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Manning A, Weingard M, Fabricius J, French A, Sendak M, Davis N. Be ExPeRT (Behavioral Health Expansion in Pediatric Residency Training): A Case-Based Seminar. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2023; 19:11326. [PMID: 37534018 PMCID: PMC10392710 DOI: 10.15766/mep_2374-8265.11326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 04/08/2023] [Indexed: 08/04/2023]
Abstract
Introduction Pediatric residents report behavioral or mental health (B/MH) assessment and treatment as a training gap and often feel ill-equipped to address these issues in clinical practice. We developed a novel interactive training program to improve resident confidence in managing common pediatric B/MH conditions. Methods The Be ExPeRT curriculum comprised a half-day interactive seminar on attention deficit hyperactivity disorder, anxiety, depression, and suicidality followed by monthly case-based discussions. Content included didactic material, role-play, and case discussion. The training was optional and open to pediatric or combined medicine-pediatrics trainees. Results Twenty-three residents (70% female) participated in four separate seminars over 2 years. Of the participants attending the seminars, 17 (74%) completed the presurvey, and 16 (70%) completed the postsurvey. Statistically significant improvement was noted in comfort treating major depressive disorder (41% pre, 94% post, p = .002), suicide risk (29% pre, 94% post, p < .001), and anxiety (24% pre, 94% post, p < .001) following program participation. Twelve (75%) of the 16 participants completing the survey rated the training in the top 5%-10% with respect to other resident learning experiences. Discussion We developed this curriculum to enhance trainee knowledge and comfort in addressing common pediatric B/MH conditions in primary care. Significant improvement was noted in self-reported comfort in treating major depressive disorder, suicide risk, and anxiety, and the program was well received. The curriculum can be adapted for use in any training program for primary care providers to provide B/MH education that may be lacking or supplement existing programming.
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Affiliation(s)
- Alison Manning
- Assistant Professor and Clinician Educator, Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University
| | - Matthew Weingard
- Assistant Professor, Division of Pediatric Behavioral Health, Department of Pediatrics, University of Utah and Intermountain Primary Children's Hospital
| | - Jacqueline Fabricius
- Pediatric Rheumatology Fellow, Department of Pediatrics, Northwestern University Feinberg School of Medicine
| | - Alexis French
- Medical Instructor, Division of Child & Family Mental Health & Community Psychiatry, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
| | - Mya Sendak
- Consulting Associate, Department of Pediatrics, Duke University School of Medicine
| | - Naomi Davis
- Assistant Professor, Division of Child & Family Mental Health & Community Psychiatry, Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine
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Adiba A, Sidhu SS, Shaligram D, Khan M, Qayyum Z. Advances in Child Psychiatry Education and Training. ADVANCES IN PSYCHIATRY AND BEHAVIORAL HEALTH 2023; 3:S2667-3827(23)00006-6. [PMID: 38620094 PMCID: PMC10132457 DOI: 10.1016/j.ypsc.2023.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
The article provides a comprehensive overview of the current state of child and adolescent psychiatry, including historical background and the impact of the COVID-19 pandemic. It discusses recent advances in theoretical frameworks related to physician burnout, prevention, access to care, diversity, equity, and inclusion, and trauma-informed care. The authors conclude by emphasizing the importance of education and training in improving the lives of youth and families and encourage their colleagues to push the boundaries of education and training for a better today and brighter tomorrow, while honoring and doing justice to those they serve.
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Affiliation(s)
- Afifa Adiba
- Sheppard Pratt Health System, Towson, MD, USA
- University of Maryland, 6501 North Charles Street, Baltimore, MD 21204, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Shawn Singh Sidhu
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, University of California San Diego Medical Center, UCSD Medical Center, Rady Children's Hospital of San Diego, 2125 Citracado Parkwy, Escondido, CA 92029, USA
| | - Deepika Shaligram
- Boston Children's Hospital, Harvard Medical School, 9 Hope Avenue, Waltham, MA 02453, USA
| | - Manal Khan
- University of California, 300 Medical Plaza Driveway, Los Angeles, CL 90095, USA
| | - Zheala Qayyum
- Harvard Medical School, Yale School of Medicine, 300 Longwood Avenue, Boston, MA 02115, USA
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Kass M, Alexander L, Moskowitz K, James N, Salum GA, Leventhal B, Merikangas K, Milham MP. Robust Parental Preferences in Mental Health Screening in Youth From a Multinational Online Survey. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.09.23285610. [PMID: 36798244 PMCID: PMC9934784 DOI: 10.1101/2023.02.09.23285610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Importance Screening youth for mental disorders may assist in prevention, promote early identification, and reduce related lifetime impairment and distress. Objective The goal was to survey parents about their comfort and preferences for pediatric mental health screening, as well as factors associated with these preferences. Design The online survey was available July 11-14, 2021 on Prolific Academic. Analyses were conducted from November 2021 to November 2022. Setting Online survey. Participants The survey was administered to English-speaking parents with at least one 5-21-year old child at home. The sample included 972 parents, aged 21 and older, from the United States ( n =265), United Kingdom ( n =282), Canada ( n =171), and Other Countries ( n =254). Exposures None. Main Outcomes/Measures Parental preferences regarding the screening content, implementation preferences, and screener reviewing preferences of pediatric mental health screening were assessed in a novel survey. Mixed effects logistic models were employed to evaluate factors that influence parental comfort levels. Results Parents, aged 21 to 65 ( M =39.4; 62.3% female), supported annual mental health screening for their child and preferred reviewing the screening results with professional staff (e.g., physicians). Parents preferred parent-report over child self-reports, though they were generally comfortable with both options. Despite slight variations based on country of residence, screening topic, and child's age, parents were generally comfortable discussing all 21 topics. The greatest comfort was with sleep problems; the least comfort was with firearms, gender identity, suicidality, and substance use/abuse. Conclusions/Relevance Our data indicated that parents support annual parent- and child self-report mental health screening in primary care settings, but comfort levels differ according to various factors, such as screening topic. Parents preferred screening to occur in the healthcare office and to discuss screening results with professional staff. In addition to parental need for expert guidance, the growing awareness of child mental health needs highlights the importance of addressing mental health concerns early via regular mental health screenings. KEY POINTS Question: What are parents' attitudes towards pediatric mental health screening in primary care settings?Findings: The vast majority of parents surveyed online ( N=972) expressed comfort with the screening of children for mental health concerns in the primary care setting. Variations in comfort were noted in relation to age of child and topics included. Parents expressed a preference for parent report over child report, as well as for reviewing screening results with professional medical staff. These findings were robust to the country of residence (e.g., United States, Canada, United Kingdom). Meaning: Our findings document parental preferences that should be incorporated to enhance the feasibility of mental health screening in primary care settings.
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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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Perrin JM, Flanagan P, Katkin J, Barabell G, Price J. The Unique Value Proposition of Pediatric Health Care. Pediatrics 2023; 151:190498. [PMID: 36995185 DOI: 10.1542/peds.2022-060681] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This document provides a framework for the value proposition of pediatric health care. It is intended to provide a succinct set of principles for establishing this proposition that demonstrates the short- and long-term value to the child and family, the health care system, and society as a whole.
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Affiliation(s)
- James M Perrin
- MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | - Patricia Flanagan
- W. Alpert Medical School of Brown University/Hasbro Children's Hospital Department of Pediatrics, Providence, Rhode Island
| | - Julie Katkin
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - Jonathan Price
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
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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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Shaligram D, Walter HJ. Utilization and Outcomes of Direct Consultation in a Child Psychiatry Access Program. Psychiatr Serv 2023; 74:100-103. [PMID: 36226370 DOI: 10.1176/appi.ps.20220093] [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: 01/04/2023]
Abstract
The high prevalence of child and adolescent psychiatric disorders in the United States, coupled with the severe and pervasive shortage of child and adolescent psychiatrists, has led 46 states and territories to launch programs providing child psychiatry consultation to pediatricians. Although these programs aim to increase access to psychiatric expertise, evidence of favorable program outcomes beyond user satisfaction has been limited. Findings from the authors' child psychiatry consultation program suggest that such programs may enable pediatricians to manage most cases referred for consultation, thereby extending the behavioral health workforce to the primary care setting.
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Affiliation(s)
- Deepika Shaligram
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, and Harvard Medical School, Boston
| | - Heather J Walter
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, and Harvard Medical School, Boston
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Godoy L, Hamburger S, Druskin LR, Willing L, Bostic JQ, Pustilnik SD, Beers LS, Biel MG, Long M. DC Mental Health Access in Pediatrics: Evaluating a Child Psychiatry Access Program in Washington, DC. J Pediatr Health Care 2022; 37:302-310. [PMID: 36529554 DOI: 10.1016/j.pedhc.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/11/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Child psychiatry access programs (CPAPs) provide primary care providers (PCPs) with assistance in mental health diagnosis, management, and resource navigation. METHOD Data collected from DC Mental Health Access in Pediatrics (MAP) included PCPs and patient demographics, clinical encounter information, and provider satisfaction. RESULTS DC MAP consult volume increased 349.3% over the first 5 years. Services requested included care coordination (85.8%), psychiatric consultation (21.4%), and psychology/social work consultation (9.9%). Of psychiatry-involved consultations, PCPs managed patient medication care with DC MAP support 50.5% of the time. Most (94.1%) PCPs said they would recommend colleagues use DC MAP, and 29.6% reported diverting patients from the emergency departments using DC MAP. DISCUSSION DC MAP grew quickly, highlighting program impact and need. Demand for care coordination required flexible staffing and highlighted the need for coordination in pediatrics. Child psychiatry access programs offer an innovative way to enhance PCP management of their patients' mental health needs.
