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Erickson BR, Marti FA, Choi K, Eberhart N, Ashwood JS, Zima B, Montero A, Kataoka S, Bromley E. "They Just Helped Save My Life:" Client Perspectives on the Los Angeles County Full Service Partnership (FSP) Program for Serious Mental Illness. Community Ment Health J 2023; 59:1227-1234. [PMID: 36735205 PMCID: PMC10330294 DOI: 10.1007/s10597-023-01096-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/18/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
The purpose of this qualitative study was to elicit client perspectives on the Los Angeles County Full Service Partnership (FSP) program - an adaptation of Assertive Community Treatment (ACT). Semi-structured interviews were conducted with 20 FSP clients. Qualitative data were analyzed using thematic analysis. Two major themes were identified from the interview data: (1) Clients' acknowledgement of the material benefits of the FSP program; and (2) FSP's impact on restoring and stabilizing clients' social and treatment relationships. Interviewees greatly valued the material (i.e., basic needs, housing assistance) and relational (i.e., relationships with providers, restored personal relationships) aspects of the program, but did not ascribe the same degree of value to mental health treatment. Interviewees' emphases on material and relational aspects reflect the status of assertive mental health treatment as an intervention on intermediary determinants of health in the lives of persons diagnosed with serious mental illness.
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Affiliation(s)
- Blake R Erickson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, Manhattan, NY, USA.
- New York State Psychiatric Institute, Manhattan, NY, USA.
| | - F Alethea Marti
- Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kristen Choi
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Bonnie Zima
- Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Alanna Montero
- Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sheryl Kataoka
- Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
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Edgcomb JB, Tseng CH, Pan M, Klomhaus A, Zima B. Detection of Suicidal Behavior and Self-harm Among Children Presenting to Emergency Departments: A Tree-based Classification Approach. AMIA Jt Summits Transl Sci Proc 2023; 2023:108-117. [PMID: 37350874 PMCID: PMC10283119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Suicide is the second leading cause of death of U.S. children over 10 years old. Application of statistical learning to structured EHR data may improve detection of children with suicidal behavior and self-harm. Classification trees (CART) were developed and cross-validated using mental health-related emergency department (MH-ED) visits (2015-2019) of children 10-17 years (N=600) across two sites. Performance was compared with the CDC Surveillance Case Definition ICD-10-CM code list. Gold-standard was child psychiatrist chart review. Visits were suicide-related among 284/600 (47.3%) children. ICD-10-CM detected cases with sensitivity 70.7 (95%CI 67.0-74.3), specificity 99.0 (98.8-100), and 85/284 (29.9%) false negatives. CART detected cases with sensitivity 85.1 (64.7-100) and specificity 94.9 (89.2-100). Strongest predictors were suicide-related code, MH- and suicide-related chief complaints, site, area deprivation index, and depression. Diagnostic codes miss nearly one-third of children with suicidal behavior and self-harm. Advances in EHR-based phenotyping have the potential to improve detection of childhood-onset suicidality.
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Affiliation(s)
- Juliet B Edgcomb
- UCLA Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA
| | - Chi-Hong Tseng
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Mengtong Pan
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Alexandra Klomhaus
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Bonnie Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA
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Choi KR, Bhakta B, Knight EA, Becerra-Culqui TA, Gahre TL, Zima B, Coleman KJ. Patient Outcomes After Applied Behavior Analysis for Autism Spectrum Disorder. J Dev Behav Pediatr 2022; 43:9-16. [PMID: 34342287 PMCID: PMC8702444 DOI: 10.1097/dbp.0000000000000995] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 04/21/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The purpose of this study was to examine patterns of service receipt and patient outcomes for children receiving applied behavior analysis (ABA) for autism spectrum disorder (ASD) in an integrated health care system in which commercially insured children were covered by a state autism mandate. METHODS This retrospective, observational study used a random sample of children with ASD (3-17 yrs) who were members of a large integrated health care system in Southern California and referred for ABA between January 2016 and November 2018. From the 4145 children referred, a random stratified sample of 334 was selected to extract data from clinical reports over 24 months of services. The primary outcome measures were time in ABA and child adaptive behavior. RESULTS Thirteen percent of the sample never received ABA after referral. Of those who were referred for ABA, 66% initiated ABA and remained in services for 12 months, whereas less than half (46%) remained in services for 24 months. Having a history of special education was associated with longer time spent in ABA, whereas having a single parent was associated with discontinuation of ABA. A minority of children received a full ABA dose (28%), but the lowest functioning children still experienced clinically significant adaptive behavior gains after 24 months of ABA (p = 0.02). CONCLUSION In a health system implementation of ABA for children with ASD, there were high rates of ABA discontinuation and low ABA dosing. These challenges may diminish the potential benefits of ABA, even in a context in which there is mandated commercial insurance coverage.
