1
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Disler ER, Steinwald P, Scott AR, Marston AP. Assessment of Psychosocial Impairment among Patients with Cleft Lip and/or Cleft Palate Using the Pediatric Symptom Checklist. Facial Plast Surg Aesthet Med 2024; 26:573-574. [PMID: 38738418 DOI: 10.1089/fpsam.2023.0273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Affiliation(s)
- Emily R Disler
- Tufts University School of Medicine, Boston, Massachusetts USA
| | - Peter Steinwald
- Dr. Elie E. Rebeiz Department of Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts USA
| | - Andrew R Scott
- Tufts University School of Medicine, Boston, Massachusetts USA
- Dr. Elie E. Rebeiz Department of Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts USA
| | - Alexander P Marston
- Tufts University School of Medicine, Boston, Massachusetts USA
- Dr. Elie E. Rebeiz Department of Otolaryngology - Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts USA
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2
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Brown FL, Steen F, Taha K, Koppenol-Gonzalez GV, Aoun M, Bryant R, Jordans MJD. Validation of Arabic versions of the child psychosocial distress screener and pediatric symptom checklist for young adolescents living in vulnerable communities in Lebanon. Int J Ment Health Syst 2024; 18:21. [PMID: 38812016 PMCID: PMC11137983 DOI: 10.1186/s13033-024-00640-y] [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: 07/10/2022] [Accepted: 05/20/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND In humanitarian settings, brief screening instruments for child psychological distress have potential to assist in assessing prevalence, monitoring outcomes, and identifying children and adolescents in most need of scarce resources, given few mental health professionals for diagnostic services. Yet, there are few validated screening tools available, particularly in Arabic. METHODS We translated and adapted the Child Psychosocial Distress Screener (CPDS) and the Pediatric Symptom Checklist (PSC) and conducted a validation study with 85 adolescents (aged 10-15) in Lebanon. We assessed internal consistency; test-retest reliability; convergent validity between adolescent- and caregiver-report and between the two measures; ability to distinguish between clinical and non-clinical samples; and concurrent validity against psychiatrist interview using the Kiddie Schedule for Affective Disorders and Schizophrenia. RESULTS The translated and adapted child-reported PSC-17 and PSC-35, and caregiver-reported PSC-35 all showed adequate internal consistency and test-retest reliability and high concurrent validity with psychiatrist interview and were able to distinguish between clinical and non-clinical samples. However, the caregiver-reported PSC-17 did not demonstrate adequate performance in this setting. Child-reported versions of the PSC outperformed caregiver-reported versions and the 35-item PSC scales showed stronger performance than 17-item scales. The CPDS showed adequate convergent validity with the PSC, ability to distinguish between clinical and non-clinical samples, and concurrent validity with psychiatrist interview. Internal consistency was low for the CPDS, likely due to the nature of the brief risk-screening tool. There were discrepancies between caregiver and child-reports, worthy of future investigation. For indication of any diagnosis requiring treatment, we recommend cut-offs of 5 for CPDS, 12 for child-reported PSC-17, 21 for child-reported PSC-35, and 26 for caregiver-reported PSC-35. CONCLUSIONS The Arabic PSC and CPDS are reliable and valid instruments for use as primary screening tools in Lebanon. Further research is needed to understand discrepancies between adolescent and caregiver reports, and optimal methods of using multiple informants.
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Affiliation(s)
- Felicity L Brown
- Research and Development Department, War Child Alliance, Helmholtzstraat 61G, Amsterdam, The Netherlands.
