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Sengupta S, Marx L, Hilt R, Martini DR, DeMaso DR, Beheshti N, Borcherding B, Butler A, Fallucco E, Fletcher K, Homan E, Lai K, Pierce K, Sharma A, Earls M, Rockhill C, Bukstein OG, Abright AR, Becker T, Diamond J, Hayek M, Keable H, Vasa RA, Walter HJ. Clinical Update: Collaborative Mental Health Care for Children and Adolescents in Pediatric Primary Care. J Am Acad Child Adolesc Psychiatry 2023; 62:91-119. [PMID: 35779696 DOI: 10.1016/j.jaac.2022.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of collaborative mental health care in the pediatric primary care setting. METHOD A search of the literature on this topic from 2001was conducted initially in 2016, yielding 2,279 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 2,467 total citations, of which 1,962 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 219 based on topic relevance. A follow-up search from 2016 was conducted in 2021, yielding 2 additional citations based on nonduplication from initial search and topic relevance. RESULTS The collaborative care approach, arising in the 1990s and gaining momentum in the 2000s, aims to extend behavioral health care to the primary care setting. The goal of collaborative care is to conserve the sparse specialty care workforce for severe and complex psychiatric disorders through shifting certain specialty mental health tasks (eg, assessment; patient self-management; brief psychosocial intervention; basic psychopharmacology; care coordination) to primary care. Collaborative care can be delivered on a spectrum ranging from coordinated to co-located to integrated care. Although each of these models has some empirical support, integrated care-a multidisciplinary team-based approach-has the strongest evidence base in improving clinical outcomes and patient satisfaction while constraining costs. Challenges to integrated care implementation include insufficient mental health education and insufficient specialist consultative and care coordination support for primary care practitioners; space, time, and reimbursement constraints in the primary care setting; discomfort among primary care practitioners in assuming mental health tasks previously undertaken by specialists; and continuing need for and unavailability of ongoing specialty mental health care for severe and complex cases. Essential supporting activities for effective collaborative care include patient and family engagement, professional education and training, evaluation/demonstration of impact, fiscal sustainability, and advocacy for model dissemination. CONCLUSION Health professionals who are educated in the collaborative care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.
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A Virtual Reality Curriculum to Enhance Residents' Behavioral Health Anticipatory Guidance Skills: A Pilot Trial. Acad Pediatr 2023; 23:185-192. [PMID: 35870801 DOI: 10.1016/j.acap.2022.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Effective educational strategies to train and assess residents' skills in behavioral health competencies have been limited. We hypothesized that a training curriculum using virtual reality (VR) simulations would enhance residents' evidence-based skills related to behavioral health anticipatory guidance (BHAG) and motivational interviewing (MI). METHODS We conducted a randomized controlled pilot trial of our curriculum within an urban academic clinic. Intervention and control groups received four 15-minute, monthly didactics on BHAG and MI followed by VR simulations to 1) deliberately practice delivering BHAG by verbally counseling avatars, who responded real-time (intervention group) or 2) assessing pediatric respiratory distress (control group). Two months post-VR training, all residents participated in a unique VR behavioral health scenario which was recorded and coded by pediatric psychologists via an observation instrument to assess residents' skills. Differences in BHAG and MI competencies were assessed via independent samples t tests for continuous variables and Fisher's exact tests for categorical variables. RESULTS Sixty-six percent (n = 55) of eligible residents completed all study protocols comprising 35 intervention and 20 control participants. Intervention participants demonstrated an increase in BHAG skills (P = .002), percentage of open-ended questions asked (P = .04), and percentage of MI adherent behaviors (P = .04) when compared to the control group. CONCLUSIONS VR may be an effective educational strategy for residents to acquire BHAG and MI skills though deliberate practice. Next steps will focus on assessing the generalizability of the VR curriculum as well as exploring the opportunities to enhance its scalability through artificial intelligence.
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Gadassi H, Millo David I, Yaari M, Kerem E, Katz M, Porter B, Stein-Zamir C, Grossman Z. Enhancing the primary care pediatrician's role in managing psychosocial issues: a cross sectional study of pediatricians and parents in Israel. Isr J Health Policy Res 2022; 11:28. [PMID: 35927695 PMCID: PMC9354415 DOI: 10.1186/s13584-022-00537-6] [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: 09/29/2021] [Accepted: 07/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Psychosocial issues are an integral part of children's health and well-being, and it is widely acknowledged that pediatricians should be involved in their management. We examined the current perception of the pediatrician’s role in the management of psychosocial problems in Israel from the perspective of parents and pediatricians, and identified possible barriers. Methods We assessed parents' and pediatricians' perspectives through a cross sectional survey. 1000 parents with children under 10 were randomly selected from a large database representing the Israeli population and phone-surveyed by a polling company. Due to a low response-rate (5.4%), there was an overrepresentation of married parents and underrepresentation of parents with primary or secondary education. 173 Pediatricians were recruited both at a medical conference and by a web-based questionnaire. Results 55% of the parents reported they were concerned with at least one psychosocial problem, yet less than 50% of them discussed these issues with the pediatrician. 59.9% of the parents did not perceive psychosocial problems as relevant to the pediatrician's role. Pediatricians with some previous training related to psychosocial issues were more likely to report on a lack of professional confidence (p = .037) and insufficient available resources (p = .022) as barriers to their involvement, while pediatricians who had no training were more likely to report on the parents' perception of their role as the barrier to involvement (p = .035). Conclusions Parents tend to avoid the discussion of psychosocial concerns in pediatric settings due to their perception that it's irrelevant to the pediatrician's role. Trained pediatricians feel unconfident in their ability to manage psychosocial issues and report on a lack of suitable resources. These findings suggest current pediatric mental-health training is insufficient to equip pediatricians with the knowledge and skills required to their involvement in psychosocial problems, and imply necessary changes to environment of community-based pediatrics. In order to change the practice of pediatricians in the community to enable them to address a variety of psychological issues, appropriate training is needed, through all stages of the pediatrician’s professional life, including medical school, pediatric residency and continuous medical education. Supplementary Information The online version contains supplementary material available at 10.1186/s13584-022-00537-6.
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Affiliation(s)
| | | | - Maya Yaari
- Haruv Campus, Mt Scopus, Jerusalem, Israel
| | - Eitan Kerem
- Hadassah Medical Organization, Kalman Mann, Jerusalem, Israel
| | - Manuel Katz
- Meuhedet Healthcare Services, Tel Aviv, Israel
| | | | - Chen Stein-Zamir
- The Hebrew University, Hadassah Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,Ministry of Health, Jerusalem, Israel
| | - Zachi Grossman
- Maccabi Healthcare Services, Tel Aviv, Israel.,Adelson School of Medicine, Ariel University, Ariel, Israel
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Hülquist J, Fangerau N, Thomasius R, Paschke K. Resource-Strengthening Training for Parents of Adolescents with Problematic Gaming (Res@t-P): A Clinical Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9495. [PMID: 35954846 PMCID: PMC9368433 DOI: 10.3390/ijerph19159495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/29/2022] [Accepted: 07/31/2022] [Indexed: 02/04/2023]
Abstract
Background: Problematic gaming (PG) has become an increasing mental health issue among adolescents during the preceding years. The role of parents and the family environment in the development of PG has been repeatedly emphasized. However, the structured involvement of parents in the therapy is still largely insufficient. Resource-strengthening training for parents of adolescents with PG (Res@t-P) is a new parent-centered 8-week group intervention to fill this substantial gap. The present pilot study aimed to collect first information on its potential effectiveness in improving parental and family factors. Methods: The study was conducted in a clinical setting with N = 43 parents of adolescents with PG, applying a pre- and post-follow-up design. Standardized questionnaires on psychological stress perception, family communication, family functioning, media rules, and adolescent PG symptoms were applied at three measurement points (before, at the end of, and 6 weeks after the training). Conditional growth models were estimated. Results: Over time, an improvement in parental and family aspects as well as a reduction in adolescent PG symptoms could be observed. Conclusions: The results of the present pilot study on the effectiveness of Res@t-P are promising. No causal inferences can be drawn at this stage. A randomized-controlled intervention study is highly warranted.
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Affiliation(s)
| | | | | | - Kerstin Paschke
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, 20246 Hamburg, Germany; (J.H.); (N.F.); (R.T.)
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Bryant BL, Wang CH, Zinn ME, Rooney K, Henderson C, Monaghan M. Promoting High-Quality Health Communication Between Young Adults With Diabetes and Health Care Providers. Diabetes Spectr 2021; 34:345-356. [PMID: 34866867 PMCID: PMC8603123 DOI: 10.2337/dsi21-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Young adults with diabetes assume increasing responsibility for communicating with their health care providers, and engaging in high-quality health communication is an integral component of overall diabetes self-management. This article provides an overview of the main features of health communication, factors that may influence communication quality, interventions to promote communication skills, and practical strategies for clinicians working with young adults with diabetes. The review concludes with a comprehensive summary of future directions for health communication research.
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Affiliation(s)
| | | | - M. Elizabeth Zinn
- George Washington University School of Medicine, Washington, DC
- George Washington University Milken Institute School of Public Health, Washington, DC
| | | | | | - Maureen Monaghan
- Children’s National Hospital, Washington, DC
- George Washington University School of Medicine, Washington, DC
- Corresponding author: Maureen Monaghan,
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Sengupta S. Engaging Pediatric Primary Care Clinicians in Collaborative and Integrated Care. Child Adolesc Psychiatr Clin N Am 2021; 30:767-776. [PMID: 34538447 DOI: 10.1016/j.chc.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Pediatric primary care clinicians (PPCCs) are managing increasing mental health challenges in the children and adolescents they treat. Child and adolescent psychiatrists (CAPs) are increasingly involved in collaborative and integrated care (CIC) work that builds the knowledge and skills of PPCCs to manage mild to moderate mental health challenges for children and adolescents in primary care. CAPs who can establish good working relationships, communicate clearly and efficiently, and facilitate the care of this population will be successful in engaging our PPCC partners in CIC.
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Affiliation(s)
- Sourav Sengupta
- Departments of Psychiatry & Pediatrics, Jacobs School of Medicine, University at Buffalo, Buffalo, NY, USA; Children's Psychiatry Clinic of Oishei Children's Hospital, 1028 Main Street, Buffalo, NY 14202, USA.
