years (98) and 51% between 15 and 17 years (102). The sex was evenly split, with 50% male (100) and 50% female (100). The 41% who did screen positive for an undiagnosed mental illness had a range of diagnoses. The top modules with positive results were oppositional defiant (13.5%, 27), attention-deficit/hyperactivity disorder (13%, 25), depression (10%, 11), conduct disorder (9%, 19), and anxiety (5%, 11). CONCLUSIONS The pediatric Mini International Neuropsychiatric Interview was effective in screening for undiagnosed mental illness in pediatric patients who presented to the ED with no psychiatric-related illness. The screening tool indicated that 41% of pediatric patients screened positive for an undiagnosed mental illness, with attention deficit-related disorders being the most widely seen. Further study should be conducted to test the tools used in a range of ED settings.
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19
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Zalta AK, Bui E, Karnik NS, Held P, Laifer LM, Sager JC, Zou D, Rauch PK, Simon NM, Pollack MH, Ohye B. Examining the Relationship Between Parent and Child Psychopathology in Treatment-Seeking Veterans. Child Psychiatry Hum Dev 2018; 49:209-216. [PMID: 28660407 PMCID: PMC5773394 DOI: 10.1007/s10578-017-0743-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study aimed to examine: (1) the relationship between parental psychopathology and child psychopathology in military families and (2) parenting sense of competence as a mediator of the relationship between veteran psychopathology and child psychopathology. As part of their standard clinical evaluations, 215 treatment-seeking veterans who reported having a child between the ages of 4 and 17 were assessed for psychopathology (posttraumatic stress disorder, depression, anxiety, and stress), their sense of competence as a parent, and their child's psychopathology (internalizing, externalizing, and attentional symptoms). A path analysis model examining parenting sense of competence as a mediator of the relationship between veteran psychopathology and child psychopathology showed significant indirect effects of veteran depression on all child psychopathology outcomes via parenting sense of competence. Parental sense of competence may be a critical mechanism linking veteran depression and child psychopathology, and may therefore be an important target for intervention.
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Affiliation(s)
- Alyson K Zalta
- Road Home Program, Department of Psychiatry, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 602, Chicago, IL, 60612, USA.
- Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
| | - Eric Bui
- Home Base, a Red Sox Foundation and Massachusetts General Hospital program, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Niranjan S Karnik
- Road Home Program, Department of Psychiatry, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 602, Chicago, IL, 60612, USA
| | - Philip Held
- Road Home Program, Department of Psychiatry, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 602, Chicago, IL, 60612, USA
| | - Lauren M Laifer
- Home Base, a Red Sox Foundation and Massachusetts General Hospital program, Boston, MA, USA
| | - Julia C Sager
- Home Base, a Red Sox Foundation and Massachusetts General Hospital program, Boston, MA, USA
| | - Denise Zou
- Road Home Program, Department of Psychiatry, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 602, Chicago, IL, 60612, USA
| | - Paula K Rauch
- Home Base, a Red Sox Foundation and Massachusetts General Hospital program, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Naomi M Simon
- Home Base, a Red Sox Foundation and Massachusetts General Hospital program, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mark H Pollack
- Road Home Program, Department of Psychiatry, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 602, Chicago, IL, 60612, USA
| | - Bonnie Ohye
- Home Base, a Red Sox Foundation and Massachusetts General Hospital program, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Abstract
We aimed to describe the quality of life (QOL) among parents of adolescent and young adult brain tumor survivors as well as parent, survivor, and diagnosis/treatment-related factors associated with adverse QOL. A cross-sectional study of 28 parents of adolescent and young adult brain tumor survivors (who were on average 10 y postdiagnosis) was used to assess QOL. Parent QOL was measured using the Patient-Reported Outcomes Measurement Information System Global Health measure. Factors associated with adverse parent QOL were explored using logistic regression including: parent, survivor, and diagnosis/treatment-related factors. Parent QOL was within the normal range; however, 40% scored below the clinical threshold of 0.5 SD below the mean for physical and mental health. Parent perceptions of greater family impact, survivor emotional/behavioral health problems, improved cognitive function, and recurrence were associated with adverse parent physical health. Parent anger/sorrow, uncertainty, survivor emotional/behavioral health problems, speech/language problems, and recurrence were associated with adverse parent mental health. Parental emotional resources and perceptions of improved survivor peer relationships were associated with greater parent physical and mental health. The impact of a brain tumor diagnosis and treatment on the QOL of parents may be significant. Interventions are needed to ensure that the needs of parents are met.
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21
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Defenderfer EK, Davies WH, Raicu AM, Brei N, Klein-Tasman BP. Childhood toilet fears as an early behavioral indicator of anxiety. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2016.1193808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - W. Hobart Davies
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Ana-Maria Raicu
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Natalie Brei
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI
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Hiott DB, Phillips S, Amella E. Adolescent Risk Screening Instruments for Primary Care: An Integrative Review Utilizing the Donabedian Framework. Compr Child Adolesc Nurs 2017; 41:255-275. [PMID: 28759282 DOI: 10.1080/24694193.2017.1330372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Adolescent risk-taking behavior choices can affect future health outcomes. The purpose of this integrative literature review is to evaluate adolescent risk screening instruments available to primary care providers in the United States using the Donabedian Framework of structure, process, and outcome. To examine the literature concerning multidimensional adolescent risk screening instruments available in the United States for use in the primary care setting, library searches, ancestry searches, and Internet searches were conducted. Library searches included a systematic search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier, Health Source Nursing Academic Ed, Medline, PsycINFO, the Psychology and Behavioral Sciences Collection, and PubMed databases with CINAHL headings using the following Boolean search terms: "primary care" and screening and pediatric. Criteria for inclusion consisted of studies conducted in the United States that involved broad multidimensional adolescent risk screening instruments for use in the pediatric primary care setting. Instruments that focused solely on one unhealthy behavior were excluded, as were developmental screens and screens not validated or designed for all ages of adolescents. In all 25 manuscripts reviewed, 16 screens met the inclusion criteria and were included in the study. These 16 screens were examined for factors associated with the Donabedian structure-process-outcome model. This review revealed that many screens contain structural issues related to cost and length that inhibit provider implementation in the primary care setting. Process limitations regarding the report method and administration format were also identified. The Pediatric Symptom Checklist was identified as a free, short tool that is valid and reliable.
