1
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Austin AE, DePadilla L, Niolon P, Stone D, Bacon S. Intersection of adverse childhood experiences, suicide and overdose prevention. Inj Prev 2024:ip-2024-045295. [PMID: 39053926 DOI: 10.1136/ip-2024-045295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 07/11/2024] [Indexed: 07/27/2024]
Abstract
Adverse childhood experiences (ACEs), suicide and overdose are linked across the life course and across generations and share common individual-, interpersonal-, community- and societal-level risk factors. The purpose of this review is to summarise the shared aetiology of these public health issues, synthesise evidence regarding potential community- and societal-level prevention strategies and discuss future research and practice directions.Growing evidence shows the potential for community- and societal-level programmes and policies, including higher minimum wage; expanded Medicaid eligibility; increased earned income tax credits, child tax credits and temporary assistance for needy families benefits; Paid Family Leave; greater availability of affordable housing and rental assistance; and increased participation in the Supplemental Nutrition Assistance Program (SNAP), to contribute to ACEs, suicide and overdose prevention. Considerations for future prevention efforts include (1) expanding the evidence base through rigorous research and evaluation; (2) assessing the implications of prevention strategies for equity; (3) incorporating a relational health perspective; (4) enhancing community capacity to implement, scale and sustain evidenced-informed prevention strategies; and (5) acknowledging that community- and societal-level prevention strategies are longer-term strategies.
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Affiliation(s)
- Anna E Austin
- Centers for Disease Control and Prevention National Center for Injury Prevention and Control, Atlanta, Georgia, USA
| | | | - Phyllis Niolon
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Sarah Bacon
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Ho M, Schermer JA. Childhood Neglect and Loneliness: The Unique Roles of Parental Figure and Child Sex. Behav Sci (Basel) 2024; 14:442. [PMID: 38920774 PMCID: PMC11200426 DOI: 10.3390/bs14060442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/06/2024] [Accepted: 05/14/2024] [Indexed: 06/27/2024] Open
Abstract
There is a well-supported link between experiences of childhood neglect and levels of loneliness in adulthood, with emotional neglect from caregivers being predictive of loneliness. However, current research has yet to explore additional, sex-linked factors that influence this relationship. This study investigates the impact of different neglect types on loneliness, with a focus on the parental figure involved and the child's sex. It was hypothesized that men who experienced emotional neglect from their fathers would score higher in loneliness compared to other parent-child combinations. The findings showed no significant differences in father-son relationships within the context of emotional neglect. However, there was a significant difference in father-son relationships in the context of supervision neglect and loneliness outcomes, relative to all other parent combinations. Consistent with existing research, emotional neglect emerged as the strongest predictor of loneliness. Additionally, sex differences were observed, with women experiencing greater levels of loneliness stemming from neglect compared to men. These findings help address the knowledge gap present in childhood neglect research, with the goal of understanding the long-term consequences of adverse childhood experiences.
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Affiliation(s)
- Megan Ho
- Department of Psychology, University of Western Ontario, London, ON N6A 5C2, Canada;
| | - Julie Aitken Schermer
- Department of Psychology and Management and Organizational Studies, University of Western Ontario, London, ON N6A 5C2, Canada
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3
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Davis PA, Hubbard D, Gladdis T, Nitkin C, Hansen K, Keith-Chancy E, Godwin J, Staggs V, Babbar S, Hardy M, Ashbaugh J, Carter BS. Improving attitudes toward trauma-informed care in the neonatal intensive care unit through comprehensive multi-disciplinary education. J Perinatol 2024; 44:650-658. [PMID: 38383575 DOI: 10.1038/s41372-024-01897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024]
Abstract
OBJECTIVE This study measured staff understanding and integration of trauma-informed care following comprehensive education. STUDY DESIGN This mixed method design used the validated Attitudes Related to Trauma-Informed Care (ARTIC) scale and open-ended survey questions via REDCap optional surveys. Trauma-informed care education was made available to staff members in a level IV NICU. Pre- and post-intervention ARTIC scores were compared and post-intervention REDCap surveys were analyzed. RESULT There were 245 multi-disciplinary NICU team members who completed the ARTIC survey before and/or after the educational intervention; and 764 REDCap surveys were completed throughout the study time. ARTIC scores increased from pre- to post-training both for participants with data at both time points (0.5 SD mean increase) and among those with data at only one time point (0.4 SD mean increase). Content analysis of the REDCap survey corroborated the ARTIC results. CONCLUSION System-wide trauma-informed education can achieve measurable effect in a NICU setting.
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Affiliation(s)
- Patricia A Davis
- Department of Social Work, Children's Mercy-Kansas City, Kansas City, MO, USA.
| | - Dena Hubbard
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Tiffany Gladdis
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Division of Developmental and Behavioral Medicine, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - Chris Nitkin
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kara Hansen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Erin Keith-Chancy
- University of Kansas School of Nursing - Undergraduate Faculty, Kansas City, MO, USA
| | - Jennifer Godwin
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Vincent Staggs
- Biostatistics & Epidemiology Core, Children's Mercy-Kansas City; School of Medicine, University of Missouri-at Kansas City, Kansas City, MO, USA
- Statistical Consulting & Research, IDDI, Inc., Raleigh, NC, USA
| | - Shilpa Babbar
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Michelle Hardy
- Neonatal Intensive Care Unit, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - Jacqulin Ashbaugh
- Neonatal Intensive Care Unit, Children's Mercy-Kansas City, Kansas City, MO, USA
| | - Brian S Carter
- Division of Neonatology, Department of Pediatrics, Children's Mercy-Kansas City, Kansas City, MO, USA
- Pediatric Bioethics Center, Children's Mercy-Kansas City, Professor of Pediatrics, School of Medicine, Kansas City, MO, USA
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4
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Colville G. How do nurses communicate with children? Evid Based Nurs 2024:ebnurs-2024-104011. [PMID: 38594074 DOI: 10.1136/ebnurs-2024-104011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Gillian Colville
- Population Health Research Institute, St George's University of London, London, UK
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5
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Kopstick AJ, Aly AM, Zientek E, Williams CN, Hall TA, Macauley RC, Duffee JH. Trauma-Informed Care as a Universal Precaution: A Brief, Case-Based, Educational Primer Featuring Role-Playing and Individual Self-Reflection Exercises. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2024:00005141-990000000-00110. [PMID: 38563499 DOI: 10.1097/ceh.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
ABSTRACT Despite its growing popularity, the implementation of Trauma-Informed Care (TIC) in standard medical practices remains insufficient. A workshop, featuring role-playing scenarios and individual self-reflection exercises, was developed to enhance compassion among health care providers. The workshop was created by a multidisciplinary team of community pediatricians, pediatric intensivists, psychologists, and palliative care physicians, was structured around key elements and principles of TIC, and was based on actual patient encounters. The 90-minute session included didactics, role-playing, writing and self-reflection exercises, and large-group debriefings, and it was presented at two academic meetings. It is currently available as an open-sourced, freely accessible website. The workshop was attended by individuals with varying levels of training and experience. Of approximated 80 participants, 39 responded to surveys about baseline knowledge and workshop satisfaction, and 24 completed self-perceived pre- and postknowledge surveys. Nearly 90% had limited prior exposure to TIC. All rated the workshop highly, with no significant differences based on workshop facilitation. Nearly 95% felt that they learned something that would impact their day-to-day practices. Self-perceived pre-post knowledge showed statistically significant improvements. This workshop is feasible and can potentially increase health care professionals' capacity to care, decrease moral injury, and alleviate burnout from difficult cases.