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Affiliation(s)
- Kristen R. Choi
- School of Nursing, University of California, Los Angeles, Los Angeles, California
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Bhumi Bhakta
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | | | - Tracy A. Becerra-Culqui
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA
| | - Teri L. Gahre
- Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA
| | - Bonnie Zima
- Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, California
| | - Karen J. Coleman
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California
- Southern California Permanente Medical Group, Kaiser Permanente, Pasadena, CA
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Bonilla AG, Pourat N, Chuang E, Ettner S, Zima B, Chen X, Lu C, Hoang H, Hair BY, Bolton J, Sripipatana A. Mental Health Staffing at HRSA-Funded Health Centers May Improve Access to Care. Psychiatr Serv 2021; 72:1018-1025. [PMID: 34074146 PMCID: PMC8410613 DOI: 10.1176/appi.ps.202000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The study objective was to examine the association between mental health staffing at health centers funded by the Health Resources and Services Administration (HRSA) and patients' receipt of mental health treatment. METHODS Data were from the 2014 HRSA-funded Health Center Patient Survey and the 2013 Uniform Data System. Colocation of any mental health staff, including psychiatrists, psychologists, and other licensed staff, was examined. The outcomes of interest were whether a patient received any mental treatment and received any such treatment on site (at the health center). Analyses were conducted with multilevel generalized structural equation logistic regression models for 4,575 patients ages 18-64. RESULTS Patients attending health centers with at least one mental health full-time equivalent (FTE) per 2,000 patients had a higher predicted probability of receiving mental health treatment (32%) compared with those attending centers with fewer than one such FTE (24%) or no such staffing (22%). Among patients who received this treatment, those at health centers with no staffing had a significantly lower predicted probability of receiving such treatment on site (28%), compared with patients at health centers with fewer than one such FTE (49%) and with at least one such FTE (65%). The predicted probability of receiving such treatment on site was significantly higher if there was a colocated psychiatrist versus no psychiatrist (58% versus 40%). CONCLUSIONS Colocating mental health staff at health centers increases the probability of patients' access to such treatment on site as well as from off-site providers.
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Affiliation(s)
- Amy G Bonilla
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Nadereh Pourat
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Emmeline Chuang
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Susan Ettner
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Bonnie Zima
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Xiao Chen
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Connie Lu
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Hank Hoang
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Brionna Y Hair
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Joshua Bolton
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
| | - Alek Sripipatana
- Department of Health Policy and Management, Fielding School of Public Health (Bonilla, Pourat, Chuang, Ettner); Center for Health Policy Research (Pourat, Chen, Lu); Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior (Zima); Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ettner); Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine (Zima), all at University of California, Los Angeles, Los Angeles; Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, U.S. Department of Health and Human Services (Hoang, Hair, Bolton, Sripipatana)
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Kerner B, Carlson M, Eskin CK, Tseng CH, Ho JMGY, Zima B, Leader E. Trends in the utilization of a peer-supported youth hotline. Child Adolesc Ment Health 2021; 26:65-72. [PMID: 32449589 DOI: 10.1111/camh.12394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 04/11/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Peer-supported youth hotlines have been in operation for many years but studies on the acceptance of this hotline model or on the demographics of the callers are lacking. This study was performed to examine the utilization of a metropolitan peer-supported youth hotline between 2010 and 2016. METHOD The change in demographics, contact channels, and the reasons for contact were analyzed with standard linear regression analysis in 67,478 contacts over 7 years. RESULTS The data revealed a significant increase in hotline utilization from 8008 annual contacts in 2010 to 12,409 contacts in 2016 (p = .03). The majority of contacts were made by 15-year-old and 16-year-old girls, but contacts by children aged 13 years old and younger have also increased significantly over the years (p = .003). In 2016, anxiety and stress were among the leading reasons for contact (20.14%), followed by sadness and depression (17.21%), suicidal ideation (14.18%), and self-harm (8.15%). Recommendations for follow-up with outside mental health resources were made in 56.22% of contacts. More than 60% of contacts had found information about the hotline on the Internet. More than 30% used text messaging to reach out to the hotline. CONCLUSIONS Our data indicate that adolescents increasingly utilize a peer-supported youth hotline to get help for mental health concerns. Therefore, it should be explored whether this hotline model could also be used for prevention and early intervention. KEY PRACTITIONER MESSAGE Peer-supported youth hotlines are well accepted and frequently utilized by adolescents to get help for mental health issues. Our data indicate that peer-supported youth hotlines could be utilized to identify youth at risk for depression and suicide. Further research should evaluate whether peer-supported youth hotlines could serve in the prevention and in early mental health intervention, and how they could be effectively linked to other mental health resources in the community.