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Affiliation(s)
- Deanna B Hiott
- a School of Nursing, Anderson University , Anderson South Carolina
| | - Shannon Phillips
- b College of Nursing, Medical University of South Carolina , Charleston , South Carolina
| | - Elaine Amella
- b College of Nursing, Medical University of South Carolina , Charleston , South Carolina
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Abstract
OBJECTIVE To determine if a new, non-validated mental health screener can detect the prevalence of alcohol/drug abuse, traumatic exposure, and behavioral symptoms in adolescents and young adults seeking care in a pediatric emergency department (ED) for medical complaints. METHODS An 11-item mental health screener (Emergency Department Distress Response Screener [ED-DRS] investigator developed) was created. Patients 12 years or older seen for medical complaints were assessed by physicians using the ED-DRS. Data were analyzed using the Kuder-Richardson Formula 20, χ test, Mann-Whitney U test, and Spearman correlation. RESULTS Among 992 ED patients, mean age was 15.11 ± 2.10 years (46.2% boys; 53.8% girls). Approximately 77.9% were Hispanic/Latino. Symptomatic patients (S) answered "yes" to at least 1 ED-DRS item; asymptomatic patients answered "no" to all items. The S patients comprised 47.5% of the sample; asymptomatic patients comprised 52.5%. Among S patients, alcohol/drug abuse frequency was 14%. The traumatic exposure frequencies included: 33.5% physically or emotionally traumatized, 29.3% bullied, 21.2% physically abused, 8.1% touched inappropriately and 7.0% exposed to domestic violence. Behavioral symptom frequencies included: 33.8% depressed mood, 30.4% anxiety, 23.8% high energy behavior, 6.6% hallucinations, and 6.2% suicidal/homicidal ideation. CONCLUSIONS Although patients present to the ED with medical complaints, they may be at risk for concomitant mental health problems potentially discoverable using the ED-DRS.
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Systematic psychosocial screening in a paediatric cardiology clinic: clinical utility of the Pediatric Symptom Checklist 17. Cardiol Young 2016; 26:1130-6. [PMID: 26423220 PMCID: PMC5621735 DOI: 10.1017/s1047951115001900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To examine the clinical utility of the Pediatric Symptom Checklist 17 for identifying psychosocial concerns and improving access to psychology services within a paediatric cardiology clinic. METHOD Parents of 561 children (aged 4-17 years) presenting for follow-up of CHD, acquired heart disease, or arrhythmia completed the Pediatric Symptom Checklist 17 as part of routine care; three items assessing parental (1) concern for learning/development, (2) questions about adjustment to cardiac diagnosis, and (3) interest in discussing concerns with a behavioural healthcare specialist were added to the questionnaire. A psychologist contacted the parents by phone if they indicated interest in speaking with a behavioural healthcare specialist. RESULTS Percentages of children scoring above clinical cut-offs for externalising (10.5%), attention (8.7%), and total (9.3%) problems were similar to a "normative" primary-care sample, whereas fewer children in this study scored above the cut-off for internalising problems (7.8%; p<0.01). Sociodemographic, but not clinical, characteristics were associated with Pediatric Symptom Checklist 17 scores. 17% of the parents endorsed concerns about learning/development, and 20% endorsed questions about adjustment to diagnosis. History of cardiac surgery was associated with increased concern about learning/development (p<0.01). Only 37% of the parents expressing psychosocial concerns reported interest in speaking with a psychologist. CONCLUSIONS The Pediatric Symptom Checklist 17 may not be sensitive to specific difficulties experienced by this patient population. A questionnaire with greater focus on learning/development and adjustment to diagnosis may yield improved utility. Psychology integration in clinics serving high-risk cardiac patients may decrease barriers to behavioural healthcare services.
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25
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Sood E, Gidding SS. Childhood Psychosocial Determinants of Cardiovascular Health. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0499-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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26
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Johnson SD. Substance abuse and parenting among African American mothers of adolescents. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2015; 32:455-463. [PMID: 26417152 PMCID: PMC4583070 DOI: 10.1007/s10560-015-0383-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Sharon D. Johnson
- School of Social Work, University of Missouri-St. Louis, 204 Bellerive Hall, One University Drive, St. Louis, Missouri 63121-4499, 314-516-6817, 314-516-6416 (fax)
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Sanci L, Chondros P, Sawyer S, Pirkis J, Ozer E, Hegarty K, Yang F, Grabsch B, Shiell A, Cahill H, Ambresin AE, Patterson E, Patton G. Responding to Young People's Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing. PLoS One 2015; 10:e0137581. [PMID: 26422235 PMCID: PMC4589315 DOI: 10.1371/journal.pone.0137581] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/17/2015] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians’ detection of health risks and patients’ risk taking behaviour, compared to a didactic seminar on young people’s health. Design Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. Setting General practices in metropolitan and rural Victoria, Australia Participants General practices with at least one interested clinician (general practitioner or nurse) and their 14–24 year old patients. Intervention This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients’ risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. Outcome Measures Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients’ sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. Results 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0·52, CI 0·28 to 0·96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0·66, CI 0·46 to 0·96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0·40, CI 0·20 to 0·80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. Conclusions A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. Trial Registration ISRCTN.com ISRCTN16059206.
