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Ayvaci ER, Minhajuddin A, Elmore JS, Yagnik K, Jha MK, Emslie GJ, Mayes TL, Trivedi MH. Treatment of Adolescent Depression: Comparison of Psychiatric and Pediatric Settings at an Academic Medical Center Using the VitalSign 6 Application. J Child Adolesc Psychopharmacol 2024; 34:80-88. [PMID: 38252552 DOI: 10.1089/cap.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background: Similar outcomes and remission rates have been found for the treatment of depression in adults in primary and psychiatric care settings. However, comparatively little is known about how pediatric depression is managed across different settings. This study aims to address this gap by comparing depression treatment in pediatric and psychiatric settings. We hypothesized that pediatric care settings would be more likely to treat individuals with lower depression severity and would select pharmacotherapy less frequently as a treatment option. Methods: Patients (n = 3498) were screened for depression at a children's hospital from May 2017 to May 2022 as part of the VitalSign6 project, a web-based application for depression management. The two-item patient health questionnaire (PHQ) was used for screening, and the data set contains patient-reported measures and provider-reported diagnoses and treatment selections at each clinic visit. Patients with nine-item PHQ (PHQ-9) scores ≥10 at baseline were included in the analysis to compare diagnosis and treatment recommendations between pediatric and psychiatric settings. Results: Among the 1323 patients who screened positive for depression, those in psychiatric settings had higher PHQ-9 scores (15.9 ± 5.0 vs. 12.1 ± 5.5; p < 0.0001). Patients with PHQ-9 ≥ 10 in psychiatric settings were more likely to be diagnosed with major depressive disorder (60.6% vs. 24.7%, p < 0.0001) and receive pharmacotherapy (54.8% vs. 6.6%) than those in pediatric settings. Pediatric setting patients were more likely to receive nonpharmacological treatment alone (36.3% vs. 4.3%) or an outside referral (27.7% vs. 5.7%). Remission rates did not significantly differ between the two settings. Conclusions: Youth in psychiatric settings are more likely to screen positive for depression and to have greater depression severity than those in pediatric settings. Both settings provide treatment recommendations for moderate-to-severe depression, but treatment types vary substantially. Yet, remission rates remain similar. Further research is needed to understand the nuances of treatment differences and their implications.
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Affiliation(s)
- Emine Rabia Ayvaci
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
- Children's Health, Children's Medical Center, Dallas, Texas, USA
| | - Abu Minhajuddin
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
- Peter O'Donnell Jr. School of Public Health, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joshua S Elmore
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Kush Yagnik
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Manish K Jha
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Graham J Emslie
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
- Children's Health, Children's Medical Center, Dallas, Texas, USA
| | - Taryn L Mayes
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, Center for Depression Research and Clinical Care, Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, Texas, USA
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McLeigh JD, Malthaner L, Winebrenner C, Stone KE. Paediatric integrated care in the primary care setting: A scoping review of populations served, models used and outcomes measured. Child Care Health Dev 2022; 48:869-879. [PMID: 35288973 DOI: 10.1111/cch.13000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/17/2022] [Accepted: 03/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Paediatric integrated care (PIC), which involves primary care and behavioural health clinicians working together with patients and families, has been promoted as a best practice in the provision of care. In this context, behavioural health includes behavioural elements in the care of mental health and substance abuse conditions, chronic illness and physical symptoms associated with stress, and addressing health behaviours. Models of and contexts in which PIC has been applied vary, as do the outcomes and measures used to determine its value. Thus, this study seeks to better understand (1) what paediatric subpopulations are receiving integrated care, (2) which models of PIC are being studied, (3) what PIC outcomes are being explored and what measures and strategies are being used to assess those outcomes, and (4) whether the various models are resulting in positive outcomes. These questions have significant policy and clinical implications, given current national- and state-level efforts aimed at promoting integrated health care. METHODS This study utilized Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews to identify relevant articles published between January 1994 and 30 June 2020. The search utilized three databases: PubMed, PsycInfo and CINAHL. A total of 28 articles met the eligibility criteria for inclusion. RESULTS Overall, acceptability of PIC appears to be high for patients and providers, with access, screening and engagement generally increasing. However, several gaps in the knowledge base on PIC were uncovered, and for some studies, ascertaining which models of integrated care were being implemented proved difficult. CONCLUSION PIC has the potential to improve access to and quality of behavioural health care, but more research is needed to understand what models of PIC prove most beneficial and which policies and conditions promote cost efficiency. Rigorous evaluation of patient outcomes, provider training, institutional buy-in and system-level changes are needed.