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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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Nayak SS, Carpenito T, Zamechek L, Roper K, Méndez-Peñate L, Arty M, Moulin C, Mirand D, Molnar BE. Predictors of Service Utilization of Young Children and Families Enrolled in a Pediatric Primary Care Mental Health Promotion and Prevention Program. Community Ment Health J 2022; 58:1191-1206. [PMID: 35043286 DOI: 10.1007/s10597-021-00929-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
Understanding early childhood mental health service utilization in community-based clinical settings is important. Project Linking Actions for Unmet Needs in Children's Health (Project LAUNCH) provided mental health-related services for young children and families within pediatric medical homes. Using data from the Project LAUNCH evaluation (n = 106), we implemented negative binomial regression models to determine if baseline variables were associated with service utilization, defined as the number of encounters between the family and the team. Past-year homelessness emerged as a significant predictor of service utilization. Encounters for families with children who experienced homelessness within the last 12 months occurred at a rate 34.5% lower than those who had not experienced homelessness. Results highlight the importance of addressing homelessness as a barrier to mental health service utilization for families. Screening for recent housing insecurity and developing interventions that integrate housing support services into mental health programs may inform strategies to increase attendance for families with young children.
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Affiliation(s)
- Sameera S Nayak
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Thomas Carpenito
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Lynn Zamechek
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Kate Roper
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Larisa Méndez-Peñate
- Massachusetts Department of Public Health, Bureau of Family Health and Nutrition, Boston, MA, USA
| | - Malika Arty
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Christy Moulin
- Early Childhood and Family Mental Health Program, Boston Public Health Commission, Boston, MA, USA
| | - Daphney Mirand
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA
| | - Beth E Molnar
- Institute for Health Equity and Social Justice Research, Northeastern University, 360 Huntington Ave, Mail Stop 314 INV, Boston, MA, 02115, USA.
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Agazzi H, Dickinson S, Plant RM. Helping Our Toddlers, Developing Our Children's Skills: Innovative Behavioral Management Training for Pediatric Residents. Adv Pediatr 2022; 69:13-21. [PMID: 35985705 DOI: 10.1016/j.yapd.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article describes the implementation of a behavioral management training program into pediatric and combined medicine-pediatric residencies at a large urban academic medical center in southwest Florida. We describe 2 modalities for training residents in effective behavioral modification strategies immediately useable in pediatric practice. Results indicate that residents significantly increased their knowledge of effective, evidence-based strategies and continued to use them 6 to 12 months following completion of the training.
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Affiliation(s)
- Heather Agazzi
- Department of Pediatrics, University of South Florida, 13101 North Bruce B Downs Boulevard, CMS 2078, Tampa, FL 33612, USA.
| | - Sarah Dickinson
- Department of Pediatrics, University of South Florida, 13101 North Bruce B Downs Boulevard, CMS 2078, Tampa, FL 33612, USA
| | - Rebecca M Plant
- University of South Florida, Department of Neurology, 2 Tampa General Circle, 5007 Tampa, FL 33606, USA
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Vidal C, Lyman C, Brown G, Hynson B. Reclaiming public spaces: The case for the built environment as a restorative tool in neighborhoods with high levels of community violence. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:2399-2410. [PMID: 34990030 DOI: 10.1002/jcop.22783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Early-life exposure to neighborhood violence can negatively affect children's socioemotional development and long-term health outcomes. Community-level interventions that modify the built environment to facilitate social encounters can have a positive impact on health. An example of such interventions is the building of green spaces and playgrounds. This case study describes collaboration among residents, local organizations, and a university that aimed to increase the utilization of a vacant lot by converting it into a green space with a playground. Informal conversations at volunteer gatherings and neighborhood association meetings indicated a positive impact of this project in the community. We propose a model for future program implementation and research to improve health in disinvested and disordered communities. We conclude that more research is needed on community partnerships that modify the built environment to decrease community violence. Community-based participatory research may be successful in evaluating future projects with this goal.
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Affiliation(s)
- Carol Vidal
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Gwen Brown
- Baltimoreans United in Leadership Development (BUILD), Baltimore, Maryland, USA
| | - Briony Hynson
- Neighborhood Design Center (NDC), Baltimore, Maryland, USA
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Ani C, Ayyash HF, Ogundele MO. Community paediatricians' experience of joint working with child and adolescent mental health services: findings from a British national survey. BMJ Paediatr Open 2022; 6:e001381. [PMID: 36053646 PMCID: PMC9020286 DOI: 10.1136/bmjpo-2021-001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/30/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Children and young people (CYP) presenting to paediatric or child and adolescent mental health services (CAMHS) often have needs spanning medical and psychiatric diagnoses. However, joint working between paediatrics and CAMHS remains limited. We surveyed community paediatricians in the UK to inform better strategies to improve joint working with CAMHS. METHODS We conducted an online survey of community paediatricians through the British Association for Community Child Health (BACCH) on how much joint working they experienced with CAMHS, any hindrances to more collaborative working, and the impact on service users and service provision. This paper is based on thematic analysis of 327 free-text comments by paediatricians. RESULTS A total of 245 community paediatricians responded to the survey (22% of BACCH members). However, some responses were made on behalf of teams rather than for individual paediatricians. The following were the key themes identified: a strong support for joint working between community paediatrics and CAMHS; an acknowledgement that current levels of joint working were limited; the main barriers to joint working were splintered commissioning and service structures (eg, where integrated care systems fund different providers to meet overlapping children's health needs); and the most commonly reported negative impact of non-joint working was severely limited access to CAMHS for CYP judged by paediatricians to require mental health support, particularly those with autism spectrum disorder. CONCLUSION There is very limited joint working between community paediatrics and CAMHS in the UK, which is associated with many adverse impacts on service users and providers. A prointegration strategy that includes joint commissioning of adequately funded paediatric and CAMHS services that are colocated and within the same health management organisations is crucial to improving joint working between paediatrics and CAMHS.
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Affiliation(s)
- Cornelius Ani
- Division of Psychiatry, Imperial College London, Faculty of Medicine, London, UK
- Child and Adolescent Mental Health Service, Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
- Executive Committee Member, Child and Adolescent Psychiatric Surveillance System, Royal College of Psychiatry, London, UK
| | - Hani F Ayyash
- Executive Committee Member, Child and Adolescent Psychiatric Surveillance System, Royal College of Psychiatry, London, UK
- Integrated Department of Paediatrics, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, UK
- Scientific Committee Member, British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, London, UK
| | - Michael Oladipo Ogundele
- Halton Community Paediatrics Unit, Bridgewater Community Healthcare NHS Foundation Trust, Runcorn, UK
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Bourassa KJ, Moffitt TE, Ambler A, Hariri AR, Harrington H, Houts RM, Ireland D, Knodt A, Poulton R, Ramrakha S, Caspi A. Association of Treatable Health Conditions During Adolescence With Accelerated Aging at Midlife. JAMA Pediatr 2022; 176:392-399. [PMID: 35188538 PMCID: PMC8861897 DOI: 10.1001/jamapediatrics.2021.6417] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Biological aging is a distinct construct from health; however, people who age quickly are more likely to experience poor health. Identifying pediatric health conditions associated with accelerated aging could help develop treatment approaches to slow midlife aging and prevent poor health in later life. OBJECTIVE To examine the association between 4 treatable health conditions in adolescence and accelerated aging at midlife. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from participants in the Dunedin Study, a longitudinal investigation of health and behavior among a birth cohort born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand, and followed up until age 45 years. Participants underwent an assessment at age 45 years and had data for at least 1 adolescent health condition (asthma, smoking, obesity, and psychological disorders) and outcome measure (pace of aging, gait speed, brain age, and facial age). Data analysis was performed from February 11 to September 27, 2021. EXPOSURES Asthma, cigarette smoking, obesity, and psychological disorders were assessed at age 11, 13, and 15 years. MAIN OUTCOMES AND MEASURES The outcome was a midlife aging factor composite score comprising 4 measures of biological aging: pace of aging, gait speed, brain age (specifically, BrainAGE score), and facial age. RESULTS A total of 910 participants (459 men [50.4%]) met the inclusion criteria, including an assessment at age 45 years. Participants who had smoked daily (0.61 [95% CI, 0.43-0.79] SD units), had obesity (0.82 [95% CI, 0.59-1.06] SD units), or had a psychological disorder diagnosis (0.43 [95% CI, 0.29-0.56] SD units) during adolescence were biologically older at midlife compared with participants without these conditions. Participants with asthma were not biologically older at midlife (0.02 [95% CI, -0.14 to 0.19] SD units) compared with those without asthma. These results remained unchanged after adjusting for childhood risk factors such as poor health, socioeconomic disadvantage, and adverse experiences. CONCLUSIONS AND RELEVANCE This study found that adolescent smoking, obesity, and psychological disorder diagnoses were associated with older biological age at midlife. These health conditions could be treated during adolescence to reduce the risk of accelerated biological aging later in life.
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Affiliation(s)
- Kyle J. Bourassa
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina,Geriatric Research, Education, and Clinical Center, Veterans Affairs Durham Healthcare System, Durham, North Carolina,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Terrie E. Moffitt
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina,Institute of Psychiatry, King’s College London, London, United Kingdom,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
| | - Antony Ambler
- Institute of Psychiatry, King’s College London, London, United Kingdom
| | - Ahmad R. Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - HonaLee Harrington
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Renate M. Houts
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - David Ireland
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Annchen Knodt
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - Richie Poulton
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Sandhya Ramrakha
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Avshalom Caspi
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina,Institute of Psychiatry, King’s College London, London, United Kingdom,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina,Center for Genomic and Computational Biology, Duke University, Durham, North Carolina
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15
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Crandal BR, Aguinaldo LD, Carter C, Billman GF, Sanderson K, Kuelbs C. Opportunities for Early Identification: Implementing Universal Depression Screening with a Pathway to Suicide Risk Screening in a Pediatric Health Care System. J Pediatr 2022; 241:29-35.e1. [PMID: 34695448 PMCID: PMC8792242 DOI: 10.1016/j.jpeds.2021.10.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To describe the implementation process and assess results of a large-scale universal depression screening program with pathways to suicide risk screening in a pediatric integrated delivery network. STUDY DESIGN This retrospective study analyzes depression and suicide risk screening data for 95 613 patients ages 12-17 years. RESULTS Of the 95 613 adolescent patients who were screened for depression, 2.4% (2266) screened positive for risk for moderate-severe depression (>10 Patient Health Questionnaire; 9-item version) and 4.1% (3942) endorsed elevated suicide risk (≥1 Columbia Suicide Severity Rating Scale). Overall, 51% of screened patients who present with a primary psychiatric concern screened positive for elevated risk of suicide (2132). Two percent of screened patients who presented with a primary medical concern screened positive for elevated risk of suicide. Nearly one-half (45.9%) of all elevated suicide risk screenings were from patients with a primary medical concern. CONCLUSIONS A large-scale universal depression screening program with a pathway to identify elevated suicide risk was implemented in a pediatric health care system using the Patient Health Questionnaire and the Columbia Suicide Severity Rating Scale. This screening program identified youth with moderate-severe depression and elevated risk for suicide with and without presenting psychiatric concerns across service settings.