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Piot MA, Dechartres A, Attoe C, Romeo M, Jollant F, Billon G, Cross S, Lemogne C, Layat Burn C, Michelet D, Guerrier G, Tesniere A, Rethans JJ, Falissard B. Effectiveness of simulation in psychiatry for nursing students, nurses and nurse practitioners: A systematic review and meta-analysis. J Adv Nurs 2021; 78:332-347. [PMID: 34378236 DOI: 10.1111/jan.14986] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/24/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
AIMS Mental disorders constitute one of the main causes of disease and disability worldwide. While nurses are often at the frontline of mental health care, they have limited access to dedicated psychiatric training opportunities. Simulation training may foster the development of the appropriate competencies required when supporting people with mental disorders. To evaluate the effectiveness of simulation training in psychiatry for nursing students, nurses and nurse practitioners. DESIGN Systematic review and meta-analysis. DATA SOURCES Eight electronic databases, trial registries, key journals and reference lists of selected studies were searched from inception to August 20, 2020 without language restriction. REVIEW METHODS We included randomized and non-randomized controlled studies and single group pre/post studies. Cochrane Risk of Bias tool 2.0 was used for randomized controlled study appraisal, and the Medical Education Research Study Quality instrument was completed for all other studies. Meta-analysis was restricted to randomized controlled studies. The other studies were synthesized narratively. The main outcomes were based on Kirkpatrick levels. RESULTS A total of 118 studies (6738 participants) were found. Interventions included simulated patients (n = 55), role-plays (n = 40), virtual reality (n = 12), manikins (n = 9) and voice simulations (n = 9). Meta-analyses based on 11 randomized controlled studies found a significant large effect size on skills at immediate post-test for simulation compared with active control; and a small and medium effect size on learners' attitudes for simulation compared with inactive control, at immediate post-test and at three-month follow-up respectively. Three quarters of non-randomized controlled studies and pre/post-tests assessing attitudes and skills showed significant differences, and three quarters of participants in randomized controlled studies and pre/post-tests showed significant differences in behaviours. Among the few studies assessing people with mental health outcomes, almost all reported significant differences. CONCLUSION These findings support the effectiveness of simulation training in psychiatric nursing throughout professional development grades, despite heterogeneity in methods and simulation interventions.
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Affiliation(s)
- Marie-Aude Piot
- Université de Paris, Institute Mutualiste Montsouris, Department of Psychiatry, Paris-Saclay University, UVSQ, INSERM 1018, CESP, Ilumens, Simulation Center, Paris, France
| | - Agnès Dechartres
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Hôpital Pitié Salpêtrière, Département de Santé Publique, Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), F75013, Paris, France
| | - Chris Attoe
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Marie Romeo
- Université de Paris, Institute Mutualiste Montsouris, Department of Psychiatry, Paris-Saclay University, UVSQ, INSERM 1018, CESP, Ilumens, Simulation Center, Paris, France
| | - Fabrice Jollant
- Université de Paris, GHU Paris Psychiatrie et Neurosciences, Sainte-Anne Hospital, Department of Psychiatry, Moods Team, INSERM UMR-1178, CESP, Paris, France.,Nîmes academic hospital (CHU), Nîmes, France.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Grégoire Billon
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Sean Cross
- Maudsley Simulation, South London & Maudsley NHS Foundation Trust, London, UK
| | - Cédric Lemogne
- Université de Paris, AP-HP, Hôpital Hôtel-Dieu, DMU Psychiatrie et Addictologie, Service de Psychiatrie de l'adulte, INSERM, Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, Paris, France
| | - Carine Layat Burn
- Department of Orthopaedic Surgery, La Providence Hospital, Neuchâtel, Switzerland.,Department of Psychotherapy, Berger Psychotherapeutic Centre, Neuchâtel, Switzerland
| | - Daphné Michelet
- Department of Pediatric Anesthesia, CHU of Reims Hôpital Maison Blanche, Reims, France
| | - Gilles Guerrier
- Université de Paris, AP-HP, Cochin Hospital, Anaesthesiology Department, Ilumens, Simulation Center, Paris, France
| | - Antoine Tesniere
- Université de Paris, AP-HP, Cochin Hospital, Anaesthesiology Department, Ilumens, Simulation Center, Paris, France
| | - Jan-Joost Rethans
- Skillslab, Faculty of Health, Medicine & Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Bruno Falissard
- Public Health Department, School of Medicine, University Paris Saclay, INSERM 1018, CESP, Villejuif, Ile-de-France, France
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Woodman J, Simon A, Hauari H, Gilbert R. A scoping review of 'think-family' approaches in healthcare settings. J Public Health (Oxf) 2021; 42:21-37. [PMID: 30668870 DOI: 10.1093/pubmed/fdy210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/27/2018] [Accepted: 11/06/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND 'Think-family' child health approaches treat child and parent/carer health as inter-related. They are promoted within health policy internationally (also called 'family paediatrics' or 'whole-family', 'family-centred' approaches or 'child-centred' approaches within adult services). METHODS We reviewed publications of think-family interventions. We developed a typology of these interventions using thematic analysis of data extracted from the included studies. RESULTS We included 62 studies (60% USA and 18% UK); 45/62 (73%) treated the parent as patient, helping the child by addressing parental mental health, substance and alcohol misuse and/or domestic violence. Our typology details three common mechanisms of change in relevant interventions: screening, health promotion and developing relationships (inter-professional and parent-professional). CONCLUSIONS Policy-makers, practitioners and researchers can use our typology to develop and evaluate think-family approaches within healthcare. Strong relationships between parents and professionals are key in think-family approaches and should be considered in service design. Although helping the child through the parent may be a good place to start for service development, care is needed to ensure parental need does not eclipse child need. Strategies that reach out to the parent behind the child (child as patient) and which work simultaneously with parent and child warrant attention.
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Affiliation(s)
- Jenny Woodman
- UCL-Institute of Education, Thomas Coram Research Unit, 27/8 Woburn Square, London, UK
| | - Antonia Simon
- UCL-Institute of Education, Social Science Research Unit, 27/8 Woburn Square, London, UK
| | - Hanan Hauari
- UCL-Institute of Education, Thomas Coram Research Unit, 27/8 Woburn Square, London, UK
| | - Ruth Gilbert
- UCL-GOS- Institute of Child Health, 30 Guilford Street, London, UK
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Patel ZS, Casline E, Jensen-Doss A, Timpano KR. Parent Distress Intolerance, Repetitive Negative Thinking, and Mental Health Service Use. Child Psychiatry Hum Dev 2021; 52:365-375. [PMID: 32632828 DOI: 10.1007/s10578-020-01017-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
While extensive evidence links service use for mental health problems to demographic variables and positive attitudes, studies have not explored the role of transdiagnostic risk factors, like distress intolerance (DI) and repetitive negative thinking (RNT). This study examined the relationship between parental DI and RNT on mental health treatment seeking for parents themselves and their children. Results suggest higher DI and RNT predict service use among parents (p < 0.05) but were not significantly associated with help seeking for their children, indicating that factors more proximal to the child may have greater influence when parents make treatment decisions for their children. Results also indicte that DI moderates the relationship between parent psychopathology and parent service use, such that parent psychopathology is significantly associated with service use for those with lower DI, but not at moderate or high levels of DI. Implications for marketing mental health information to parents and engaging them in treatment are discussed.
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Affiliation(s)
- Zabin S Patel
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA.
| | - Elizabeth Casline
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
| | - Kiara R Timpano
- Department of Psychology, University of Miami, Coral Gables, FL, 33124, USA
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10
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Piot MA, Dechartres A, Attoe C, Jollant F, Lemogne C, Layat Burn C, Rethans JJ, Michelet D, Cross S, Billon G, Guerrier G, Tesniere A, Falissard B. Simulation in psychiatry for medical doctors: A systematic review and meta-analysis. MEDICAL EDUCATION 2020; 54:696-708. [PMID: 32242966 DOI: 10.1111/medu.14166] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/14/2020] [Accepted: 03/23/2020] [Indexed: 05/06/2023]
Abstract
CONTEXT Most medical doctors are likely to work with patients experiencing mental health conditions. However, educational opportunities for medical doctors to achieve professional development in the field of psychiatry are often limited. Simulation training in psychiatry may be a useful tool to foster this development. OBJECTIVES The purpose of this study was to assess the effectiveness of simulation training in psychiatry for medical students, postgraduate trainees and medical doctors. METHODS For this systematic review and meta-analysis, we searched eight electronic databases and trial registries up to 31 August 2018. We manually searched key journals and the reference lists of selected studies. We included randomised and non-randomised controlled studies and single group pre- and post-test studies. Our main outcomes were based on Kirkpatrick levels. We included data only from randomised controlled trials (RCTs) using random-effects models. RESULTS From 46 571 studies identified, we selected 163 studies and combined 27 RCTs. Interventions included simulation by role-play (n = 69), simulated patients (n = 72), virtual reality (n = 22), manikin (n = 5) and voice simulation (n = 2). Meta-analysis found significant differences at immediate post-tests for simulation compared with active and inactive control groups for attitudes (standardised mean difference [SMD] = 0.52, 95% confidence interval [CI] 0.31-0.73 [I2 = 0.0%] and SMD = 0.28, 95% CI 0.04-0.53 [I2 = 52.0%], respectively), skills (SMD = 1.37, 95% CI 0.56-2.18 [I2 = 93.0%] and SMD = 1.49, 95% CI 0.39-2.58 [I2 = 93.0%], respectively), knowledge (SMD = 1.22, 95% CI 0.57-1.88 [I2 = 0.0%] and SMD = 0.72, 95% CI 0.14-1.30 [I2 = 80.0%], respectively), and behaviours (SMD = 1.07, 95% CI 0.49-1.65 [I2 = 68.0%] and SMD = 0.45, 95% CI 0.11-0.79 [I2 = 41.0%], respectively). Significant differences in terms of patient benefit and doctors' behaviours and skills were found at the 3-month follow-up. CONCLUSIONS Despite heterogeneity in methods and simulation interventions, our findings demonstrate the effectiveness of simulation training in psychiatry training.