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Affiliation(s)
- Berit Kerner
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | - Bonnie Zima
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Elaine Leader
- Cedars-Sinai Medical Center, Teen Line, Los Angeles, CA, USA
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Barnert ES, Lopez N, Pettway B, Keshav N, Abrams LS, Zima B, Chung PJ. The Role of Parent Engagement in Overcoming Barriers to Care for Youth Returning Home After Incarceration. J Community Health 2021; 45:329-337. [PMID: 31541349 DOI: 10.1007/s10900-019-00747-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We sought to understand the role of parent engagement in overcoming barriers to care for youth re-entering the community following incarceration. For this mixed methods study, we conducted quantitative surveys on healthcare needs and access with youth (n = 50) at 1-month post-incarceration, and semi-structured interviews with a subset of these youth (n = 27) and their parents (n = 34) at 1, 3, and 6-months post-incarceration (total 94 interviews). Differences by race/ethnicity and gender were assessed using Chi square test of proportions. We performed thematic analysis of interview transcripts to examine the role of parent engagement in influencing youths' access to healthcare during reentry. Most youth were from racial/ethnic minority groups and reported multiple ACEs. Girls, compared to boys, had higher ACE scores (p = 0.03), lower family connectedness (p = 0.03), and worse general health (p = 0.02). Youth-identified barriers to care were often parent-dependent and included lack of: affordable care (22%), transportation (16%), and accompaniment to health visits (14%). Two major themes emerged from the qualitative interviews: (1) parents motivate youth to seek healthcare during reentry and (2) parents facilitate the process of youth seeking healthcare during reentry. Parents are instrumental in linking youth to healthcare during reentry, dispelling prevailing myths that parents of incarcerated youth are inattentive and that youth do not want their help. Efforts that support and enhance parent engagement in access to care during reentry, such as by actively involving parents in pre-release healthcare planning, may create stronger linkages to care.
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Affiliation(s)
- Elizabeth S Barnert
- Department of Pediatrics, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA. .,Children's Discovery & Innovation Institute, Mattel Children's Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Nathalie Lopez
- Department of Pediatrics, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Children's Discovery & Innovation Institute, Mattel Children's Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Bria Pettway
- Department of Pediatrics, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Children's Discovery & Innovation Institute, Mattel Children's Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Nivedita Keshav
- Department of Pediatrics, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Children's Discovery & Innovation Institute, Mattel Children's Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Laura S Abrams
- Department of Social Welfare, UCLA Luskin School of Public Affairs, UCLA, 337 Charles E Young Dr, Los Angeles, CA, 90095, USA
| | - Bonnie Zima
- Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Paul J Chung
- Department of Pediatrics, David Geffen School of Medicine, UCLA, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Children's Discovery & Innovation Institute, Mattel Children's Hospital, 757 Westwood Plaza, Los Angeles, CA, 90095, USA.,Department of Health Policy & Management, UCLA Fielding School of Public Health, UCLA, 650 Charles E Young Dr, Los Angeles, CA, 90095, USA.,RAND Health, RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA.,Department of Health Systems Science, Kaiser Permanente School of Medicine, 100 S Los Robles Ave #501, Pasadena, CA, 91101, USA
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Barnert ES, Abrams LS, Lopez N, Sun A, Tran J, Zima B, Chung PJ. Parent and Provider Perspectives on Recently Incarcerated Youths' Access to Healthcare During Community Reentry. Child Youth Serv Rev 2020; 110:104804. [PMID: 34040268 PMCID: PMC8145947 DOI: 10.1016/j.childyouth.2020.104804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Incarcerated youth have numerous healthcare needs, yet access to healthcare following community reentry is limited. Healthcare and juvenile justice providers, along with parents, strongly influence access to care for youth undergoing reentry. However, their perspectives are often missing from the literature. We examined parent and provider perspectives on youths' access to healthcare during community reentry. We conducted 72 longitudinal interviews with parents of youth undergoing reentry (n= 34 parents) and cross-sectional interviews with health and juvenile justice providers (n=20 providers). We performed inductive analysis of interview transcripts to identify the major themes related to access to healthcare during reentry. Respondents identified key leverage points that influence access to healthcare along the spectrum of individual, community, and policy-level factors. Parent and provider perspectives demonstrated substantial overlap, strongly concurring on the essential role of parents in linking youth to care and the external factors that limit parents' ability to connect youth to care. However, providers discussed parents not buying-in to treatment plans as a barrier to care, and parents uniquely described feeling powerless when their children were not motivated to receive care. Parents and providers agreed on priority solutions for improving care access during reentry. Immediate solutions centered on: 1) increasing reliability and continuity of providers, 2) providing free or low-cost transportation to healthcare visits, and 3) eliminating gaps in Medicaid coverage post-incarceration. Findings also signal the broader need to pursue strategies that increase family engagement in healthcare during reentry. In doing so, health and juvenile justice providers can partner with parents to overcome barriers to healthcare for youth during reentry.