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Affiliation(s)
- Avi J Kopstick
- Dr. Kopstick: Assistant Professor, Division of Pediatric Critical Care, Department of Pediatric Medicine, Texas Tech University Health Science Center El Paso, El Paso, TX. Dr. Aly: Resident, Department of Pediatric Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX. Ms. Zientek: Medical Student, Paul L. Foster School of Medicine, El Paso, TX. Dr. Williams: Associate Professor, Division of Pediatric Critical Care, Department of Pediatrics, and an Associate Director, Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR. Dr. Hall: Associate Professor, Department of Pediatrics, and an Associate Director, Pediatric Critical Care and Neurotrauma Recovery Program; and a Co-Training Director, Psychology & Neuropsychology Fellowships, Oregon Health & Science University, Portland, OR. Dr. Macauley: Professor, Division of Pediatric Palliative Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR. Dr. Duffee: AAP Council on Community Pediatrics
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6
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Barreca J, Swiggum M. Trauma-Informed Care in Pediatric Physical Therapy as a Standard Precaution: The Time Is Here. Pediatr Phys Ther 2024; 36:278-284. [PMID: 38568276 DOI: 10.1097/pep.0000000000001095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
In this special communication, an overview of the research on trauma, resilience, and action items for the pediatric physical therapist (PT) is addressed. The experiences of early childhood, positive and negative, impact overall development and well-being throughout the lifespan. Childhood trauma can include exposure to abuse, neglect, violence, racism, or medical procedures. These adverse childhood experiences are associated with poor physical and mental health outcomes that can extend into adulthood and can appear in the pediatric rehabilitative realm as caregivers who become labeled noncompliant. Trauma is common and impacts all children; however, some populations, such as children with disabilities, have greater risk for experiencing adversity. An individual's trauma history is not always visible, necessitating a standard approach. Pediatric PTs must take an intentional approach to address the detrimental effects of trauma on those we serve. Many organizations recommend adopting trauma-informed care as the standard of care for all populations.
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Affiliation(s)
- Jessica Barreca
- Center for Interprofessional Education and Research (Dr Barreca), Saint Louis University, Saint Louis, Missouri; Doctor of Physical Therapy Program (Dr Swiggum), Wingate University, Wingate, North Carolina
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7
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Scott VP, Rhee KE. Using the lens of trauma informed care to inform pediatric obesity management. Curr Opin Pediatr 2024; 36:49-56. [PMID: 37965895 DOI: 10.1097/mop.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
PURPOSE OF REVIEW Summarize the evolution of the trauma-informed care (TIC) approach in pediatrics, highlight the importance of using this lens in pediatric obesity management and treating the whole patient and family, and suggest recommendations for providers to incorporate TIC into their practice. RECENT FINDINGS Implementing TIC in pediatric obesity management is recommended and offers an approach to address trauma-related symptoms associated with obesity. The TIC framework creates a safe, nurturing space to have open conversations with patients and families to promote resilience and reduce stigma related to obesity without re-traumatization. Screening tools may expose symptoms related to trauma, but are limited. Provider training is available and development of TIC related skills may be improved through using the arts and humanities. Success of TIC requires a tailored, integrated healthcare system approach with commitment from all levels. SUMMARY The TIC approach offers providers skills to uncover trauma-related symptoms and address obesity-related health disparities while reducing stigma. Collaboration across all levels of the healthcare system and community partners is essential. Further research is warranted on the effectives of this approach in pediatric obesity prevention and management.
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Affiliation(s)
- Vanessa P Scott
- UC San Diego School of Medicine, Department of Pediatrics, UC San Diego Health, Academic General Pediatrics, La Jolla, California, USA
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8
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Rodrigues SM, Bounds DT, Terry J, Pinto MD, Shin S, Burton CW. Application of Trauma-Informed Care Principles to Care Needs Identified by Mothers of NICU-Hospitalized Children. Issues Ment Health Nurs 2024; 45:142-151. [PMID: 37699105 DOI: 10.1080/01612840.2023.2250000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Systematic uptake of family-centered care (FCC) interventions remains challenging and frequently suboptimal in many neonatal intensive care units (NICUs). Across NICUs in the United States, integrating family members as partners in infant caregiving and decision-making has not been well supported and routine screening and provision of psychological support for parents remains inadequate. Trauma-informed care (TIC) may offer a more comprehensive approach to NICU care which can encompass FCC principles and promote family recovery and resilience by recognizing and responding to the traumas experienced by NICU infants and families. The current paper aimed to understand needs identified by mothers of NICU-hospitalized children and reports a focused analysis of one-on-one interview data (n = 13 mothers) collected during a larger mixed methods study. Reflexive thematic analysis was used to understand needs identified by mothers and to explore how these needs aligned with TIC principles. Six themes were identified and subsequently examined in the context of the principles of TIC: I Just Had No Control, That Really Caught Us Off Guard, So Much Was Already Taken Away, We're People and There Needs To Be More Support and Practices Which Helped. Mothers' care needs were found to align with TIC principles. Findings suggest that implementation of TIC principles in NICU settings can support parental presence, participation in infant care, and mental health and support the potential of TIC as a more comprehensive approach to meeting the needs of NICU parents.
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Affiliation(s)
- Sarah M Rodrigues
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Dawn T Bounds
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Jennifer Terry
- Department of Gender & Sexuality Studies, University of California, Irvine, California, USA
| | - Melissa D Pinto
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Sanghyuk Shin
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
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9
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Chaplo SD, Shepard Abdulahad LD, Keeshin BR. Utilizing screening as a trauma-responsive approach in pediatric health care settings. Curr Probl Pediatr Adolesc Health Care 2024; 54:101548. [PMID: 38336539 DOI: 10.1016/j.cppeds.2023.101548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Given the widespread impact of child trauma, it is important that child- and family-serving systems adopt trauma-informed care. Because of their integral relationships with families, pediatricians and family medicine physicians play critical roles in disrupting negative societal and developmental cascades for trauma-exposed youth through their potential for early identification and intervention. When implemented alongside organization-wide trauma-informed care practices, trauma screening is one concrete trauma-informed care practice that has shown both feasibility and positive impacts on pediatric healthcare. In support of this practice, the Care Process Model for Pediatric Traumatic Stress (CPM-PTS) helps pediatric care providers to identify and respond to children and adolescents who may need trauma-focused supports. In this paper we discuss the importance of pediatric physicians adopting trauma-informed care and how evidence-based screening practices in pediatric settings is a trauma-responsive approach with great potential for meeting unmet needs among trauma-exposed children and families.
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10
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Hua LL, Lee J, Rahmandar MH, Sigel EJ. Suicide and Suicide Risk in Adolescents. Pediatrics 2024; 153:e2023064800. [PMID: 38073403 DOI: 10.1542/peds.2023-064800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 01/02/2024] Open
Abstract
Suicide is the second leading cause of death for 10- to 24-year-olds in the United States and is a global public health issue, with a recent declaration of a National State of Emergency in Children's Mental Health by the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and Children's Hospital Association. This clinical report is an update to the previous American Academy of Pediatrics clinical report, "Suicide and Suicide Attempts in Adolescents." Because pediatricians and pediatric health care providers are at the front line of care for adolescents amid a child and adolescent mental health crisis, and because of the chronic and severe shortage of mental health specialists, it is important that pediatric health care providers become facile with recognizing risk factors associated with suicidality and at-risk populations, screening and further assessment of suicidality as indicated, and evidence-based interventions for patients with suicidal ideation and associated behaviors. Suicide risk can be mitigated by appropriate screening, bolstering of protective factors, indicated treatment, community resources, and referrals to mental health providers when available.
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Affiliation(s)
- Liwei L Hua
- Division of Integrated Behavioral Health, South Bend Clinic, South Bend, Indiana
| | - Janet Lee
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Maria H Rahmandar
- Potocsnak Family Division of Adolescent & Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, and Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Eric J Sigel
- Department of Pediatrics, University of Colorado School of Medicine, Section of Adolescent Medicine, Children's Hospital Colorado, Aurora, Colorado
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11
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Israel BS, Belcher AM, Ford JD. A Harm Reduction Framework for Integrated Treatment of Co-Occurring Opioid Use Disorder and Trauma-Related Disorders. J Dual Diagn 2024; 20:52-85. [PMID: 38165922 DOI: 10.1080/15504263.2023.2295416] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
The opioid epidemic has exposed a gulf in mental health research, treatment, and policy: Most patients with comorbid trauma-related disorder (TRD) and opioid use disorder (OUD) (TRD + OUD) remain undiagnosed or unsuccessfully treated for the combination of TRD symptoms and opioid use. TRD treatments tend to be psychotherapies that are not accessible or practical for many individuals with TRD + OUD, due to TRD treatment models not systematically incorporating principles of harm reduction (HR). HR practices prioritize flexibility and unequivocally improve outcomes and save lives in the treatment of OUD. Considering the urgent need to improve TRD + OUD treatment and outcomes, we propose that the OUD and TRD fields can be meaningfully reconciled by integrating HR principles with classic phasic treatment for TRD. Adding a "prestabilization" phase of treatment for TRD - largely analogous to the precontemplation Stage of Change - creates opportunities to advance research, clinical practice, and policies and potentially improve patient outcomes.