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Affiliation(s)
- Jill D McLeigh
- Children's Health, Rees-Jones Center for Foster Care Excellence, Dallas, Texas, USA.,Department of Epidemiology, Human Genetics, and Environmental Sciences, UT Health School of Public Health, Dallas Campus, Dallas, Texas, USA
| | - Lauren Malthaner
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UT Health School of Public Health, Dallas Campus, Dallas, Texas, USA
| | | | - Kimberly E Stone
- Children's Health, Rees-Jones Center for Foster Care Excellence, Dallas, Texas, USA.,University of Texas Southwestern Medical Center, Dallas, Texas, USA
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3
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Mieloo CL, van der Ende J, van Zijl AL, Schuring M, Steijn B, Jansen W. Changes in youth care use after the implementation of community-based support teams: repeated measurement study using registry data and data on team characteristics. BMJ Open 2022; 12:e048933. [PMID: 35172992 PMCID: PMC8852673 DOI: 10.1136/bmjopen-2021-048933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES New legislation on youth care in the Netherlands led to the implementation of community-based support teams, providing integrated primary youth care. Important aims of the new Youth Act were more integrated, timely care and less use of intensive forms of care. Our aim was to study changes in youth care use in time and the role of newly introduced community-based support teams herein. SETTING Register data (2015-2018) on youth of a large city were linked and combined with administrative and aggregated data on team characteristics. PARTICIPANTS Data on 126 095 youth (0-18 years) were available for analyses. PRIMARY AND SECONDARY OUTCOME MEASURES Primary, specialised and residential youth care use were the primary outcomes. RESULTS Generalised estimating equations analyses adjusted for individual characteristics demonstrated that over 4 years, use of primary youth care increased from 2.2% to 8.5% (OR 1.70; 99% CI 1.67 to 1.73), specialised youth care decreased from 7.2% to 6.4% (OR 0.98; 99% CI 0.97 to 1.00) and residential youth care increased slightly (OR 1.04; 99% CI 1.01 to 1.06). Gender, age, family status, migrant background and educational level were all associated with the types of youth care use and also with some trends in time. Likelihood to receive care increased in time for preschool and younger children but did not improve for migrant children.Case load, team size, team turnover, team performance and transformational leadership showed significant associations with different types of youth care use but hardly with trends in time. CONCLUSION Patterns of youth care use changed towards more locally provided primary youth care, slightly less specialised and slightly more residential youth care. Furthermore, youth care use among younger children increased in time. These trends are partly in line with the trends intended by the Youth Act. Little evidence was found for the role of specific team characteristics on changes in youth care use in time.