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Affiliation(s)
- Marie-Aude Piot
- Epidemiological and Public Health Research Centre, Villejuif, France
- University of Paris, Faculty of Health, Medicine School, Paris, France
- Department of Psychiatry, Institute Mutualiste Montsouris, Paris, France
- Health Care Simulation Center iLumens, University of Paris, France
| | - Agnès Dechartres
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP.Sorbonne Université, Hôpital Pitié Salpêtrière, Département de Santé Publique, Paris, France
| | - Chris Attoe
- Maudsley Simulation, South London and Maudsley NHS Foundation Trust, London, UK
| | - Fabrice Jollant
- University of Paris, Faculty of Health, Medicine School, Paris, France
- Department of Psychiatry, GHU Paris Psychiatry and Neurosciences, Sainte-Anne Hospital Center, Paris, France
- Department of Psychiatry, Nîmes Academic Hospital (CHU), Nîmes, France
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Cédric Lemogne
- University of Paris, Faculty of Health, Medicine School, Paris, France
- University of Paris, INSERM, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France
- AP-HP.Centre-University of Paris, European Georges-Pompidou Hospital, Department of Psychiatry, Paris, France
| | - Carine Layat Burn
- Department of Orthopaedic Surgery, La Providence Hospital, Neuchâtel, Switzerland
- Department of Psychotherapy, Berger Psychotherapeutic Centre, Neuchâtel, Switzerland
| | - Jan-Joost Rethans
- Institute for Education and Skills Lab, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands
| | - Daphne Michelet
- Health Care Simulation Center iLumens, University of Paris, France
- Department of Pediatric Anesthesia, CHU of Reims Hôpital Maison Blanche, Reims, France
| | - Sean Cross
- Maudsley Simulation, South London and Maudsley NHS Foundation Trust, London, UK
| | - Gregoire Billon
- Maudsley Simulation, South London and Maudsley NHS Foundation Trust, London, UK
| | - Gilles Guerrier
- University of Paris, Faculty of Health, Medicine School, Paris, France
- Health Care Simulation Center iLumens, University of Paris, France
- Department of Anaesthesiology, Cochin Hospital, AP-HP, Paris, France
| | - Antoine Tesniere
- University of Paris, Faculty of Health, Medicine School, Paris, France
- Health Care Simulation Center iLumens, University of Paris, France
| | - Bruno Falissard
- Epidemiological and Public Health Research Centre, Villejuif, France
- Department of Public health, School of Medecine, University Paris Saclay, Villejuif, France
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11
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Smith JD, Cruden GH, Rojas LM, Van Ryzin M, Fu E, Davis MM, Landsverk J, Brown CH. Parenting Interventions in Pediatric Primary Care: A Systematic Review. Pediatrics 2020; 146:e20193548. [PMID: 32581000 PMCID: PMC7329253 DOI: 10.1542/peds.2019-3548] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 01/13/2023] Open
Abstract
CONTEXT More than 4 decades of research indicate that parenting interventions are effective at preventing and treating mental, emotional, and behavioral disorders in children and adolescents. Pediatric primary care is a viable setting for delivery of these interventions. OBJECTIVE Previous meta-analyses have shown that behavioral interventions in primary care can improve clinical outcomes, but few reviews have been focused specifically on the implementation of parenting interventions in primary care. We aimed to fill this gap. DATA SOURCES We reviewed 6532 unique peer-reviewed articles published in PubMed, the Cumulative Index to Nursing and Allied Health Literature, and PsycInfo. STUDY SELECTION Articles were included if at least part of the intervention was delivered in or through primary care; parenting was targeted; and child-specific mental, emotional, and behavioral health outcomes were reported. DATA EXTRACTION Articles were reviewed in Covidence by 2 trained coders, with a third coder arbitrating discrepancies. RESULTS In our review of 40 studies, most studies were coded as a primary. Few researchers collected implementation outcomes, particularly those at the service delivery system level. LIMITATIONS Including only published articles could have resulted in underrepresentation of implementation-related data. CONCLUSIONS Parenting interventions delivered and implemented with fidelity in pediatric primary care could result in positive and equitable impacts on mental, emotional, and behavioral health outcomes for both parents and their children. Future research on the implementation strategies that can support adoption and sustained delivery of parenting interventions in primary care is needed if the field is to achieve population-level impact.
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Affiliation(s)
- Justin D Smith
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
| | | | - Lourdes M Rojas
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Emily Fu
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew M Davis
- Division of Academic General Pediatrics, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics, Medicine, Medical Social Sciences, and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - C Hendricks Brown
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Perez Jolles M, Zullig LL, Lee PJ, Kolhatkar G. Disparities in Shared Decision Making and Service Receipt Among Children With Special Health Care Needs and Developmental Delay: A National Survey Analysis. J Prim Care Community Health 2020; 11:2150132720924588. [PMID: 32560592 PMCID: PMC7307398 DOI: 10.1177/2150132720924588] [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] [Indexed: 11/15/2022] Open
Abstract
Shared decision making (SDM) is associated with increased service satisfaction among pediatric patients. Our objective was to examine the association between SDM and service use experiences across racial/ethnic child groups. This secondary data analysis used the 2009-2010 National Survey of Children with Special Health Care Needs (CSHCN) and 2011 Pathways to Diagnosis and Services Survey. We used a rank-and-replace matching approach consistent with Institute of Medicine recommendations for health disparities research. We included CSHCN aged 6 to 17 years. The exposure of interest was parents of CSHCN reporting engagement in SDM with clinicians. There were 4032 CSHCN included in analysis. CSHCNs experiencing SDM had a 16% higher probability of reporting service use compared to those not experiencing it (95% CI, 14.24-19.42). Black children experiencing SDM reported seeing all needed care providers at a lower rate than whites (79% and 87.6% respectively; 95% CI, -14.05-3.27). The benefit of SDM over not experiencing it for blacks was 12.2% less than for whites for the outcome of seeing all needed care providers. For the outcome of receiving all needed treatments and services, the SDM benefit was 9.1% lower for Hispanics compared with whites. SDM can improve service experiences but implementation flexibility may be needed.
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Affiliation(s)
| | - Leah L Zullig
- Durham Veterans Affairs Health Care System, Duke University Medical Center, Durham, NC, USA
| | - Pey-Jiuan Lee
- University of Southern California, Los Angeles, CA, USA
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13
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Espinet SD, Gotovac S, Knight S, Wissow L, Zwarenstein M, Lingard L, Steele M. Primary Care Practitioner Training in Child and Adolescent Psychiatry (PTCAP): A Cluster-Randomized Trial. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:319-329. [PMID: 31813273 PMCID: PMC7265617 DOI: 10.1177/0706743719890161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Rural primary care practitioners (PCPs) have a pivotal role to play in frontline pediatric mental health care, given limited options for referral and consultation. Yet they report a lack of adequate training and confidence to provide this care. The aim of this study was to test the effectiveness of the Practitioner Training in Child and Adolescent Psychiatry (PTCAP) program, which was designed to enhance PCPs' pediatric mental health care confidence. The program includes brief therapeutic skills and practice guidelines PCPs can use to address both subthreshold concerns and diagnosable conditions, themselves. METHODS The study design was a pilot, cluster-randomized, multicenter trial. Practices were randomly assigned to intervention (n practices = 7; n PCPs = 42) or to wait-list control (n practices = 6; n PCPs = 34). The intervention involved 8 hr of training in practice guidelines and brief therapeutic skills for depression, anxiety, attention deficit hyperactivity disorder, and behavioral disorders with case discussion and video examples, while the control practiced as usual. A linear random-effects model controlling for clustering and baseline was carried out on the individual-level data to examine between-group differences in the primary (i.e., confidence) and secondary (i.e., attitude and knowledge) outcomes at 1-week follow-up. RESULTS Findings were a statistically significant difference in the primary outcomes. Compared to the control group, the intervention group indicated significantly greater confidence in managing diagnosable conditions (d = 1.81) and general concerns (d = 1.73), as well as in making necessary referrals (d = 1.27) and obtaining consults (d = 0.74). While the intervention did not significantly impact secondary outcomes (attitudes and knowledge), regression analysis indicated that the intervention may have increased confidence, in part, by ameliorating the adverse impact of negative mental health care attitudes. CONCLUSION PTCAP enhances PCPs' child/youth mental health care confidence in managing both general and diagnosable concerns. However, an 8-hr session focused on applying brief therapeutic skills was insufficient to significantly change attitudes and knowledge. Formal testing of PTCAP may be warranted, perhaps using more intensive training and including outcome assessments capable of determining whether increased PCP confidence translates to more effective management and better patient outcomes.
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Affiliation(s)
- Stacey D Espinet
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Centre for Education Research and Innovation, The University of Western Ontario, London, Ontario, Canada
| | - Sandra Gotovac
- Division of Child and Adolescent Psychiatry, London Health Sciences Center, London, Ontario, Canada
| | - Sommer Knight
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Centre for Education Research and Innovation, The University of Western Ontario, London, Ontario, Canada
| | - Larry Wissow
- School of Medicine, University of Washington, DC, USA
| | - Merrick Zwarenstein
- Department of Family Medicine, Centre for Studies in Family Medicine, The University of Western Ontario, Ontario, Canada
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Health Sciences Addition, The University of Western Ontario, London, Ontario, Canada
| | - Margaret Steele
- Discipline of Psychiatry, Faculty of Medicine, Memorial University of Newfoundland, Saint John's, Newfoundland, Canada
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Abstract
Pediatricians have unique opportunities and an increasing sense of responsibility to promote healthy social-emotional development of children and to prevent and address their mental health and substance use conditions. In this report, the American Academy of Pediatrics updates its 2009 policy statement, which proposed competencies for providing mental health care to children in primary care settings and recommended steps toward achieving them. This 2019 policy statement affirms the 2009 statement and expands competencies in response to science and policy that have emerged since: the impact of adverse childhood experiences and social determinants on mental health, trauma-informed practice, and team-based care. Importantly, it also recognizes ways in which the competencies are pertinent to pediatric subspecialty practice. Proposed mental health competencies include foundational communication skills, capacity to incorporate mental health content and tools into health promotion and primary and secondary preventive care, skills in the psychosocial assessment and care of children with mental health conditions, knowledge and skills of evidence-based psychosocial therapy and psychopharmacologic therapy, skills to function as a team member and comanager with mental health specialists, and commitment to embrace mental health practice as integral to pediatric care. Achievement of these competencies will necessarily be incremental, requiring partnership with fellow advocates, system changes, new payment mechanisms, practice enhancements, and decision support for pediatricians in their expanded scope of practice.
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Affiliation(s)
- Jane Meschan Foy
- Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina;
| | - Cori M Green
- Department of Pediatrics, Weill Cornell Medicine, Cornell University, New York, New York; and
| | - Marian F Earls
- Community Care of North Carolina, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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What can clinicians do to improve outcomes across psychiatric treatments: a conceptual review of non-specific components. Epidemiol Psychiatr Sci 2019; 29:e48. [PMID: 31412975 PMCID: PMC8061300 DOI: 10.1017/s2045796019000428] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AIMS Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research. METHODS We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them. RESULTS The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication - focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns - non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures - i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes - i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes. CONCLUSIONS Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice.