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam , 1098LE, The Netherlands.
| | - Frederik Steen
- Research and Development Department, War Child Alliance, Helmholtzstraat 61G, Amsterdam, The Netherlands
| | | | | | - May Aoun
- War Child Alliance Lebanon, Beirut, Lebanon
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Mark J D Jordans
- Research and Development Department, War Child Alliance, Helmholtzstraat 61G, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam , 1098LE, The Netherlands
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3
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Vaillant-Coindard E, Briet G, Lespiau F, Gisclard B, Charbonnier E. Effects of three prophylactic interventions on French middle-schoolers' mental health: protocol for a randomized controlled trial. BMC Psychol 2024; 12:204. [PMID: 38615007 PMCID: PMC11016224 DOI: 10.1186/s40359-024-01723-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024] Open
Abstract
Adolescence is a strategic developmental stage in terms of preventing later difficulties and ensuring good mental health. Prophylactic interventions, which are conducted before the onset, prolongation, or worsening of difficulties, and aim to prevent or reduce symptoms or to promote wellbeing, therefore appear particularly appropriate for adolescents. However, existing prophylactic interventions conducted with adolescents have several weaknesses, including sparse theoretical frameworks, ambivalent evidence of their efficacy, and implementation and dissemination difficulties. In addition, no data are currently available on the effectiveness of such interventions in France. To fill this gap, a four-arm randomized controlled trial will be performed to assess the effectiveness of three prophylactic interventions targeting reactive, proactive and interpersonal adaptation in fourth-grade middle-school students, together with participants' experience and perception of the interventions. Based on existing knowledge about adolescents, their learning mechanisms, and field constraints, these three interventions have been designed to promote their learning and receptiveness to interventions. Compared with baseline (i.e., before the intervention), we expect to observe a significant decrease in the level of distress (anxiety and depressive symptoms, functional impairment, and psychosocial difficulties) and a significant increase in the level of wellbeing after the intervention, across the three intervention groups, but not in the control group. In addition, we expect to observe post-intervention improvements in the processes targeted by the reactive adaptation intervention (operationalized as coping strategy use and flexibility), those targeted by the proactive adaptation intervention (operationalized as the tendency to engage in committed actions and general self-efficacy), and those targeted by the interpersonal adaptation intervention (operationalized as assertiveness in interactions), but only in the corresponding groups, with no change in any of these processes in the control group. The results of this research will not only enrich our knowledge of the processes involved in adolescents' distress and wellbeing, but also provide clues as to the best targets for intervention. Moreover, the material for these interventions will be freely available in French on request to the corresponding author, providing access to innovative and fully assessed interventions aimed at promoting adolescents' mental health in France.This clinical trial is currently being registered under no. 2023-A01973-42 on https://ansm.sante.fr/ . This is the first version of the protocol.
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Affiliation(s)
| | - Gaëtan Briet
- UNIV. NIMES, APSY-V, F-30021, Nîmes Cedex 1, France
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4
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Fox CK, Molitor SJ, Vock DM, Peterson CB, Crow SJ, Gross AC. Appetitive and psychological phenotypes of pediatric patients with obesity. Pediatr Obes 2024; 19:e13101. [PMID: 38290813 DOI: 10.1111/ijpo.13101] [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] [Received: 06/13/2023] [Revised: 12/15/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Obesity is a heterogeneous disease with variable treatment response. Identification of the unique constellation of contributors to obesity may allow for targeted interventions and improved outcomes. OBJECTIVE Identify empirically derived phenotypes of pediatric patients with obesity based on appetitive and psychological correlates of obesity. METHODS This cross-sectional study included patients aged 5-12 years who were treated in a weight management clinic and completed standard intake questionnaires including Child Eating Behavior Questionnaire (CEBQ), Vanderbilt ADHD Scale and Pediatric Symptom Checklist. Phenotypes were elicited using latent profile analysis of 12 indicators: eight CEBQ subscales, inattention, hyperactivity/impulsivity, internalizing and externalizing symptoms. RESULTS Parents/guardians of 384 patients (mean age 9.8 years, mean BMI 30.3 kg/m2 ) completed the intake questionnaires. A 4-phenotype model best fits the data. Hedonic Impulsive phenotype (42.5%) exhibited high food enjoyment and hyperactivity/impulsivity. Inattentive Impulsive phenotype (27.4%) exhibited overall low food approach and high food avoid behaviours, and highest inattention. Hedonic Emotional phenotype (20.8%) scored the highest on food enjoyment, internalizing and externalizing symptoms. Picky Eating phenotype (9.3%) scored the lowest on food approach, inattention, hyperactivity/impulsivity, internalizing and externalizing symptoms. CONCLUSION Appetitive traits and psychological symptoms appear to cluster in distinct patterns, giving rise to four unique phenotypic profiles, which, if replicated, may help inform the development of tailored treatment plans.