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Affiliation(s)
- Cathelijne L Mieloo
- Governance of Urban Transitions - Research Group Transforming Youth Care, Haagsche Hogeschool, Den Haag, Zuid-Holland, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Alissa Lysanne van Zijl
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Merel Schuring
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Bram Steijn
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
- Department of Social Development, Gemeente Rotterdam, Rotterdam, The Netherlands
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4
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Sarakbi D, Groll D, Tranmer J, Sears K. Achieving Quality Integrated Care for Adolescent Depression: A Scoping Review. J Prim Care Community Health 2022; 13:21501319221131684. [PMID: 36345229 PMCID: PMC9647275 DOI: 10.1177/21501319221131684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introduction: While primary care is often the first point of contact for adolescents with
depression, more than half of depressed adolescents are either untreated or
undertreated. A scoping review had been completed to summarize approaches
for achieving quality integrated care in primary care focused on adolescent
depression. Methods: The scoping review followed the methodological framework for scoping studies
from Arksey and O’Malley. Articles were grouped into themes and mapped to 6
quality domains for integrated care from the practice integration profile
survey and 3 levels of stakeholders based on WHO’s definition for health
systems (patient/family, primary care team, and national/sub-national health
system). Results: A total of 868 records were screened resulting in 22 articles at the
patient/family-level (5/22), the primary care team-level (18/22), and the
national/sub-national health system-level (16/22). The results highlighted
multilevel approaches to support the delivery of quality integrated care for
adolescent depression in primary care: (1) population-focused using patient
registries, routine screening based on standardized algorithms, and
patient-centered strategies, (2) team-driven where primary care clinicians
collaborate with mental health clinicians as part of a primary care team,
(3) evidence-based delivery of mental health services across the integrated
care pathway from screening to follow-up visits, and (4) measurement-guided
by leveraging the electronic health record infrastructure to learn from
patient outcomes. Conclusion: More research is needed on how to provide quality integrated care for
adolescent depression, specifically on patient engagement and retention,
grounded in the frontline experiences of patients, families, and clinicians
and supported by national and/or sub-national guidelines. A learning system
could help integrate mental health services in primary care in a way that is
consistent across the national and/or sub-national health system.
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Affiliation(s)
| | | | | | - Kim Sears
- Queen’s University, Kingston, ON, Canada
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5
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Schraeder K, Allemang B, Felske AN, Scott CM, McBrien KA, Dimitropoulos G, Samuel S. Community based Primary Care for Adolescents and Young Adults Transitioning From Pediatric Specialty Care: Results from a Scoping Review. J Prim Care Community Health 2022; 13:21501319221084890. [PMID: 35323055 PMCID: PMC8961382 DOI: 10.1177/21501319221084890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Ongoing primary care during adolescence is recommended by best practice
guidelines for adolescents and young adults (AYAs; ages 12-25) with chronic
conditions. A synthesis of the evidence on the roles of Primary Care
Physicians (PCPs) and benefits of primary care is needed to support existing
guidelines. Methods: We used Arksey and O’Malley’s scoping review framework, and searched
databases (MEDLINE, EMBASE, PsychINFO, CINAHL) for studies that (i) were
published in English between 2004 and 2019, (ii) focused on AYAs with a
chronic condition(s) who had received specialist pediatric services, and
(iii) included relevant findings about PCPs. An extraction tool was
developed to organize data items across studies (eg, study design,
participant demographics, outcomes). Results: Findings from 58 studies were synthesized; 29 (50%) studies focused
exclusively on AYAs with chronic health conditions (eg, diabetes, cancer),
while 19 (33%) focused exclusively on AYAs with mental health conditions.
Roles of PCPs included managing medications, “non-complex” mental health
conditions, referrals, and care coordination, etc. Frequency of PCP
involvement varied by AYAs; however, female, non-Black, and older AYAs, and
those with severe/complex conditions appeared more likely to visit a PCP.
Positive outcomes were reported for shared-care models targeting various
conditions (eg, cancer, concussion, mental health). Conclusion: Our findings drew attention to the importance of effective collaboration
among multi-disciplinary specialists, PCPs, and AYAs for overcoming multiple
barriers to optimal transitional care. Highlighting the need for further
study of the implementation of shared care models to design strategies for
care delivery during transitions to adult care.