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Harris E, Bowden J, Greiner E, Duby JC. Mental Health Training in Pediatric Residency: Where Can We Go? J Pediatr 2019; 211:4-6. [PMID: 31349919 DOI: 10.1016/j.jpeds.2019.05.075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Emily Harris
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Emily Greiner
- Wright State University Boonshoft School of Medicine
| | - John C Duby
- Wright State University Boonshoft School of Medicine, Dayton Children's Hospital, Dayton, OH.
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Sharifi V, Shahrivar Z, Zarafshan H, Ashkezary SB, Stuart E, Mojtabai R, Wissow L. Collaborative care for child and youth mental health problems in a middle-income country: study protocol for a randomized controlled trial training general practitioners. Trials 2019; 20:405. [PMID: 31287011 PMCID: PMC6615304 DOI: 10.1186/s13063-019-3467-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/24/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Child and youth mental health problems are leading causes of disability and particular problems in low- and middle-income countries where populations are young and child mental health services are in short supply. Collaborative care models that support primary care providers' efforts to detect and treat child mental health problems offer one way to address this need. However, collaborative care for child mental health can be more complex than collaboration for adults for a number of reasons, including two-generational aspects of care, high degrees of co-morbidity, and variations in presentation across developmental stages. METHODS The study takes advantage of an existing collaborative care network in Tehran, Iran, in which general practitioners are supported by community mental health centers to care for adult mental health problems. At present, those practitioners are asked to refer children with mental health problems to the collaborating centers rather than treating them themselves. We are conducting a cluster randomized trial in which practitioners in the network will be randomized to receive training in child/youth mental health treatment or a booster training on recognition and referral. Children/youth aged 5-15 years making visits to the practitioners will be screened using the Strengths and Difficulties Questionnaire; those found positive will be followed for six months to compare outcomes between those treated by trained or control practitioners. DISCUSSION If the trial demonstrates superior outcomes among children treated by trained practitioners, it will support the feasibility of expanding collaborative care networks to include children. TRIAL REGISTRATION ClinicalTrials.gov, NCT03144739 . Registered on 8 May 2017.
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Affiliation(s)
- Vandad Sharifi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Shahrivar
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Zarafshan
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Elizabeth Stuart
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Lawrence Wissow
- Division of Child and Adolescent Psychiatry, School of Medicine, University of Washington, 4800 Sand Point Way NE, M/S OA.5.154, PO Box 5371, Seattle, WA 98145-5005 USA
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Kodish I, Richardson L, Schlesinger A. Collaborative and Integrated Care for Adolescent Depression. Child Adolesc Psychiatr Clin N Am 2019; 28:315-325. [PMID: 31076110 DOI: 10.1016/j.chc.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Creative collaborative approaches are required to meet the demands of managing depression in youth. Primary care providers are well positioned to engage depressed youth and their families, yet often lack the training, access to psychiatric providers, and the reimbursement structure to support their efforts. Child and adolescent psychiatrists are encouraged to support pediatricians in establishing more robust systems to provide screening and effective treatment interventions, particularly for youth at higher risk. Several models of collaborative care are described, in addition to their emerging evidence-base, in an effort to disseminate evolving treatment strategies that can drive implementation of effective collaborative approaches.
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Affiliation(s)
- Ian Kodish
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 4800 Sand Point Way Northeast, O/A 5.154, Seattle, WA 98105, USA
| | - Laura Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Research Institute, M/S CSB-200, PO Box 5371, Seattle, WA 98105, USA
| | - Abigail Schlesinger
- UPMC Western Psychiatric Hospital, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 11279 Perry Highway, Suite 204, Wexford, PA 15090, USA.
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19
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Krockow EM, Riviere E, Frosch CA. Improving shared health decision making for children and adolescents with chronic illness: A narrative literature review. PATIENT EDUCATION AND COUNSELING 2019; 102:623-630. [PMID: 30578102 DOI: 10.1016/j.pec.2018.11.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This review aims to increase understanding of health decision-making by children and adolescents with chronic illnesses and offer suggestions for improving shared decision-making with healthcare professionals. METHODS Using cross-disciplinary publication databases, we surveyed literature on children's and adolescents' health decision-making from psychology, health sciences, and neuroscience. RESULTS Several factors influencing health decision-making were identified. Considering neurobiological aspects, children lack functionality in the frontal lobe resulting in lesser cognitive control and higher risk-taking compared to adults. Additionally, adolescents' generally higher arousal of socioemotional systems demonstrates neurological underpinnings for reward-seeking behaviours. Psychological investigations of children's health decision-making indicate important age-dependent differences in risk-taking, locus of control, affect and cognitive biases. Furthermore, social influences, particularly from peers, have a large, often negative, effect on individual decision-making due to desire for peer acceptance. CONCLUSION Acknowledging these factors is necessary for optimising the process of shared decision-making to support minors with chronic illnesses during healthcare consultations. PRACTICE IMPLICATIONS Doctors and other healthcare professionals may need to counteract some adolescents' risk-taking behaviours which are often spurred by peer pressure. This can be achieved by highlighting the patient's control over health outcomes, emphasising short-term benefits and long-term consequences of risky behaviours, and recommending peer support networks.
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Affiliation(s)
- Eva M Krockow
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, United Kingdom
| | - Erica Riviere
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, United Kingdom
| | - Caren A Frosch
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, United Kingdom.
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20
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McMillan JA, Land ML, Rodday AM, Wills K, Green CM, Leslie LK. Report of a Joint Association of Pediatric Program Directors-American Board of Pediatrics Workshop: Preparing Future Pediatricians for the Mental Health Crisis. J Pediatr 2018; 201:285-291. [PMID: 30029867 DOI: 10.1016/j.jpeds.2018.06.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/19/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Julia A McMillan
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Marshall L Land
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT; The American Board of Pediatrics, Chapel Hill, NC
| | - Angie M Rodday
- Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Boston, MA
| | - Kelly Wills
- Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Cori M Green
- Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Laurel K Leslie
- The American Board of Pediatrics, Chapel Hill, NC; Institute for Clinical Research and Health Policy Studies, Tufts School of Medicine, Boston, MA
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21
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Gutman T, Hanson CS, Bernays S, Craig JC, Sinha A, Dart A, Eddy AA, Gipson DS, Bockenhauer D, Yap HK, Groothoff J, Zappitelli M, Webb NJ, Alexander SI, Goldstein SL, Furth S, Samuel S, Blydt-Hansen T, Dionne J, Michael M, Wenderfer SE, Winkelmayer WC, Currier H, McTaggart S, Walker A, Ralph AF, Ju A, James LJ, Carter S, Tong A. Child and Parental Perspectives on Communication and Decision Making in Pediatric CKD: A Focus Group Study. Am J Kidney Dis 2018; 72:547-559. [DOI: 10.1053/j.ajkd.2018.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 05/02/2018] [Indexed: 11/11/2022]
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Brown CM, Raglin Bignall WJ, Ammerman RT. Preventive Behavioral Health Programs in Primary Care: A Systematic Review. Pediatrics 2018; 141:e20180611. [PMID: 29632256 DOI: 10.1542/peds.2017-0611] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Early childhood is a critical period for socioemotional development. Primary care is a promising setting for behavioral health programs. OBJECTIVES To identify gaps in the literature on effectiveness and readiness for scale-up of behavioral health programs in primary care. DATA SOURCES PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Embase, Evidence-Based Medicine Reviews, and Scopus databases were searched for articles published in English in the past 15 years. Search terms included terms to describe intervention content, setting, target population, and names of specific programs known to fit inclusion criteria. STUDY SELECTION Inclusion criteria were: (1) enrolled children 0 to 5 years old, (2) primary care setting, (3) measured parenting or child behavior outcomes, and (4) clinical trial, quasi-experimental trial, pilot study, or pre-post design. DATA EXTRACTION Data were abstracted from 44 studies. The rigor of individual studies and evidence base as a whole were compared with the Society of Prevention Research's standards for efficacy, effectiveness, and scale-up research. RESULTS Gaps in the literature include: study findings do not always support hypotheses about interventions' mechanisms, trust in primary care as a mediator has not been sufficiently studied, it is unclear to which target populations study findings can be applied, parent participation remains an important challenge, and the long-term impact requires further evaluation. LIMITATIONS Potential limitations include publication bias, selective reporting within studies, and an incomplete search. CONCLUSIONS Targeting gaps in the literature could enhance understanding of the efficacy, effectiveness, and readiness for scale-up of these programs.
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Affiliation(s)
- Courtney M Brown
- Divisions of General and Community Pediatrics and
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
| | | | - Robert T Ammerman
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Behavioral Medicine and Clinical Psychology, and
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23
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Hendaus MA, Nassar S, Leghrouz BA, Alhammadi AH, Alamri M. Parental preference and perspectives on continuous pulse oximetry in infants and children with bronchiolitis. Patient Prefer Adherence 2018; 12:483-487. [PMID: 29662305 PMCID: PMC5892958 DOI: 10.2147/ppa.s152880] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE The purpose of the study was to investigate parental preference of continuous pulse oximetry in infants and children with bronchiolitis. MATERIALS AND METHODS A cross-sectional prospective study was conducted at Hamad Medical Corporation in Qatar. Parents of infants and children <24 months old and hospitalized with bronchiolitis were offered an interview survey. RESULTS A total of 132 questionnaires were completed (response rate 100%). Approximately 90% of participants were 20-40 years of age, and 85% were females. The mean age of children was 7.2±5.8 months. Approximately eight in ten parents supported the idea of continuous pulse oximetry in children with bronchiolitis. Almost 43% of parents believed that continuous pulse-oximetry monitoring would delay their children's hospital discharge. Interestingly, approximately 85% of caregivers agreed that continuous pulse oximetry had a good impact on their children's health. In addition, around one in two of the participants stated that good bedside examinations can obviate the need for continuous pulse oximetry. Furthermore, 80% of parents believed that continuous pulse-oximetry monitoring would give the health-care provider a good sense of security regarding the child's health. Finally, being a male parent was associated with significantly increased risk of reporting unnecessary fatigue, attributed to the sound of continuous pulse oximetry (P=0.031). CONCLUSION Continuous pulse-oximetry monitoring in children with bronchiolitis was perceived as reassuring for parents. Involving parents in decision-making is considered essential in the better management of children with bronchiolitis or any other disease. The first step to decrease continuous pulse oximetry will require provider education and change as well. Furthermore, we recommend proper counseling for parents, emphasizing that medical technology is not always essential, but is a complementary mode of managing a disease.
