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Stewart SL, Vasudeva AS, Mistry D, Poss JW. The impact of child maltreatment on mental health outcome improvements among children and youth accessing community mental health care. CHILD ABUSE & NEGLECT 2023; 139:106066. [PMID: 36791630 DOI: 10.1016/j.chiabu.2023.106066] [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: 05/24/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although children with histories of maltreatment are more likely to engage with mental healthcare than non-maltreated children, few studies have examined the impact of maltreatment on children's mental health outcome improvement over time. OBJECTIVE The current study addresses this gap in the present literature by exploring the ways that histories of physical, sexual, and emotional abuse and exposure to domestic violence can influence children's improvement on mental health outcomes commonly associated with trauma. PARTICIPANTS AND SETTING De-identified routine care data from 58 community mental health agencies across Ontario, Canada, representing 16,517 children was obtained. This data represented assessments that occurred between February 2015 and December 2021. METHODS General linear models were used to illustrate the effect of each trauma type on change scores computed between baseline and follow-up assessments of externalizing behaviours, risk of harm to others, depressive symptoms, risk of suicide and self-harm, and anxiety, while adjusting for baseline scores, inpatient status, time between assessments, and select demographic variables. RESULTS When the effects of each trauma type was considered separately, children without histories of trauma consistently showed greater improvement than those with that trauma across all mental health outcomes (0.07-0.44, p < 0.01). When all trauma types were considered together, sexual abuse was associated with some of the most significant negative impacts on children's mental health improvements. CONCLUSIONS Our findings highlight an urgent need for the implementation of standardized, evidence-based assessments that screen trauma histories of children accessing mental health supports and research examining the impact of trauma on children's treatment responsiveness.
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Affiliation(s)
- Shannon L Stewart
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON N6G 1G7, Canada
| | - Aadhiya S Vasudeva
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON N6G 1G7, Canada.
| | - Divya Mistry
- Faculty of Education, University of Western Ontario, 1137 Western Rd, London, ON N6G 1G7, Canada
| | - Jeffrey W Poss
- Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G5, Canada
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2
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Cohen AK, Hazelton T, Bassey H, Gutierrez-Padilla M, Novosel C, Nichols CR, Jain S. Improving Functioning of Children Birth to Five with Emotional and Behavioral Problems: The Role of Comprehensive Mental Health Services and Supports. Pediatr Rep 2023; 15:33-44. [PMID: 36649005 PMCID: PMC9844479 DOI: 10.3390/pediatric15010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Emotional and behavioral problems are growing among children ages birth to five, and racial/ethnic and socioeconomic disparities exist. Comprehensive, culturally responsive, family-driven systems of care, such as the one operated by California's diverse, urban Alameda County, offer one potential intervention. METHODS We used client-level service data (n = 496 children) to calculate descriptive statistics and regression analyses (including multilevel models to account for observations for the same client at multiple points in time). We estimated the prevalence of mental health issues and assessed the association between the length of time using services and emotional and behavioral functioning. RESULTS Comprehensive mental health services and supports were associated with improved emotional and behavioral functioning outcomes for children over time, even after controlling for other risk factors. DISCUSSION Systems of care appear to support the multidimensional functioning of children and their families.
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Affiliation(s)
- Alison K. Cohen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, CA 94158, USA
- Correspondence:
| | - Tracy Hazelton
- Alameda County Behavioral Health Care Services, Oakland, CA 94606, USA
| | | | | | - Carolyn Novosel
- Alameda County Behavioral Health Care Services, Oakland, CA 94606, USA
| | - Chloe R. Nichols
- Department of Health Sciences, Northeastern University, Boston, MA 02115, USA
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3
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Clinical Update: Child and Adolescent Behavioral Health Care in Community Systems of Care. J Am Acad Child Adolesc Psychiatry 2022; 62:367-384. [PMID: 35690302 DOI: 10.1016/j.jaac.2022.06.001] [Citation(s) in RCA: 4] [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] [Received: 05/02/2022] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this Clinical Update is to review the principles, structures, processes, and outcomes of community systems of care as they pertain to the delivery of behavioral health care to children and adolescents METHOD: A search of the literature on this topic from 2002 was initially conducted in 2016 and repeated in 2019 and 2021, yielding 1,604 English-language citations. These citations were supplemented by references suggested by topic experts and identified through Web searches, increasing the yield to 1,684 total citations, of which 1,184 were unduplicated. After sequential review by Update authors at title/abstract and then full-text levels, the citations were winnowed to 156 based on relevance to the topic. RESULTS The systems of care approach, arising in the 1980s, expanded child and adolescent behavioral health care from the core services of psychotherapy, medication management, inpatient psychiatric services, and residential treatment to include home- and community-based treatment and support services; promotion, prevention, and early intervention programs; and specialized services for very young children and youth and young adults of transition age. These services and supports are delivered by a large multidisciplinary workforce and are governed by key principles, including a biopsychosocial case conceptualization; family-driven, youth-guided, strengths-based, and trauma-informed care. Services in the least restrictive setting; continuity of care across transitions; a public health framework for service delivery; promotion of wellness and resilience; and elimination of health disparities. Challenges to systems of care implementation include funding availability, workforce shortages, deficiencies in cross-systems collaboration, and variability in insurance coverage. Although controlled studies have failed to provide convincing evidence of favorable outcomes from the whole systems of care approach, uncontrolled research has demonstrated increased access to care, positive clinical and functional outcomes, improved family functioning, and reductions in costs, particularly when research is focused on specific behavioral health problems, specific interventions such as Wraparound care, or highly specified groups of youth. CONCLUSION Health professionals who are educated in the systems of care approach can improve access to and quality of behavioral health care for children and adolescents with behavioral health needs.