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Affiliation(s)
- Benjamin S Israel
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Annabelle M Belcher
- Division of Addiction Research and Treatment, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
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12
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Burton ET, Moore JM, Vidmar AP, Chaves E, Cason-Wilkerson R, Novick MB, Fernandez C, Tucker JM. Assessment of Adverse Childhood Experiences and Social Determinants of Health: A Survey of Practices in Pediatric Weight Management Programs. Child Obes 2023. [PMID: 38133550 DOI: 10.1089/chi.2023.0152] [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: 12/23/2023]
Abstract
Introduction: Adverse childhood experiences (ACEs) and social determinants of health (SDoH) are associated with increased incidence of pediatric obesity. Recent literature highlights an imperative need to assess ACEs and SDoH among youth and families with obesity to identify those individuals requiring targeted interventions. The primary objective of the present study was to examine the frequency, methodology, and barriers in evaluation of ACEs and SDoH within pediatric weight management programs (PWMPs). Methods: Invitations were e-mailed to a comprehensive directory of 92 PWMPs in the United States with a link to complete an electronic survey. Results: Forty-one PWMPs from 26 states completed the survey. Assessment of one or more ACEs and SDoH was common and typically took place during the initial patient visit by the psychologist or medical practitioner through unstructured conversations. Reported barriers to assessment included lack of time to assess and to follow-up, lack of clinic protocols, and inadequate referral resources. Programs offering bariatric surgery and those with embedded mental health clinicians reported fewer barriers to ACEs/SDoH referral resources, while family-based and healthy lifestyle-focused programs perceived more barriers related to insufficient support staff and time to follow-up with families. Conclusions: Most PWMPs assess a subset of ACEs and SDoH; however, approaches to assessment vary, are often unstructured, and several barriers remain to optimizing assessment and follow-up. Future research should evaluate standardized ACEs/SDoH assessment protocols, ideal workflow, and their impact on obesity treatment and related health outcomes.
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Affiliation(s)
- E Thomaseo Burton
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jaime M Moore
- Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alaina P Vidmar
- Department of Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA
- Diabetes & Obesity Program, Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Eileen Chaves
- Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Rochelle Cason-Wilkerson
- Children's Hospital Colorado, Aurora, CO, USA
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marsha B Novick
- Department of Pediatrics, Penn State Hershey Medical Center, Hershey, PA, USA
| | - Cristina Fernandez
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jared M Tucker
- Health Optimization Services, Helen Devos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, East Lansing, MI, USA
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13
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Pryce P, Gangopadhyay M, Edwards JD. Parental Adverse Childhood Experiences and Post-PICU Stress in Children and Parents. Pediatr Crit Care Med 2023; 24:1022-1032. [PMID: 37615404 DOI: 10.1097/pcc.0000000000003339] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Hospitalization in a PICU is a stressful experience for children and their parents, with many experiencing posttraumatic stress disorder (PTSD) after discharge. Risk factors may include preillness traumatic events, such as adverse childhood experiences (ACEs). We sought to assess the feasibility of screening ACEs in parents of children admitted to a PICU, their prevalence, and their association with post-PICU PTSD symptoms in them and their children. DESIGN Single-center prospective observational study. SETTING Urban academic children's hospital from January to December 2021. PATIENTS One hundred forty-five children (2-18 yr old, admitted ≥ 2 d) and their parents. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data on parental demographics, ACEs, coping skills, and PICU environmental stressors, as well as patient clinical data, were collected. One month after PICU discharge, parents completed inventories assessing PTSD symptoms in them and their children. Bivariate and logistic regression analyses were used to explore associations of ACEs with post-PICU PTSD. Of 145 enrolled parents, 95% completed the ACE questionnaire, 58% of whom reported greater than or equal to 1 ACE, and 14% had substantial (≥ 4) ACEs. Parent and patient follow-up was 79% and 70%, respectively. Sixteen percent of parents had provisional PTSD. Regression analysis showed parents with greater than or equal to 4 ACEs had 10 times greater odds of parental PTSD, compared to parents with less than 4 ACEs, (adjusted odds ratio [aOR] = 10.2; 95% CI, 1.03-100.9; p = 0.047). Fifty-six percent of patients screened at risk for PTSD. There was no association between substantial parental ACEs and patients' risk for PTSD (aOR = 3.5 [95% CI, 0.56-21.31]; p = 0.18). CONCLUSIONS ACEs were common among parents of critically ill children. Having substantial parental ACEs was associated with provisional parental PTSD after their child's PICU admission, but not with PTSD in the children. Family-centered care that seeks to mitigate post-PICU stress should be mindful of the potential relevance of parental ACEs.
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Affiliation(s)
- Patrice Pryce
- Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Maalobeeka Gangopadhyay
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Jeffrey D Edwards
- Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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14
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Kemal S, Nwabuo A, Hoffmann J. Mental Health and Violence in Children and Adolescents. Pediatr Clin North Am 2023; 70:1201-1215. [PMID: 37865440 DOI: 10.1016/j.pcl.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
This article examines the complex interplay between mental health and violence among children. Although children with mental illness are more likely to be victims of violence than perpetrators, this article describes the few mental health conditions associated with increased violent behavior among children. Next, the authors examine the spectrum of mental health sequelae among children following exposure to various forms of violence. Lastly, the authors discuss the underutilization of mental health services in this population and highlight screening and intervention tools available to pediatric clinicians caring for children exposed to violence.
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Affiliation(s)
- Samaa Kemal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611, USA.
| | - Adaobi Nwabuo
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, 2230 Stockton Boulevard, Sacramento, CA 95817, USA
| | - Jennifer Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611, USA
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15
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Williams PG, Yogman M. Addressing Early Education and Child Care Expulsion. Pediatrics 2023; 152:e2023064049. [PMID: 37899732 DOI: 10.1542/peds.2023-064049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 10/31/2023] Open
Abstract
An important goal of early childhood education is teaching emotional self-regulation within the context of a safe, stable, nurturing environment. Expulsion of young children ignores underlying emotional and behavioral concerns, disproportionately affects children of color (Black or Hispanic), males, children with disabilities, and socioeconomically disadvantaged populations, and has long-term consequences on educational and life success. Addressing implicit bias and providing child mental health consultation (psychologists, social workers, developmental behavioral pediatricians, child psychiatrists, and child neurologists) to child care providers can prevent expulsion. Pediatricians and other providers within the medical home play an important part in preventing expulsion. However, pediatricians need more training in early childhood mental health and in understanding how systemic racism and implicit bias lead to preschool expulsion in children of color. By identifying children at risk for expulsion because of poverty, racial discrimination, toxic stress, insecure attachment, or history of trauma, the pediatrician can connect families with community resources that may ameliorate these effects. Pediatricians can provide information on social-emotional development in early childhood, promote positive parent-child relationships, and model and discuss age-appropriate and developmentally appropriate behavior management. Pediatricians can also guide parents toward high-quality child care programs that use mental health consultation and developmentally appropriate activities, both of which lessen the chance of child expulsion. Furthermore, behavioral health providers integrated into the medical home can provide consultation to child care providers on managing patients. These recommendations are consistent with our knowledge of early child brain development and support the current tenets of the American Academy of Pediatrics regarding the pediatrician's role in building resilience and buffering toxic stress to promote optimal child development.