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Affiliation(s)
| | | | | | | | | | - Cynthia Kuelbs
- Rady Children's Hospital, San Diego, San Diego, CA; Department of Pediatrics, University of San Diego, La Jolla, CA
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16
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Sheridan DC, Marshall R, Nunez Morales A, Johnson K. Access to Outpatient Pediatric Mental Health Care After Emergency Department Discharge. Pediatr Emerg Care 2021; 37:e1388-e1391. [PMID: 32150001 DOI: 10.1097/pec.0000000000002057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pediatric mental health presentations to emergency departments (EDs) have shown dramatic increases nationally. This study aimed to identify the ability of patients discharged with mental health from the ED to establish outpatient care. METHODS This was a cross-sectional study of all mental health patients aged 7 to 19 years who were seen by a child psychiatry consult team in a tertiary care pediatric ED from September 2016 to January 2017. Patients were contacted by phone at least 6 months after discharge. Data obtained included time to follow-up, reasons for delayed follow-up, type of provider seen, and frequency of outpatient visits. RESULTS Two hundred twenty-eight charts were reviewed and 51 were successfully interviewed. The median age was 14 years and 61% were female. Most patients (61%) reported seeing a psychiatrist or therapist, whereas 19% reported a primary care provider and 19% reporting "other." The majority were able to establish care within 1 month (73%), whereas 9% reported never obtaining outpatient follow-up. Most patients (58%) were able to be seen more than once per month. The most common reason for delayed follow-up was provider availability. CONCLUSIONS This study found that a large number of patients were able to be seen within 1 month of discharge for mental health care. However, almost 10% of patients never established outpatient care, which is concerning and is an area needing further research.
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Affiliation(s)
| | - Rebecca Marshall
- Child and Adolescent Psychiatry, Oregon Health & Science University, Portland, OR
| | | | - Kyle Johnson
- Child and Adolescent Psychiatry, Oregon Health & Science University, Portland, OR
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17
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Mazur SL, Edelsohn GA, DePergola PA, Sarvet BD. Ethical Imperatives for Participation in Integrated/Collaborative Care Models for Pediatric Mental Health Care. Child Adolesc Psychiatr Clin N Am 2021; 30:697-712. [PMID: 34538442 DOI: 10.1016/j.chc.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The significant and ongoing shortage of child and adolescent psychiatrists has limited access to mental health care in the pediatric population. In response to this problem, integrated/collaborative care models have been established. These models, as all imperfect things in medicine, have their own set of challenges. A careful ethical analysis of integrated/collaborative care models is essential to protect the social and emotional health and safety of children with mental illness. To this end, ethical assessment supports the use of integrated/collaborative care models, and recent studies have demonstrated the benefits of their implementation.
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Affiliation(s)
- Shannon L Mazur
- Department of Psychological Medicine, Yale New Haven Hospital, 20 York Street, Fitkin 607, New Haven, CT 06510, USA.
| | - Gail A Edelsohn
- Community Care Behavioral Health Organization, UPMC Insurance Services Division, 1 East Uwchlan Avenue, Suite 311, Exton, PA 19341, USA
| | - Peter A DePergola
- Department of Medicine, University of Massachusetts Medical School - Baystate, 759 Chestnut Street, Daly 6100B, Springfield, MA 01199, USA; Department of Bioethics and Medical Humanities, College of Our Lady of the Elms, 291 Springfield Street, Chicopee, MA 01013, USA; St. Augustine Center for Ethics, Religion, and Culture, College of Our Lady of the Elms, 291 Springfield Street, Chicopee, MA 01013, USA
| | - Barry D Sarvet
- Department of Psychiatry, University of Massachusetts Medical School - Baystate, 759 Chestnut Street, WG703, Springfield, MA 01199, USA
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18
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van Driessche A, van Stel HF, Vink RM, Staal IIE. Assessing Concerns and Care Needs of Expectant Parents: Development and Feasibility of a Structured Interview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9585. [PMID: 34574510 PMCID: PMC8467634 DOI: 10.3390/ijerph18189585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/30/2021] [Accepted: 09/09/2021] [Indexed: 11/18/2022]
Abstract
Many adverse situations for parenting and healthy child development can be detected before a child's birth. The aim of this project was to develop and test an instrument to use in prenatal home visits, to improve the identification of adverse situations and care needs during pregnancy. The preSPARK is based on a valid and reliable broad-scope structured interview called SPARK (Structured Problem Analysis of Raising Kids). The preSPARK focuses on 12 topics ranging from aspects of the period before pregnancy to future parents' expectations. The preSPARK was tested in daily practice for feasibility and discriminative capacity. User experience was assessed from the perspective of the professional. In total, 64 home visits using the preSPARK were carried out by 21 nurses. About 24% of the expectant parents needed intensive help or immediate action on one or more topics. The risk assessment showed 29% of the participants were at high risk, 40% at increased risk, and 31% at low risk for future parenting and child developmental problems. The nurses indicated that the preSPARK provides a good structure for home visits and gives insight in interrelated factors. The preSPARK is feasible in daily practice and clarifies risks and care needs of expectant parents.
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Affiliation(s)
| | - Henk F. van Stel
- Julius Centre for Health Sciences and Primary Care, Department of Healthcare Innovation and Evaluation, University Medical Centre Utrecht, 3584 CG Utrecht, The Netherlands
| | - Remy M. Vink
- TNO Innovation for Life, 2316 ZL Leiden, The Netherlands;
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19
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Green CM, Leyenaar JK, Nuncio B, Leslie LK. Where Do Future Pediatricians Learn Behavioral and Mental Health Skills? Acad Pediatr 2021; 21:1288-1296. [PMID: 34058405 DOI: 10.1016/j.acap.2021.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This national study identified the rotations in which pediatric residents received training in the assessment and treatment of behavioral/mental health (B/MH) problems, and examined associations between learning B/MH skills during multiple clinical rotations and resident-reported interest in B/MH issues. METHODS Cross-sectional survey of applicants for the initial American Board of Pediatrics certifying exam (62.4% response rate; 1555 eligible respondents). Respondents reported their overall interest in B/MH issues, and specified where they had received training in 7 B.M. assessment skills and 8 treatment skills. Logistic regression models were estimated to identify associations between learning B/MH assessment and treatment skills in multiple clinical rotations and resident-reported B/MH interest, adjusting for respondent characteristics. RESULTS Respondents reported continuity clinic as the predominant site of B/MH learning, followed by development-behavioral and adolescent rotations. Multisite learning varied across B/MH skills, ranging from 45.1 % (n = 678) for using rating scales to titrate medications to 82.1% (n = 1234) for eliciting parent concerns. 946 (63.2%) reported having overall interest in B/MH issues. Adjusting for respondent characteristics, learning the majority of B/MH skills in >1 rotation was associated with an increased odds of B/MH interest for both assessment and treatment domains (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI] 1.16-1.83 for assessment skills and aOR = 1.36, 95% CI 1.09-1.69 for treatment skills). CONCLUSIONS The majority of residents report learning B/MH skills in continuity clinic, with substantial variation in the proportion learning these skills in more than one rotation. Teaching B/MH skills during multiple clinical rotations may enhance resident interest in B/MH care delivery for children.
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Affiliation(s)
- Cori M Green
- Department of Pediatrics, Weill Cornell Medicine (CM Green), New York, NY; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center (JK Leyenaar), Lebanon, NH; American Board of Pediatrics (B Nuncio, LK Leslie), Chapel Hill, NC.
| | - JoAnna K Leyenaar
- Department of Pediatrics, Weill Cornell Medicine (CM Green), New York, NY; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center (JK Leyenaar), Lebanon, NH; American Board of Pediatrics (B Nuncio, LK Leslie), Chapel Hill, NC
| | - Brenda Nuncio
- Department of Pediatrics, Weill Cornell Medicine (CM Green), New York, NY; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center (JK Leyenaar), Lebanon, NH; American Board of Pediatrics (B Nuncio, LK Leslie), Chapel Hill, NC
| | - Laurel K Leslie
- Department of Pediatrics, Weill Cornell Medicine (CM Green), New York, NY; The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center (JK Leyenaar), Lebanon, NH; American Board of Pediatrics (B Nuncio, LK Leslie), Chapel Hill, NC
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20
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Walter HJ, Vernacchio L, Correa ET, Bromberg J, Goodman E, Barton J, Young GJ, DeMaso DR, Focht G. Five-Phase Replication of Behavioral Health Integration in Pediatric Primary Care. Pediatrics 2021; 148:peds.2020-001073. [PMID: 34210739 DOI: 10.1542/peds.2020-001073] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Because of severe and protracted shortages of pediatric behavioral health (BH) specialists, collaboration between pediatric primary care practitioners (PCPs) and BH specialists has the potential to increase access to BH services by expanding the BH workforce. In a previous study, we demonstrated that phase 1 of a behavioral health integration program (BHIP) enrolling 13 independently owned, community-based pediatric practices was associated with increased access to BH services while averting substantial cost increases and achieving high provider self-efficacy and professional satisfaction. The current study was undertaken to assess whether the initial access findings were replicated over 4 subsequent implementation phases and to explore the practicality of broad dissemination of the BHIP model. METHODS After phase 1, BHIP was extended over 4 subsequent phases in a stepped-wedge design to 46 additional pediatric practices, for a total cohort of 59 practices (354 PCPs serving >300 000 patients). Program components comprised BH education and consultation and support for integrated practice transformation; these components facilitated on-site BH services by an interprofessional BH team. Outcomes were assessed quarterly, preprogram and postprogram launch. RESULTS Across combined phases 1 to 5, BHIP was associated with increased primary care access to BH services (screening, psychotherapy, PCP BH visits, psychotropic prescribing) and performed well across 7 standard implementation outcome domains (acceptability, appropriateness, feasibility, fidelity, adoption, penetration, and sustainability). Emergency BH visits and attention-deficit/hyperactivity disorder prescribing were unchanged. CONCLUSIONS These findings provide further support for the potential of integrated care to increase access to BH services in pediatric primary care.
