Parent medication concerns predict underutilization of mental health services for minority children with ADHD

OBJECTIVE. Disparities in attention deficit hyperactivity disorder (ADHD) treatment are recognized with minority children using services less than nonminority children. The authors examine minority parents' knowledge and perceptions of ADHD as they relate to service utilization. METHODS. Using a longitudinal cohort design, parents of children with untreated ADHD were surveyed regarding their knowledge and perceptions of ADHD and then followed for 3 to 6 months to determine whether they used services. RESULTS. Seventy parents of 5- to 18-year-old children with untreated ADHD were enrolled. Of the 70 children, 33 (47.1%) had not attended any mental health appointments and 51 (72.9%) had not used any treatments by 3- to 6-month follow-up. Logistic regression indicated that increasing age and medication concerns were associated with less follow-up at mental health appointments (P < .05) and less utilization of treatments (P < .05). CONCLUSIONS. The results of this study highlight the importance of addressing medication concerns, when referring minority children to mental health services or offering treatments.

Effect of routine mental health screening in a low-resource pediatric primary care population

OBJECTIVE

Despite evidence for its feasibility, the usage of mental health screening in primary care practices with overburdened providers and few referral options remains unclear. This study explores the effects of routine screening on mental health problem identification and management in a low-resource setting.

METHODS

Medical records of 5 to 12 year-old children presenting for well visits before and after screening was implemented were reviewed. Multivariate logistic regression was used to explore associations between study period and identification/management practices. Changes in the number of visits and wait times for a co-located referral service were assessed post hoc.

RESULTS

Parents disclosed more mental health problems, and providers initiated more workups but referred fewer patients after screening was implemented. The proportion of new visits and wait times for the referral service did not change.

CONCLUSIONS

Even in low-resource settings, screening may facilitate parental disclosure and increase clinical attention to mental health problems without overburdening referral services.

School-aged Children Who Are Not Progressing Academically: Considerations for Pediatricians

Pediatricians and other pediatric primary care providers may be consulted when families have concerns that their child is not making expected progress in school. Pediatricians care not only for an increasingly diverse population of children who may have behavioral, psychological, and learning difficulties but also for increasing numbers of children with complex and chronic medical problems that can affect the development of the central nervous system and can present with learning and academic concerns. In many instances, pediatric providers require additional information about the nature of cognitive, psychosocial, and educational difficulties that affect their school-aged patients. Our purpose for this report is to describe the current state of the science regarding educational achievement to inform pediatricians' decisions regarding further evaluation of a child's challenges. In this report, we review commonly available options for psychological evaluation and/or treatment, medical referrals, and/or recommendations for referral for eligibility determinations at school and review strategies for collaborating with families, schools, and specialists to best serve children and families.

School-Based Mental Health Promotion and Prevention Program "Turn 2 Us" Reduces Mental Health Risk Behaviors in Urban, Minority Youth

BACKGROUND

Turn 2 Us (T2U) is an elementary school-based mental health promotion and prevention program in New York City. It targets fourth- and fifth-grade students at risk for social/emotional and behavioral problems and provides a range of services to students, staff, and parents. The purpose of this study is to determine if T2U decreases internalizing and externalizing behaviors in participating students.

METHODS

Teachers measured students' symptoms before and after participation using the strengths and difficulties questionnaire (SDQ). Change in the total SDQ score was analyzed using Wilcoxon rank-sum nonparametric testing. We assessed the effects of covariates on the score change with linear regression models.

RESULTS

The 185 unique students who participated in the intervention showed a significant improvement in total SDQ score (Z = -4.107, p < .001). Students who were at higher risk prior to the intervention showed greatest improvement in behaviors. None of the covariates assessed affected the change in SDQ score. Regression models showed that higher initial SDQ scores predicted higher post-intervention SDQ scores (β = 0.681, p < .001).

CONCLUSION

T2U significantly decreased internalizing and externalizing behaviors in participating students, with the greatest impact for highest risk students. This study helps validate T2U's unique and comprehensive approach.