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Affiliation(s)
- Kyleigh Schraeder
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Brooke Allemang
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Ashley N Felske
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cathie M Scott
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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6
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Woodford J, Månberg J, Cajander Å, Enebrink P, Harila-Saari A, Hagström J, Karlsson M, Placid Solimena H, von Essen L. Help-seeking behaviour and attitudes towards internet-administered psychological support among adolescent and young adults previously treated for cancer during childhood: protocol for a survey and embedded qualitative interview study in Sweden. BMJ Open 2021; 11:e041350. [PMID: 34155002 PMCID: PMC8039225 DOI: 10.1136/bmjopen-2020-041350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION A subgroup of adolescent and young adult childhood cancer survivors (AYACCS) are at increased risk of psychological distress. Despite this, AYACCS experience difficulties accessing psychological support. E-mental health (e-MH) may offer a solution to reduce this treatment gap. However, research examining e-MH for AYACCS has experienced difficulties with recruitment, retention and adherence. Such difficulties may relate to: (1) help-seeking behaviour and/or (2) e-MH acceptability. The overall study aims are to: (1) examine potential associations between health service use factors, informed by Andersen's behavioural model of health services use, and help-seeking behaviour; (2) examine attitudes towards e-MH interventions; and (3) explore perceived need for mental health support; past experience of receiving mental health support; preferences for support; and barriers and facilitators to help-seeking. METHODS AND ANALYSIS An online and paper-based cross-sectional self-report survey (98 items) and embedded qualitative interview study across Sweden, with a target sample size of n=365. Participants are aged 16-39 years, diagnosed with cancer when 0-18 years and have completed successful cancer treatment. The survey examines sociodemographic and clinical characteristics, actual help-seeking behaviour, attitudes towards e-MH, stigma of mental illness, mental health literacy, social support and current symptoms of depression, anxiety, and stress. Survey respondents with past and/or current experience of mental health difficulties are invited into the qualitative interview study to explore: (1) perceived need for mental health support; (2) past experience of receiving mental health support; (3) preferences for support; and (4) barriers and facilitators to help-seeking. Potential associations between health service use factors and help-seeking behaviour are examined using univariable and multivariable logistic regressions. Qualitative interviews are analysed using content analysis. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Swedish Ethical Review Authority (Dnr: 2020-06271). Results will be disseminated in scientific publications and academic conference presentations. TRIAL REGISTRATION NUMBER ISRCTN70570236.
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Affiliation(s)
- Joanne Woodford
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jenny Månberg
- Child and Adolescent Psychiatry, Region Vasternorrland, Sundsvall, Sweden
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Pia Enebrink
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Arja Harila-Saari
- Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Josefin Hagström
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Mathilda Karlsson
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hanna Placid Solimena
- International Maternal and Child Health Care, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Abstract
Patient-centered care requires providing care that is responsive to patient preferences, needs, and values, yet data on parent and youth treatment preferences remains sparse. The present study (1) identifies variations in parent and youth preferences for depression treatment, and (2) explores relationships between parent and youth demographics and psychosocial functioning, and the preferences that parents and youth endorse. Participants were 64 youth and 63 parents awaiting randomization in a clinical trial evaluating psychosocial youth depression treatments. Parents preferred treatments that emphasize learning skills and strategies (82.5%) and include the parent in treatment at least some of the time (96.8%). Youth preferred that the therapist meet mostly with the youth alone (67.2%) but share at least some information with parents (78.1%). Youth (43.8%) tended to respond "don't know" to questions about their preferred therapeutic approach. Understanding parent and youth preferences, especially psychosocial treatment preferences, is needed to provide high-quality, patient-centered care.
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8
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Callejo-Black A, Wagner DV, Ramanujam K, Manabat AJ, Mastel S, Riley AR. A Systematic Review of External Validity in Pediatric Integrated Primary Care Trials. J Pediatr Psychol 2020; 45:1039-1052. [PMID: 32909603 DOI: 10.1093/jpepsy/jsaa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/18/2020] [Accepted: 07/17/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to conduct a systematic review of external validity reporting in integrated primary care (IPC) interventions for mental health concerns. METHODS We searched Medline, CINAHL, PsycINFO, the Cochrane Center Register of Controlled Trials, and relevant literature to identify publications from 1998 to 2018 reporting on open, randomized, or quasi-randomized trials of IPC interventions that targeted child (ages 0-18 years) psychological symptoms. For each publication, we extracted the information reported in each RE-AIM domain and calculated the proportion of the total studies reviewed. RESULTS Thirty-nine publications describing 25 studies were included in the review. Publications rarely reported some indicators of external validity, including the representativeness of participants (12%), rate of adoption clinics or providers (16%), cost of implementation (8%), or evidence of maintenance (16%). Few studies reported on key pragmatic factors such as cost or organizational change processes related to implementation and maintenance. Strengths of some studies included comparisons of multiple active treatments, use of tailorable interventions, and implementation in "real world" settings. CONCLUSIONS Although IPC interventions appear efficacious under research conditions, there are significant knowledge gaps regarding the degree to which they reach and engage target recipients, what factors impact adoption and implementation of IPC interventions by clinicians, how fidelity can be maintained over time, and cost-effectiveness. Pediatric IPC researchers should embrace dissemination and implementation science methods to balance internal and external validity concerns moving forward.