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Affiliation(s)
| | - Laura S Abrams
- UCLA Luskin School of Public Affairs, Los Angeles, California
| | - Nathalie Lopez
- UCLA Department of Pediatrics, 10955 Le Conte Ave, LA, CA 90095
| | - Ava Sun
- UCLA Department of Pediatrics, 10955 Le Conte Ave, LA, CA 90095
| | - John Tran
- UCLA Department of Pediatrics, 10955 Le Conte Ave, LA, CA 90095
| | - Bonnie Zima
- UCLA Department of Psychiatry, Los Angeles, California
| | - Paul J Chung
- UCLA Department of Pediatrics, 10955 Le Conte Ave, LA, CA 90095
- Kaiser Permanente Medical School, Pasadena, California
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McCreary M, Arevian AC, Brady M, Mosqueda Chichits AE, Zhang L, Tang L, Zima B. A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study. JMIR Ment Health 2019; 6:e12358. [PMID: 31012861 PMCID: PMC6658269 DOI: 10.2196/12358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/03/2019] [Accepted: 03/01/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND National recommendations for pediatric integrated care models include improved capacity for care coordination and communication across primary care and specialty mental health providers using technology, yet few practical, short-term solutions are available for low-resource, community-based pediatric integrated care clinics. OBJECTIVE The goal of the paper is to describe the development and features of a Web-based tool designed for program evaluation and clinician monitoring of embedded pediatric mental health care using a community-partnered approach. In addition, a longitudinal study design was used to assess the implementation of the tool in program evaluation, including clinical monitoring and data collection. METHODS Biweekly meetings of the partnered evaluation team (clinic, academic, and funding partners) were convened over the course of 12 months to specify tool features using a participatory framework, followed by usability testing and further refinement during implementation. RESULTS A data collection tool was developed to collect clinic population characteristics as well as collect and display patient mental health outcomes and clinical care services from 277 eligible caregiver/child participants. Despite outreach, there was little uptake of the tool by either the behavioral health team or primary care provider. CONCLUSIONS Development of the H3 Tracker (Healthy Minds, Healthy Children, Healthy Chicago Tracker) in two community-based pediatric clinics with embedded mental health teams serving predominantly minority children is feasible and promising for on-site program evaluation data collection. Future research is needed to understand ways to improve clinic integration and examine whether promotion of primary care/mental health communication drives sustained use. TRIAL REGISTRATION ClinicalTrials.gov NCT02699814; https://clinicaltrials.gov/ct2/show/NCT02699814 (Archived by WebCite at http://www.webcitation.org/772pV5rWW).
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Affiliation(s)
- Michael McCreary
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, CA, United States
| | - Armen C Arevian
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, CA, United States
| | - Madeline Brady
- Metropolitan Family Services, Chicago, IL, United States
| | | | - Lily Zhang
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, CA, United States
| | - Lingqi Tang
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, CA, United States
| | - Bonnie Zima
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California - Los Angeles, Los Angeles, CA, United States
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Abstract
An unprecedented amount of clinical information is now available via electronic health records (EHRs). These massive data sets have stimulated opportunities to adapt computational approaches to track and identify target areas for quality improvement in mental health care. In this column, three key areas of EHR data science are described: EHR phenotyping, natural language processing, and predictive modeling. For each of these computational approaches, case examples are provided to illustrate their role in mental health services research. Together, adaptation of these methods underscores the need for standardization and transparency while recognizing the opportunities and challenges ahead.