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Affiliation(s)
- P Gail Williams
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - Michael Yogman
- Department of Pediatrics, Harvard Medical School, Harvard University, Boston Mass and Cambridge Hospital, Cambridge, Massachusetts
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16
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Lewis KN, McKelvey LM, Zhang D, Moix E, Whiteside-Mansell L. Risks of adverse childhood experiences on healthcare utilization and outcomes in early childhood. CHILD ABUSE & NEGLECT 2023; 145:106396. [PMID: 37573799 DOI: 10.1016/j.chiabu.2023.106396] [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: 04/10/2023] [Revised: 07/28/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND The American Academy of Pediatrics recommends all pediatricians to be ready to implement trauma-informed care, including the mitigation of impacts of Adverse Childhood Experiences (ACEs) through screening and identification of at-risk population. Reliable survey tools and knowledge of the consequences of ACEs are needed. OBJECTIVE This study examines the healthcare utilization and diagnoses captured in insurance claims in association with the number of ACEs recorded by the Family Map Inventories (FMI). The FMI offers a comprehensive family assessment, which includes child ACEs (FMI-ACEs) using prospective, proxy risk indicators. PARTICIPANTS AND SETTING Low-income families (N = 1647) with children aged three to five years who completed the FMI were linked to their insurance records. METHODS Multivariable logistic and generalized linear regression models were fitted to explore the association between the number of ACEs (FMI-ACEs scores) and healthcare utilization and health outcomes. RESULTS Children were exposed at rates of 32.4 % to zero, 31.7 % to one, 19.7 % to two, and 16.3 % to three or more ACEs. The FMI-ACEs scores were associated with greater use of non-preventive outpatient visits, filled prescriptions, and overall use of healthcare. Incidences of adjustment disorders were 4 times and attention-deficit conducts were 2 times higher among children with the highest FMI-ACEs scores than those with zero FMI-ACEs. CONCLUSIONS This study marks the first effort to conduct insurance claims data review to ascertain association between a survey measure of ACEs and health utilization and diagnosed conditions. The association of ACEs risk screening and healthcare utilization and diagnoses was observed.
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Affiliation(s)
- Kanna N Lewis
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA.
| | - Lorraine M McKelvey
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
| | - Dong Zhang
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
| | - Elise Moix
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
| | - Leanne Whiteside-Mansell
- University of Arkansas for Medical Sciences, Department of Family and Preventive Medicine, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA
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17
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Williams RC. Des expériences négatives de l'enfance à la santé relationnelle précoce : les conséquences pour la pratique clinique. Paediatr Child Health 2023; 28:377-393. [PMID: 37744761 PMCID: PMC10517240 DOI: 10.1093/pch/pxad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023] Open
Abstract
Les enfants grandissent et se développent dans un environnement de relations. Des relations sécuritaires, stables et bienveillantes contribuent à consolider la résilience et à atténuer les répercussions des expériences négatives. La promotion de la santé relationnelle en pratique clinique recentre l'attention accordée aux expériences négatives de l'enfance sur les expériences positives de l'enfance. Cette approche, qui évalue les forces et les atouts d'une famille, peut être intégrée à la fois aux rendez-vous réguliers de l'enfant en santé et aux soins surspécialisés. Il est optimal de réaliser de telles interventions pendant la période prénatale ou le plus rapidement possible avant l'âge de trois ans, mais il n'est jamais trop tard pour les entreprendre. Le présent document de principes décrit comment les cliniciens peuvent adopter une approche de santé relationnelle lors de chacune de leurs rencontres médicales s'ils comprennent ce qu'est le stress toxique et ses effets sur le cerveau en développement, les relations familiales et le développement de l'enfant; à quel point les relations, expériences et comportements positifs peuvent en atténuer les effets et renforcer la résilience; quels sont les signes observables de la santé relationnelle et des risques relationnels dans les interactions entre les parents et l'enfant; quelles sont les caractéristiques de relations thérapeutiques de confiance avec les familles et comment en optimiser les avantages par les échanges et la pratique clinique.
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Affiliation(s)
- Robin C Williams
- Société canadienne de pédiatrie, groupe de travail de la petite enfance, Ottawa (Ontario), Canada
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18
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Shah AN, Goodman E, Lawler J, Bosse D, Rubeiz C, Beck AF, Parsons A. Inpatient Screening of Parental Adversity and Strengths. Hosp Pediatr 2023; 13:922-930. [PMID: 37724391 DOI: 10.1542/hpeds.2022-007111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
BACKGROUND AND OBJECTIVES Social adversities, including health-harming social risks and adverse childhood experiences, contribute to poor outcomes after hospital discharge. Screening for social adversities is increasingly pursued in outpatient settings. Identifying and addressing such adversities has been linked to improved child outcomes. Screening for social adversities and strengths in the inpatient setting may contribute to better transitions from hospital to home. Our goal was twofold: 1. to use qualitative methods to understand parent perspectives around screening tools for potential use in inpatient settings; and 2. to develop a family-friendly inpatient screening tool for social adversity. METHODS We used in-depth, cognitive qualitative interviews with parents to elicit their views on existing screening tools covering social adversities and strengths. We partnered with a local nonprofit to recruit parents who recently had a child hospitalized or visited the emergency department. There were 2 phases of the study. In the first phase, we used qualitative methods to develop a screening prototype. In the second phase, we obtained feedback on the prototype. RESULTS We interviewed 18 parents who identified 3 major themes around screening: 1. factors that promote parents to respond openly and honestly during screening; 2. feedback about screening tools and the prototype; and 3. screening should include resources. CONCLUSIONS Social adversity routinely affects children; hospitalization is an important time to screen families for adversity and potential coexisting strengths. Using qualitative parent feedback, we developed the family friendly Collaborate to Optimize Parent Experience screening tool.
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Affiliation(s)
- Anita N Shah
- Divisions of Hospital Medicine
- Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | | | - Julianne Lawler
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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19
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Williams RC. From ACEs to early relational health: Implications for clinical practice. Paediatr Child Health 2023; 28:377-393. [PMID: 37744756 PMCID: PMC10517248 DOI: 10.1093/pch/pxad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023] Open
Abstract
Children grow and develop in an environment of relationships. Safe, stable, nurturing relationships help build resilience and buffer the negative impact of adverse experiences. Promoting relational health in clinical practice shifts the focus from adverse childhood experiences (ACEs) to positive childhood experiences (PCEs). This approach evaluates a family's strengths and assets, and can be incorporated into both well-child and subspecialty care. While the optimal window for such interventions is in the prenatal period or as early as possible within the first 3 years of life, it is never too late to start. This statement describes how clinicians can bring a relational health approach to any medical encounter by understanding: what toxic stress is and how it can affect the developing brain, family relationships, and child development; how positive relationships, experiences, and behaviours can help buffer such effects and build resilience; observable signs of relational health and risk in parent-child interactions; the attributes of trustful, therapeutic relationships with families; and how to optimize these benefits through conversation and clinical practice.
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Affiliation(s)
- Robin C Williams
- Canadian Paediatric Society, Early Years Task Force, Ottawa, Ontario, Canada
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20
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Saidinejad M, Duffy S, Wallin D, Hoffmann JA, Joseph M, Uhlenbrock JS, Brown K, Waseem M, Snow SK, Andrew M, Kuo AA, Sulton C, Chun T, Lee LK. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies. J Emerg Nurs 2023; 49:703-713. [PMID: 37581617 DOI: 10.1016/j.jen.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure, challenges with timely access to a mental health professional, the nature of a busy ED environment, and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affects patient care and ED operations. Strategies to improve care for MBH emergencies, including systems level coordination of care, is therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.
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21
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Saidinejad M, Duffy S, Wallin D, Hoffmann JA, Joseph M, Schieferle Uhlenbrock J, Brown K, Waseem M, Snow SK, Andrew M, Kuo AA, Sulton C, Chun T, Lee LK, Conners GP, Callahan J, Gross T, Joseph M, Lee L, Mack E, Marin J, Mazor S, Paul R, Timm N, Dietrich AM, Alade KH, Amato CS, Atanelov Z, Auerbach M, Barata IA, Benjamin LS, Berg KT, Brown K, Chang C, Chow J, Chumpitazi CE, Claudius IA, Easter J, Foster A, Fox SM, Gausche-Hill M, Gerardi MJ, Goodloe JM, Heniff M, Homme JJL, Ishimine PT, John SD, Joseph MM, Lam SHF, Lawson SL, Lee MO, Li J, Lin SD, Martini DI, Mellick LB, Mendez D, Petrack EM, Rice L, Rose EA, Ruttan T, Saidinejad M, Santillanes G, Simpson JN, Sivasankar SM, Slubowski D, Sorrentino A, Stoner MJ, Sulton CD, Valente JH, Vora S, Wall JJ, Wallin D, Walls TA, Waseem M, Woolridge DP, Brandt C, Kult KM, Milici JJ, Nelson NA, Redlo MA, Curtis Cooper MR, Redlo M, Kult K, Logee K, Bryant DE, Cooper MC, Cline K. The Management of Children and Youth With Pediatric Mental and Behavioral Health Emergencies. Ann Emerg Med 2023; 82:e97-e105. [PMID: 37596031 DOI: 10.1016/j.annemergmed.2023.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/01/2023] [Indexed: 08/20/2023]
Abstract
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure, challenges with timely access to a mental health professional, the nature of a busy ED environment, and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affects patient care and ED operations. Strategies to improve care for MBH emergencies, including systems level coordination of care, is therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.