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Affiliation(s)
- Lena Sanci
- Department of General Practice, Melbourne Medical School, The University of Melbourne, 200 Berkeley St., Carlton, VIC, 3053, Australia
- * E-mail:
| | - Patty Chondros
- Department of General Practice, Melbourne Medical School, The University of Melbourne, 200 Berkeley St., Carlton, VIC, 3053, Australia
| | - Susan Sawyer
- Centre for Adolescent Health, Royal Children’s Hospital, 50 Flemington Rd., Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, VIC, 3010, Australia
- Murdoch Children’s Research Institute, 50 Flemington Rd., Parkville, VIC, 3052, Australia
| | - Jane Pirkis
- Melbourne School of Population and Global Health, Level 5, 207 Bouverie St., The University of Melbourne, VIC, 3010, Australia
| | - Elizabeth Ozer
- Division of Adolescent & Young Adult Medicine, University of California San Francisco, San Francisco, 94118, United States of America
- UCSF Office of Diversity and Outreach, University of California San Francisco, San Francisco, 94118, United States of America
| | - Kelsey Hegarty
- Department of General Practice, Melbourne Medical School, The University of Melbourne, 200 Berkeley St., Carlton, VIC, 3053, Australia
| | - Fan Yang
- Department of General Practice, Melbourne Medical School, The University of Melbourne, 200 Berkeley St., Carlton, VIC, 3053, Australia
| | - Brenda Grabsch
- Department of General Practice, Melbourne Medical School, The University of Melbourne, 200 Berkeley St., Carlton, VIC, 3053, Australia
| | - Alan Shiell
- Centre of Excellence in Intervention and Prevention Science Limited, 15–31 Pelham St., P.O. Box 35, Carlton, VIC, 3053, Australia
| | - Helen Cahill
- Youth Research Centre, Melbourne Graduate School of Education, The University of Melbourne, 100 Leicester St., Carlton, VIC, 3053, Australia
| | - Anne-Emmanuelle Ambresin
- Division Interdisciplinaire de santé des adolescents, Centre Hospitalier Universitaire Vaudois Lausanne Switzerland, Av. De Beaumont 48, CH-101, Lausanne, Switzerland
| | - Elizabeth Patterson
- Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, 161 Barry St., Carlton, VIC, 3053, Australia
| | - George Patton
- Centre for Adolescent Health, Royal Children’s Hospital, 50 Flemington Rd., Parkville, VIC, 3052, Australia
- Department of Paediatrics, The University of Melbourne, VIC, 3010, Australia
- Murdoch Children’s Research Institute, 50 Flemington Rd., Parkville, VIC, 3052, Australia
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Asato MR, Doss JL, Plioplys S. Clinic-friendly screening for cognitive and mental health problems in school-aged youth with epilepsy. Epilepsy Behav 2015; 48:97-102. [PMID: 25900224 DOI: 10.1016/j.yebeh.2015.03.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/28/2015] [Accepted: 03/30/2015] [Indexed: 11/16/2022]
Abstract
Cognitive, psychiatric, psychosocial, and behavioral difficulties are common in youth with epilepsy. Collectively, these comorbidities can be referred to as mental health problems as they reflect brain and behavioral function. Detection and treatment of mental health problems remain an unmet need in epilepsy care that can impact epilepsy, psychosocial, scholastic, and quality-of-life outcomes. Given limited resources in everyday pediatric epilepsy practice, this targeted review provides a stratified plan and suggested tools for screening school-aged youth with epilepsy for the presence of mental health problems. Comanagement of epilepsy and associated comorbidities is a newer concept that may help address the complex, long-term needs of patients by using a multidisciplinary team approach and by engaging primary care providers.
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Affiliation(s)
- Miya R Asato
- Department of Pediatrics, Division of Child Neurology, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Julia L Doss
- Psychology, Minnesota Epilepsy Group, St. Paul, MN, USA.
| | - Sigita Plioplys
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
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Grasso DJ, Connor DF, Scranton V, Macary S, Honigfeld L. Implementation of a Computerized Algorithmic Support Tool for Identifying Depression and Anxiety at the Pediatric Well-Child Visit. Clin Pediatr (Phila) 2015; 54:796-9. [PMID: 25106946 DOI: 10.1177/0009922814545493] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Damion J Grasso
- University of Connecticut School of Medicine, Farmington, CT, USA
| | - Daniel F Connor
- University of Connecticut School of Medicine, Farmington, CT, USA
| | | | - Susan Macary
- Child Health and Development Institute of Connecticut, Farmington, CT, USA
| | - Lisa Honigfeld
- Child Health and Development Institute of Connecticut, Farmington, CT, USA
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Sigel E, Harpin SB, Tung G. Increasing documentation and referral for youth at risk for violence through the primary health care setting. Clin Pediatr (Phila) 2015; 54:451-7. [PMID: 25305258 DOI: 10.1177/0009922814553431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Evaluate the use of a previsit violence risk screen to determine whether screening during routine care increases health care practitioner's (HCP's) documentation of violence risk. METHODS Once consented, adolescents filled out the Violence Injury, Protection and Risk Screen Tool (VIPRS). For usual care screen results were not viewed by the HCP. For the intervention screen results were imbedded in the electronic medical record and viewed by the HCP. The primary outcome-documented reference to violence risk-was determined by chart review. RESULTS Three hundred and fifty-six youth participated. Age was 14.5 years (SD 0.3); 65% female, 45% Hispanic, 38% black. Odds of violence related documentation was 47.4 (P < .001) in the intervention compared with usual care. Those who were positive on the VIPRS had a 10 times greater odds of receiving a violence intervention compared with controls. CONCLUSIONS Previsit screening for violence risk significantly increases HCP's documentation of violent behavior and referral for intervention.