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Affiliation(s)
- Heather J Walter
- Departments of Psychiatry .,Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | - Louis Vernacchio
- Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts.,Pediatric Physicians' Organization at Children's, Boston, Massachusetts
| | | | - Jonas Bromberg
- Departments of Psychiatry.,Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts
| | | | - Jessica Barton
- Social Work, Boston Children's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Gregory J Young
- Pediatrics.,Social Work, Boston Children's Hospital, Boston, Massachusetts.,Pediatric Physicians' Organization at Children's, Boston, Massachusetts
| | | | - Glenn Focht
- Connecticut Children's Medical Center, Hartford, Connecticut
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21
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Fallucco EM, Landy RE, Leung K, Robertson Blackmore E. Child Psychiatry Consultation Clinic for Pediatricians: Long-Term Outcomes. Clin Pediatr (Phila) 2021; 60:350-362. [PMID: 34008439 DOI: 10.1177/00099228211015844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is an urgent need for new clinical models to improve access to child mental health care. Pediatricians are tasked to care for youth with mild to moderate mental health problems, but require additional training. This article describes an outpatient child psychiatry consultation clinic (CPC) designed to empower pediatricians to care for youth with depression, anxiety, and attention deficit/hyperactivity disorder. Over a 2-year period, 40 primary care physicians (PCPs) referred 159 patients to the CPC. The most common primary diagnoses of patients seen for consultation were generalized anxiety disorder (35%), major depressive disorder (24%), and attention deficit/hyperactivity disorder (20%). Most patients (89%) had at least 2 psychiatric diagnoses. Nearly four fifths (79%) of these patients successfully returned to their PCP for ongoing care. PCPs reported that the CPC enhanced their skills and improved access to mental health care. Similar models are needed to facilitate early intervention for the millions of youth with mental health problems.
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Affiliation(s)
- Elise M Fallucco
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | | | - Kitty Leung
- University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
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22
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deJong NA, Wofford M, Song PH, Kappelman MD. Association of Care Coordination Experience and Health Services Use with Main Provider Type for Children with Inflammatory Bowel Disease. J Pediatr 2021; 234:142-148.e1. [PMID: 33798510 PMCID: PMC8238824 DOI: 10.1016/j.jpeds.2021.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/29/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe care coordination experience for families of children with inflammatory bowel disease (IBD) and compare use of health services between families who identified a primary care physician (PCP) vs a gastroenterologist as a child's main provider. STUDY DESIGN This is a cross-sectional survey of care coordination experiences and health services use for children 6-19 years old receiving care in the IBD program at a children's hospital during 2018. English-speaking parents completed the Family Experiences with Coordination of Care Survey about their child's main provider and reported past-year health services. Bivariate testing and multivariate logistic regression explored differences in care coordination experience and health services by main provider, adjusted for demographic and clinical variables. RESULTS A total of 113 of 270 (42%) invited patients participated. Among 101 patients with complete data, 41% identified a PCP main provider. Performance on 5 of 16 Family Experiences with Coordination of Care indicators was higher for patients reporting a gastroenterologist vs a PCP main provider. However, having a PCP vs gastroenterologist main provider was associated with greater use of any past-year primary care services (adjusted proportion 94% vs 75%; P = .01) and of mental health services when needed (95% vs 60%; P < .01). Need for IBD-related hospitalization and emergency department visits did not differ between groups. CONCLUSIONS Children with IBD may experience trade-offs in care coordination quality and important, non-disease-focused health services based on whom parents perceive as the main provider. Efforts to enhance cross-team coordination among families and primary and specialty care teams are needed to improve overall care quality.
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Affiliation(s)
- Neal A. deJong
- Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine
| | - Marie Wofford
- Department of Emergency Medicine, Carolinas Medical Center
| | - Paula H. Song
- Department of Health Administration, VCU College of Health Professions
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23
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Herbst R, Rybak T, Meisman A, Whitehead M, Rosen B, Crosby LE, Klein MD, Real FJ. A Virtual Reality Resident Training Curriculum on Behavioral Health Anticipatory Guidance: Development and Usability Study. JMIR Pediatr Parent 2021; 4:e29518. [PMID: 34081601 PMCID: PMC8244725 DOI: 10.2196/29518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/19/2021] [Accepted: 05/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Behavioral health disorders have steadily increased and been exacerbated by the COVID-19 pandemic. Though behavioral health disorders can be successfully mitigated with early implementation of evidence-based parent management strategies, education for pediatric residents on behavioral health anticipatory guidance has been limited to date, with training challenges compounded by the physical distancing requirements of the COVID-19 pandemic. Virtual reality (VR) simulations provide an opportunity to train residents on this complex competency by allowing deliberate practice of necessary skills while adhering to current social distancing guidelines. OBJECTIVE This study explored the usability of a VR-based behavioral health anticipatory guidance curriculum for pediatric residents. METHODS This mixed methods study included 14 postgraduate third-year pediatric residents who completed the behavioral health anticipatory guidance VR curriculum. Residents completed the MEC Spatial Presence Questionnaire to assess immersion in the virtual environment. Semistructured interviews were used to elucidate residents' perspectives on the curriculum's content and format. The interviews were analyzed using conventional content analysis. RESULTS Quantitatively, residents reported a high degree of immersion, spatial presence, and cognitive involvement. Most residents (11/14, 79%) agreed or strongly agreed that it seemed as though they took part in the action of the simulation. Qualitatively, two themes emerged from the data: (1) the curriculum expands behavioral health anticipatory guidance and motivational interviewing knowledge and skills and (2) VR technology is uniquely positioned to develop competence. These themes revealed that the curriculum expanded their current level of knowledge and skill, addressed training gaps, and was applicable to all residents. Additionally, residents experienced VR as immersive, feasible, realistic to the clinic setting, and a safe space to practice and learn new skills. CONCLUSIONS Pilot data indicates that VR may be an effective tool to teach pediatric residents behavioral health anticipatory guidance, meeting a current gap in medical education training. This VR curriculum is particularly relevant in the context of the COVID-19 pandemic given the increased behavioral health concerns of families.
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Affiliation(s)
- Rachel Herbst
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Tiffany Rybak
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Andrea Meisman
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Monica Whitehead
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Brittany Rosen
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lori E Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Melissa D Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Francis J Real
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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24
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White K, Stetson L, Hussain K. Integrated Behavioral Health Role in Helping Pediatricians Find Long Term Mental Health Interventions with the Use of Assessments. Pediatr Clin North Am 2021; 68:685-705. [PMID: 34044994 DOI: 10.1016/j.pcl.2021.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article explores the role of assessments in integrated behavioral health within a pediatric primary care setting, specifically exploring what valid and reliable standardized assessments may be used and for what concerns the assessment be of most use. The article also considers how assessments used by integrated behavioral health may inform the type of evidenced-based intervention that would be most appropriate and efficacious for the patient, as well as assist in determining if longer term or more formal mental health treatment may be required.
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Affiliation(s)
- Katie White
- Division of Pediatric Psychology, Western Michigan University School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA.
| | - Lydia Stetson
- Division of Pediatric Psychology, Western Michigan University School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
| | - Khadijah Hussain
- MD Candidate Class of 2022, Western Michigan University Homer Stryker, MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008, USA
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25
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Need for Integrated Behavior Health Model in Primary Care. Pediatr Clin North Am 2021; 68:533-540. [PMID: 34044982 DOI: 10.1016/j.pcl.2021.02.009] [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: 11/23/2022]
Abstract
Children and adolescents with clinically concerning behavioral health conditions face several barriers to accessing specialized mental health care. One proposed solution is to improve and expand integrated care provided in the primary health care provider's office. Several strategies can increase pediatrician comfort and willingness to collaborate in diagnosing and treating behavioral health conditions, and increased utilization of new technologies (such as telehealth) are likely to play an increasingly important role in the process.
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26
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McKague DK, Beebe SL, McNelis AM, Dreifuerst KT. Lack of pediatric mental health clinical experiences among FNP students. Arch Psychiatr Nurs 2021; 35:267-270. [PMID: 33966791 DOI: 10.1016/j.apnu.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mental health disorders accounted for approximately 5% of outpatient child and adolescent visits between 2008 and 2011, and 34.8% of these children were seen by a primary care provider. As primary care providers, family nurse practitioners (FNP) are positioned to address mental health issues across the lifespan; however, they require appropriate training and experience. AIM The study examined pediatric mental health assessment clinical experiences in a national survey of FNP students. METHODS A secondary analysis was performed on a data set of FNP students (N = 3940). Frequencies and chi-square analyses were performed to examine pediatric mental health assessment clinical experiences. RESULTS Nearly 30% (n = 1118) of FNP students reported experiencing two or fewer pediatric mental health assessments during their clinical rotations. More than half (53%) of these students were required to set up their own preceptors and clinical sites. CONCLUSION Despite the growing need for mental health care in the U.S, students reported lacking pediatric mental health assessment clinical opportunities. Moreover, students who set up their own clinical sites and preceptors were even less likely to assess pediatric patients' mental health. FNP educators and programs are encouraged to provide students with the support and opportunity for adequate pediatric practice, including mental health assessment.
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Affiliation(s)
- Dustin K McKague
- The George Washington University, School of Nursing, United States of America.
| | - Sarah L Beebe
- The George Washington University, School of Nursing, United States of America
| | - Angela M McNelis
- The George Washington University, School of Nursing, United States of America
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Abstract
Millions of children and adolescents are living with a chronic condition. It is common for mental and behavioral health challenges to arise during their courses of illness. With the complexity of care needed, pediatric subspecialty providers have recognized the need to integrate behavioral health interventions into practice. Continued research in this area has allowed for focused behavioral interventions, particularly in diabetes and asthma. Adult congenital heart programs have adapted a similar model of care and have shown promising success in promotion of health. More established programs have been in existence for childhood cancer and cystic fibrosis.