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22
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Kumar D, Forkey H. Utilizing Experiential Modalities to Teach Principles of Trauma in Pediatrics: Foster Care Evaluation Services Clinic Partnership in Medical Education. Acad Pediatr 2023; 23:1295-1297. [PMID: 37270151 DOI: 10.1016/j.acap.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 06/05/2023]
Affiliation(s)
- Dhanya Kumar
- University of Massachusetts Chan Medical School (D Kumar), Worcester, Mass.
| | - Heather Forkey
- University of Massachusetts Chan Medical School (D Kumar), Worcester, Mass; University of Massachusetts Memorial Children...s Medical Center (H Forkey), Worcester, Mass.
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23
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Jost GM, Hang S, Shaikh U, Hostinar CE. Understanding adolescent stress during the COVID-19 pandemic. Curr Opin Psychol 2023; 52:101646. [PMID: 37473661 PMCID: PMC10282927 DOI: 10.1016/j.copsyc.2023.101646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 07/22/2023]
Abstract
Longitudinal studies across the globe documented significant increases in psychological stress and mental health problems among adolescents during the COVID-19 pandemic. Health concerns, school disruptions, and social disconnection were major sources of stress. High levels of perceived stress predicted worse mental health outcomes, with girls, older adolescents, and socio-economically marginalized youth experiencing more pronounced mental health deteriorations. However, social support from family and peers was a protective factor against increased stress and accompanying mental health problems. We urge policymakers and other key decision-makers to improve the availability and financing of mental health services and support programs for adolescents to address the wave of mental health challenges following the pandemic.
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Affiliation(s)
- Geneva M Jost
- University of California-Davis, Psychology Department, Davis, CA, USA
| | - Sally Hang
- University of California-Davis, Psychology Department, Davis, CA, USA
| | - Ulfat Shaikh
- University of California-Davis, Department of Pediatrics, Davis, CA, USA
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24
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Ronis S, Guyon-Harris KL, Burkhart K, Gabriel M, Cipolla K, Riggs JL, Huth-Bocks A. Profiles of Early Childhood Adversity in an Urban Pediatric Clinic: Implications for Pediatric Primary Care. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1023. [PMID: 37371255 DOI: 10.3390/children10061023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/27/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023]
Abstract
Pediatricians are well-positioned to screen for early childhood adversities, but effective responses to positive screens require an understanding of which adversities typically co-occur, and to what extent they are associated with other risk or protective factors. Among children seen at an urban academic pediatric practice, this study aimed to (1) examine the prevalence of different types of early adversity and protective experiences reported by primary caregivers, and (2) define latent classes of co-occurring adversities. Of 1434 children whose parents completed the Safe Environment for Every Kid (SEEK) at well-child visits during November 2019-January 2021, three classes of adverse experiences emerged, including those reporting low adversity (L; 73%), caregiver stress (CS; 17%), and both caregiver stress and depression (CSD; 10%). Among those who also completed the Adverse Childhood Experiences Questionnaire (ACE-Q, n = 1373) and the Protective and Compensatory Experiences Scale (PACES, n = 1377), belonging to the L class was associated with lower ACE-Q and higher PACES scores. For parent-respondents only, ACE-Q scores were significantly greater for the CSD class compared to the CS and L classes. Pediatricians should attend to the needs of caregivers reporting both stress and depression, as these families may face especially high levels of adversity and low levels of protective factors.
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Affiliation(s)
- Sarah Ronis
- UH Rainbow Center for Child Health and Policy, Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH 44106, USA
| | - Katherine L Guyon-Harris
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Kimberly Burkhart
- Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Cleveland, OH 44106, USA
| | - Mary Gabriel
- Department of Psychiatry, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Kristin Cipolla
- Department of Pediatrics, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Jessica L Riggs
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alissa Huth-Bocks
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
- Merrill Palmer Skillman Institute, Division of Research, Wayne State University, Detroit, MI 48202, USA
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25
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Braddock A, Browne NT, Houser M, Blair G, Williams DR. Weight stigma and bias: A guide for pediatric clinicians. OBESITY PILLARS 2023; 6:100058. [PMID: 37990653 PMCID: PMC10661884 DOI: 10.1016/j.obpill.2023.100058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/10/2023] [Accepted: 02/18/2023] [Indexed: 11/23/2023]
Abstract
Introduction Many children and adolescents with obesity experience weight stigma and bias, which can have detrimental mental health, medical, and social consequences. Weight stigma in the healthcare setting threatens the therapeutic relationship between health care providers and their pediatric patients and families. Methods Data supporting this guidance were derived from cited references. Results Based upon referenced citations, this review offers 7 best practices for pediatric providers to work to reduce weight stigma including: assess for personal weight bias, improve communication, provide a welcoming clinic environment, seek out additional training and informative experiences, evaluate the messaging and culture of the organization, screen for trauma and bullying, and enlist the help of board-certified obesity medicine specialists. Conclusions Providers have an important role in mitigating the harmful effects of weight stigma. It is our hope these recommendations, as well as the other resources provided, will help providers to begin to address their own individual weight biases, as well as the institutional weight biases where we care for patients.
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Affiliation(s)
- Amy Braddock
- University of Missouri, 1 Hospital Drive, Columbia, MO, 65212, USA
| | - Nancy T. Browne
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | - Marcella Houser
- LSUHSC School of Medicine, Department of Pediatrics, 200 Henry Clay Ave., New Orleans, LA, 70118, USA
| | | | - Dominique R. Williams
- The Ohio State University College of Medicine Center for Healthy Weight and Nutrition, Nationwide Children's Hospital, 700 Children's Drive LA, Suite 5F, Columbus, OH, 43215, USA
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26
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Panagou E, Missouridou ED, Zartaloudi A, Koutelekos J, Dousis E, Dafogianni C, Vlachou E, Evagelou E. Compassion Fatigue and Compassion Satisfaction in Pediatric Intensive Care Professionals. Mater Sociomed 2023; 35:28-32. [PMID: 37095878 PMCID: PMC10122523 DOI: 10.5455/msm.2023.35.28-32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023] Open
Abstract
Background Paediatric ICU doctors and nurses' quality of professional life is influenced by the intense emotions and distress experienced when caring for suffering children and their families. Objective The aim of this study was to examine the prevalence of compassion satisfaction (CS) and compassion fatigue (CF) in Paediatric Intensive Care Units in Greece. Methods Out of 147 intensive care professionals in public hospitals in Greece completed the ProQOL-V scale as well as a socio-demographic and professional-life characteristics questionnaire. Results Almost two thirds of participants reported medium-risk for CF (74.8%) while 23.1% and 76.9% of professionals expressed high or medium potential for CS respectively. More than half of doctors and nurses in paediatric ICUs report being overprotective towards members of the family as a result of their professional life and that their work-life affects their attitude towards life in general. Conclusion Recognizing factors related to CF may support paediatric intensive care professionals in avoiding the costs of exposure to the trauma and loss experiences of patients and their families. A trauma-informed intensive care culture and continuing trauma-informed education may shield professionals from the erosive effects of lingering emotions which may trigger secondary traumatic stress symptoms and also facilitate adequate reflection on their emotional reactions in the landscape of intensive care.