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Affiliation(s)
- Juliet Beni Edgcomb
- Department of Psychiatry and Behavioral Sciences (Edgcomb, Zima) and Center for Health Services and Society (Zima), University of California, Los Angeles, Los Angeles
| | - Bonnie Zima
- Department of Psychiatry and Behavioral Sciences (Edgcomb, Zima) and Center for Health Services and Society (Zima), University of California, Los Angeles, Los Angeles
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Edgcomb JB, Zima B. Medication Adherence Among Children and Adolescents with Severe Mental Illness: A Systematic Review and Meta-Analysis. J Child Adolesc Psychopharmacol 2018; 28:508-520. [PMID: 30040434 DOI: 10.1089/cap.2018.0040] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis of studies investigating predictors of medication adherence in children and adolescents with severe mental illness (SMI). METHOD A systematic literature search was conducted in PubMed/MEDLINE, Web of Science, and PsycINFO from 1980 through October 1st, 2017, for original peer-reviewed articles that investigated predictors of adherence to psychopharmacologic treatment among children (≤18-years-old) with a primary psychotic disorder, bipolar disorder, depression, recent suicide attempt, or psychiatric hospitalization. Effect sizes (ESs) for individual predictors were extracted and combined using DerSimonian-Laird random-effects meta-analysis. Meta-regression and moderator analyses were conducted to investigate subgroups. This review complied with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement guidelines. RESULTS A total of 28 studies (n = 180,870) met inclusion criteria; 65.9% (±20.9%) of children and adolescents with SMI were medication adherent. Adherence was associated with patient and family attitudes toward care, adherence to psychotherapy, and insight. Nonadherence was associated with illness severity, substance use, and attention-deficit/hyperactivity disorder. Heterogeneity was moderate-to-large for most ES estimates (I2 > 50%). Age, sex, underlying diagnosis, and study methodology emerged as significant moderators. CONCLUSION Medication nonadherence among youth with SMI is highly prevalent. Children and adolescents with more severe illness and higher comorbidity burden are at greater risk for nonadherence. Positive interpersonal care processes and adherence to nonpharmacological treatment may be protective. These findings inform development of a risk profile for nonadherence among youth with SMI. Future prospective research is needed to address the shortcomings in the existing literature and inform interventions to improve adherence.
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Affiliation(s)
- Juliet Beni Edgcomb
- 1 Department of Psychiatry and Behavioral Sciences, University of California , Los Angeles, Los Angeles, California
| | - Bonnie Zima
- 2 Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, University of California , Los Angeles, Los Angeles, California
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Wells KB, Jones L, Zima B, Eisen C. Editorial: Developments in Community Partnered Participatory Research for Behavioral Health. Ethn Dis 2018; 28:287-290. [PMID: 30202179 PMCID: PMC6128341 DOI: 10.18865/ed.28.s2.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Ethn Dis. 2018;28(Suppl 2): 287-290; doi:10.18865/ed.28.S2.287.
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Affiliation(s)
- Kenneth B. Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA and RAND Health Program; Los Angeles CA
| | - Loretta Jones
- Healthy African American Families Phase II and Charles R Drew University of Medicine and Science; Los Angeles CA
| | - Bonnie Zima
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute; Los Angeles, CA
| | - Carol Eisen
- Semel Institute for Neuroscience and Human Behavior, Los Angeles Country Department of Mental Health, Los Angeles, CA
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Myers K, Cummings JR, Zima B, Oberleitner R, Roth D, Merry SM, Bohr Y, Stasiak K. Advances in Asynchronous Telehealth Technologies to Improve Access and Quality of Mental Health Care for Children and Adolescents. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s41347-018-0055-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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Abstract
A scoping review was performed to determine what evidence exists to support the clinical use of mobile health (mHealth) interventions to address child psychiatric disorders. The review focused on children less than 18 years old who were diagnosed with a mental disorder, used an mHealth intervention, and included novel outcome data. Each study assessed feasibility of the intervention and concluded that the interventions were accepted and/or liked by patients. Of the 2 studies that examined effectiveness using a randomized controlled trial design, there were no statistically significant differences in clinical outcomes, but results were limited by small sample size.
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Affiliation(s)
- Christopher Archangeli
- Department of Psychiatry, University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA.