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Affiliation(s)
- Eric Sigel
- University of Colorado, School of Medicine, Aurora, CO, USA
| | - Scott B Harpin
- University of Colorado, College of Nursing, Aurora, CO, USA
| | - Gregory Tung
- Colorado School of Public Health, Aurora, CO, USA
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Hacker K, Arsenault L, Franco I, Shaligram D, Sidor M, Olfson M, Goldstein J. Referral and follow-up after mental health screening in commercially insured adolescents. J Adolesc Health 2014; 55:17-23. [PMID: 24525226 DOI: 10.1016/j.jadohealth.2013.12.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 12/06/2013] [Accepted: 12/11/2013] [Indexed: 12/17/2022]
Abstract
PURPOSE Although mental health screening is recommended for adolescents, little is known about the predictors of referral to mental health services or engagement in treatment. We examined predictors of mental health referral from primary care and service use for commercially insured youth who had been screened using the Pediatric Symptom Checklist or Youth-Pediatric Symptom Checklist. METHODS A retrospective chart review was conducted of commercially insured patients 14-17 years of age who were newly identified by the Pediatric Symptom Checklist or Youth-Pediatric Symptom Checklist at a well-child visit. Comparisons were made with propensity-matched negative adolescents meeting the same criteria. Bivariate analyses were conducted to examine differences between positives and negatives and between referred and nonreferred positives. Logistic regression analyses were performed to assess predictors of mental health referral for positive youth. RESULTS Medical records of 117 positive and 110 negative youth were examined. Compared with negative youth, positive youth were significantly more likely to be referred for mental health treatment (p < .0001) and receive specialty mental health services (p < .0001). Of the positives, 54% were referred for mental health care and 67% of them accepted. However, only 18% completed a face-to-face mental health visit in the next 180 days. Pediatric Symptom Checklist score (odds ratio, 1.21; confidence interval, 1.03-1.42), parental or personal concern (odds ratio, 10.87; confidence interval, 2.70-43.76), and having depressive symptoms (odds ratio, 9.18; confidence interval, 1.49-56.60) were predictive of referral. CONCLUSIONS Despite identification after behavioral health screening, limited treatment engagement by referred patients persists. Primary care physicians and mental health specialists must enhance their efforts to engage and monitor identified patients.
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Affiliation(s)
- Karen Hacker
- Institute for Community Health, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts; Division of Child/Adolescent Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts.
| | - Lisa Arsenault
- Institute for Community Health, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Idalid Franco
- Division of Child/Adolescent Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts
| | - Deepika Shaligram
- Division of Child/Adolescent Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mardoche Sidor
- Division of Child/Adolescent Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Mark Olfson
- Department of Psychiatry, Columbia University Medical Center, New York, New York
| | - Joel Goldstein
- Division of Child/Adolescent Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Harvard Medical School, Boston, Massachusetts
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Blucker RT, Jackson D, Gillaspy JA, Hale J, Wolraich M, Gillaspy SR. Pediatric behavioral health screening in primary care: a preliminary analysis of the pediatric symptom checklist-17 with functional impairment items. Clin Pediatr (Phila) 2014; 53:449-55. [PMID: 24647696 DOI: 10.1177/0009922814527498] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Roughly 21% of youth in the United States meet criteria for a mental health diagnosis, but only one-fifth of those children obtain help. The Pediatric Behavioral Health Screen (PBHS) utilizes the Pediatric Symptom Checklist-17 (PSC-17) and functional impairment items to assess behavioral health concerns. METHODS Data were obtained from a systematic chart review for children 6 to 16 years old. Descriptive analyses and a confirmatory factor analysis were used to evaluate the clinical performance and utility of the PBHS. RESULTS A positive screen was endorsed for 26.7% of the sample, of whom 68% also experienced functional impairment. Clinicians appropriately administered the screen 73.5% of the time. The 3-factor model of the PSC-17 exhibited a good model fit. CONCLUSIONS Prevalence rates of psychosocial concerns and functional impairment affirm the need for routine behavioral health screening in the pediatric primary care setting. The PBHS exhibited good psychometric performance and clinical utility.
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Affiliation(s)
- Ryan T Blucker
- 1University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Cronholm PF, Ismailji T, Mettner J. Academy on Violence and Abuse: highlights of proceedings from the 2011 conference, "toward a new understanding". TRAUMA, VIOLENCE & ABUSE 2013; 14:271-281. [PMID: 23878147 DOI: 10.1177/1524838013495961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In April 2011, the Academy on Violence Abuse (http://www.avahealth.org/) convened a network of experts for its second annual conference, "Developing the Science of Violence and Abuse: Toward a New Understanding." The conference served as a forum for highlighting the growing body of research regarding the biological consequences and adverse health consequences of abuse. In doing so, it underscored an important scientific premise: By evaluating the impact of violence and abuse from birth to death, one can better evaluate the social, behavioral, psychological, and biological context and pathways that result in the morbidity, mortality, and quality of life of all affected individuals and communities. In this article, we summarize content presented by the conference's keynote speakers and provide citations that speakers have submitted to support their statements.