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Affiliation(s)
- Eleni Panagou
- Athens General Children's Hospital "P. and Aglaia Kyriakou", Athens, Greece
| | | | | | - John Koutelekos
- Department of Nursing, University of West Attica, Athens, Greece
| | - Evangelos Dousis
- Department of Nursing, University of West Attica, Athens, Greece
| | | | - Eugenia Vlachou
- Department of Nursing, University of West Attica, Athens, Greece
| | - Eleni Evagelou
- Department of Nursing, University of West Attica, Athens, Greece
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Dewan T, Birnie K, Drury J, Jordan I, Miller M, Neville A, Noel M, Randhawa A, Zadunayski A, Zwicker J. Experiences of medical traumatic stress in parents of children with medical complexity. Child Care Health Dev 2023; 49:292-303. [PMID: 35947493 PMCID: PMC10087969 DOI: 10.1111/cch.13042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 05/25/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Parents of children with medical complexity (CMC) experience high levels of stress and adverse mental health outcomes. Pediatric medical traumatic stress (PMTS) could be an important contributor that has not yet been explored. PMTS describes parents' reactions to their child's illness and medical treatment and can lead to post-traumatic stress symptoms. This is the first study to describe the experiences and impact of PMTS among parents of CMC. METHODS We conducted semi-structured interviews with 22 parents of CMC. Reflexive thematic analysis was used to generate themes that described the experiences of PMTS and potential contributing factors in the healthcare setting. Themes were validated by study participants. RESULTS Parents experienced a spectrum of events and circumstances that impacted PMTS. These corresponded to three major themes: (a) the distinctive context of being the parent of a CMC, (b) interactions with healthcare providers that can hurt or heal and (c) system factors that set the stage for trauma. The consequences of repeated PMTS were a common point of emphasis among all the themes. Parents identified numerous changes that could mitigate PMTS such as acknowledgement of trauma and provision of proactive mental health support. CONCLUSIONS Our study highlights the issue of PMTS among parents of CMC and presents opportunities to mitigate their traumatic experiences. Supporting the integration of trauma-informed care practices, increasing awareness of PMTS and advocating for parental mental health services could better support parents and families.
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Affiliation(s)
- Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Canada.,Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Katie Birnie
- Department of Anesthesia and Pain Medicine, University of Calgary, Calgary, Canada
| | | | | | - Megan Miller
- Rotary Flames Children's Hospice and Palliative Care Service, Calgary, Canada
| | | | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Alam Randhawa
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Anna Zadunayski
- Department of Pediatrics, University of Calgary, Calgary, Canada
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28
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Abstract
Trauma is common within the United States. It is important for individuals to understand how trauma may affect their health and how trauma in childhood can have adverse effects on a child's development and health. To reduce retraumatization of patients, it is imperative to use trauma-informed approaches in a clinical encounter. Screening is an effective way to understand a patient's trauma history. When screening for trauma, it is important to take a family-centered approach and provide appropriate referrals if a patient screens positive for trauma. Primary care providers are essential players in addressing and preventing trauma.
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29
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Orionzi B. Trauma-Informed Care and How Social Media Contributes to Trauma. Pediatr Ann 2023; 52:e78-e80. [PMID: 36881799 DOI: 10.3928/19382359-20230118-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Trauma has become an important part of medical care as we continue to understand further its effects on health over time. Trauma-informed care therefore has become a necessary part of medical services. Understanding the fundamentals of trauma-informed care and how it was developed is crucial to implementing this care into medical training and across all medical services involved in children's health. This leads to the framework created for the public health approach of trauma-informed care, with primary, secondary, and tertiary levels of management. Social media has also increasingly been implicated in contributing to trauma, including causing vicarious trauma, which can be just as detrimental to health and wellness. If we can encourage advocating for trauma-informed care training and policies across medical services, we can create a system with a focus on this growing factor in health care. [Pediatr Ann. 2023;52(3):e78-e80.].
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31
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Implementing trauma-informed care across the lifespan to acknowledge childhood adverse event prevalence: best clinical practices. Nurse Pract 2023; 48:14-21. [PMID: 36700790 DOI: 10.1097/01.npr.0000000000000002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
ABSTRACT Adverse childhood experiences and toxic stress in childhood have been correlated with negative physical and mental health outcomes, poor social outcomes, and early mortality. Understanding the prevalence of trauma and its effects on lifelong health outcomes has been the focus of an evolving concept of care delivery known as trauma-informed care (TIC). The aim of this article is to provide a general overview of TIC and to review current best-practice recommendations and models of care, thereby providing NPs with practical ways to empower a trauma-informed approach to care in their daily practice setting.
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Ben-Ari A, Sela Y, Ben-David S, Ankri YLE, Benarroch F, Aloni R. A Cross Sectional Study to Identify Traumatic Stress, Medical Phobia and Non-Adherence to Medical Care among Very Young Pediatric Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1122. [PMID: 36673876 PMCID: PMC9859071 DOI: 10.3390/ijerph20021122] [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: 11/09/2022] [Revised: 12/26/2022] [Accepted: 01/05/2023] [Indexed: 06/17/2023]
Abstract
After a traumatic medical event, such as surgery or hospitalization, a child may develop a phobia of medical care, sometimes preventing future medical adherence and impairing recovery. This study examined the correlation of Pediatric Medical Traumatic Stress (PMTS) on the development of Medical Phobia (MP) and subsequent treatment adherence. We enrolled 152 parents of children aged 1-6 hospitalized in a surgical ward. During hospitalization, parents completed questionnaires that identified post-traumatic stress symptoms. Four months post hospitalization, parents completed questionnaires on post-traumatic stress, medical phobia, psychosocial variables and medical adherence. We found a positive correlation between PMTS and MP and low adherence to medical treatment. In addition, MP mediated the relationship between PMTS severity and adherence, indicating that PMTS severity is associated with stronger medical phobia, and lower pediatric adherence to medical treatment. Our findings suggest that medical phobia serves as an essential component of PMTS. It is important to add medical phobia to medical stress syndrome definition. In addition, as MP and PMTS are involved in the rehabilitation and recovery process and subsequent success, it is an important aspect of treatment adherence.
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Affiliation(s)
- Amichai Ben-Ari
- Department of Behavioral Sciences, Ariel University, Ariel 40700, Israel
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem 91240, Israel
| | - Yaron Sela
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Shiri Ben-David
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem 91240, Israel
- Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem 91240, Israel
| | - Yael L. E. Ankri
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem 91240, Israel
| | - Fortu Benarroch
- Herman Dana Division of Child and Adolescent Psychiatry, Hadassah-Hebrew University Medical Center, Jerusalem 91240, Israel
| | - Roy Aloni
- Department of Behavioral Sciences, Ariel University, Ariel 40700, Israel
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O'Hara MA, Swerdin HR, Botash AS. Expanding Trauma-Informed Care to Telemedicine: Brief Report From Child Abuse Medical Professionals. Clin Pediatr (Phila) 2023; 62:5-7. [PMID: 35864730 DOI: 10.1177/00099228221111233] [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: 11/16/2022]
Affiliation(s)
- Mandy A O'Hara
- New York Presbyterian Child Advocacy Center, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Hanna R Swerdin
- College of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
| | - Ann S Botash
- College of Medicine, State University of New York Upstate Medical University, Syracuse, NY, USA
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34
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Gilgoff R, Schwartz T, Owen M, Bhushan D, Burke Harris N. Opportunities to Treat Toxic Stress. Pediatrics 2023; 151:190226. [PMID: 36450652 DOI: 10.1542/peds.2021-055591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Rachel Gilgoff
- Aurrera Health Group, Sacramento, California.,UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, California
| | | | - Mikah Owen
- UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, California
| | - Devika Bhushan
- Office of the California Surgeon General, Sacramento, California
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35
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Johnson LM, Elliott A, Sawyer KE, Steuer KB, Levine DR. Beyond Mediation: A Toolkit Approach to Preventing and Managing Conflict with Patients and Families in Difficulty. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:70-73. [PMID: 36595020 DOI: 10.1080/15265161.2022.2146799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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36
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Tyack Z. The greatest challenges and solutions to improve children's health and well-being worldwide in the next decade and beyond: Using complex systems and implementation science approaches. Front Pediatr 2023; 11:1128642. [PMID: 36923277 PMCID: PMC10009164 DOI: 10.3389/fped.2023.1128642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/07/2023] [Indexed: 03/02/2023] Open
Abstract
The health and well-being of children is paramount to health and well-being of society and is the foundation of health and well-being later in life. This paper presents the perspective that a complex systems approach that embeds implementation science is needed to address the rising challenges to child health and well-being in this decade (2020-2030) and beyond. Reflection on facilitators of the success of programs deemed promising to address child health and well-being in the past decade (2010-2020) is presented, to advance programs to address children's health and well-being. A priority that needs to be addressed is developing, testing and using theories of child and family health and well-being (and related initiatives) that can be used to build on existing successes to make progress. Understanding context including further elucidating the drivers of child health and well-being at multiple levels of relevant systems (e.g., health, education, community) across the life course, and considering implications for caregivers also require greater consideration. Methods to address future challenges to child health and well-being include co-designing initiatives that support child health and well-being with children and families themselves rather than using predesigned initiatives, thoughtful outcome selection, and reporting the challenges of implementing future programs to promote learning. The approaches, priorities and methods presented can be used to design or refine interventions, models or care or community-based initiatives and provide new direction to fields of child health enquiry.