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Affiliation(s)
- Mohamed A Hendaus
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar
- Department of Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar
- Correspondence: Mohamed A Hendaus, Department of Pediatrics, Sidra Medicine, Al Al Luqta Street, PO BOX 26999, Doha, Qatar, Tel +974 4003 6559, Fax +974 4443 9571, Email
| | - Suzan Nassar
- Department of Pediatrics, Hamad General Corporation, Doha, Qatar
| | | | - Ahmed H Alhammadi
- Department of Pediatrics, Section of Academic General Pediatrics, Sidra Medicine, Doha, Qatar
- Department of Clinical Pediatrics, Weill Cornell Medicine, Doha, Qatar
| | - Mohammed Alamri
- Pediatric Emergency Center, Hamad General Corporation, Doha, Qatar
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Abstract
OBJECTIVE Brief, well-validated instruments are needed to facilitate screening for early childhood behavioral and emotional problems (BEPs). The objectives of this study were to empirically reduce the length of the Early Childhood Screening Assessment (ECSA) and to assess the validity and reliability of this shorter tool. METHODS Using caregiver ECSA responses for 2467 children aged 36 to 60 months seen in primary care, individual ECSA items were ranked on a scale ranging from "absolutely retain" to "absolutely delete." Items were deleted sequentially beginning with "absolutely delete" and going up the item prioritization list, resulting in 35 shorter versions of the ECSA. A separate primary care sample (n = 69) of mothers of children aged 18 to 60 months was used to determine the sensitivity and specificity of each shorter ECSA version using psychiatric diagnosis on the Diagnostic Infant and Preschool Assessment as the gold standard. The version with the optimal balance of sensitivity, specificity, and length was selected as the Brief ECSA. Associations between Brief ECSA scores and other pertinent measures were evaluated to estimate reliability and validity. RESULTS A 22-item measure reflected the best combination of brevity, sensitivity and specificity. A cutoff score of 9 or higher on the 22-item Brief ECSA demonstrated acceptable sensitivity (89%) and specificity (85%) for predicting a psychiatric diagnosis. Brief ECSA scores correlated significantly and in expected directions with scores on pertinent measures and with demographic variables. CONCLUSION The results indicate that the Brief ECSA has sound psychometric properties for identifying young children with BEPs in primary care.
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25
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Biel MG, Anthony BJ, Mlynarski L, Godoy L, Beers LS. Collaborative Training Efforts with Pediatric Providers in Addressing Mental Health Problems in Primary Care. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2017; 41:610-616. [PMID: 28421477 DOI: 10.1007/s40596-017-0709-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/20/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Matthew G Biel
- Georgetown University School of Medicine, Washington, DC, USA.
| | - Bruno J Anthony
- Georgetown University School of Medicine, Washington, DC, USA
| | - Laura Mlynarski
- Georgetown University School of Medicine, Washington, DC, USA
| | - Leandra Godoy
- Children's National Health System, Washington, DC, USA
| | - Lee S Beers
- Children's National Health System, Washington, DC, USA
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26
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Giles LL, Martini DR. Essential Elements of a Collaborative Mental Health Training Program for Primary Care. Child Adolesc Psychiatr Clin N Am 2017; 26:839-850. [PMID: 28916018 DOI: 10.1016/j.chc.2017.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Mental health integration in primary care is based on creating an environment that encourages collaboration and supports appropriate care for patients and families while offering a full range of services. Training programs for primary care practitioners should include sessions on how to build and maintain such a practice along with information on basic mental health competencies.
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Affiliation(s)
- Lisa L Giles
- Primary Children's Hospital, 100 North Mario Capecchi Drive, Salt Lake City, UT 841113, USA; Division of Pediatric Psychiatry and Behavioral Health, Department of Pediatrics, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Salt Lake City, UT 841113, USA
| | - D Richard Martini
- Primary Children's Hospital, 100 North Mario Capecchi Drive, Salt Lake City, UT 841113, USA; Division of Pediatric Psychiatry and Behavioral Health, Department of Pediatrics, University of Utah School of Medicine, 100 North Mario Capecchi Drive, Salt Lake City, UT 841113, USA.
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27
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Levy SL, Hill E, Mattern K, McKay K, Sheldrick RC, Perrin EC. Colocated Mental Health/Developmental Care. Clin Pediatr (Phila) 2017; 56:1023-1031. [PMID: 28449589 DOI: 10.1177/0009922817701172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The inadequacy of mental health and developmental services for children is a widely recognized and growing problem. Although a variety of solutions have been proposed, none has been generally successful or feasible. This research describes models of colocation that have evolved in primary care settings in Massachusetts and reports on pediatricians' and their colocated colleagues' impressions of their benefits and challenges. Pediatricians in 18 practices that included a colocated mental health/developmental specialist (MH/DS) were identified through a survey administered through the state American Academy of Pediatrics Chapter, and interviewed. Practices varied widely in the professional expertise/training and roles of the MH/DSs, communication among providers, and financial arrangements. The majority of pediatricians and MH/DSs reported being pleased with their colocated arrangements, despite the costs rarely being supported by billing revenues. This study suggests that further development of such systems hold promise to meet the growing need for accessible pediatric mental and developmental health care.
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Affiliation(s)
- Sheryl L Levy
- 1 Division of Developmental-Behavioral Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA, USA
| | - Elena Hill
- 2 Tufts University School of Medicine, Boston, MA, USA
| | - Kathryn Mattern
- 1 Division of Developmental-Behavioral Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA, USA
| | - Kevin McKay
- 2 Tufts University School of Medicine, Boston, MA, USA
| | - R Christopher Sheldrick
- 1 Division of Developmental-Behavioral Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA, USA
| | - Ellen C Perrin
- 1 Division of Developmental-Behavioral Pediatrics, Floating Hospital for Children, Tufts Medical Center, Boston, MA, USA.,2 Tufts University School of Medicine, Boston, MA, USA
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28
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Abstract
As primary care models increasingly include nonphysician team members, more attention should be paid to patient- and family-centered care (PFCC) among medical assistants (MAs). The aims of this article are to describe parent perceptions of PFCC by MAs and assess associations between MA PFCC and other perceptions of their care experience. To assess PFCC, we administered the CARE (Consultation and Relational Empathy) measure to the parent/guardian of 360 children following a primary care visit. Perceptions of PFCC by MAs were significantly associated with 6 of 7 other measures of patient experience, including PFCC by the physician, treatment by the receptionist, and satisfaction with wait time. Each team member can potentially shape perceptions of care in ways that could "spill over" into other parts of the visit.
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Carpenter AL, Pincus DB, Perrin EC, Bair-Merritt MH, Mian ND. Early identification of anxiety disorders: The role of the pediatrician in primary care. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2016.1275642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
| | - Donna B. Pincus
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Ellen C. Perrin
- Floating Hospital, Tufts Medical Center and Tufts University School of Medicine, Boston, MA
| | | | - Nicholas D. Mian
- Department of Psychology, University of New Hampshire at Manchester, Manchester, NH
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Richardson LP, McCarty CA, Radovic A, Suleiman AB. Research in the Integration of Behavioral Health for Adolescents and Young Adults in Primary Care Settings: A Systematic Review. J Adolesc Health 2017; 60:261-269. [PMID: 28087267 PMCID: PMC5973784 DOI: 10.1016/j.jadohealth.2016.11.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 11/12/2016] [Accepted: 11/17/2016] [Indexed: 12/30/2022]
Abstract
Despite the recognition that behavioral and medical health conditions are frequently intertwined, the existing health care system divides management for these issues into separate settings. This separation results in increased barriers to receipt of care and contributes to problems of underdetection, inappropriate diagnosis, and lack of treatment engagement. Adolescents and young adults with mental health conditions have some of the lowest rates of treatment for their conditions of all age groups. Integration of behavioral health into primary care settings has the potential to address these barriers and improve outcomes for adolescents and young adults. In this paper, we review the current research literature for behavioral health integration in the adolescent and young adult population and make recommendations for needed research to move the field forward.
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Affiliation(s)
- Laura P. Richardson
- University of Washington Department of Pediatrics,Seattle Children’s Research Institute Center for Child Health, Behavior and Development
| | - Carolyn A. McCarty
- University of Washington Department of Pediatrics,Seattle Children’s Research Institute Center for Child Health, Behavior and Development
| | - Ana Radovic
- University of Pittsburgh School of Medicine Department of Pediatrics,Children’s Hospital of Pittsburgh of UPMC
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Bauer NS, Ofner S, Pottenger A, Carroll AE, Downs SM. Follow-up of Mothers with Suspected Postpartum Depression from Pediatrics Clinics. Front Pediatr 2017; 5:212. [PMID: 29043246 PMCID: PMC5632353 DOI: 10.3389/fped.2017.00212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/20/2017] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Pediatric providers are increasingly screening for postpartum depression (PD), yet, it is unknown how often mothers comply with recommendations to seek treatment. The objectives were to describe the rate at which mothers with suspected PD seek treatment and explore factors that predict help-seeking behavior. DESIGN AND METHODS Mothers were recruited from four pediatric clinics after identification using the Child Health Improvement through Computer Automation (CHICA) system. Mothers with a positive screen were invited to participate in a telephone interview between January 2012 and December 2014. Mothers reported if they sought treatment or called a community resource. RESULTS 73 of 133 eligible mothers participated (55% response rate). Fifty women recalled a recommendation to seek help. Only 43.8% (32/73) made a follow-up appointment with an adult provider and even fewer kept the appointment. CONCLUSION A majority of mothers suspected of having PD recalled a referral for further intervention; yet, less than half took action. Further investigation of barriers of help-seeking behavior is warranted.