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Affiliation(s)
- Peter F Cronholm
- 1Department of Family Medicine and Community Health, Firearm and Injury Center at Penn, University of Pennsylvania, Philadelphia, PA, USA
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Kang-Yi CD, Mandell DS, Hadley T. School-based mental health program evaluation: children's school outcomes and acute mental health service use. THE JOURNAL OF SCHOOL HEALTH 2013; 83:463-472. [PMID: 23782088 DOI: 10.1111/josh.12053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 05/09/2012] [Accepted: 06/15/2012] [Indexed: 06/02/2023]
Abstract
BACKGROUND This study examined the impact of school-based mental health programs on children's school outcomes and the utilization of acute mental health services. METHODS The study sample included 468 Medicaid-enrolled children aged 6 to 17 years who were enrolled 1 of 2 school-based mental health programs (SBMHs) in a metropolitan area sometime during school year 2006-2007. A multilevel analysis examined the relative effects of SBMHs on children's absence, suspension, grade promotion, use of acute mental health services, as well as the association of child and school-level factors on the outcomes of interest. RESULTS Little change in average number of days absent per month and no significant change in the use of acute mental health services were found. The mean number of days suspended per month out-of-school decreased from 0.100 to 0.003 days (p < .001). The percentage of children promoted to the next grade increased almost 13% after program enrollment (p < .01). Program type did not predict outcome changes except grade promotion. CONCLUSIONS Despite the positive effect of school-based mental health programs on some school outcomes, the lack of difference between programs suggests the need to identify active mechanisms associated with outcome to make the delivery of care more efficient.
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Affiliation(s)
- Christina D Kang-Yi
- University of Pennsylvania Center for Mental Health Policy and Services Research, 3535 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
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Rausch J, Hametz P, Zuckerbrot R, Rausch W, Soren K. Screening for depression in urban Latino adolescents. Clin Pediatr (Phila) 2012; 51:964-71. [PMID: 22523275 DOI: 10.1177/0009922812441665] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Investigations were conducted on whether screening for adolescent depression was feasible and acceptable to patients in low-income, urban, predominantly Latino clinics. Further investigations were undertaken for provider acceptance of such screening. METHODS Adolescents aged between 13 and 20 years presenting to 3 pediatric and adolescent primary care practices affiliated with an academic medical center in New York City were screened for depressive symptoms using the Columbia Depression Scale. Providers were surveyed pre- and postimplementation of the screening regarding their attitudes and practices. RESULTS The vast majority (92%) of those approached accepted the screening. Twelve percent of those screened were referred for mental health treatment. Providers reported satisfaction with the screening tool and a desire to continue to use it. Screening was limited to 24% of eligible participants, and only 10% of screens were at sick visits. CONCLUSIONS The Columbia Depression Scale seems acceptable to adolescent providers and patients in the mostly Latino study population. It may prove to be a helpful tool in evaluating adolescents presenting to primary care for depression. Further study will be required in other Spanish-speaking and minority populations. New methods will also be required to reach a greater proportion of patients, particularly those presenting for sick visits.
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Affiliation(s)
- John Rausch
- Department of Pediatrics, Columbia University, New York, NY 10032, USA.
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Unmet developmental, behavioral, and psychosocial needs in children attending pediatric outpatient clinics. J Dev Behav Pediatr 2012; 33:469-78. [PMID: 22772821 DOI: 10.1097/dbp.0b013e31825a70e6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In this study of children attending general pediatric hospital outpatient clinics, we aimed to examine the proportion of (1) children with developmental and behavioral concerns; (2) parents with mental health problems; and (3) families with less than adequate psychosocial resources. We were also interested in the extent to which pediatricians discussed these problems with parents. METHODS This was a cross-sectional study of families with children aged 4 to 8 years attending pediatric outpatient clinics at the Royal Children's Hospital, Melbourne. The Strengths and Difficulties Questionnaire, Parents' Evaluation of Developmental Status, Kessler-6 Scale for Psychological Distress, and Family Resource Scale were administered postvisit to assess development and behavior, parental mental health, and psychosocial resources. Parents were asked whether these issues were discussed during the consultation. RESULTS A total of 162 families participated. Behavioral concerns were identified in 26% of children and concerns about language and motor development in 24% and 11%, respectively. Only 39% of consultations included discussion about development and 46% about behavior. Almost two-thirds (64%) of families reported less than adequate psychosocial resources, yet fewer than 10% of consultations included discussion of this, and only 7% addressed parental mental health. Parental perception of reasons why concerns were not discussed included "not relevant" (47%) and "the doctor did not bring it up" (21%). Only 2% of parents "didn't want to discuss the concern." CONCLUSIONS A high proportion of children and families attending pediatric outpatients have unidentified concerns in development and/or behavior, and parents have mental health or psychosocial issues; these concerns are often not discussed, and thus opportunities for timely intervention are missed.