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Affiliation(s)
- Claudia K Fox
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen J Molitor
- Division of Pediatric Psychology and Developmental Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Carol B Peterson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Amy C Gross
- Center for Pediatric Obesity Medicine and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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5
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Crandal BR, Hazen AL, Dickson KS, Tsai CYK, Trask EV, Aarons GA. Mental health symptoms of youth initiating psychiatric care at different phases of the COVID-19 pandemic. Child Adolesc Psychiatry Ment Health 2022; 16:77. [PMID: 36180887 PMCID: PMC9524341 DOI: 10.1186/s13034-022-00511-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To examine differences in caregiver and youth reported mental health symptoms for youth initiating mental health treatment through phases of the Coronavirus Disease (COVID-19) pandemic, compared with symptomology reported the prior year. STUDY DESIGN This retrospective study analyzes group differences in mental health symptoms (Pediatric Symptom Checklist; PSC-35) based on 7874 youth seeking treatment in publicly funded mental health treatment programs during California's Stay-At-Home order (March-May, 2020) and the prolonged pandemic (May-December, 2020) phases of the COVID-19 pandemic as compared with matching groups in 2019. RESULTS Youth entering mental health treatment services, and their caregivers, reported significantly increased internalizing, externalizing, and attention-related symptoms during the prolonged pandemic phase, but not during the acute stay-at-home phase of the COVID-19 pandemic, and with small effect sizes. Group comparison analyses did not detect a significantly larger effect for Sexual and Gender Diverse (SGD) youth who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex, and Black, Indigenous, People of Color (BIPOC). CONCLUSIONS A large-scale comparison of youth mental health symptoms before and during the COVID-19 pandemic suggests that mental health was disrupted for youth seeking treatment as the pandemic prolonged throughout 2020.
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Affiliation(s)
- Brent R. Crandal
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093 USA ,grid.286440.c0000 0004 0383 2910Behavioral Health Services, Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA 92123 USA
| | - Andrea L. Hazen
- grid.286440.c0000 0004 0383 2910Chadwick Center for Children & Families, Rady Children’s Hospital, 3020 Children’s Way, San Diego, CA 92123 USA ,grid.266100.30000 0001 2107 4242Child and Adolescent Services Research Center, 3665 Kearny Villa Road, Suite 200N, San Diego, CA 92123 USA
| | - Kelsey S. Dickson
- grid.266100.30000 0001 2107 4242Child and Adolescent Services Research Center, 3665 Kearny Villa Road, Suite 200N, San Diego, CA 92123 USA ,grid.263081.e0000 0001 0790 1491Department of Child and Family Development, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182 USA
| | - Chia-Yu Kathryn Tsai
- grid.514026.40000 0004 6484 7120California University of Science and Medicine, 1501 Violet Street, Colton, CA 92324 USA
| | - Emily Velazquez Trask
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093 USA ,grid.427930.b0000 0004 4903 9942Behavioral Health Services Department, Health and Human Services, County of San Diego, 3255 Camino del Rio South, San Diego, CA 92108 USA
| | - Gregory A. Aarons
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093 USA ,grid.266100.30000 0001 2107 4242Child and Adolescent Services Research Center, 3665 Kearny Villa Road, Suite 200N, San Diego, CA 92123 USA ,grid.427930.b0000 0004 4903 9942Behavioral Health Services Department, Health and Human Services, County of San Diego, 3255 Camino del Rio South, San Diego, CA 92108 USA
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6
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Matthan NR, Barger K, Wylie-Rosett J, Xue X, Groisman-Perelstein AE, Diamantis PM, Ginsberg M, Mossavar-Rahmani Y, Lichtenstein AH. Spillover Effects of a Family-Based Childhood Weight-Management Intervention on Parental Nutrient Biomarkers and Cardiometabolic Risk Factors. Curr Dev Nutr 2022; 6:nzab152. [PMID: 35155982 PMCID: PMC8826936 DOI: 10.1093/cdn/nzab152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 12/14/2021] [Accepted: 12/17/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Parental involvement has been shown to favorably affect childhood weight-management interventions, but whether these interventions influence parental diet and cardiometabolic health outcomes is unclear. OBJECTIVES The aim was to evaluate whether a 1-y family-based childhood