Wellness Councils Build Capacity for School-Based Obesity Prevention in Harlem and Washington Heights, New York City

Schools experience barriers when implementing wellness policies, and there is a dearth of research detailing how district wellness policies are implemented at the school level. Wellness councils were established in 7 elementary schools in Harlem and Washington Heights, New York City (NYC), to help these schools implement the NYC district wellness policy. Data on 4 wellness council process indicators and wellness council self-evaluation scores were correlated with obesity prevention process outcomes using Kendall tau correlations. An average of 8.9 (standard deviation = 0.7) wellness council meetings were held per school throughout the 10-month academic year. The average attendance at each meeting ranged from 7.1 to 15.2 members. There was a positive relationship between wellness council attendance and the number of participant encounters at staff physical activity events ( r = .71, P = .02). Higher self-evaluation scores on staff wellness initiatives were associated with more student nutrition encounters ( r = .69, P = .04) and in-class student physical activity minutes ( r = .69, P = .04). The wellness councils served as a forum for regular interaction between health professionals and school staff and allowed for evidence-based interventions to be adapted to local school needs and culture. School staff engagement is important for successful obesity prevention initiatives and should be a goal of school-based wellness programs.

Engaging Caregivers in School-Based Obesity Prevention Initiatives in a Predominantly Latino Immigrant Community: A Qualitative Analysis

OBJECTIVES

To explore caregiver perceptions of, and barriers and facilitators to, their involvement in school-based obesity prevention programs in underserved Latino immigrant communities.

METHODS

Focus groups discussions were conducted with caregivers (n = 42) at 7 elementary schools with an academic partnership-based obesity prevention program. Thematic analysis was used to identify key findings in the data.

RESULTS

Caregivers described their role as (1) learners of new and often complex health information using their children as primary messengers and (2) champions within their homes in which healthier choices are assimilated. Barriers to involvement included lack of time, financial pressures, unhealthy family practices, and concern that attempts to engage peers would be perceived as intrusive. Facilitators included assurance that stigmatizing health issues would be addressed with sensitivity.

CONCLUSIONS AND IMPLICATIONS

Caregiver involvement in obesity prevention may be fostered by transmitting information through children, addressing cultural barriers, and avoiding potentially stigmatizing approaches to delivering health messages.

Trauma-Informed Positive Parenting in Primary Care as a Tool to Support Child and Family Well-Being

Factors affecting caregiver health and wellbeing, such as trauma and stress, can have significant negative impact on parenting behaviors and on subsequent child physical and mental health. Trauma-informed positive parenting (TIPP) is an effective tool that acknowledges and addresses a family's unique journey and needs, while promoting both nurturing caregiver-child interactions and appropriate limit setting. Primary care practices are in unique positions to provide such interventions, due to their long-standing and trusted involvement with families. Therefore, we propose that TIPP can feasibly be incorporated into the pediatric primary care setting to support overall family health and well-being. [Pediatr Ann. 2024;53(10):e360-e365.].

The Role of an Early Childhood Community Health Worker in Addressing Psycho-Social Needs in the Perinatal and Early Childhood Period

OBJECTIVE

Addressing family psychosocial and mental health needs in the perinatal and early childhood period has a significant impact on long-term maternal and child health and is key to achieving health equity. We aimed to (1) describe and evaluate the role of an Early Childhood Community Health Worker (EC-CHW) to address psychosocial needs and improve psychosocial well-being for families in the perinatal period, and (2) examine factors associated with completion of goals.

METHODS

An EC-CHW program was modeled after an existing hospital CHW program for children with special healthcare needs and chronic disease. An evaluation was conducted using repeated measures to assess improvements in psychosocial outcomes such as family stress and protective factors after participating in the EC-CHW program. Linear regression was also used to assess factors associated with completion of goals.

RESULTS

Over a 21-month period (January 2019-September 2020), 161 families were referred to the EC-CHW. The most common reasons for referral included social needs and navigating systems for child developmental and behavioral concerns. There were high rates of family engagement in services (87%). After 6 months, families demonstrated statistically significant improvements in protective factors including positive parenting knowledge and social support. Only 1 key predictor variable, maternal depression, showed significant associations with completion of goals in the multivariable analysis.

CONCLUSIONS

This study demonstrated the need for, and potential impact of an EC-CHW in addressing psychosocial and mental health needs in the perinatal period, and in a primary care setting. Impacts on protective factors are promising.