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Affiliation(s)
- Ethel Clemente
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA.
| | - Gordon Liu
- Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
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Murphy JM, Stepanian S, Riobueno-Naylor A, Holcomb JM, Haile H, Dutta A, Giuliano CP, Bernstein SC, Joseph B, Shui AM, Jellinek MS. Implementation of an Electronic Approach to Psychosocial Screening in a Network of Pediatric Practices. Acad Pediatr 2021; 21:702-709. [PMID: 33285307 DOI: 10.1016/j.acap.2020.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE A network of 18 pediatric practice locations serving predominantly commercially insured patients implemented the electronic administration of the Pediatric Symptom Checklist-17 parent-report (PSC-17P) for all 5.50- to 17.99-year-old children seen for well child visits (WCVs) and wrote up the results as a quality improvement project. The current study investigated this screening over 2 years to assess its implementation and risk rates over time. METHODS Parents completed the PSC-17P electronically before the visit and the scored data were immediately available in the patient's chart. Using billing and screening data, the study tracked rates of overall and positive screening during the first-year baseline (4 months) and full implementation phases of the project in the first (8 months) and second (12 months) year. RESULTS A total of 35,237 patients completed a WCV in the first year. There was a significant improvement in PSC-17P screening rates from the first-year baseline (26.3%) to full implementation (89.3%; P < .001) phases. In the second year, a total of 40,969 patients completed a WCV and 77.9% (n = 31,901) were screened, including 18,024 patients with screens in both years. PSC-17P screening rates varied significantly across the 18 locations and rates of PSC-17P risk differed significantly by practice, insurance type, sex, and age. CONCLUSIONS The current study demonstrated the feasibility of routine psychosocial screening over 2 years using the electronically administered PSC-17P in a network of pediatric practices. This study also corroborated past reports that PSC-17 risk rates differed significantly by insurance type (Medicaid vs commercial), sex, and age group.
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Affiliation(s)
- J Michael Murphy
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (JM Murphy, MS Jellinek), Harvard Medical School, Boston, Mass.
| | - Salpi Stepanian
- Department of Clinical and Quality Programs (S Stepanian, CP Giuliano, SC Bernstein), Affiliated Pediatric Practices, Dedham, Mass
| | - Alexa Riobueno-Naylor
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass
| | - Juliana M Holcomb
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass
| | - Haregnesh Haile
- Department of Psychology (H Haile), The Catholic University of America, Washington, DC
| | - Anamika Dutta
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass
| | - Christopher P Giuliano
- Department of Clinical and Quality Programs (S Stepanian, CP Giuliano, SC Bernstein), Affiliated Pediatric Practices, Dedham, Mass
| | - Shelly C Bernstein
- Department of Clinical and Quality Programs (S Stepanian, CP Giuliano, SC Bernstein), Affiliated Pediatric Practices, Dedham, Mass; Department of Pediatrics (SC Bernstein, MS Jellinek), Harvard Medical School, Boston, Mass
| | | | - Amy M Shui
- Biostatistics Center (AM Shui), Massachusetts General Hospital, Boston, Mass
| | - Michael S Jellinek
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (JM Murphy, MS Jellinek), Harvard Medical School, Boston, Mass; Department of Pediatrics (SC Bernstein, MS Jellinek), Harvard Medical School, Boston, Mass
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29
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Nash KA, Zima BT, Rothenberg C, Hoffmann J, Moreno C, Rosenthal MS, Venkatesh A. Prolonged Emergency Department Length of Stay for US Pediatric Mental Health Visits (2005-2015). Pediatrics 2021; 147:peds.2020-030692. [PMID: 33820850 PMCID: PMC8086002 DOI: 10.1542/peds.2020-030692] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children seeking care in the emergency department (ED) for mental health conditions are at risk for prolonged length of stay (LOS). A more contemporary description of trends and visit characteristics associated with prolonged ED LOS at the national level is lacking in the literature. Our objectives were to (1) compare LOS trends for pediatric mental health versus non-mental health ED visits and (2) explore patient-level characteristics associated with prolonged LOS for mental health ED visits. METHODS We conducted an observational analysis of ED visits among children 6 to 17 years of age using the National Hospital Ambulatory Medical Care Survey (2005-2015). We assessed trends in rates of prolonged LOS and the association between prolonged LOS and demographic and clinical characteristics (race and ethnicity, payer type, and presence of a concurrent physical health diagnosis) using descriptive statistics and survey-weighted logistic regression. RESULTS From 2005 to 2015, rates of prolonged LOS for pediatric mental health ED visits increased over time from 16.3% to 24.6% (LOS >6 hours) and 5.3% to 12.7% (LOS >12 hours), in contrast to non-mental health visits for which LOS remained stable. For mental health visits, Hispanic ethnicity was associated with an almost threefold odds of LOS >12 hours (odds ratio 2.74; 95% confidence interval 1.69-4.44); there was no difference in LOS by payer type. CONCLUSIONS The substantial rise in prolonged LOS for mental health ED visits and disparity for Hispanic children suggest worsening and inequitable access to definitive pediatric mental health care. Policy makers and health systems should work to provide equitable and timely access to pediatric mental health care.
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Affiliation(s)
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | | | - Jennifer Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago and Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and
| | - Claudia Moreno
- Yale Child Study Center, School of Medicine, Yale University, New Haven, Connecticut
| | | | - Arjun Venkatesh
- Emergency Medicine, and,Center for Outcomes Research & Evaluation, New Haven, Connecticut
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Qureshi F, Derks IP, Jaddoe VW, Williams MA, Koenen KC, Tiemeier H, Kubzansky LD. Mental Health in Early Childhood and Changes in Cardiometabolic Dysregulation by Preadolescence. Psychosom Med 2021; 83:256-264. [PMID: 33657082 PMCID: PMC8016708 DOI: 10.1097/psy.0000000000000927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Poor mental health in childhood is associated with a greater risk of cardiometabolic disease in adulthood, but less is known about when these associations begin to emerge. This study tests whether poor mental health (indexed by emotional and behavioral problems) in early childhood predicts increases in cardiometabolic dysregulation over 4 years of follow-up. METHODS Data are from 4327 participants in the Generation R Study. Problem behaviors were reported by mothers using the Child Behavior Checklist at age 6 years. Repeated measurements of six cardiometabolic parameters were collected at ages 6 and 10 years: high-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, systolic and diastolic blood pressures, C-reactive protein, and body mass index. Standardized measures were used to create continuous cardiometabolic dysregulation scores at ages 6 and 10 years. Change in dysregulation was defined as the difference in dysregulation scores over time. Cross-sectional and prospective associations were tested using linear regression, sequentially adjusting for relevant confounders. Additional analyses examined whether prospective relationships were robust to adjustment for baseline levels of dysregulation. RESULTS There was no association between child problem behaviors and cardiometabolic dysregulation at age 6 years. However, higher levels of problem behaviors predicted increases in cardiometabolic dysregulation (β = 0.12, 95% confidence interval = 0.00-0.23) from ages 6 to 10 years. CONCLUSIONS Worse child mental health may be associated with increases in cardiometabolic dysregulation by preadolescence. To our knowledge, this is the first study to demonstrate that adverse physiologic effects of psychological distress identified in adult populations may be observed as early as childhood.
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Affiliation(s)
- Farah Qureshi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
| | - Ivonne P.M. Derks
- Department of Psychology, Education and Child Studies, Erasmus University Rotterdam
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center Rotterdam
| | - Vincent W.V. Jaddoe
- The Generation R Study Group, Department of Pediatrics, Erasmus Medical Center Rotterdam
| | | | | | - Henning Tiemeier
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
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31
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Shanahan L, Hill SN, Bechtiger L, Steinhoff A, Godwin J, Gaydosh LM, Harris KM, Dodge KA, Copeland WE. Prevalence and Childhood Precursors of Opioid Use in the Early Decades of Life. JAMA Pediatr 2021; 175:276-285. [PMID: 33369615 PMCID: PMC7770613 DOI: 10.1001/jamapediatrics.2020.5205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Opioid use disorder and opioid deaths have increased dramatically in young adults in the US, but the age-related course or precursors to opioid use among young people are not fully understood. OBJECTIVE To document age-related changes in opioid use and study the childhood antecedents of opioid use by age 30 years in 6 domains of childhood risk: sociodemographic characteristics; school or peer problems; parental mental illness, drug problems, or legal involvement; substance use; psychiatric illness; and physical health. DESIGN, SETTING, AND PARTICIPANTS This community-representative prospective longitudinal cohort study assessed 1252 non-Hispanic White individuals and American Indian individuals in rural counties in the central Appalachia region of North Carolina from January 1993 to December 2015. Data were analyzed from January 2019 to January 2020. EXPOSURES Between ages 9 and 16 years, participants and their parents were interviewed up to 7 times using the Child and Adolescent Psychiatric Assessment and reported risk factors in 6 risk domains. MAIN OUTCOMES AND MEASURES Participants were assessed again at ages 19, 21, 25, and 30 years for nonheroin opioid use (any and weekly) and heroin use using the structured Young Adult Psychiatric Assessment. RESULTS Of 1252 participants, 342 (27%) were American Indian. By age 30 years, 322 participants had used a nonheroin opioid (24.2%; 95% CI, 21.8-26.5), 155 had used a nonheroin opioid weekly (8.8%; 95% CI, 7.2-10.3), and 95 had used heroin (6.6%; 95% CI, 5.2-7.9). Childhood risk markers for later opioid use included male sex, tobacco use, depression, conduct disorder, cannabis use, having peers exhibiting social deviance, parents with legal involvement, and elevated systemic inflammation. In final models, childhood tobacco use, depression, and cannabis use were most robustly associated with opioid use in young adulthood (ages 19 to 30 years). Chronic depression and dysthymia were strongly associated with any nonheroin opioid use (OR. 5.43; 95% CI, 2.35-12.55 and OR, 7.13; 95% CI, 1.99-25.60, respectively) and with weekly nonheroin opioid use (OR, 8.89; 95% CI, 3.61-21.93 and OR, 11.51; 95% CI, 3.05-42.72, respectively). Among young adults with opioid use, those with heroin use had the highest rates of childhood psychiatric disorders and comorbidities. CONCLUSIONS AND RELEVANCE Childhood tobacco use and chronic depression may be associated with impaired reward system functioning, which may increase young adults' vulnerability to opioid-associated euphoria. Preventing and treating early substance use and childhood mental illness may help prevent later opioid use.