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Sanci L, Grabsch B, Chondros P, Shiell A, Pirkis J, Sawyer S, Hegarty K, Patterson E, Cahill H, Ozer E, Seymour J, Patton G. The prevention access and risk taking in young people (PARTY) project protocol: a cluster randomised controlled trial of health risk screening and motivational interviewing for young people presenting to general practice. BMC Public Health 2012; 12:400. [PMID: 22672481 PMCID: PMC3533834 DOI: 10.1186/1471-2458-12-400] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/20/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are growing worldwide concerns about the ability of primary health care systems to manage the major burden of illness in young people. Over two thirds of premature adult deaths result from risks that manifest in adolescence, including injury, neuropsychiatric problems and consequences of risky behaviours. One policy response is to better reorientate primary health services towards prevention and early intervention. Currently, however, there is insufficient evidence to support this recommendation for young people. This paper describes the design and implementation of a trial testing an intervention to promote psychosocial risk screening of all young people attending general practice and to respond to identified risks using motivational interviewing. MAIN OUTCOMES clinicians' detection of risk-taking and emotional distress, young people's intention to change and reduction of risk taking. SECONDARY OUTCOMES pathways to care, trust in the clinician and likelihood of returning for future visits. The design of the economic and process evaluation are not detailed in this protocol. METHODS PARTY is a cluster randomised trial recruiting 42 general practices in Victoria, Australia. Baseline measures include: youth friendly practice characteristics; practice staff's self-perceived competency in young people's care and clinicians' detection and response to risk taking behaviours and emotional distress in 14-24 year olds, attending the practice. Practices are then stratified by a social disadvantage index and billing methods and randomised. Intervention practices receive: nine hours of training and tools; feedback of their baseline data and two practice visits over six weeks. Comparison practices receive a three hour seminar in youth friendly practice only. Six weeks post-intervention, 30 consecutive young people are interviewed post-consultation from each practice and followed-up for self-reported risk taking behaviour and emotional distress three and 12 months post consultation. DISCUSSION The PARTY trial is the first to examine the effectiveness and efficiency of a psychosocial risk screening and counselling intervention for young people attending primary care. It will provide important data on health risk profiles of young people attending general practice and on the effects of the intervention on engagement with primary care and health outcomes over 12 months. TRIAL REGISTRATION ISRCTN16059206.
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Affiliation(s)
- Lena Sanci
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia
| | - Brenda Grabsch
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia
| | - Patty Chondros
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia
| | - Alan Shiell
- Centre of Excellence in Intervention and Prevention Science, Melbourne, Australia
| | - Jane Pirkis
- School of Population Health, The University of Melbourne, Melbourne, Australia
| | - Susan Sawyer
- Centre for Adolescent Health, Royal Children’s Hospital; Department of Paediatrics, Murdoch Children’s Research Institute, The University of Melbourne, Melbourne, Australia
| | - Kelsey Hegarty
- General Practice and Primary Health Care Academic Centre, The University of Melbourne, Melbourne, Australia
| | | | - Helen Cahill
- Youth Research Centre, University of Melbourne, Melbourne, Australia
| | - Elizabeth Ozer
- Division of Adolescent & Young Adult Medicine and Office of Diversity and Outreach, University of California, San Francisco, USA
| | - Janelle Seymour
- Centre for Health Economics, Monash University, Melbourne, Australia
| | - George Patton
- Centre for Adolescent Health, Royal Children’s Hospital; Department of Paediatrics, Murdoch Children’s Research Institute, The University of Melbourne, Melbourne, Australia
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Lowenthal E, Lawler K, Harari N, Moamogwe L, Masunge J, Masedi M, Matome B, Seloilwe E, Gross R. Rapid psychosocial function screening test identified treatment failure in HIV+ African youth. AIDS Care 2012; 24:722-7. [PMID: 22292411 DOI: 10.1080/09540121.2011.644233] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Psychosocial dysfunction in older children and adolescents is common and may lead to nonadherence to HIV treatments. Poor adherence leads to HIV treatment failure and the development of resistant virus. In resource-limited settings where treatment options are typically limited to only one or two available lines of therapy, identification of individuals at highest risk of failure before failure occurs is of critical importance. Rapid screening tools for psychosocial dysfunction may allow for identification of those children and adolescents who are most likely to benefit from limited psychosocial support services targeted at preventing HIV treatment failure. The Pediatric Symptom Checklist (PSC) is used in high resource settings for rapid identification of at-risk youth. In 692 HIV-infected treated children (ages of 8-< 17 years) in Botswana, having a high score on the PSC was associated with having virologic failure (OR 1.7, 95% CI: 1.1-2.6). The PSC may be a useful screening tool in pediatric HIV.
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Stoppelbein L, Greening L, Moll G, Jordan S, Suozzi A. Factor analyses of the Pediatric Symptom Checklist-17 with African-American and Caucasian pediatric populations. J Pediatr Psychol 2011; 37:348-57. [PMID: 22171075 DOI: 10.1093/jpepsy/jsr103] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To validate a three-factor model for the Pediatric Symptom Checklist-17 (PSC-17) and evaluate its diagnostic accuracy with African-American and Caucasian children with and without a chronic illness. METHODS Mothers of 723 youth diagnosed with either type I diabetes (n = 210) or sickle cell disease (n = 191) and a nonill peer group (n = 322) completed a demographic questionnaire, the PSC-17, and the Child Behavior Checklist (CBCL). RESULTS Confirmatory factor analyses and tests of measurement invariance validated a three-factor structure for the PSC-17 with African-American and Caucasian youth with and without a chronic illness. Receiver operating characteristic curves revealed optimal cut-off scores that are similar to published reports. CONCLUSIONS A three-factor solution was replicated for the PSC-17 with African-American and Caucasian children with and without a chronic illness. Cut-off scores for identifying children at risk for emotional/behavioral problems were evaluated using the CBCL as the gold standard and are discussed.