weight-management intervention altered parental nutrient biomarker concentrations and cardiometabolic risk factors (CMRFs). METHODS Secondary analysis from a randomized-controlled, parallel-arm clinical trial (NCT00851201). Families were recruited from a largely Hispanic population and assigned to either standard care (SC; American Academy of Pediatrics overweight/obesity recommendations) or SC + enhanced program (SC+EP; targeted diet/physical activity strategies, skill building, and monthly support sessions). Nutrient biomarkers (plasma carotenoids and fat-soluble vitamins, RBC fatty acid profiles) and CMRFs (BMI, blood pressure, glucose, insulin, lipid profile, inflammatory and endothelial dysfunction markers, adipokines) were measured in archived samples collected from parents of participating children at baseline and end of the 1-y intervention. RESULTS Parents in both groups (SC = 106 and SC+EP = 99) had significant reductions in trans fatty acid (-14%) and increases in MUFA (2%), PUFA n-6 (ɷ-6) (2%), PUFA n-3 (7%), and β-carotene (20%) concentrations, indicative of lower partially hydrogenated fat and higher vegetable oil, fish, and fruit/vegetable intake, respectively. Significant reductions in high-sensitivity C-reactive protein (hsCRP; -21%) TNF-α (-19%), IL-6 (-19%), and triglycerides (-6%) were also observed in both groups. An additional significant improvement in serum insulin concentrations (-6%) was observed in the SC+EP parents. However, no major reductions in BMI or blood pressure and significant unfavorable trajectories in LDL-cholesterol and endothelial dysfunction markers [P-selectin, soluble intercellular adhesion molecule (sICAM), thrombomodulin] were observed. Higher carotenoid, MUFA, and PUFA (n-6 and n-3) and lower SFA and trans fatty acid concentrations were associated with improvements in circulating glucose and lipid measures, inflammatory markers, and adipokines. CONCLUSIONS The benefits of a family-based childhood weight-management intervention can spill over to parents, resulting in apparent healthier dietary shifts that are associated with modest improvements in some CMRFs.
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Affiliation(s)
- Nirupa R Matthan
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Kathryn Barger
- Biostatistics and Data Management Core Unit, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xiaonan Xue
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Pamela M Diamantis
- Department of Pediatrics, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Mindy Ginsberg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alice H Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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7
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Goddard A, Janicek E, Etcher L. Trauma-informed care for the pediatric nurse. J Pediatr Nurs 2022; 62:1-9. [PMID: 34798581 PMCID: PMC9757999 DOI: 10.1016/j.pedn.2021.11.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/05/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Trauma is not limited to medical trauma and includes chronic stressors, toxic stress, adverse childhood events, abuse, and now the COVID-19 pandemic. Principles of trauma-informed care and resiliency guide pediatric nursing care across the life span from birth to adolescence. Trauma-informed care principles are pertinent to the nursing care needs of healthy and ill children from infancy to adolescence across care settings. METHODS The purpose of this integrative literature review (IRL) is to elucidate evidence-based practices for pediatric nurses specific to trauma, trauma-informed principles, and the integration of these principles to care. Using Whittemore and Knafl's (2005) methodology, this IRL presents empirical literature to operationalize trauma-informed care for the pediatric nurse through 1) identification of the problem; 2) literature search; 3) data evaluation; 4) data analysis; 5) result presentation. FINDINGS Results are presented in a contemporary framework by the Substance Abuse and Mental Health Services Administration (2018) of trauma-awareness for the pediatric nurse, trauma-informed principles, and the integration of these principles to care. Pediatric nurses are in a unique position to offer trauma-informed care by recognizing and managing trauma to include chronic stressors, toxic stress, adverse childhood experiences, and abuse. DISCUSSION Pediatric nurses today are caring for patients in a complex and diverse healthcare climate amid the world's worst public health pandemic in living memory. Awareness of trauma, assessment of trauma in pediatrics, and health and resiliency promotion are critical in moving forward post-pandemic. The overview of trauma-informed care provides a guide for the pediatric nurse.