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Affiliation(s)
- Lilly Shanahan
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland,Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Sherika N. Hill
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Laura Bechtiger
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Annekatrin Steinhoff
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Jennifer Godwin
- Center for Child and Family Policy, Duke University, Durham, North Carolina
| | - Lauren M. Gaydosh
- Center for Medicine, Health, and Society, Public Policy Studies, Vanderbilt University, Nashville, Tennessee
| | - Kathleen Mullan Harris
- Carolina Population Center, Department of Sociology, University of North Carolina at Chapel Hill
| | - Kenneth A. Dodge
- Center for Child and Family Policy, Duke University, Durham, North Carolina,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina
| | - William E. Copeland
- Vermont Center for Children, Youth, and Families, Department of Psychiatry, University of Vermont, Burlington
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32
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Shenkman E, Thompson L, Bussing R, Forrest CB, Woodard J, Sun Y, Mack J, Mistry KB, Gurka MJ. Provider Specialty and Receipt of Metabolic Monitoring for Children Taking Antipsychotics. Pediatrics 2021; 147:e20200658. [PMID: 33262265 PMCID: PMC7780961 DOI: 10.1542/peds.2020-0658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Metabolic monitoring is important for children taking antipsychotic medication, given the risk for increased BMI, impaired glucose metabolism, and hyperlipidemia. The purpose was to examine the influence of provider specialty on the receipt of metabolic monitoring. Specifically, differences in the receipt of recommended care when a child receives outpatient care from a primary care provider (PCP), a mental health provider with prescribing privileges, or both was examined. METHODS Medicaid enrollment and health care and pharmacy claims data from 2 states were used in the analyses. Providers were assigned to specialties by using a crosswalk of the National Provider Identifier numbers to specialty type. A total of 41 078 children were included. RESULTS For both states, 61% of children saw ≥1 provider type and had adjusted odds ratios for receiving metabolic monitoring that were significantly higher than those of children seeing PCPs only. For example, children seeing a PCP and a mental health provider with prescribing privileges during the year had adjusted odds of receiving metabolic monitoring that were 42% higher than those seeing a PCP alone (P < .001). CONCLUSIONS Shared care arrangements significantly increased the chances that metabolic monitoring would be done. For states, health plans, and clinicians to develop meaningful quality improvement strategies, identifying the multiple providers caring for the children and potentially responsible for ordering tests consistent with evidence-based care is essential. Provider attribution in the context of shared care arrangements plays a critical role in driving quality improvement efforts.
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Affiliation(s)
| | | | - Regina Bussing
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Yijun Sun
- Departments of Health Outcomes and Biomedical Informatics and
| | - Jasmine Mack
- Departments of Health Outcomes and Biomedical Informatics and
| | - Kamila B Mistry
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Matthew J Gurka
- Departments of Health Outcomes and Biomedical Informatics and
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33
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Mian ND, Pincus DB, Perrin EC, Bair-Merritt M. Identifying and Making Recommendations for Pediatric Anxiety Disorders in Primary Care Settings: A Video-Based Training. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:11033. [PMID: 33324746 PMCID: PMC7732138 DOI: 10.15766/mep_2374-8265.11033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/04/2020] [Indexed: 06/12/2023]
Abstract
Introduction Pediatric anxiety disorders have high rates of prevalence and confer risk for later disorders if they go undetected. In primary care, they are underdiagnosed, partly because pediatricians often lack relevant training. We developed a brief, video-based training program for pediatric residents aimed at improving early identification of anxiety disorders in primary care. Methods Video content was consistent with the American Academy of Pediatrics Behavioral Health Competencies, as applied to the evaluation of anxiety disorders and guidance for discussing treatment options. This training can be delivered in two formats: videos (43 minutes) can be shown in a live, group-based format, or accessed via an online, asynchronous training. We tested this training program using both formats and developed surveys to evaluate knowledge about child anxiety, perceived evaluation skills, and satisfaction with the training. We also developed a video-based vignette to measure sensitivity to detecting disorders (how much the condition is interfering, diagnostic severity, and referral urgency). Results Pediatric residents from two residency programs completed the training and pre- and posttraining assessments to evaluate program efficacy. Residents' knowledge and perceived evaluation skills increased posttraining, with large effect sizes. Residents also demonstrated increased sensitivity to detecting anxiety disorders on the vignette-based assessment and reported high levels of satisfaction. Discussion Our results suggested that residents participating in this training improved their evaluation skills and that residents found the training beneficial. Video-based trainings can significantly supplement existing education. This cost-effective and minimally burdensome training program can be used to enhance resident education in a much-needed area.
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Affiliation(s)
- Nicholas D. Mian
- Assistant Professor, Department of Life Sciences, University of New Hampshire
| | - Donna B. Pincus
- Associate Professor, Department of Psychological and Brain Sciences, Boston University
| | - Ellen C. Perrin
- Professor, Department of Pediatrics, Tufts University School of Medicine
| | - Megan Bair-Merritt
- Professor of Pediatrics, Department of Pediatrics, Boston University Medical School; Director of BMC Pediatrics Center for the Urban Child and Healthy Family
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An Assessment of the Utility of the Youth Mental Health First Aid Training: Effectiveness, Satisfaction, and Universality. Community Ment Health J 2020; 56:1581-1591. [PMID: 32285372 DOI: 10.1007/s10597-020-00612-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/28/2020] [Indexed: 10/24/2022]
Abstract
Youth Mental Health First Aid (YMHFA) is a training program developed to educate child-serving professionals on how to properly identify and respond to mental health needs among children and adolescents. The current study tested the utility of the training by examining the effectiveness, satisfaction, and universality across child-serving occupations. Data collected from 893 child-serving professionals was used to compare training effectiveness and training experiences across four different occupational settings (child welfare, education, support services, and the justice system). Using a pretest/posttest survey design, strong support for the effectiveness of YMHFA (i.e. knowledge, confidence, preparedness, and intentions to intervene), satisfaction with the training program, and universality of effectiveness and satisfaction across the occupational groups was found. Results highlight the utility of YMHFA across different sectors of child-serving agencies and support its sustainability.
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35
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Oh JE, López-Santacruz HD. Adaptation measures in dental care for children with history of Adverse Childhood Experiences: A practical proposal. SPECIAL CARE IN DENTISTRY 2020; 41:3-12. [PMID: 33040392 DOI: 10.1111/scd.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/03/2020] [Accepted: 09/21/2020] [Indexed: 11/28/2022]
Abstract
Adverse Childhood Experiences (ACEs) such as maltreatment, abuse, or neglect can disrupt childhood development and increase the risk of health issues, including dental health. Such a vulnerable population frequently may deny dental treatment due to fear of intimate contact in the oral cavity, resulting in a vicious cycle that further leads to detrimental oral health. It is important for dentists, particularly pediatric dentists, to not only understand how to identify potential cases of abuse or maltreatment but also how to treat these patients so that the dental treatment does not become a negative experience. The purpose of this paper is to understand the psychological and physical implications of pediatric patients who have had ACEs and to identify the best methods to manage these patients during the dental treatment.
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Affiliation(s)
- Jung Eun Oh
- School of Dentistry, De La Salle Bajío University, León, Guanajuato, Mexico
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36
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Mansour M, Krishnaprasadh D, Lichtenberger J, Teitelbaum J. Implementing the Patient Health Questionnaire Modified for Adolescents to improve screening for depression among adolescents in a Federally Qualified Health Centre. BMJ Open Qual 2020; 9:bmjoq-2019-000751. [PMID: 33028654 PMCID: PMC7542616 DOI: 10.1136/bmjoq-2019-000751] [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: 06/16/2019] [Revised: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 11/21/2022] Open
Abstract
Background Depression, which is a serious medical illness, is prevalent worldwide and it negatively impacts the adolescent lifestyle. Adolescent depression is associated with adverse emotional and functional outcomes and suboptimal physical health. Over the last decade, it has been found that approximately 9% of teenagers meet the criteria for depression at any given time, and one in five teenagers have a history of depression during adolescence. Ninety per cent of paediatricians believe that recognition of child and adolescent depression is their responsibility; however, it has been reported that 46% lacked confidence that they could recognise depression. Methods In this study, adolescents between 12 and 17 years of age were screened during their well-child visits using the Patient Health Questionnaire Modified for Adolescents. A score of 10 or higher warrants a referral to a social worker and psychiatrist. The goals of this quality improvement project were to implement a standardised questionnaire and to improve the screening, diagnosis and treatment of depression in children from 12 to 17 years of age. Results It was found that the adolescent depression screening rate significantly improved within 6 months of implementing this quality improvement project. The screening rate improved to 50% by mid-cycle (Plan-Do-Study-Act (PDSA) cycle 3) and up to 70% at the end of the 6-month period (PDSA cycle 5). Improvement was noted among all providers, across all age groups, and in both male and female patients by the end of the study period. Conclusion Standardised screening tests with a scoring system help providers to identify and monitor depression symptoms using a common language, especially in the outpatient clinical setting where the patient may be seen by different providers.