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Affiliation(s)
- Laura Stoppelbein
- Department of Psychology, University of Alabama, Birmingham, AL, USA
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Sanci L. Clinical preventive services for adolescents: facing the challenge of proving "an ounce of prevention is worth a pound of cure". J Adolesc Health 2011; 49:450-2. [PMID: 22018557 DOI: 10.1016/j.jadohealth.2011.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 09/06/2011] [Indexed: 11/19/2022]
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Jee SH, Halterman JS, Szilagyi M, Conn AM, Alpert-Gillis L, Szilagyi PG. Use of a brief standardized screening instrument in a primary care setting to enhance detection of social-emotional problems among youth in foster care. Acad Pediatr 2011; 11:409-13. [PMID: 21683668 DOI: 10.1016/j.acap.2011.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 02/16/2011] [Accepted: 03/08/2011] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether systematic use of a validated social-emotional screening instrument in a primary care setting is feasible and improves detection of social-emotional problems among youth in foster care. METHODS Before-and-after study design, following a practice intervention to screen all youth in foster care for psychosocial problems using the Strengths and Difficulties Questionnaire (SDQ), a validated instrument with 5 subdomains. After implementation of systematic screening, youth aged 11 to 17 years and their foster parents completed the SDQ at routine health maintenance visits. We assessed feasibility of screening by measuring the completion rates of SDQ by youth and foster parents. We compared the detection of psychosocial problems during a 2-year period before systematic screening to the detection after implementation of systematic screening with the SDQ. We used chart reviews to assess detection at baseline and after implementing systematic screening. RESULTS Altogether, 92% of 212 youth with routine visits that occurred after initiation of screening had a completed SDQ in the medical record, demonstrating high feasibility of systematic screening. Detection of a potential mental health problem was higher in the screening period than baseline period for the entire population (54% vs 27%, P < .001). More than one-fourth of youth had 2 or more significant social-emotional problem domains on the SDQ. CONCLUSIONS Systematic screening for potential social-emotional problems among youth in foster care was feasible within a primary care setting and doubled the detection rate of potential psychosocial problems.
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Affiliation(s)
- Sandra H Jee
- Division of General Pediatrics, Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
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Lowenthal E, Lawler K, Harari N, Moamogwe L, Masunge J, Masedi M, Matome B, Seloilwe E, Jellinek M, Murphy M, Gross R. Validation of the Pediatric Symptom Checklist in HIV-infected Batswana. J Child Adolesc Ment Health 2011; 23:17-28. [PMID: 22685483 DOI: 10.2989/17280583.2011.594245] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE: To determine the validity of the Pediatric Symptom Checklist (PSC), a brief measure of psychosocial health, for screening HIV+ Batswana children. METHOD: Setswana versions of the parent and child PSC were administered to 509 HIV+ Batswana children (age 8-16) and their parents/guardians. Test properties were evaluated and cut-off scores were derived using receiver operating characteristic curve analysis. Scores on the parent-completed PSC and the child-completed PSC-Y were compared to parental and clinic staff reports of concern about the child's psychosocial health and to scores on the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. RESULTS: The Setswana PSC has high internal consistency (Cronbach's alpha 0.87 for the parent-completed version). Comparing PSC scores to parental reports of concern and child-reported depression symptoms, a cut-off score of 20 on the PSC and PSC-Y maximised the sensitivity and specificity. CONCLUSIONS: The PSC performed well in Setswana-speaking children and is a promising screening tool for paediatric psychosocial problems in busy clinical settings. Screening with the PSC may allow for early detection and treatment of psychosocial problems. This is likely to be of particular value for HIV+ children for whom HIV treatment non-adherence may result from untreated psychosocial dysfunction.
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Affiliation(s)
- Elizabeth Lowenthal
- Children's Hospital of Philadelphia, 3535 Market Street Room 1513, Philadelphia, PA, USA 19104
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Psychosocial issues and care in pediatric oncology: medical and nursing professionals' perceptions. Cancer Nurs 2011; 33:E12-20. [PMID: 20555261 DOI: 10.1097/ncc.0b013e3181d5c476] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Children with cancer and their families have psychosocial support needs. Medical and nursing professionals in pediatrics and pediatric oncology are in a position to identify and help manage these. However, little is known about their perceptions of psychosocial issues and interventions. OBJECTIVE The purpose of this study was to investigate physicians' and nurses' perceptions of psychosocial issues in pediatric oncology including their awareness of the psychosocial impact of childhood cancer on families and their knowledge and views of psychosocial interventions. METHODS A phenomenological approach was taken whereby semistructured interviews were conducted with a purposive sample of 10 physicians and nurses. RESULTS Findings showed that despite a lack of formal training in psychosocial issues, professionals identified a number of psychosocial issues associated with childhood cancer, including effects for family members. In addition, findings illustrated the psychosocial roles that they frequently adopt in relation to the identification, treatment, and referral of psychosocial issues. Finally, physicians and nurses recognized the value of formal intervention, reporting benefits for children, families, and themselves. CONCLUSION These findings give a preliminary insight into physicians' and nurses' perceptions and awareness of the psychosocial issues experienced by children with cancer and their families and their knowledge of psychosocial interventions. They highlight ways to enhance the delivery of care in pediatric oncology. IMPLICATIONS FOR PRACTICE Specifically, they suggest the need for more formal training on psychosocial issues for medical and nursing professionals, for additional experienced psychosocial professionals to be recruited, and for more access to services for both families and medical and nursing professionals.
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Abstract
This study examines routine computerized mental health screening for adolescents scheduled for a routine physical examination in a group pediatric practice. Medical records of adolescents aged 13 to 17 who were offered screening (n = 483) were reviewed. Approximately 44.7% (95% confidence interval (CI) 40.3-49.2) were screened, and 13.9% (95% CI 9.3-18.5) were identified as being at risk. Screening was associated with significantly increased odds of receiving either pediatric mental health care or a referral for specialty mental health care (adjusted odds ratio (AOR): 2.6 95% CI 1.2-5.6). Among patients who received either mental health intervention, those who were screened were significantly more likely to be referred to specialty care (AOR: 15.9 95% CI 2.5-100.4), though they were less likely to receive pediatric mental health care (AOR: 0.10 95% CI 0.02-0.54). The findings support the feasibility of routine mental health screening in pediatric practice. Screening is acceptable to many parents and adolescents, and it is associated with referral for specialized mental health care rather than care from the pediatrician.