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Affiliation(s)
- Nerissa S Bauer
- Section of Children's Health Services Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
| | - Susan Ofner
- Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amy Pottenger
- Section of Children's Health Services Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Aaron E Carroll
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States.,Section of Pediatric and Adolescent Comparative Effectiveness Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Stephen M Downs
- Section of Children's Health Services Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
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Fallucco EM, Robertson Blackmore E, Bejarano CM, Wysocki T, Kozikowski CB, Gleason MM. Feasibility of Screening for Preschool Behavioral and Emotional Problems in Primary Care Using the Early Childhood Screening Assessment. Clin Pediatr (Phila) 2017; 56:37-45. [PMID: 27009614 DOI: 10.1177/0009922816638077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The American Academy of Pediatrics recommends screening young children for behavioral and emotional problems (BEP) during primary care visits. Because of time constraints, few primary care providers (PCPs) use standardized screening tools to detect BEP. The Early Childhood Screening Assessment (ECSA) is a brief screening tool developed specifically to meet the needs of pediatric primary care providers (PCPs). The ECSA has established psychometric properties, but the feasibility and acceptability of the ECSA have not been established. This study examines the degree to which PCPs would incorporate ECSA screening and how PCPs value the ECSA as a tool to detect children with BEP. Twenty-seven pediatric PCPs were trained to implement ECSA screening. Six months after training, 96% of PCPs reported that the ECSA was practical for use at well-visits, 70% were still screening and 89% agreed that it helped detect more cases of BEP than by routine history-taking alone.
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Affiliation(s)
| | | | | | - Tim Wysocki
- 1 Nemours Children's Healthcare System, Jacksonville, FL, USA
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McMillan JA, Land M, Leslie LK. Pediatric Residency Education and the Behavioral and Mental Health Crisis: A Call to Action. Pediatrics 2017; 139:peds.2016-2141. [PMID: 28011943 DOI: 10.1542/peds.2016-2141] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 11/24/2022] Open
Abstract
For at least 4 decades, the need for improved pediatric residency training in behavioral and mental health has been recognized. The prevalence of behavioral and mental health conditions in children, adolescents, and young adults has increased during that period. However, as recently as 2013, 65% of pediatricians surveyed by the American Academy of Pediatrics indicated that they lacked training in recognizing and treating mental health problems. Current pediatric residency training requirements do not stipulate curricular elements or assessment requirements in behavioral and mental health, and fewer than half of pediatric residents surveyed felt that their competence in dealing with mental health problems was good to excellent. It is time that pediatric residency programs develop the capacity to prepare their residents to meet the behavioral and mental health needs of their patients. Meeting this challenge will require a robust curriculum and effective assessment tools. Ideal training environments will include primary care ambulatory sites that encourage residents to work longitudinally in partnership with general pediatricians and behavioral and mental health trainees and providers; behavioral and mental health training must be integrated into both ambulatory and inpatient experiences. Faculty development will be needed, and in most programs it will be necessary to include nonpediatrician mental health providers to enhance pediatrician faculty expertise. The American Board of Pediatrics intends to partner with other organizations to ensure that pediatric trainees develop the competence needed to meet the behavioral and mental health needs of their patients.
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Affiliation(s)
| | - Marshall Land
- University of Vermont College of Medicine, Burlington, Vermont and Consultant for Maintenance of Certification and Strategic Planning, American Board of Pediatrics; and
| | - Laurel K Leslie
- Tufts University School of Medicine, Boston, Massachusetts, and Vice President for Research, American Board of Pediatrics
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Tovar A, Emond JA, Hennessy E, Gilbert-Diamond D. An FTO Gene Variant Moderates the Association between Parental Restriction and Child BMI. PLoS One 2016; 11:e0155521. [PMID: 27196523 PMCID: PMC4873182 DOI: 10.1371/journal.pone.0155521] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 04/29/2016] [Indexed: 01/21/2023] Open
Abstract
Objective This study aimed to explore whether a common variant in the FTO gene moderates the relationship between parental restriction and child BMI. Methods This study reports on baseline data from 178 parent-child (ages 9–10 years) dyads. Parents completed the Child Feeding Questionnaire and reported on socio-demographic characteristics. Each child’s height, weight and FTO rs9939609 genotype was assessed. Ordinary least squares regression was used to fit the child’s BMI-percentile on parental restriction and the child’s FTO genotype, adjusted for covariates. A likelihood ratio test was used to compare a model with and without a multiplicative interaction term between restriction and genotype. Results Most participants (93.3%) were white, non-Hispanic. Twenty-three percent of children were overweight/obese and FTO genotype was associated with weight status. Mean parental restriction was statistically higher among overweight/obese vs. normal weight children: 3.3 (SD 0.8) vs. 2.8 (SD 1.0); t-test p-value = 0.002. Parental restriction was positively associated with child BMI-percentile and BMI-z only among children with two copies of the high-risk FTO allele (p for interaction = 0.02), where each one-point increase in parental restriction was associated with a 14.7 increase in the child’s BMI-percentile or a 0.56-point increase in the child’s BMI z-score. Conclusion For only the children with two high-risk alleles, parental restriction was positively associated with child BMI-percentile.
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Affiliation(s)
- Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, 02881, United States of America
- * E-mail:
| | - Jennifer A. Emond
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 3756, United States of America
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, 02111, United States of America
| | - Diane Gilbert-Diamond
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Lebanon, NH, 3756, United States of America
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Mikesell L, Bromley E, Young AS, Vona P, Zima B. Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts. HEALTH COMMUNICATION 2015; 31:707-717. [PMID: 26529605 DOI: 10.1080/10410236.2014.993296] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management, and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued client-centered priorities such as autonomy and empowerment when making decisions. However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: (a) the role of communication and information exchange and (b) the value and stability of clinician and client epistemic expertise. Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of Shared Decision Making (CEM-SDM).
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Affiliation(s)
- Lisa Mikesell
- a School of Communication & Information , Rutgers University
| | - Elizabeth Bromley
- b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles
- c Desert Pacific VA Mental Illness Research , Education and Clinical Center (MIRECC), West Los Angeles VA
| | - Alexander S Young
- b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles
- c Desert Pacific VA Mental Illness Research , Education and Clinical Center (MIRECC), West Los Angeles VA
| | - Pamela Vona
- b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles
| | - Bonnie Zima
- b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles
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Hacker KA, Penfold RB, Arsenault LN, Zhang F, Soumerai SB, Wissow LS. Effect of Pediatric Behavioral Health Screening and Colocated Services on Ambulatory and Inpatient Utilization. Psychiatr Serv 2015; 66:1141-8. [PMID: 26129994 PMCID: PMC4633707 DOI: 10.1176/appi.ps.201400315] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study sought to determine the impact of a pediatric behavioral health screening and colocation model on utilization of behavioral health care. METHODS In 2003, Cambridge Health Alliance, a Massachusetts public health system, introduced behavioral health screening and colocation of social workers sequentially within its pediatric practices. An interrupted time-series study was conducted to determine the impact on behavioral health care utilization in the 30 months after model implementation compared with the 18 months prior. Specifically, the change in trends of ambulatory, emergency, and inpatient behavioral health utilization was examined. Utilization data for 11,223 children ages ≥4 years 9 months to <18 years 3 months seen from 2003 to 2008 contributed to the study. RESULTS In the 30 months after implementation of pediatric behavioral health screening and colocation, there was a 20.4% cumulative increase in specialty behavioral health visit rates (trend of .013% per month, p=.049) and a 67.7% cumulative increase in behavioral health primary care visit rates (trend of .019% per month, p<.001) compared with the expected rates predicted by the 18-month preintervention trend. In addition, behavioral health emergency department visit rates increased 245% compared with the expected rate (trend .01% per month, p=.002). CONCLUSIONS After the implementation of a behavioral health screening and colocation model, more children received behavioral health treatment. Contrary to expectations, behavioral health emergency department visits also increased. Further study is needed to determine whether this is an effect of how care was organized for children newly engaged in behavioral health care or a reflection of secular trends in behavioral health utilization or both.
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Affiliation(s)
- Karen A Hacker
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Robert B Penfold
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Lisa N Arsenault
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Fang Zhang
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Stephen B Soumerai
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Lawrence S Wissow
- Dr. Hacker is with the Allegheny County Health Department, Pittsburgh, Pennsylvania (e-mail: ). Dr. Penfold is with the Department of Health Services Research, Group Health Research Institute, Seattle. Dr. Arsenault is with the Institute for Community Health, Cambridge, Massachusetts. Dr. Zhang and Dr. Soumerai are with the Harvard Pilgrim Health Care Institute and the Department of Population Medicine, Harvard Medical School, both in Boston. Dr. Wissow is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore
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Correlates of treatment engagement in an ADHD primary care-based intervention for urban families. J Behav Health Serv Res 2015; 41:539-47. [PMID: 24435226 DOI: 10.1007/s11414-013-9385-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
In restructuring the delivery of primary care to improve the wellness of a community, every community must review its own circumstances for factors such as resources and capacities, health concerns, social and political perspectives, and competing priorities. Strengthening the health care team with community health workers to create a patient-centered medical home can enhance health care access and outcomes. Community health workers can serve as critical connectors between health systems and communities; they facilitate access to and improve quality and culturally sensitive medical care, emphasizing preventive and primary care.
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Affiliation(s)
- Sheri L Johnson
- Department of Pediatrics, Center for the Advancement of Underserved Children, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Veronica L Gunn
- Department of Pediatrics, Center for the Advancement of Underserved Children, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, Population Health Management, Children's Hospital of Wisconsin, PO Box 1997, C525, Milwaukee, WI 53201-1997, USA.
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40
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Bhui KS, Aslam RW, Palinski A, McCabe R, Johnson MRD, Weich S, Singh SP, Knapp M, Ardino V, Szczepura A. Interventions to improve therapeutic communications between Black and minority ethnic patients and professionals in psychiatric services: systematic review. Br J Psychiatry 2015; 207:95-103. [PMID: 26243761 PMCID: PMC4523926 DOI: 10.1192/bjp.bp.114.158899] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Communication may be an influential determinant of inequality of access to, engagement with and benefit from psychiatric services. AIMS To review the evidence on interventions designed to improve therapeutic communications between Black and minority ethnic patients and clinicians who provide care in psychiatric services. METHOD Systematic review and evidence synthesis (PROSPERO registration: CRD42011001661). Data sources included the published and the 'grey' literature. A survey of experts and a consultation with patients and carers all contributed to the evidence synthesis, interpretation and recommendations. RESULTS Twenty-one studies were included in our analysis. The trials showed benefits mainly for depressive symptoms, experiences of care, knowledge, stigma, adherence to prescribed medication, insight and alliance. The effect sizes were smaller for better-quality trials (range of d 0.18-0.75) than for moderate- or lower-quality studies (range of d 0.18-4.3). The review found only two studies offering weak economic evidence. CONCLUSIONS Culturally adapted psychotherapies, and ethnographic and motivational assessment leading to psychotherapies were effective and favoured by patients and carers. Further trials are needed from outside of the UK and USA, as are economic evaluations and studies of routine psychiatric care practices.