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Affiliation(s)
- Mohamed Mansour
- Department of Pediatrics, Monmouth Medical Center, Long Branch, New Jersey, USA
| | - Dharshana Krishnaprasadh
- Department of Pediatrics, Monmouth Medical Center, Long Branch, New Jersey, USA.,Beaumont Health, Royal Oak, Michigan, USA
| | | | - Jonathan Teitelbaum
- Department of Pediatrics, Monmouth Medical Center, Long Branch, New Jersey, USA
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Abstract
OBJECTIVE To assess pediatric primary care providers' (PCPs) knowledge, perceived barriers, and needs related to child and adolescent anxiety in their practice. METHODS Primary care providers licensed and practicing in the state of Colorado were invited to complete an online knowledge and needs assessment. The survey queried their knowledge of pediatric anxiety, experience in assessing and treating anxiety, perceived barriers in their practice setting to adequately addressing youth anxiety, and interest in additional training on this topic. RESULTS Survey completers included 115 PCPs (51 medical doctors and 64 nurses/nurse practitioners). PCPs had been practicing with their current medical license with pediatric patients for an average of 14 years (SD = 10.45), and 70% reported that they regularly discuss anxiety with patients and parents. Although PCPs had a basic knowledge of youth anxiety, there appeared to be significant gaps in PCP knowledge. Specifically, knowledge gaps included evidence-based assessment and treatment, how to differentiate between developmentally appropriate, transient episodes of anxiety versus anxiety disorders, and where and how to refer youth for specialty services. Nearly all (80%) PCPs indicated that they would be "extremely interested" in additional training in pediatric anxiety, particularly if it occurred in their organizational setting, at a nearby community setting, or online. CONCLUSION Primary care providers reported that a substantial proportion of the patients they see struggle with anxiety. PCPs also reported a growing need for training in how to assess, treat, and refer anxious youth. This needs assessment supports a need for the development of easily accessible training and resources for PCPs to better support their pediatric patients.
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Abstract
Pediatricians are increasingly asked to address the mental health care needs of their patients, despite lack of formal mental health training. Pediatricians who wish to expand their scope of practice to include mental health care may benefit from didactic training as well as ongoing consultative or collaborative relationships with mental health specialists. Consultative and collaborative relationships between mental health and primary care have evolved in various models across the country. We outline models of mental health consultation and collaboration, address some considerations for pediatricians prior to adopting a model, and list key collaborative care resources. [Pediatr Ann. 2020;49(10):e416-e420.].
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Lustbader AS, Borer MS. Counterpoint: Risks of Implementing Measurement-Based Care in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am 2020; 29:775-782. [PMID: 32891376 DOI: 10.1016/j.chc.2020.06.012] [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: 10/23/2022]
Abstract
Psychiatric measurement-based care has a significant role in nonpsychiatric medical and surgical settings for identifying mental illness and plays a research role in generating aggregated data. Psychiatric illnesses are multifactorial and not uniform in nature, patient distress/suffering have a complex etiology, and appropriate treatments are varied. Measures commonly used in measurement-based care are subjective ratings of symptom severity. In clinical mental health settings, measurement-based care may contribute more of a qualitative role as part of the psychiatric input to the identification and severity of illness. Psychiatrists must limit the use of measurement-based care in assisting the assessment of patient progress.
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Affiliation(s)
- Andrew S Lustbader
- Yale Child Study Center, New Haven, CT, USA; Therapeutic Center for Children and Families, 215 Main Street, Westport, CT 06880, USA.
| | - Mark S Borer
- Psychiatric Access for Central DE, 846 Walker Road Suite 32-2, Dover, DE 19904, USA
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40
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Abstract
The article describes and discusses several key elements of the paediatric healthcare system in Israel, including paediatric training, family and community paediatrics, hospital-based paediatric services, preventive care services, and special programs such as the "Drop of Milk" (Tipat Halav) program. Although child care in Israel has gained several notable achievements, such as a low infant mortality rate, there are several significant challenges for the coming years. These include training of enough paediatricians and periodic updating of training programs to fulfil needs and provide an adequate preventive care from fetal life through infancy, childhood, and adulthood. In addition, paediatricians in Israel should continue to be involved in national public health programs to reduce health inequities among mothers and children and reduce health disparities among certain geographic areas and various populations. Graduates of paediatric residency are expected to be able to address the new technologies, the requirements for personal medicine and on-line medicine, and to be able to deal with both pure "medical" issues, and public health, lifestyle, and environmental issues.
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Affiliation(s)
- Eli Somekh
- Department of Paediatrics, Mayaney Hayeshuah Medical Center, Bnei Brak and Sackler School of Medicine, Tel Aviv University, Israel
- European Paediatric Association, Union of National European Paediatric Societies and Associations, Berlin, Germany
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University and Schneider Children’s Medical Center, Petach Tikva, Israel
| | - Zachi Grossman
- Maccabi Healthcare Services, Tel Aviv and Adelson School of Medicine, Ariel University, Ariel, Israel
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41
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Improving Integration of Behavioral Health Into Primary Care for Adolescents and Young Adults. J Adolesc Health 2020; 67:302-306. [PMID: 32624355 DOI: 10.1016/j.jadohealth.2020.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 11/20/2022]
Abstract
Problems related to mood, substance use, anxiety, body image issues, post-traumatic stress, and suicidality are common in adolescence and become even more common in young adulthood. Integrated behavioral health (IBH) in primary care has shown great promise in identifying and treating adolescents and young adults who have these problems. Treatment outcomes in IBH settings outperform those in usual primary care settings where a primary care provider may identify behavioral health problems and refer youth to colocated or outside behavioral health specialists. Despite the success of IBH care systems, limited training opportunities and inadequate financial compensation for these services jeopardize the wide scale expansion and universal adoption of IBH. To optimize patient care, providers from all disciplines in adolescent primary care settings should have dedicated professional training in IBH. This should include incorporating IBH professional competencies into each discipline's formal training program and building interprofessional, multidisciplinary IBH training settings. Likewise, payers should work with primary care systems to create and implement reimbursement models for IBH services. Efforts to expand the footprint of IBH would pay off significantly by building more worldwide BH systems with increased efficacy at identifying and treating adolescents with BH conditions.
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Green C, Leyenaar JK, Turner AL, Leslie LK. Competency of Future Pediatricians Caring for Children With Behavioral and Mental Health Problems. Pediatrics 2020; 146:peds.2019-2884. [PMID: 32561612 DOI: 10.1542/peds.2019-2884] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES There is an urgent need to prepare pediatricians to care for children with behavioral and mental health (B/MH) conditions. In this study, we evaluate the perceived competence of pediatric residents and recent graduates in the assessment and treatment of B/MH conditions, characterize variation in competence across residency programs, and identify program characteristics associated with high competence. METHODS Cross-sectional survey of applicants for the initial certifying examination in pediatrics. Questions were focused on (1) who should be competent in B/MH skills, (2) institutional support around B/MH training, and (3) perceived competence in 7 B/MH assessment skills and 9 treatment skills. Competence was rated on a 5-point scale, and high levels of assessment and treatment competence were defined as scores of ≥4. Composite measures for B/MH assessment and treatment were calculated as mean scores for each domain. We examined variation in residents' self-reported competence across programs and used linear regression to identify factors associated with high levels of competence at the program level. RESULTS Of applicants, 62.3% responded to the survey (n = 2086). Of these, 32.8% (n = 595) reported high competence in assessment skills and 18.9% (n = 337) in treatment skills. There were large variations in reported competence across programs. Respondents from smaller programs (<30 trainees) reported higher competence in assessment and treatment than those from large programs (P < .001). CONCLUSIONS Current and recent pediatric trainees do not report high levels of perceived competence in the assessment and treatment of children with B/MH conditions. The substantial variation across programs indicates that the pediatric community should create standards for B/MH training.
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Affiliation(s)
- Cori Green
- Department of Pediatrics, Weill Cornell Medicine, New York, New York;
| | - JoAnna K Leyenaar
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Adam L Turner
- The American Board of Pediatrics, Chapel Hill, North Carolina; and
| | - Laurel K Leslie
- The American Board of Pediatrics, Chapel Hill, North Carolina; and.,Departments of Medicine and Pediatrics, School of Medicine, Tufts University, Boston, Massachusetts
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43
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Variation in Rate of Attention-Deficit/Hyperactivity Disorder Management by Primary Care Providers. Acad Pediatr 2020; 20:384-390. [PMID: 31794864 DOI: 10.1016/j.acap.2019.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/21/2019] [Accepted: 11/27/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To describe variation in rates of attention-deficit/hyperactivity disorder (ADHD) management by pediatrics primary care providers (PCPs) and to assess influence of clinician characteristics on variation. METHODS Retrospective cohort study of electronic health records from all office visits of patients aged 4 to 17 years seen at least twice between 2015 and 2017 by 73 clinicians in 9 pediatrics practices of a community-based primary health care network in California. Outcomes per clinician: 1) percent patients seen for ADHD management; (2) percent ADHD patients with diagnosed comorbid conditions. Logistic random-effects regression models examined practice- and clinician-level variation. RESULTS Of 40,323 patients in the cohort, 2039 (5.1%) carried an ADHD diagnosis, of which 1142 (56%) received ADHD medication. Percent of patients seen for ADHD management varied by clinician from 0.0% to 8.3% (median 3.0%). After accounting for practice-level variation and patient characteristics (ie, sex, age, insurance), clinician characteristics explained 28% of clinician variation in ADHD management. ADHD management rate was associated with high-percent full-time equivalent (odds ratio 1.17; 95% confidence interval 1.07-1.27). Percent of ADHD patients with diagnoses of comorbidities varied by clinician from 0.0% to 100% (median 35%). Association between ADHD management rate and comorbidity diagnosis was minimal (R = 0.10). CONCLUSIONS Objective electronic health records measures showed that PCPs in this network varied widely in their involvement in ADHD management. For most PCPs, percent of patients with ADHD and diagnosis of comorbidities was lower than estimated prevalence rates. Exploration of modifiable factors associated with PCP variation is needed to inform strategies for implementation of evidence-based practices.