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Affiliation(s)
- Zephanie Tyack
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
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37
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Long DA, Waak M, Doherty NN, Dow BL. Brain-Directed Care: Why Neuroscience Principles Direct PICU Management beyond the ABCs. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121938. [PMID: 36553381 PMCID: PMC9776953 DOI: 10.3390/children9121938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Major advances in pediatric intensive care (PICU) have led to increased child survival. However, the long-term outcomes among these children following PICU discharge are a concern. Most children admitted to PICU are under five years of age, and the stressors of critical illness and necessary interventions can affect their ability to meet crucial developmental milestones. Understanding the neuroscience of brain development and vulnerability can inform PICU clinicians of new ways to enhance and support the care of these most vulnerable children and families. This review paper first explores the evidence-based neuroscience principles of brain development and vulnerability and the impact of illness and care on children's brains and ultimately wellbeing. Implications for clinical practice and training are further discussed to help optimize brain health in children who are experiencing and surviving a critical illness or injury.
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Affiliation(s)
- Debbie A. Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
- Correspondence: ; Tel.: +61-7-3138-3834
| | - Michaela Waak
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
| | - Nicola N. Doherty
- Regional Trauma Network, SPPG, DOH, Belfast BT2 8BS, Northern Ireland, UK
- School of Psychology, Faculty of Life and Health Sciences, Coleraine Campus, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - Belinda L. Dow
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
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Abstract
By age 18, one in fourteen American children has had a parent incarcerated. Although children from all backgrounds experience parental incarceration, racial and ethnic minority groups and those living in poverty are disproportionately affected. Parental incarceration is an adverse childhood experience that can negatively affect health and well-being over the life course. However, resilient children of incarcerated parents can flourish despite profound adversity. Pediatric providers should create safe, inclusive medical homes that foster sensitive disclosures and discussions about parental incarceration. If pediatric providers identify parental incarceration, they should promote foundational relationships and family resilience (including relationships with incarcerated parents when appropriate) and consider referrals to mental health specialists and specialized programs for children of incarcerated parents. Pediatric providers are also uniquely positioned to advocate for partnerships and policies that support children of incarcerated parents.
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Affiliation(s)
- Rosemary A Martoma
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH.,KidsMates Inc, Boca Raton, FL
| | - Kelly J Kelleher
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH
| | - Alex R Kemper
- Division of Primary Care Pediatrics, Nationwide Children's Hospital, Columbus, OH
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Demers LA, Wright NM, Kopstick AJ, Niehaus CE, Hall TA, Williams CN, Riley AR. Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101575. [PMID: 36291511 PMCID: PMC9600460 DOI: 10.3390/children9101575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/23/2022]
Abstract
Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.
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Affiliation(s)
- Lauren A. Demers
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Naomi M. Wright
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Psychology, University of Denver, Denver, CO 80208, USA
| | - Avi J. Kopstick
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Texas Tech University Health Science Center El Paso, El Paso, TX 97705, USA
| | - Claire E. Niehaus
- Division of Psychology and Psychiatry, University of Louisville School of Medicine, Louisville, KY 40202, USA
| | - Trevor A. Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Correspondence: ; Tel.: +1-503-418-2134
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
- Division of Pediatric Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
| | - Andrew R. Riley
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, OR 97239, USA
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40
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Hails KA, Petts RA, Hostutler CA, Simoni M, Greene R, Snider TC, Riley AR. COVID-19 distress, negative parenting, and child behavioral problems: The moderating role of parent adverse childhood experiences. CHILD ABUSE & NEGLECT 2022; 130:105450. [PMID: 34969517 PMCID: PMC8710429 DOI: 10.1016/j.chiabu.2021.105450] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/13/2021] [Accepted: 12/13/2021] [Indexed: 05/26/2023]
Abstract
BACKGROUND Heightened familial stress and distress during the COVID-19 pandemic may lead to increased negative parenting practices, particularly for parents with substantial adverse childhood experiences (ACES). OBJECTIVE To determine whether families' COVID-19-related distress is associated with young children's emotional/behavioral functioning via negative parenting, and whether these relationships vary based on parents' ACEs. PARTICIPANTS AND SETTING Participants were 267 parents of children ages 1.5-5 years recruited from five primary care sites across the United States. METHODS Participants completed internet questionnaires including measures of demographics, parent ACES, negative parenting, parent mental health, and COVID-19 distress. We used regression analyses to test a moderated mediation model in which the relationship between COVID-19 distress and child emotional/behavioral problems is mediated by negative parenting, and both the direct and indirect effects of COVID-19 distress on child emotional/behavioral problems is moderated by parents' ACEs. RESULTS Negative parenting significantly mediated the relationship between COVID-19 distress and child emotional/behavioral problems (indirect effect β = 0.07). Parents' ACEs moderated the associations between COVID-19 distress and both negative parenting and child emotional/behavioral problems, such that each relationship was stronger in the context of higher parental ACEs. The model accounted for 42% of the variance in child emotional/behavioral problems. CONCLUSIONS Findings have implications for managing risk and promoting well-being in young children during periods of significant stress and routine disruption. This study advances understanding of factors influencing negative outcomes in children during the pandemic's acute phase and may have implications for the development of targeted interventions to improve families' adjustment in the future.
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Affiliation(s)
- Katherine A Hails
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States of America; University of Oregon Prevention Science Institute, 1600 Millrace Dr., Eugene, OR 97403, United States of America.
| | - Rachel A Petts
- Fairleigh Dickinson University, 1000 River Rd., Teaneck, NJ 07666, United States of America.
| | - Cody A Hostutler
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, United States of America.
| | - Marisa Simoni
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States of America.
| | - Rachel Greene
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States of America.
| | - Tyanna C Snider
- Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH 43205, United States of America.
| | - Andrew R Riley
- Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, United States of America.
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41
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Wright JL, Davis WS, Joseph MM, Ellison AM, Heard-Garris NJ, Johnson TL. Eliminating Race-Based Medicine. Pediatrics 2022; 150:186963. [PMID: 35491483 DOI: 10.1542/peds.2022-057998] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Joseph L Wright
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland
| | - Wendy S Davis
- Department of Pediatrics, Robert Larner, MD, College of Medicine, University of Vermont, Burlington, Vermont
| | - Madeline M Joseph
- Departments of Emergency Medicine and Pediatrics, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida
| | - Angela M Ellison
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Nia J Heard-Garris
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tiffani L Johnson
- Department of Emergency Medicine, University of California, Davis, Sacramento, California
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42
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Shonkoff JP, Boyce WT, Bush NR, Gunnar MR, Hensch TK, Levitt P, Meaney MJ, Nelson CA, Slopen N, Williams DR, Silveira PP. Translating the Biology of Adversity and Resilience Into New Measures for Pediatric Practice. Pediatrics 2022; 149:187008. [PMID: 35535547 DOI: 10.1542/peds.2021-054493] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 02/06/2023] Open
Abstract
As the science of adversity and resilience advances, and public awareness of the health consequences of stress grows, primary care providers are being increasingly asked to address the effects of adverse experiences on child wellbeing. Given limited tools for assessing these effects early in life, the authors explore how enhanced capacity to measure stress activation directly in young children could transform the role and scope of pediatric practice. When employed within a trusted relationship between caregivers and clinicians, selective use of biological measures of stress responses would help address the documented limitations of rating scales of adverse childhood experiences as a primary indicator of individual risk and strengthen the ability to focus on variation in intervention needs, assess their effectiveness, and guide ongoing management. The authors provide an overview of the potential benefits and risks of such expanded measurement capacity, as well as an introduction to candidate indicators that might be employed in an office setting. The ultimate value of such measures for both pediatricians and parents will require vigilant attention to the ethical responsibilities of assuring their correct interpretation and minimizing the harm of inappropriate labeling, especially for children and families experiencing the hardships and threats of racism, poverty, and other structural inequities. Whereas much work remains to be done to advance measurement development and ensure its equitable use, the potential of validated markers of stress activation and resilience to strengthen the impact of primary health care on the lives of young children facing significant adversity demands increased attention.