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Affiliation(s)
| | - David V Wagner
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
| | - Krishnapriya Ramanujam
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
| | | | - Sarah Mastel
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
| | - Andrew R Riley
- Department of Pediatrics, Institute on Development & Disability, Oregon Health & Science University, Portland, Oregon
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9
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Petsis D, Min J, Huang YSV, Akers AY, Wood S. HIV Testing Among Adolescents With Acute Sexually Transmitted Infections. Pediatrics 2020; 145:peds.2019-2265. [PMID: 32179661 PMCID: PMC7579673 DOI: 10.1542/peds.2019-2265] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing. METHODS Retrospective study of STI episodes (gonorrhea, Chlamydia, trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis. RESULTS The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing. CONCLUSIONS HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.
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Affiliation(s)
- Danielle Petsis
- Craig Dalsimer Division of Adolescent Medicine and .,PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jungwon Min
- PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA
| | | | - Aletha Y Akers
- Craig A. Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA,,PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA,,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sarah Wood
- Craig A. Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA,,PolicyLab, Children’s Hospital of Philadelphia, Philadelphia, PA,,University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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10
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Abstract
PURPOSE OF REVIEW This review discusses the role of the patient-centered medical home (PCMH) in treating depression, focusing on findings from primary care-based studies and their implications for the PCMH. RECENT FINDINGS Pharmacotherapy, psychotherapy, and collaborative care are evidence-based treatments for depression that can be delivered in primary care and extended to diverse populations. Recent research aligns with the core components of the PCMH model. The core components of the PCMH are critical elements of depression treatment. Comprehensive care within the PCMH addresses medical and behavioral health concerns, including depression. Psychiatric and psychological care must be flexibly delivered so services remain accessible yet patient-centered. To ensure the quality and safety of treatment, depression symptoms must be consistently monitored. Coordination within and occasionally outside of the PCMH is needed to ensure patients receive the appropriate level of care. More research is needed to empirically evaluate depression treatment within the PCMH.
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11
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Kodish I, Richardson L, Schlesinger A. Collaborative and Integrated Care for Adolescent Depression. Child Adolesc Psychiatr Clin N Am 2019; 28:315-325. [PMID: 31076110 DOI: 10.1016/j.chc.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Creative collaborative approaches are required to meet the demands of managing depression in youth. Primary care providers are well positioned to engage depressed youth and their families, yet often lack the training, access to psychiatric providers, and the reimbursement structure to support their efforts. Child and adolescent psychiatrists are encouraged to support pediatricians in establishing more robust systems to provide screening and effective treatment interventions, particularly for youth at higher risk. Several models of collaborative care are described, in addition to their emerging evidence-base, in an effort to disseminate evolving treatment strategies that can drive implementation of effective collaborative approaches.
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Affiliation(s)
- Ian Kodish
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 4800 Sand Point Way Northeast, O/A 5.154, Seattle, WA 98105, USA
| | - Laura Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Research Institute, M/S CSB-200, PO Box 5371, Seattle, WA 98105, USA
| | - Abigail Schlesinger
- UPMC Western Psychiatric Hospital, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 11279 Perry Highway, Suite 204, Wexford, PA 15090, USA.