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Colburn MD, Harris E, Lehmann C, Widdice LE, Klein MD. Adolescent Depression Curriculum Impact on Pediatric Residents' Knowledge and Confidence to Diagnose and Manage Depression. J Adolesc Health 2020; 66:240-246. [PMID: 31690535 DOI: 10.1016/j.jadohealth.2019.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/13/2019] [Accepted: 08/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Despite the need for pediatricians to diagnose and manage adolescent depression, few pediatric residency curricula exist. This study evaluated the impact of an adolescent depression curriculum on pediatric residents' knowledge and confidence to manage depression. METHODS A novel, case-based, adolescent depression curriculum simulating patient-provider continuity was developed and implemented within an adolescent medicine (AM) rotation. The curriculum addressed seven domains critical for diagnosis and management of adolescent depression. Participants were recruited from the pediatric residency at one institution. A survey assessed residents' demographics, prior training, and self-assessed knowledge and confidence within each domain using a retrospective pre-post evaluation. Wilcoxon signed-rank test evaluated changes in knowledge and confidence. RESULTS Forty-two of a total 51 residents (82%) completed the curriculum and survey during their AM rotation. Residents reported that within their continuity clinic, 45% (n = 19) had never initiated medication for depression, and 60% (n = 25) did not manage their adolescent patients' depression medications. Comparisons before and after participation in the curriculum, using the retrospective pre-post survey, demonstrated increased self-assessed knowledge (p < .001, for each domain) and confidence (p < .001, for each domain). CONCLUSIONS In this study, few residents reported experience initiating medication or managing adolescent depression in the continuity clinic. Residents demonstrated increased self-assessed knowledge and confidence to diagnose and manage adolescent depression after participation in a case-based adolescent depression curriculum simulating patient-provider continuity. Incorporation of training on management of adolescent depression into AM rotation may be a feasible option to standardize training within pediatric residency.
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Affiliation(s)
- Michael D Colburn
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa; Division of General Pediatric and Adolescent Medicine, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa.
| | - Emily Harris
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Child Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Corinne Lehmann
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lea E Widdice
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Melissa D Klein
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Levelink B, Feron FJM, Dompeling E, van Zeben-van de Aa DMCB. Children With ADHD Symptoms: Who Can Do Without Specialized Mental Health Care? J Atten Disord 2020; 24:104-112. [PMID: 29471702 PMCID: PMC6935830 DOI: 10.1177/1087054718756194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective: A new Dutch Child and Youth Act should reduce specialized mental health care for children with symptoms of ADHD. Characteristics of children referred to a specialized ADHD clinic are explored to give direction to this intention. Method: Data of 261 children who underwent a multidisciplinary best practice evaluation (including rating scales, and demographic, psychological, and somatic findings) were analyzed. Univariable and multivariable logistic regression models were used to find predictive variables for the need of specialized mental health care. Results: Collected data were heterogeneous. (Sub)clinical total scores on the Teacher Report Form (TRF) and Child Behavior Checklist (CBCL) were predictive variables for specialized mental health care. Also children with divorced parents were more often referred to specialized care. Conclusion: (Sub)clinical scores on the CBCL and TRF increased the need for specialized care, but comprehensive assessment of every child with ADHD symptoms was necessary to differentiate between levels of care.
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46
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Grossman Z, Porter B, Meyerovitch J, Rubin L, Kuint J, Wechsler E, Dushnitzky D, Ashkenazi S. International workshop on the future of community child healthcare. Isr J Health Policy Res 2019; 8:85. [PMID: 31806046 PMCID: PMC6896762 DOI: 10.1186/s13584-019-0355-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 11/29/2019] [Indexed: 12/01/2022] Open
Abstract
Increasing numbers of children with developmental, emotional, and psychosocial issues require adaptation of the services provided by pediatricians in the community. An international workshop that took place in Israel on June 3–4, 2019, addressed this need. Local policy makers and international experts discussed the following topics: (1) the future of training in community pediatrics; (2) enhancing the prestige of the community pediatrician; (3) development of management and research skills; (4) academic advancement within community pediatrics; (5) the future content of community pediatric practice; (6) visit length and community pediatricians’ reimbursement; (7) developing the collaborative model of care in community pediatrics and (8) integrating child healthcare. The meeting provided a venue to understand the challenges and to formulate recommendations to policymakers. A key target highlighted was the increased exposure of all pediatric residents to community pediatrics. This gained the support of the Chief Executive Officers of all four Health Funds in Israel. This document provides a synopsis of the topics addressed and suggested recommendations.
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Affiliation(s)
- Zachi Grossman
- Pediatric clinic, Maccabi Healthcare Services, 26 Rofe Hamachtarot, 69372, Tel Aviv, Israel.
| | - Boaz Porter
- Pediatric clinic, Maccabi Healthcare Services, 26 Rofe Hamachtarot, 69372, Tel Aviv, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Joseph Meyerovitch
- Clalit Health Services and Schneider Children's Medical Center, Petah Tikva, Israel.,Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Rubin
- Ministry of Health, Jerusalem, Israel.,School of Public Health, University of Haifa, Haifa, Israel
| | - Jacob Kuint
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel.,K.S.M Research and innovation Institute, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Doron Dushnitzky
- Leumit Health Services, Tel Aviv, Israel.,Tel Aviv University, Tel Aviv, Israel
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
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47
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Sheldrick RC, Schlichting LE, Berger B, Clyne A, Ni P, Perrin EC, Vivier PM. Establishing New Norms for Developmental Milestones. Pediatrics 2019; 144:peds.2019-0374. [PMID: 31727860 PMCID: PMC6889967 DOI: 10.1542/peds.2019-0374] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric surveillance of young children depends on providers' assessment of developmental milestones, yet normative data are sparse. Our objectives were to develop new norms for common milestones to aid in clinical interpretation of milestone attainment. METHODS We analyzed responses to the developmental screening form of the Survey of Well-being of Young Children from 41 465 screens across 3 states. Associations between developmental status and a range of child characteristics were analyzed, and norms for individual questions were compared to guidelines regarding attainment of critical milestones from the Centers for Disease Control and Prevention (CDC). RESULTS A contemporary resource of normative data for developmental milestone attainment was established. Lower developmental status was associated with child age in the presence of positive behavioral screening scores (P < .01), social determinants of health (P < .01), Medicaid (P < .01), male sex (P < .01), and child race (P < .01). Comparisons between Survey of Well-being of Young Children developmental questions and CDC guidelines reveal that a high percentage of children are reported to pass milestones by the age at which the CDC states that "most children pass" and that an even higher percentage of children are reported to pass milestones by the age at which the CDC states that parents should "act early." An interactive data visualization tool that can assist clinicians in real-time developmental screening and surveillance interpretation is also provided. CONCLUSIONS Detailed normative data on individual developmental milestones can help clinicians guide caregivers' expectations for milestone attainment, thereby offering greater specificity to CDC guidelines.
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Affiliation(s)
- R. Christopher Sheldrick
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts
| | - Lauren E. Schlichting
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Blythe Berger
- Rhode Island Department of Health, Providence, Rhode Island; and
| | - Ailis Clyne
- Rhode Island Department of Health, Providence, Rhode Island; and
| | - Pensheng Ni
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, Massachusetts
| | - Ellen C. Perrin
- Division of Developmental-Behavioral Pediatrics, School of Medicine, Tufts University and Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
| | - Patrick M. Vivier
- Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
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48
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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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49
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McMillan JA. Robert Haggerty, the New Morbidities, and the Dissonance between Education and Child Health Needs. Pediatr Rev 2019; 40:9-11. [PMID: 31575685 DOI: 10.1542/pir.2019-40s09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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50
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Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics 2019; 144:e20192528. [PMID: 31570648 PMCID: PMC7067282 DOI: 10.1542/peds.2019-2528] [Citation(s) in RCA: 582] [Impact Index Per Article: 116.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is 1 of the most common neurobehavioral disorders of childhood and can profoundly affect children's academic achievement, well-being, and social interactions. The American Academy of Pediatrics first published clinical recommendations for evaluation and diagnosis of pediatric ADHD in 2000; recommendations for treatment followed in 2001. The guidelines were revised in 2011 and published with an accompanying process of care algorithm (PoCA) providing discrete and manageable steps by which clinicians could fulfill the clinical guideline's recommendations. Since the release of the 2011 guideline, the Diagnostic and Statistical Manual of Mental Disorders has been revised to the fifth edition, and new ADHD-related research has been published. These publications do not support dramatic changes to the previous recommendations. Therefore, only incremental updates have been made in this guideline revision, including the addition of a key action statement related to diagnosis and treatment of comorbid conditions in children and adolescents with ADHD. The accompanying process of care algorithm has also been updated to assist in implementing the guideline recommendations. Throughout the process of revising the guideline and algorithm, numerous systemic barriers were identified that restrict and/or hamper pediatric clinicians' ability to adopt their recommendations. Therefore, the subcommittee created a companion article (available in the Supplemental Information) on systemic barriers to the care of children and adolescents with ADHD, which identifies the major systemic-level barriers and presents recommendations to address those barriers; in this article, we support the recommendations of the clinical practice guideline and accompanying process of care algorithm.
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Affiliation(s)
- Mark L. Wolraich
- Section of Developmental and Behavioral Pediatrics, University of Oklahoma, Oklahoma City, Oklahoma
| | - Joseph F. Hagan
- Department of Pediatrics, The Robert Larner, MD, College of Medicine, The University of Vermont, Burlington, Vermont
- Hagan, Rinehart, and Connolly Pediatricians, PLLC, Burlington, Vermont
| | - Carla Allan
- Division of Developmental and Behavioral Health, Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, Missouri
- School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
| | - Eugenia Chan
- Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Dale Davison
- Children and Adults with Attention-Deficit/Hyperactivity Disorder, Lanham, Maryland
- Dale Davison, LLC, Skokie, Illinois
| | - Marian Earls
- Community Care of North Carolina, Raleigh, North Carolina
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Steven W. Evans
- Department of Psychology, Ohio University, Athens, Ohio
- Center for Intervention Research in Schools, Ohio University, Athens, Ohio
| | | | - Tanya Froehlich
- Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jennifer Frost
- Swope Health Services, Kansas City, Kansas
- American Academy of Family Physicians, Leawood, Kansas
| | - Joseph R. Holbrook
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christoph Ulrich Lehmann
- Departments of Biomedical Informatics and Pediatrics, Vanderbilt University, Nashville, Tennessee
| | | | | | - Karen L. Pierce
- American Academy of Child and Adolescent Psychiatry, Washington, District of Columbia
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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