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Affiliation(s)
- Jack P Shonkoff
- Center on the Developing Child.,Harvard Graduate School of Education.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.,Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - W Thomas Boyce
- University of California, San Francisco, San Francisco, California
| | - Nicole R Bush
- Departments of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences.,Department of Pediatrics, Division of Developmental Medicine, University of California, San Francisco, San Francisco, California
| | - Megan R Gunnar
- Institute of Child Development, University of Minnesota, Minneapolis, Minnesota
| | - Takao K Hensch
- Center on the Developing Child.,Conte Center for Basic Mental Health Research.,Center for Brain Science, Harvard University, Cambridge, Massachusetts.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Pat Levitt
- Developmental Neuroscience and Neurogenetics Program, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California.,Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael J Meaney
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Brenner Centre for Molecular Medicine, Singapore, Republic of Singapore
| | - Charles A Nelson
- Center on the Developing Child.,Harvard Graduate School of Education.,Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Natalie Slopen
- Center on the Developing Child.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - David R Williams
- Center on the Developing Child.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Patricia Pelufo Silveira
- Ludmer Centre for Neuroinformatics and Mental Health, Douglas Hospital Research Center, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada.,Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
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43
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Duffee J. Trauma-Informed Ethics and Relational Health. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:62-65. [PMID: 35475954 DOI: 10.1080/15265161.2022.2055217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- James Duffee
- Wright State University Boonshoft School of Medicine
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44
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Bucholz EM, Toomey SL, McCulloch CE, Bardach NS. Adjusting for Social Risk Factors in Pediatric Quality Measures: Adding to the Evidence Base. Acad Pediatr 2022; 22:S108-S114. [PMID: 35339237 PMCID: PMC9279115 DOI: 10.1016/j.acap.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Outcome and utilization quality measures are adjusted for patient case-mix including demographic characteristics and comorbid conditions to allow for comparisons between hospitals and health plans. However, controversy exists around whether and how to adjust for social risk factors. OBJECTIVE To assess an approach to incorporating social risk variables into a pediatric measure of utilization from the Pediatric Quality Measures Program (PQMP). METHODS We used data from California Medicaid claims (2015-16) and Massachusetts All Payer Claims Database (2014-2015) to calculate health plan performance using measure specifications from the Pediatric Asthma Emergency Department Use measure. Health plan performance categories were assessed using mixed effect negative binomial models with and without adjustment for social risk factors, with both models adjusting for age, gender and chronic condition category. Mixed effects linear models were then used to compare patient social risk for health plans that changed performance categories to patient social risk for health plans that did not. RESULTS Of 133 health plans, serving 404,649 pediatric patients with asthma, 7% to 13% changed performance categories after social risk adjustment. Health plans that moved to higher performance categories cared for lower socioeconomic status (SES) patients whereas those that moved to lower performance categories cared for higher SES patients. CONCLUSIONS Adjustment for social risk factors changed performance rankings on the PQMP Pediatric Asthma Emergency Department Use measure for a substantial number of health plans. Some health plans caring for higher risk patients performed more poorly when social risk factors were not included in risk adjustment models. In light of this, social risk factors are incorporated into the National Quality Forum-endorsed measure; whether to incorporate social risk factors into pediatric quality measures will differ depending on the use case.
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Affiliation(s)
- Emily M. Bucholz
- Department of Cardiology, Boston Children’s Hospital, Boston, MA,Harvard Medical School, Boston, MA
| | - Sara L. Toomey
- Harvard Medical School, Boston, MA,Department of Pediatrics, Boston Children’s Hospital, Boston, MA
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Naomi S. Bardach
- Department of Pediatrics, University of California San Francisco
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45
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Su CJ, Cyr PEP. Accessible Medical Education & TIC: Increasing Equitable Care for Disabled Patients. HARVARD PUBLIC HEALTH REVIEW (CAMBRIDGE, MASS.) 2022; 44:https://hphr.org/edition-44-su/. [PMID: 36176338 PMCID: PMC9518008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
An estimated 1 in 4 U.S. adults has a disability, and this number continues to increase. Disabled individuals face significant healthcare inequities, including but not limited to inaccessibility and mistreatment. Our current healthcare system is ill-equipped to provide equitable care to this population. There is a lack of accessibility in healthcare environments, lack of accessible medical training to enable disabled people to become healthcare providers serving their own community, and lack of thorough medical education that encompasses care for disabled patients. Furthermore, the increased risk of trauma, as well as increased risk of medical trauma specifically, endured by disabled people puts them at greater risk of long-lasting adverse effects. In this commentary, we analyze three key areas: 1) the current state of healthcare for disabled patients, 2) disability in medical education & physician workforce, and 3) the relationship between trauma and disability. We argue that the road to more equitable care for disabled patients involves changes to medical education that address all three of these areas. Medical training should expose trainees to disability early and throughout their training, should be made more accessible to support disabled physicians, and finally, should be trauma-informed in a manner that explicitly includes caring for disabled patients and their other intersecting identities.
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46
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Purtell R, Tam RP, Avondet E, Gradick K. We are part of the problem: the role of children's hospitals in addressing health inequity. Hosp Pract (1995) 2021; 49:445-455. [PMID: 35061953 DOI: 10.1080/21548331.2022.2032072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/17/2022] [Indexed: 06/14/2023]
Abstract
Racism is an ongoing public health crisis that undermines health equity for all children in hospitals across our nation. The presence and impact of institutionalized racism contributes to health inequity and is under described in the medical literature. In this review, we focus on key interdependent areas to foster inclusion, diversity, and equity in Children's Hospitals, including 1) promotion of workforce diversity 2) provision of anti-racist, equitable hospital patient care, and 3) prioritization of academic scholarship focused on health equity research, quality improvement, medical education, and advocacy. We discuss the implications for clinical and academic practice.Plain Language Summary: Racism in Children's Hospitals harms children. We as health-care providers and hospital systems are part of the problem. We reviewed the literature for the best ways to foster inclusion, diversity, and equity in hospitals. Hospitals can be leaders in improving child health equity by supporting a more diverse workforce, providing anti-racist patient care, and prioritizing health equity scholarship.
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Affiliation(s)
- Rebecca Purtell
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Reena P Tam
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Erin Avondet
- Assistant Professor of Pediatrics, Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katie Gradick
- Assistant Professor of Pediatrics, Division of Pediatric Palliative Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
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47
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Abstract
Most children will experience some type of trauma during childhood, and many children suffer from significant adversities. Research in genetics, neuroscience, and epidemiology all provide evidence that these experiences have effects at the molecular, cellular, and organ level, with consequences on physical, emotional, developmental, and behavioral health across the life span. Trauma-informed care translates that science to inform and improve pediatric care and outcomes. To practically address trauma and promote resilience, pediatric clinicians need tools to assess childhood trauma and adversity experiences as well as practical guidance, resources, and interventions. In this clinical report, we summarize current, practical advice for rendering trauma-informed care across varied medical settings.
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Affiliation(s)
- Heather Forkey
- Department of Pediatrics, University of Massachusetts, Worcester, Massachusetts
| | - Moira Szilagyi
- Divisions of General and Developmental-Behavioral Pediatrics, Department of Pediatrics, University of California, Los Angeles, Los Angeles, California
| | - Erin T Kelly
- Ambulatory Health Services, Philadelphia Department of Public Health, Philadelphia, Pennsylvania
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