| | - F Alethea Marti
- UCLA Center for Health Services and Society, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024, USA
| | - Emilia Antonievna Wobga-Pasiah
- University of Arkansas for Medical Sciences, Northwest Family Medicine Residency, 1125 North College Avenue, Fayetteville, AR 72701, USA
| | - Bonnie Zima
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, UCLA Center for Health Services and Society, 10920 Wilshire Boulevard, Suite 300, Los Angeles, CA 90024, USA
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Perrin JM, Houtrow A, Kelleher K, Hoagwood K, Stein REK, Zima B. Supplemental Security Income Benefits for Mental Disorders. Pediatrics 2016; 138:peds.2016-0354. [PMID: 27279648 DOI: 10.1542/peds.2016-0354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2016] [Indexed: 11/24/2022] Open
Abstract
The Supplemental Security Income Program (SSI) provides financial support to low-income households with children and youth with severe disabilities. The program included children when it began in the early 1970s. The numbers of children receiving SSI benefits increased substantially in the early 1990s, in part through an expansion of the listings of mental health conditions with which children could become eligible. Over the past 20 years, larger numbers of children have received SSI benefits for mental disorders, and these increases have led to questions from the press and Congress regarding these numbers. Do they indicate more of an increase in mental disorders among SSI children than in the general population? The National Academy of Medicine (NAM; formerly the Institute of Medicine) convened a study panel to examine what is known about mental disorders among the child SSI population and how that compares with evidence about mental disorders in children in general. The NAM report provides detailed information about how SSI works, about the changing numbers of children receiving SSI for mental disorders, and some comparisons with other evidence about rising rates of mental disorders in the general population and especially among children living in poverty. The report indicates that increasing numbers of children with mental disorders in SSI mirror similar increases in the population in general. This article summarizes key evidence from the NAM report and suggests the implications for pediatricians.
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Affiliation(s)
- James M Perrin
- MassGeneral Hospital for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
| | - Amy Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Children's Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Kelly Kelleher
- Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State University, Columbus, Ohio
| | - Kimberly Hoagwood
- Department of Child Psychiatry, New York University School of Medicine, New York, New York
| | - Ruth E K Stein
- Children's Hospital at Montefiore, Bronx, New York; Albert Einstein College of Medicine, Bronx, New York; and
| | - Bonnie Zima
- Department of Psychiatry and Biobehavioral Sciences and UCLA-Semel Institute for Neurosciences and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, California
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Mikesell L, Bromley E, Young AS, Vona P, Zima B. Integrating Client and Clinician Perspectives on Psychotropic Medication Decisions: Developing a Communication-Centered Epistemic Model of Shared Decision Making for Mental Health Contexts. Health Commun 2015; 31:707-717. [PMID: 26529605 DOI: 10.1080/10410236.2014.993296] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Shared decision making (SDM) interventions aim to improve client autonomy, information sharing, and collaborative decision making, yet implementation of these interventions has been variably perceived. Using interviews and focus groups with clients and clinicians from mental health clinics, we explored experiences with and perceptions about decision support strategies aimed to promote SDM around psychotropic medication treatment. Using thematic analysis, we identified themes regarding beliefs about participant involvement, information management, and participants' broader understanding of their epistemic expertise. Clients and clinicians highly valued client-centered priorities such as autonomy and empowerment when making decisions. However, two frequently discussed themes revealed complex beliefs about what that involvement should look like in practice: (a) the role of communication and information exchange and (b) the value and stability of clinician and client epistemic expertise. Complex beliefs regarding these two themes suggested a dynamic and reflexive approach to information management. Situating these findings within the Theory of Motivated Information Management, we discuss implications for conceptualizing SDM in mental health services and adapt Siminoff and Step's Communication Model of Shared Decision Making (CMSDM) to propose a Communication-centered Epistemic Model of Shared Decision Making (CEM-SDM).
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Affiliation(s)
- Lisa Mikesell
- a School of Communication & Information , Rutgers University
| | - Elizabeth Bromley
- b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles
- c Desert Pacific VA Mental Illness Research , Education and Clinical Center (MIRECC), West Los Angeles VA
| | - Alexander S Young
- b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles
- c Desert Pacific VA Mental Illness Research , Education and Clinical Center (MIRECC), West Los Angeles VA
| | - Pamela Vona
- b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles
| | - Bonnie Zima
- b Department of Psychiatry and Biobehavioral Sciences , University of California, Los Angeles
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Barnert ES, Perry R, Azzi VF, Shetgiri R, Ryan G, Dudovitz R, Zima B, Chung PJ. Incarcerated Youths' Perspectives on Protective Factors and Risk Factors for Juvenile Offending: A Qualitative Analysis. Am J Public Health 2014; 105:1365-71. [PMID: 25521878 DOI: 10.2105/ajph.2014.302228] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to understand incarcerated youths' perspectives on the role of protective factors and risk factors for juvenile offending. METHODS We performed an in-depth qualitative analysis of interviews (conducted October-December 2013) with 20 incarcerated youths detained in the largest juvenile hall in Los Angeles. RESULTS The adolescent participants described their homes, schools, and neighborhoods as chaotic and unsafe. They expressed a need for love and attention, discipline and control, and role models and perspective. Youths perceived that when home or school failed to meet these needs, they spent more time on the streets, leading to incarceration. They contrasted the path through school with the path to jail, reporting that the path to jail felt easier. All of them expressed the insight that they had made bad decisions and that the more difficult path was not only better but also still potentially achievable. CONCLUSIONS Breaking cycles of juvenile incarceration will require that the public health community partner with legislators, educators, community leaders, and youths to determine how to make success, rather than incarceration, the easier path for disadvantaged adolescents.