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12
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Rodríguez EM, Gulbas LE, George-Jones J, Leija A, Burrows D, Neavel C. Interdisciplinary Perspectives on an Integrated Behavioral Health Model of Psychiatry in Pediatric Primary Care: A Community-Based Participatory Research Study. Community Ment Health J 2019; 55:569-577. [PMID: 30171449 DOI: 10.1007/s10597-018-0330-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
Integrated behavioral health services have positive outcomes for patients and providers, but little is known about providers' perspectives on implementing these services. This community-based participatory research collaboration with a Federally Qualified Health Center examined provider perspectives on implementing a collaborative psychiatry consultation program in pediatric primary care. We interviewed providers (N = 14) from psychiatry, social work, primary care, and psychology regarding their experiences implementing the program, and their recommendations for its sustainability. Providers described interdisciplinary integration arising from the program, with accompanying benefits (e.g., increased access to care for patients with complex diagnostic profiles, increased learning and role satisfaction among providers), and challenges (e.g., increased burden on primary care providers, potential patient discomfort with team-based care). Our results highlight the complexities of implementing collaborative psychiatry consultation in pediatric primary care, and suggest the importance of supporting primary care providers and patients within this context.
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Affiliation(s)
- Erin M Rodríguez
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA.
| | - Lauren E Gulbas
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd D3500, Austin, TX, 78712, USA
| | - Julia George-Jones
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA
| | - Annette Leija
- Department of Educational Psychology, University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA
| | - David Burrows
- People's Community Clinic, 1101 Camino La Costa, Austin, TX, 78752, USA
| | - Celia Neavel
- People's Community Clinic, 1101 Camino La Costa, Austin, TX, 78752, USA
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13
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Abstract
PURPOSE OF REVIEW Mental and physical disorders commonly co-occur leading to higher morbidity and mortality in people with mental and substance use disorders (collectively called behavioral health disorders). Models to integrate primary and behavioral health care for this population have not yet been implemented widely across health systems, leading to efforts to adapt models for specific subpopulations and mechanisms to facilitate more widespread adoption. RECENT FINDINGS Using examples from the UK and USA, we describe recent advances to integrate behavioral and primary care for new target populations including people with serious mental illness, people at the extremes of life, and for people with substance use disorders. We summarize mechanisms to incentivize integration efforts and to stimulate new integration between health and social services in primary care. We then present an outline of recent enablers for integration, concentrating on changes to funding mechanisms, developments in quality outcome measurements to promote collaborative working, and pragmatic guidance aimed at primary care providers wishing to enhance provision of behavioral care. Integrating care between primary care and behavioral health services is a complex process. Established models of integrated care are now being tailored to target specific patient populations and policy initiatives developed to encourage adoption in particular settings. Wholly novel approaches to integrate care are significantly less common. Future efforts to integrate care should allow for flexibility and innovation around implementation, payment models that support delivery of high value care, and the development of outcome measures that incentivize collaborative working practices.
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14
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Platt RE, Spencer AE, Burkey MD, Vidal C, Polk S, Bettencourt AF, Jain S, Stratton J, Wissow LS. What's known about implementing co-located paediatric integrated care: a scoping review. Int Rev Psychiatry 2018; 30:242-271. [PMID: 30912463 PMCID: PMC6499629 DOI: 10.1080/09540261.2018.1563530] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several studies have demonstrated clinical benefits of integrated care for a range of child and adolescent mental health outcomes. However, there is a significant gap between the evidence for efficacy of integrated care interventions vs their implementation in practice. While several studies have examined large-scale implementation of co-located integrated care for adults, much less is known for children. The goal of this scoping review was to understand how co-located mental health interventions targeting children and adolescents have been implemented and sustained. The literature was systematically searched for interventions targeting child and adolescent mental health that involved a mental health specialist co-located in a primary care setting. Studies reporting on the following implementation outcomes were included: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. This search identified 34 unique studies, including randomized controlled trials, observational studies, and survey/mixed method approaches. Components facilitating implementation of on-site integrated behavioural healthcare included interprofessional communication and collaboration at all stages of implementation; clear protocols to facilitate intervention delivery; and co-employment of integrated care providers by specialty clinics. Some studies found differences in service use by demographic factors, and others reported funding challenges affecting sustainability, warranting further study.