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Gindt M, Fernandez A, Zeghari R, Ménard ML, Nachon O, Richez A, Auby P, Battista M, Askenazy F. A 3-year retrospective study of 866 children and adolescent outpatients followed in the Nice Pediatric Psychotrauma Center created after the 2016 mass terror attack. Front Psychiatry 2022; 13:1010957. [PMID: 36569628 PMCID: PMC9772007 DOI: 10.3389/fpsyt.2022.1010957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The mass terrorist attack in Nice, France, in July 2016 caused deaths and injuries in a local population, including children and adolescents. The Nice Pediatric Psychotrauma Center (NPPC) was opened to provide mental health care to the pediatric population (0-18 years) who experienced traumatic events. OBJECTIVES This study describes the specificity of the care pathway for young trauma victims, with an explanation of how the NPPC works during the first three years. METHODS In this retrospective study, we conducted quantitative and qualitative data collection about new and follow-up consultations, primary and comorbid diagnoses, and the kind of trauma (terrorist attack versus other kinds of trauma). Ethics approval was obtained from the local Ethics committee. RESULTS 866 children and adolescents were followed in the NPPC. We found a high rate of Post-Traumatic Stress Disorder (PTSD; 71%) in this population with a high rate of comorbidities (67%), mainly sleep disorders (34.7%) and mood and anxiety disorders (16.2%). A high number of children and adolescents impacted by the terrorist attack required follow-up consultations after exposure to the mass terrorist attack, the first care-seeking requests continued to occur three years later, although at a slower rate than in the first and second years. New consultations for other kinds of trauma were observed over time. DISCUSSION This study supports previous findings on the significant impact of mass trauma in the pediatric population showing even a higher level of PTSD and a high rate of comorbidities. This may be explained by the brutality of the traumatic event, particularly for this age group. The findings of this study have implications for early interventions and long-term care for children and adolescents to prevent the development of chronic PTSD into adulthood.
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Affiliation(s)
- Morgane Gindt
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Arnaud Fernandez
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Radia Zeghari
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Marie-Line Ménard
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Ophelie Nachon
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Aurélien Richez
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Philippe Auby
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France
| | - Michele Battista
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Florence Askenazy
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
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Sierra M, McGinty K. The Role of the Child and Adolescent Psychiatrist in Systems of Care. Child Adolesc Psychiatr Clin N Am 2021; 30:727-736. [PMID: 34538444 DOI: 10.1016/j.chc.2021.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
To effectively fulfill various roles in systems of care, a child and adolescent psychiatrist must first define "system of care" and become familiar with the child-serving systems that make up the overarching system of care. They should know what roles are currently being fulfilled by child and adolescent psychiatrists, recognize the challenges they may face while fulfilling these roles, and use this knowledge to become catalysts for system improvements. This article discusses these points in greater detail.