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Affiliation(s)
- Elizabeth S Barnert
- At the time of the study, Elizabeth S. Barnert was with the Robert Wood Johnson Foundation Clinical Scholars Program, Los Angeles, CA. Veronica F. Azzi was with the Department of Medicine, University of California, Los Angeles. Bonnie Zima was with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles. Rebecca Dudovitz and Paul J. Chung were with the Department of Pediatrics, University of California, Los Angeles. Raymond Perry was with Juvenile Court Health Services, Los Angeles County Department of Health Services. Rashmi Shetgiri was with the Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas. Gery Ryan was with the RAND Corporation, Santa Monica, CA
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Zangos S, Zima B, Thalhammer A, Eichler K, Müller C, Lehnert T, Vogl TJ. Beurteilung der Gefäßveränderungen nach thorakaler endovaskulärer Behandlung (TEVAR) von Aortenpathologien im Langzeitverlauf. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Smith K, Siddarth P, Zima B, Sankar R, Mitchell W, Gowrinathan R, Shewmon A, Caplan R. Unmet mental health needs in pediatric epilepsy: insights from providers. Epilepsy Behav 2007; 11:401-8. [PMID: 17870672 DOI: 10.1016/j.yebeh.2007.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2007] [Revised: 05/12/2007] [Accepted: 05/23/2007] [Indexed: 10/22/2022]
Abstract
Eighteen pediatric neurologists and 18 pediatricians completed a 5-point Likert scale questionnaire on their knowledge of, attitudes toward, and management of the behavioral, cognitive, and psychosocial aspects of pediatric epilepsy, before and after a lecture on this topic. They also responded to questions about possible barriers to mental health care of children with epilepsy. The brief educational intervention modified the knowledge/attitudes of pediatricians compared with pediatric neurologists on the impact of epilepsy on behavior and cognition in children with epilepsy. However, there were no between-group differences in how providers perceived their competence to assess behavioral and cognitive comorbid conditions in pediatric epilepsy. Responses to open-ended questions suggested insufficient mental health coverage for and expertise on pediatric epilepsy, resistance of mental health clinicians to treat children with epilepsy, and the stigma of mental health as possible barriers to mental health care in children with epilepsy. In addition to the need for provider education about the behavioral and cognitive comorbid conditions of pediatric epilepsy, these findings emphasize the importance of examining alternative routes to increasing mental health care for children with epilepsy.
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Affiliation(s)
- Kimberly Smith
- Department of Psychiatry, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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Bhatara V, Feil M, Hoagwood K, Vitiello B, Zima B. National trends in concomitant psychotropic medication with stimulants in pediatric visits: practice versus knowledge. J Atten Disord 2004; 7:217-26. [PMID: 15487478 DOI: 10.1177/108705470400700404] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (1) To examine U.S. national trends in the use of concomitant pharmacotherapy with the stimulant class of psychotropic drugs in youth; and (2) to present these trends in the context of (a) extant safety and efficacy data, and (b) overall trends in concomitant pharmacotherapy with psychotropic drugs for youth. METHODS Prescribing data for youths under age 18 years from National Ambulatory Medical Surveys from 1993 to 1998 were analyzed. The visits were categorized into monotherapy (only one psychotropic prescribed) and concomitant pharmacotherapy (>1 psychotropic prescribed). The proportions of these groups were computed as a percentage of all visits during which a psychotropic medication was prescribed. Differences in proportions between surveys were analyzed to determine trends. RESULTS Between 1993--94 and 1997--98, the proportions of visits for concomitant pharmacotherapy in association with the stimulant class increased nearly five-fold. This increase paralleled an overall increase in the proportion of visits involving prescription of more than one psychotropic medication among youth. CONCLUSIONS The growth in concomitant pharmacotherapy with the stimulants class has out-paced the increase in safety/efficacy data to inform the use of this practice, resulting in a mismatch between trends in prescribing and growth in knowledge. A simultaneous trend of note is the overall increase in the use of concomitant pharmacotherapy with all psychotropic drugs in youth. Controlled trials are particularly needed to support commonly used combinations of stimulants with antidepressants in youth. In the absence of definitive data, clinical guidelines based on expert consensus and limited data are available and are useful.