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Affiliation(s)
- Kamaldeep S. Bhui
- Correspondence: K. S. Bhui, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Old Anatomy Building, Charterhouse Square, London EC1M 6Q, UK.
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Fernandez A, Moreno-Peral P, Zabaleta-del-Olmo E, Bellon JA, Aranda-Regules JM, Luciano JV, Serrano-Blanco A, Rubio-Valera M. Is there a case for mental health promotion in the primary care setting? A systematic review. Prev Med 2015; 76 Suppl:S5-11. [PMID: 25475684 DOI: 10.1016/j.ypmed.2014.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 11/11/2014] [Accepted: 11/24/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of mental health promotion (MHP) interventions by primary health care professionals in the adult population. METHODS Systematic review of literature in English and Spanish for randomized controlled trials (RCTs) and observational studies evaluating the impact of interventions carried out by primary care professionals explicitly to promote and improve the overall mental health of adult patients. PubMed, PsycINFO, and Web of Science were independently searched by two investigators to identify all MHP articles from inception to October 2013 (no restrictions). RESULTS We retrieved 4262 records and excluded 4230 by a review of title and abstract. Of 32 full-text articles assessed, 3 RCTs were selected (2 in USA, 1 in UK); two focused on the mental health of parents whose children have behavioral problems, the other on older people with disabilities. One study reported a MHP intervention that improved participants' mental health at 6-month follow-up. All studies had low-moderate quality (2 of 5 points) on the Jadad Scale. CONCLUSION There is a lack of implementation and/or evaluation of mental health promotion activities conducted by primary care professionals. More research is needed to clearly understand the benefits of promoting mental health in this setting.
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Affiliation(s)
- Ana Fernandez
- Centre for Disability Research and Policy/Brain and Mind Research Institute, Faculty of Health Sciences, University of Sydney, Australia; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Department of Pharmacology and Therapeutic Chemistry, School of Pharmacy, Universitat de Barcelona, Spain.
| | - Patricia Moreno-Peral
- Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Investigación del Distrito de Atención Primaria de Málaga, Spain
| | - Edurne Zabaleta-del-Olmo
- Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Juan Angel Bellon
- Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Investigación del Distrito de Atención Primaria de Málaga, Spain; Centro de Salud El Palo, Distrito de Atención Primaria Málaga-Guadalohorce, Departamento de Medicina Preventiva, Universidad de Málaga, Spain
| | - Jose Manuel Aranda-Regules
- Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Unidad de Investigación del Distrito de Atención Primaria de Málaga, Spain; Centro de Salud San Andrés Torcal, Distrito Sanitario Málaga-Guadalhorce, Servicio Andaluz de Salud, Málaga, Spain
| | - Juan Vicente Luciano
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Open University of Catalonia, Barcelona, Spain
| | - Antoni Serrano-Blanco
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain
| | - Maria Rubio-Valera
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Network for Prevention and Health Promotion in Primary Care (RedIAPP, ISCIII), Spain; Open University of Catalonia, Barcelona, Spain
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Bhui K, Aslam RW, Palinski A, McCabe R, Johnson MRD, Weich S, Singh SP, Knapp M, Ardino V, Szczepura A. Interventions designed to improve therapeutic communications between black and minority ethnic people and professionals working in psychiatric services: a systematic review of the evidence for their effectiveness. Health Technol Assess 2015; 19:vii-xxiv, 1-173. [PMID: 25921977 PMCID: PMC4780955 DOI: 10.3310/hta19310] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Black and minority ethnic (BME) people using psychiatric services are at greater risk of non-engagement, dropout from care and not receiving evidence-based interventions than white British people. OBJECTIVES To identify effective interventions designed to improve therapeutic communications (TCs) for BME patients using psychiatric services in the UK, to identify gaps in the research literature and to recommend future research. PARTICIPANTS Black African, black Caribbean, black British, white British, Pakistani and Bangladeshi patients in psychiatric services in the UK, or recruited from the community to enter psychiatric care. Some studies from the USA included Hispanic, Latino, Chinese, Vietnamese, Cambodian and African American people. INTERVENTIONS Any that improve TCs between BME patients and staff in psychiatric services. DATA SOURCES The published literature, 'grey' literature, an expert survey, and patients' and carers' perspectives on the evidence base. Databases were searched from their inception to 4 February 2013. Databases included MEDLINE, Applied Social Sciences Index and Abstracts, The Cochrane Library, Social Science Citation Index, Allied and Complementary Medicine Database, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, EMBASE, The Campbell Collaboration and ProQuest for dissertations. REVIEW METHODS Studies were included if they reported evaluation data about interventions designed to improve therapeutic outcomes by improving communication between BME patients and psychiatric professionals. Qualitative studies and reports in the grey literature were included only if they gave a critical evaluative statement. Two members of the team selected studies against pre-established criteria and any differences were resolved by consensus or by a third reviewer, if necessary. Data were extracted independently by two people and summarised in tables by specific study designs. Studies were subjected to a narrative synthesis that included a thematic analysis contrasting populations, countries and the strength of evidence for any intervention. The components of the interventions were compared. Patient perspectives on acceptability were considered alongside quality scores and methodological strengths and weaknesses. RESULTS Twenty-one studies (19 from the published literature and two from the grey literature) met the inclusion criteria. There were 12 trials, two observational quantitative studies, three case series, a qualitative study and three descriptive case studies. Only two studies, one a pilot trial and one a case series, included economic data; in both, a favourable but weak economic case could be made for the intervention. The trials tested interventions to prepare patients for therapeutic interventions, variable levels of ethnic matching (of professional to patient), cultural adaptation of therapies, and interventions that included social community systems in order to facilitate access to services. Empowering interventions favoured by patients and carers included adapted cognitive-behavioural therapy, assessments of explanatory models, cultural consultation, ethnographic and motivational interviews, and a telepsychiatry intervention. LIMITATIONS Studies tended to have small sample sizes or to be pilot studies, and to use proxy rather than direct measures for TCs. CONCLUSIONS Empowering interventions should be further researched and brought to the attention of commissioners. Several promising interventions need further evaluative research and economic evaluations are needed. STUDY REGISTRATION The study is registered as PROSPERO CRD42011001661. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rabbea'h W Aslam
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrea Palinski
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rose McCabe
- Centre for Psychiatry, Wolfson Institute of Preventative Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mark R D Johnson
- School of Applied Social Science, Faculty of Health and Life Sciences, De Montfort University Leicester, Leicester, UK
| | - Scott Weich
- Department of Psychiatry, Warwick Medical School, University of Warwick, Coventry, UK
| | - Swaran Preet Singh
- Department of Psychiatry, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Knapp
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Vittoria Ardino
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Ala Szczepura
- Department of Psychiatry, Warwick Medical School, University of Warwick, Coventry, UK
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43
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Making time for mental health: computerized previsit screening in primary care. J Adolesc Health 2015; 56:257-8. [PMID: 25703317 DOI: 10.1016/j.jadohealth.2014.12.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 11/20/2022]
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Lê Cook B, Brown JD, Loder S, Wissow L. Acculturation differences in communicating information about child mental health between Latino parents and primary care providers. J Immigr Minor Health 2014; 16:1093-102. [PMID: 24705736 PMCID: PMC4185306 DOI: 10.1007/s10903-014-0010-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Significant Latino-white disparities in youth mental health care access and quality exist yet little is known about Latino parents' communication with providers about youth mental health and the role of acculturation in influencing this communication. We estimated regression models to assess the association between time in the US and the number of psychosocial issues discussed with the medical assistant (MA) and doctor, adjusting for child and parent mental health and sociodemographics. Other proxies of acculturation were also investigated including measures of Spanish and English language proficiency and nativity. Parent's length of time in the US was positively associated with their communication of: their child's psychosocial problems with their child's MA, stress in their own life with their child's MA, and their child's school problems with their child's doctor. These differences were especially apparent for parents living in the US for >10 years. Parent-child language discordance, parent and child nativity were also significantly associated with communication of psychosocial problems. Greater provider and MA awareness of variation in resistance to communicating psychosocial issues could improve communication, and improve the prevention, diagnosis and treatment of youth mental illness.
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Affiliation(s)
- Benjamin Lê Cook
- Center for Multicultural Mental Health Research, Cambridge Health Alliance, Assistant Professor, Department of Psychiatry, Harvard Medical School, 120 Beacon Street, 4 Floor, Somerville, MA 02143, 617-503-8449, 617-503-8430 (fax),
| | - Jonathan D. Brown
- Mathematica Policy Research, 1100 1st St NE #1200, Washington, DC 20002, (202) 484-9220,
| | - Stephen Loder
- Center for Multicultural Mental Health Research, Cambridge Health, Alliance, 120 Beacon Street, 4 Floor, Somerville, MA 02143, 617-503-8440, 617-503-8430 (fax),
| | - Larry Wissow
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway Street, #703 Baltimore, MD 21287, 410-614-1243,
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Krippeit L, Belzer F, Martens-Le Bouar H, Mall V, Barth M. Communicating psychosocial problems in German well-child visits. What facilitates, what impedes pediatric exploration? A qualitative study. PATIENT EDUCATION AND COUNSELING 2014; 97:188-194. [PMID: 25182000 DOI: 10.1016/j.pec.2014.07.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 07/09/2014] [Accepted: 07/29/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To examine whether, and if so, how psychosocial topics are discussed between parents and pediatricians. METHODS Thirty well-child visits at eight pediatricians' practices in southwest Germany were video recorded. Conversations were analyzed. RESULTS Although psychosocial topics were frequently touched upon, they were rarely thoroughly explored. Pediatricians pursued a rather reserved conversation style. Especially when parents withdraw and psychosocial stressors are less baby-related, pediatricians hardly explore the psychosocial situation. CONCLUSION In summary, the pediatrician's conversation style, the nature of the stressors and the parents' openness are paramount in determining the depth of psychosocial exploration. PRACTICE IMPLICATIONS In order to ensure a good and fair quality of care to all parents, pediatricians should be provided with tailored communicative skills training allowing them to create a climate in which parents may open up and build trust toward their pediatrician.