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Dolan MA, Fein JA. Pediatric and adolescent mental health emergencies in the emergency medical services system. Pediatrics 2011; 127:e1356-66. [PMID: 21518712 DOI: 10.1542/peds.2011-0522] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Emergency department (ED) health care professionals often care for patients with previously diagnosed psychiatric illnesses who are ill, injured, or having a behavioral crisis. In addition, ED personnel encounter children with psychiatric illnesses who may not present to the ED with overt mental health symptoms. Staff education and training regarding identification and management of pediatric mental health illness can help EDs overcome the perceived limitations of the setting that influence timely and comprehensive evaluation. In addition, ED physicians can inform and advocate for policy changes at local, state, and national levels that are needed to ensure comprehensive care of children with mental health illnesses. This report addresses the roles that the ED and ED health care professionals play in emergency mental health care of children and adolescents in the United States, which includes the stabilization and management of patients in mental health crisis, the discovery of mental illnesses and suicidal ideation in ED patients, and approaches to advocating for improved recognition and treatment of mental illnesses in children. The report also addresses special issues related to mental illness in the ED, such as minority populations, children with special health care needs, and children's mental health during and after disasters and trauma.
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Whitaker TM, Bada HS, Bann CM, Shankaran S, LaGasse L, Lester BM, Bauer CR, Hammond J, Higgins R. Serial pediatric symptom checklist screening in children with prenatal drug exposure. J Dev Behav Pediatr 2011; 32:206-15. [PMID: 21200328 PMCID: PMC3069136 DOI: 10.1097/dbp.0b013e318208ee3c] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine screening results obtained by serial annual behavioral assessment of children with prenatal drug exposure. METHOD The Maternal Lifestyle Study enrolled children with prenatal cocaine exposure (PCE) at birth for longitudinal assessments of developmental, behavioral, and health outcomes. At 8, 9, 10, 11, and 12 years of age, caregivers rated participants on the Pediatric Symptom Checklist (PSC). Serial PSC results were compared with an established broad-based behavioral measure at 9, 11, and 13 years. PSC results were analyzed for 1081 children who had at least 2 annual screens during the 5-year time span. Most subjects (87%) had 4 or more annual screens rated by the same caregiver (80%). PSC scores (and Positive screens) over time were compared at different time points for those with and without PCE. Covariates, including demographic factors and exposures to certain other substances, were controlled. RESULTS Children with PCE had significantly higher scores overall, with more Positive screens for behavior problems than children without PCE. Children with PCE had more externalizing behavior problems. Children exposed to tobacco prenatally and postnatally also showed higher PSC scores. Over time, PSC scores differed slightly from the 8-year scores, without clear directional trend. Earlier PSC results predicted later behavioral outcomes. CONCLUSION Findings of increased total PSC scores and Positive PSC screens for behavioral concerns in this group of children with prenatal substance exposure support the growing body of evidence that additional attention to identification of mental health problems may be warranted in this high-risk group.
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Affiliation(s)
- Toni M Whitaker
- Department of Pediatrics, Boling Center for Developmental Disabilities, University of Tennessee College of Medicine, Memphis, TN 38105, USA.
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Polaha J, Dalton WT, Allen S. The Prevalence of Emotional and Behavior Problems in Pediatric Primary Care Serving Rural Children. J Pediatr Psychol 2011; 36:652-60. [PMID: 21227909 DOI: 10.1093/jpepsy/jsq116] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jodi Polaha
- Department of Psychology, East Tennessee State University, Johnson City, TN 37614, USA.
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Brown JD, Wissow LS. Screening to identify mental health problems in pediatric primary care: considerations for practice. Int J Psychiatry Med 2010; 40:1-19. [PMID: 20565041 DOI: 10.2190/pm.40.1.a] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Few pediatric primary care providers routinely use mental health screening tools, in part because they may have concerns about whether screening is useful and how it will affect their practice. This study examined the extent to which screening in primary care would increase the identification of mental health problems among a diverse population of children and youth. METHODS Prior to the visit, the parents of 767 patients age 5 to 16 completed the Strengths and Difficulties Questionnaire to report their child's mental health symptoms and impairment. Without viewing the screening results, each child's provider (N = 53) completed a questionnaire to report whether the child or youth demonstrated a mental health problem. RESULTS Compared with providers, the screen identified twice as many patients with moderate symptoms and nearly 28% more patients with high symptoms. Among patients with high symptoms, providers failed to identify a problem among 78% of those who were Latino/Other and 55% of those who were African American compared with 27% of Caucasian patients (p < 0.001). Providers were not more likely to identify patients with externalizing versus internalizing symptoms but were more likely to identify patients who demonstrated symptoms across multiple domains of functioning. CONCLUSIONS Screening substantially increased the number of children and youth who would be identified as possibly having a mental health problem. Screening may have the most potential to increase the identification of problems among patients who have moderate mental health symptoms and those who are African American or Latino.
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Gleason MM, Zeanah CH, Dickstein S. Recognizing young children in need of mental health assessment: Development and preliminary validity of the early childhood screening assessment. Infant Ment Health J 2010; 31:335-357. [DOI: 10.1002/imhj.20259] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Adolescents constitute a significant proportion of pediatric transplant patients, whether they have survived a transplant in early childhood (like most heart and liver recipients) or are transplanted in older childhood or adolescence, such as many renal transplant recipients. Their needs can be significantly different from either children or adults, as they are undergoing a major transformation that involves making educational and vocational decisions and commitments, establishing a new and more equal relationship with their parents, discovering their sexual identity, taking increasing responsibility for their health and creating the moral, philosophic, and ethical perspective that they will carry through their lives. This article discusses adolescent issues in transplantation.
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Affiliation(s)
- Miriam Kaufman
- The Transplant Centre, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada.
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