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Affiliation(s)
- Vinod Bhatara
- University of South Dakota, Psychiatry and Family Medicine, USA.
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Sargent J, Sexson S, Cuffe S, Drell M, Dugan T, Ferren P, Kim WJ, Stubbe D, Zima B, Brown T. Assessment of competency in child and adolescent psychiatry training. Acad Psychiatry 2004; 28:18-26. [PMID: 15140804 DOI: 10.1176/appi.ap.28.1.18] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Residency training programs in all areas of medicine are required to identify core competencies expected of all graduates and develop methods to assess and ensure attainment of these competencies. To assist with this process for residency programs in child and adolescent psychiatry, the Work Group on Training and Education of the American Academy of Child and Adolescent Psychiatry has developed several principles of the assessment process and compiled a variety of assessment methodologies for use in assessing competency. The principles of assessment include 1) residents should share responsibility for assessment; 2) assessment should be an open, ongoing and predictable process; 3) a wide range of evaluators should be utilized in the process; 4) residents should demonstrate competency in a variety of formats; 5) the goal is for 100% of residents to achieve core competencies. METHODS Sample methods of assessment are provided in the report with special attention to how the method could be used in child and adolescent psychiatry. CONCLUSION A multi-method, multi-evaluator for process of assessment is recommended.
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Affiliation(s)
- John Sargent
- Baylor College of Medicine, Houston, Texas 77030, USA.
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Affiliation(s)
- Vinod S Bhatara
- Health Services Research Center of the University of California, Los Angeles, USA
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Sexson S, Sargent J, Zima B, Beresin E, Cuffe S, Drell M, Dugan T, Fox G, Kim WJ, Matthews K, Sylvester C, Pope K. Sample Core Competencies in Child and Adolescent Psychiatry Training: A Starting Point. Acad Psychiatry 2001; 25:201-213. [PMID: 11744536 DOI: 10.1176/appi.ap.25.4.201] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In an effort to improve the preparedness of residents to address health care needs, the Accreditation Council for Graduate Medical Education mandated that all Residency Review Committees (RRCs) incorporate the general competencies of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice into their requirements. In response, the Psychiatry RRC mandated that child and adolescent psychiatry programs develop one competency for each of the six areas, effective January 1, 2001. To assist in this effort, the Work Group on Training and Education of the American Academy of Child and Adolescent Psychiatry has developed sample core competencies for each area. These samples are meant to serve as potential models for consideration by training programs as they develop criteria tailored to their program's unique resources and needs.
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Affiliation(s)
- Sandra Sexson
- The authors are the members of the Work Group on Training and Education of the American Academy of Child and Adolescent Psychiatry. Address correspondence to Dr. Sexson, Director, Child and Adolescent Psychiatry, Emory University, 1256 Briarcliff Road, Room 314 South, Atlanta, GA 30306. E-mail:
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Bussing R, Menvielle E, Zima B. Relationship between behavioral problems and unintentional injuries in US children. Findings of the 1988 National Health Interview Survey. Arch Pediatr Adolesc Med 1996; 150:50-56. [PMID: 8542007 DOI: 10.1001/archpedi.1996.02170260054009] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate (1) the incidence of unintentional injuries among children with and without behavioral problems and (2) the role of ethnicity on the relationship between behavioral problems and risk for unintentional injuries, as unintentional injuries among children represent a major public health concern in the United States. DESIGN Cross-sectional analysis of data on 11 630 children contained in the 1988 National Health Interview Survey. MAIN OUTCOME MEASURES AND METHODS We studied the annual incidence of unintentional injury and its relationship to child behavioral problems among three ethnic groups (white, African American, and Hispanic) through stratified as well as multivariate analytic models. RESULTS Accident rates were higher in white children (17.9%) than in African-American (9.3%) or Hispanic (9.3%) children. The odds of unintentional injury in children with severe behavioral problems was 1.65 times greater than in children without behavioral problems, after controlling for relevant sociodemographic characteristics. Ethnicity did not alter the relationship between overall behavioral problems and increased injury rates; however, ethnic differences emerged in the subscale analysis of disruptive behaviors. CONCLUSIONS Children with behavioral problems represent a significant risk group for unintentional injuries among three ethnic groups in the United States. These findings emphasize the need to implement accident prevention strategies that are specially targeted at children with behavioral disorders.
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Affiliation(s)
- R Bussing
- Department of Psychiatry, University of Florida, Gainesville, USA
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