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Affiliation(s)
- Lorena Krippeit
- Center for Pediatrics and Adolescent Medicine of the University Medical Center Freiburg, Germany.
| | - Florian Belzer
- Center for Pediatrics and Adolescent Medicine of the University Medical Center Freiburg, Germany
| | - Heike Martens-Le Bouar
- Center for Pediatrics and Adolescent Medicine of the University Medical Center Freiburg, Germany
| | | | - Michael Barth
- Center for Pediatrics and Adolescent Medicine of the University Medical Center Freiburg, Germany
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Wissow LS, Tegegn T, Asheber K, McNabb M, Weldegebreal T, Jerene D, Ruff A. Collaboratively reframing mental health for integration of HIV care in Ethiopia. Health Policy Plan 2014; 30:791-803. [PMID: 25012090 DOI: 10.1093/heapol/czu058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Integrating mental health with general medical care can increase access to mental health services, but requires helping generalists acquire a range of unfamiliar knowledge and master potentially complex diagnostic and treatment processes. METHOD We describe a model for integrating complex specialty care with generalist/primary care, using as an illustration the integration of mental health into hospital-based HIV treatment services in Ethiopia. Generalists and specialists collaboratively developed mental health treatments to fit the knowledge, skills and resources of the generalists. The model recognizes commonalities between mental health and general medical care, focusing on practical interventions acceptable to patients. It was developed through a process of literature review, interviews, observing clinical practice, pilot trainings and expert consultation. Preliminary evaluation results were obtained by debriefing generalist trainees after their return to their clinical sites. RESULTS In planning interviews, generalists reported discomfort making mental health diagnoses but recognition of symptom groups including low mood, anxiety, thought problems, poor child behaviour, seizures and substance use. Diagnostic and treatment algorithms were developed for these groups and tailored to the setting by including possible medical causes and burdens of living with HIV. First-line treatment included modalities familiar to generalists: empathetic patient-provider interactions, psychoeducation, cognitive reframing, referral to community supports and elements of symptom-specific evidence-informed counselling. Training introduced basic skills, with evolving expertise supported by job aides and ongoing support from mental health nurses cross-trained in HIV testing. Feedback from trainees suggested the programme fit well with generalists' settings and clinical goals. CONCLUSIONS An integration model based on collaboratively developing processes that fit the generalist setting shows promise as a method for incorporating complex, multi-faceted interventions into general medical settings. Formal evaluations will be needed to compare the quality of care provided with more traditional approaches and to determine the resources required to sustain quality over time.
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Affiliation(s)
- Lawrence S Wissow
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Teketel Tegegn
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Kassahun Asheber
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Marion McNabb
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Teklu Weldegebreal
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Degu Jerene
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Andrea Ruff
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia, Johns Hopkins University, Technical Support for Ethiopia HIV/AIDS ART Initiative (JHU-TSEHAI), Addis Ababa, Ethiopia, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA and Centers for Disease Control and Prevention, Addis Ababa, Ethiopia
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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: 47] [Impact Index Per Article: 4.7] [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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Barlow J, Smailagic N, Huband N, Roloff V, Bennett C. Group-based parent training programmes for improving parental psychosocial health. Cochrane Database Syst Rev 2014; 2014:CD002020. [PMID: 24838729 PMCID: PMC10898322 DOI: 10.1002/14651858.cd002020.pub4] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Parental psychosocial health can have a significant effect on the parent-child relationship, with consequences for the later psychological health of the child. Parenting programmes have been shown to have an impact on the emotional and behavioural adjustment of children, but there have been no reviews to date of their impact on parental psychosocial wellbeing. OBJECTIVES To address whether group-based parenting programmes are effective in improving parental psychosocial wellbeing (for example, anxiety, depression, guilt, confidence). SEARCH METHODS We searched the following databases on 5 December 2011: CENTRAL (2011, Issue 4), MEDLINE (1950 to November 2011), EMBASE (1980 to week 48, 2011), BIOSIS (1970 to 2 December 2011), CINAHL (1982 to November 2011), PsycINFO (1970 to November week 5, 2011), ERIC (1966 to November 2011), Sociological Abstracts (1952 to November 2011), Social Science Citation Index (1970 to 2 December 2011), metaRegister of Controlled Trials (5 December 2011), NSPCC Library (5 December 2011). We searched ASSIA (1980 to current) on 10 November 2012 and the National Research Register was last searched in 2005. SELECTION CRITERIA We included randomised controlled trials that compared a group-based parenting programme with a control condition and used at least one standardised measure of parental psychosocial health. Control conditions could be waiting-list, no treatment, treatment as usual or a placebo. DATA COLLECTION AND ANALYSIS At least two review authors extracted data independently and assessed the risk of bias in each study. We examined the studies for any information on adverse effects. We contacted authors where information was missing from trial reports. We standardised the treatment effect for each outcome in each study by dividing the mean difference in post-intervention scores between the intervention and control groups by the pooled standard deviation. MAIN RESULTS We included 48 studies that involved 4937 participants and covered three types of programme: behavioural, cognitive-behavioural and multimodal. Overall, we found that group-based parenting programmes led to statistically significant short-term improvements in depression (standardised mean difference (SMD) -0.17, 95% confidence interval (CI) -0.28 to -0.07), anxiety (SMD -0.22, 95% CI -0.43 to -0.01), stress (SMD -0.29, 95% CI -0.42 to -0.15), anger (SMD -0.60, 95% CI -1.00 to -0.20), guilt (SMD -0.79, 95% CI -1.18 to -0.41), confidence (SMD -0.34, 95% CI -0.51 to -0.17) and satisfaction with the partner relationship (SMD -0.28, 95% CI -0.47 to -0.09). However, only stress and confidence continued to be statistically significant at six month follow-up, and none were significant at one year. There was no evidence of any effect on self-esteem (SMD -0.01, 95% CI -0.45 to 0.42). None of the trials reported on aggression or adverse effects.The limited data that explicitly focused on outcomes for fathers showed a statistically significant short-term improvement in paternal stress (SMD -0.43, 95% CI -0.79 to -0.06). We were unable to combine data for other outcomes and individual study results were inconclusive in terms of any effect on depressive symptoms, confidence or partner satisfaction. AUTHORS' CONCLUSIONS The findings of this review support the use of parenting programmes to improve the short-term psychosocial wellbeing of parents. Further input may be required to ensure that these results are maintained. More research is needed that explicitly addresses the benefits for fathers, and that examines the comparative effectiveness of different types of programme along with the mechanisms by which such programmes bring about improvements in parental psychosocial functioning.
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Affiliation(s)
- Jane Barlow
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Gibbett Hill Road, Coventry, UK, CV4 7LF
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Mackey ER, Struemph K, Powell PW, Chen R, Streisand R, Holmes CS. Maternal depressive symptoms and disease care status in youth with type 1 diabetes. Health Psychol 2014; 33:783-91. [PMID: 24799001 DOI: 10.1037/hea0000066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current study assessed relations among maternal depressive symptoms, poorer youth diabetes adherence, and glycemic control. Specifically, hypothesized mediating links of lowered expectations of parental involvement, less parental monitoring, and more conflict were examined. METHOD Participants included 225 mothers and their young adolescents, aged 11-14 years (M = 12.73 years, SD = 1.2) diagnosed with T1D. Maternal depressive symptoms and outcome expectancies for maternal involvement were evaluated with self-report questionnaires. Multisource, parent/youth, and multimethod assessment of adherence, parental monitoring, and conflict were evaluated during a baseline assessment from a larger randomized clinical trial. RESULTS The first hypothesized structural equation model demonstrated a good fit and indicated that more maternal depressive symptoms were directly associated with less parental monitoring and more conflict, which in turn each were associated with poorer adherence and glycemic control. Although higher involvement expectancies were associated with more monitoring and less conflict, they were not associated with other model variables. A second alternative model also fit the data well; poorer youth adherence was associated with more conflict that in turn related to maternal depressive symptoms. CONCLUSIONS Two models were tested by which maternal depressive symptoms and poorer youth adherence were interrelated via less monitoring and more conflict. Follow-up longitudinal evaluation can best characterize the full extent of these relations.
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Affiliation(s)
| | - Kari Struemph
- Department of Psychology, Virginia Commonwealth University
| | | | - Rusan Chen
- Center For New Designs In Learning & Scholarship, Georgetown University
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50
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Kolko DJ, Campo J, Kilbourne AM, Hart J, Sakolsky D, Wisniewski S. Collaborative care outcomes for pediatric behavioral health problems: a cluster randomized trial. Pediatrics 2014; 133:e981-92. [PMID: 24664093 PMCID: PMC3966503 DOI: 10.1542/peds.2013-2516] [Citation(s) in RCA: 147] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To assess the efficacy of collaborative care for behavior problems, attention-deficit/hyperactivity disorder (ADHD), and anxiety in pediatric primary care (Doctor Office Collaborative Care; DOCC). METHODS Children and their caregivers participated from 8 pediatric practices that were cluster randomized to DOCC (n = 160) or enhanced usual care (EUC; n = 161). In DOCC, a care manager delivered a personalized, evidence-based intervention. EUC patients received psychoeducation and a facilitated specialty care referral. Care processes measures were collected after the 6-month intervention period. Family outcome measures included the Vanderbilt ADHD Diagnostic Parent Rating Scale, Parenting Stress Index-Short Form, Individualized Goal Attainment Ratings, and Clinical Global Impression-Improvement Scale. Most measures were collected at baseline, and 6-, 12-, and 18-month assessments. Provider outcome measures examined perceived treatment change, efficacy, and obstacles, and practice climate. RESULTS DOCC (versus EUC) was associated with higher rates of treatment initiation (99.4% vs 54.2%; P < .001) and completion (76.6% vs 11.6%, P < .001), improvement in behavior problems, hyperactivity, and internalizing problems (P < .05 to .01), and parental stress (P < .05-.001), remission in behavior and internalizing problems (P < .01, .05), goal improvement (P < .05 to .001), treatment response (P < .05), and consumer satisfaction (P < .05). DOCC pediatricians reported greater perceived practice change, efficacy, and skill use to treat ADHD (P < .05 to .01). CONCLUSIONS Implementing a collaborative care intervention for behavior problems in community pediatric practices is feasible and broadly effective, supporting the utility of integrated behavioral health care services.
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Affiliation(s)
- David J. Kolko
- Departments of Psychiatry,,Psychology, and Pediatrics, School of Medicine,,Special Services Unit, Western Psychiatric Institute and Clinic,,Clinical and Translational Science Institute
| | - John Campo
- Department of Psychiatry, Ohio State University, Columbus, Ohio; and
| | - Amy M. Kilbourne
- VA Ann Arbor Center for Clinical Management Research and Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Jonathan Hart
- Special Services Unit, Western Psychiatric Institute and Clinic
| | | | - Stephen Wisniewski
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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