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Affiliation(s)
| | | | | | - Carolina Vidal
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sonal Jain
- New York Institute of Technology College of Osteopathic Medicine
| | - Julia Stratton
- Vancouver Coastal Health Authority, Pacific Spirit and Raven Song Child and Youth Mental Health Teams
| | - Lawrence S Wissow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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15
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Bai S, Zeledon LR, D’Amico EJ, Shoptaw S, Avina C, LaBorde AP, Anderson M, Fitzpatrick OM, Asarnow JR. Reducing Health Risk Behaviors and Improving Depression in Adolescents: A Randomized Controlled Trial in Primary Care Clinics. J Pediatr Psychol 2018; 43:1004-1016. [PMID: 30016473 PMCID: PMC6147756 DOI: 10.1093/jpepsy/jsy048] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/06/2018] [Accepted: 06/08/2018] [Indexed: 11/12/2022] Open
Abstract
Objective Primary care (PC) is a major service delivery setting that can provide preventive behavioral health care to youths. To explore the hypothesis that reducing health risk behaviors (HRBs) would lower depressive symptoms, and that health risk and depression can be efficiently targeted together in PC, this study (1) evaluates an intervention designed to reduce HRBs among adolescent PC patients with depressive symptoms and (2) examines prospective links between HRBs and depressive symptoms. Method A Randomized controlled trial was conducted comparing a behavioral health intervention with enhanced Usual PC (UC+). Participants were 187 adolescents (ages 13-18 years) with past-year depression, assessed at baseline, 6 months, and 12 months. Primary outcome was the Health Risk Behavior Index (HRBI), a composite score indexing smoking, substance use, unsafe sex, and obesity risk. Secondary/exploratory outcomes were an index of the first three most correlated behaviors (HRBI-S), each HRB, depressive symptoms, and satisfaction with mental health care. Results Outcomes were similar at 6 and 12 months, with no significant between-group differences. HRBI, HRBI-S, and depressive symptoms decreased, and satisfaction with mental health care increased across time in both groups. HRBI, HRBI-S, and smoking predicted later severe depression. Conversely, severe depression predicted later HRBI-S and substance use. Conclusions UC+ and the behavioral health intervention yielded similar benefits in reducing HRBs and depressive symptoms. Findings underscore the bidirectional links between depression and HRBs, supporting the importance of monitoring for HRBs and depression in PC to allow for effective intervention in both areas.
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Affiliation(s)
- Sunhye Bai
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles
- Department of Human Development and Family Studies, The Pennsylvania State University
| | | | | | - Steve Shoptaw
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles
- Department of Family Medicine, University of California Los Angeles
- Department of Psychiatry, University of Cape Town
| | - Claudia Avina
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles
| | | | - Martin Anderson
- Department of Pediatrics, University of California Los Angeles
| | - Olivia M Fitzpatrick
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles
| | - Joan R Asarnow
- Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles
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16
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Devine KA, Monaghan M, Schwartz LA. Introduction to the Special Issue on Adolescent and Young Adult Health: Why We Care, How Far We Have Come, and Where We Are Going. J Pediatr Psychol 2018; 42:903-909. [PMID: 29046043 DOI: 10.1093/jpepsy/jsx101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/24/2017] [Indexed: 11/14/2022] Open
Abstract
This special issue on adolescent and young adult (AYA) health comprises 15 original articles. The special issue recognizes the importance of AYA-focused research, highlights unique issues across the AYA period, and showcases cutting-edge research focused on AYAs. We describe the rationale for focusing on the AYA population, themes of the special issue, and future directions.
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Affiliation(s)
- Katie A Devine
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey
| | - Maureen Monaghan
- Department of Psychology & Behavioral Health, Children's National Health System
| | - Lisa A Schwartz
- The Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania
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17
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Tuchman LK. Commentary: The Science of Adolescent and Young Adult Health: A Growing Field and the Team Science Behind It. J Pediatr Psychol 2017; 42:1075-1076. [PMID: 29046042 DOI: 10.1093/jpepsy/jsx100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/20/2017] [Indexed: 11/13/2022] Open
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