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Affiliation(s)
- Michael Sierra
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Prisma Health, Greenville, SC 29605, USA.
| | - Kaye McGinty
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Prisma Health, Greenville, SC 29605, USA
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Latzman NE, Casanueva C, Brinton J, Forman‐Hoffman VL. The promotion of well-being among children exposed to intimate partner violence: A systematic review of interventions. CAMPBELL SYSTEMATIC REVIEWS 2019; 15:e1049. [PMID: 37131508 PMCID: PMC8356495 DOI: 10.1002/cl2.1049] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Affiliation(s)
| | | | - Julia Brinton
- RTI InternationalResearch Triangle ParkNorth Carolina
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7
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Champine RB, Shaker AH, Tsitaridis KA, Whitson ML, Kaufman JS. Service-Related Barriers and Facilitators in an Early Childhood System of Care: Comparing the Perspectives of Parents and Providers. Community Ment Health J 2019; 55:942-953. [PMID: 31165963 DOI: 10.1007/s10597-019-00418-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/30/2019] [Indexed: 01/13/2023]
Abstract
Systems of care (SOCs) have the potential to enhance underserved families' access to integrated health and support services. Most scholarship on SOCs has involved school-aged children and adolescents. Thus, research is needed to better understand barriers to, and facilitators of, families' access to services during early childhood. The present study included a community-based participatory approach in understanding services for families of children under age six years with severe emotional and behavioral problems. We analyzed data from two focus groups with caregivers (n = 7) and three focus groups with service providers (n = 22). Our thematic analysis of participants' responses revealed five primary barriers to family service access, including challenges associated with transition planning. In comparison, participants described four primary facilitators of family service access, including providers' adoption of "whole-family" service delivery approaches. Findings indicated areas of convergence and divergence in caregivers' and providers' responses. We discuss limitations and potential implications.
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Affiliation(s)
- Robey B Champine
- Division of Public Health, College of Human Medicine, Michigan State University, Flint, MI, 48503, USA. .,Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT, USA. .,Child Health and Development Institute of Connecticut, Farmington, CT, USA.
| | - Andrea H Shaker
- Department of Psychology, University of New Haven, New Haven, CT, USA
| | | | - Melissa L Whitson
- Department of Psychology, University of New Haven, New Haven, CT, USA
| | - Joy S Kaufman
- Division of Prevention and Community Research, Yale School of Medicine, New Haven, CT, USA
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8
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Prince DM, Vidal S, Okpych N, Connell CM. Effects of individual risk and state housing factors on adverse outcomes in a national sample of youth transitioning out of foster care. J Adolesc 2019; 74:33-44. [PMID: 31136857 DOI: 10.1016/j.adolescence.2019.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 05/10/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Compared to their peers, youth who leave the foster care system without permanency experience greater risks for adverse young adult outcomes, including homelessness, incarceration, substance abuse, and early child birth. Extant literature focuses on individual-level factors related to adversity. In this study, we estimated the impact of state and individual-level risk and protective factors on adverse 19-year-old outcomes among a cohort of U.S. transition age youth. METHODS We used multilevel modeling to analyze prospective, longitudinal data from two waves of the National Youth in Transitions Database (N = 7449). These data were linked to the Adoption and Foster Care Reporting System, the Administration for Children and Families budget expenditures, and the American Community Survey for the period from 2011 to 2013. RESULTS Approximately 30% of the variation in each of the 19-year-old outcomes could be attributed to state-level effects. Residence in a state that spent above average of CFCIP budget on housing supports reduced the risk of homelessness and incarceration. Living in a state with a higher proportion of housing-burdened low-income renters significantly increased the risk of substance abuse and child birth. Individual-level risks were significant: racial/ethnic minority, male gender, past risk history, placement instability, child behavioral problems, residence in group home or runaway. Remaining in foster care at age 19 reduced the odds of homelessness, incarceration, and substance abuse. CONCLUSION Macro factors, including financial support for transition-age youth, and broader housing market characteristics, have a bearing on young adult outcomes, and raise policy questions across social and human service sectors.
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Affiliation(s)
- Dana M Prince
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA.
| | | | | | - Christian M Connell
- Human Development and Family Studies, College of Health and Human Development, The Pennsylvania State University, USA
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9
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Garcia AR, Gupta M, Greeson JKP, Thompson A, DeNard C. Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing. CHILD ABUSE & NEGLECT 2017; 70:292-302. [PMID: 28668759 DOI: 10.1016/j.chiabu.2017.06.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 06/07/2023]
Abstract
The negative influence of adverse childhood experiences (ACEs) on social, emotional, and behavioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic regression of this data showed that the odds of being diagnosed with internalizing problems increased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health services. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse.
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Affiliation(s)
- Antonio R Garcia
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States.
| | - Meera Gupta
- Division of Transplant Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 2 Dulles, Philadelphia, PA 19104, United States
| | - Johanna K P Greeson
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States
| | - Allison Thompson
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States
| | - Christina DeNard
- School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA 19104, United States
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