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Affiliation(s)
- Anna Goddard
- Quality, Research, & Evaluation, School-Based Health Alliance, United States of America; Sacred Heart University, Davis & Henley College of Nursing, United States of America; Child and Family Agency of Southeastern Connecticut, United States of America.
| | - Erin Janicek
- Child and Family Agency of Southeastern Connecticut, United States of America.
| | - LuAnn Etcher
- Sacred Heart University, Davis & Henley College of Nursing, United States of America.
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8
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Barajas-Gonzalez RG, Ursache A, Kamboukos D, Huang KY, Dawson-McClure S, Urcuyo A, Huang TJJ, Brotman LM. Parental perceived immigration threat and children's mental health, self-regulation and executive functioning in pre-Kindergarten. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2021; 92:176-189. [PMID: 34968118 PMCID: PMC9132160 DOI: 10.1037/ort0000591] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Many children in immigrant households endure unique stressors shaped by national, state, and local immigration policies and enforcement activity in the United States. Qualitative studies find that during times of heightened immigration enforcement, children as young as 3 years of age show signs of behavioral distress related to national anti-immigrant sentiment and the possibility of losing a parent. Using multiple sources of data from 168 racially and ethnically diverse families of children in pre-Kindergarten, the present study examined variability in perceived levels of immigration enforcement threat by parental immigrant status and ethnicity. This study examined associations between immigration enforcement threat and child mental health, self-regulation, and executive functioning and whether parent immigrant status or child gender moderates these associations. We found substantial variability in perceived immigration threat, with immigrant parents and Latinx parents reporting significantly greater levels of immigration threat compared to nonimmigrant parents and non-Latinx parents. Immigration enforcement threat was associated with greater child separation anxiety and overanxious behaviors, and lower self-regulation among boys and girls and among children of immigrant and U.S.-born parents. In contrast to our hypothesis, immigration enforcement threat was associated with higher self-regulation according to independent assessor ratings. Educators and healthcare providers working with young children from immigrant and Latinx households should be aware of the disproportionate stress experienced by immigrant and Latinx families due to a xenophobic sociopolitical climate marked by heightened immigration enforcement threat and racist, anti-immigrant rhetoric. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | - Anya Urcuyo
- Center for Early Childhood Health and Development
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9
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Wambua GN, Kumar M, Falkenström F, Cuijpers P. Routine outcome measurement in adolescents seeking mental health services: standardization of HoNOSCA in Kenyan sample. BMC Psychiatry 2021; 21:440. [PMID: 34488702 PMCID: PMC8422761 DOI: 10.1186/s12888-021-03438-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 08/24/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The evaluation of treatment outcomes is important for service providers to assess if there is improvement or not. The Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) was developed for this use in child and adolescent mental health services. Outcome measurement in routine mental health services is limited. This paper evaluates the psychometric properties of the self and clinician rated versions of the HoNOSCA for routine use in child and adolescent mental health services in Kenya. METHODS Using a prospective design, the clinician- and self-rated versions of the HoNOSCA and the Paediatric Symptom Checklist (PSC) were administered at the Youth Centre at the Kenyatta National Hospital in Nairobi. Initial ratings were obtained from adolescents 12-17 years (n = 201). A sample of 98 paired ratings with 2 follow-ups were examined for measurement of change over time. RESULTS Our findings showed good reliability with the self-rated version of the HoNOSCA score, correlating well with the self-reported version of the PSC (r = .74, p < .001). Both versions correlated well at follow-up and were sensitive to change. Using factor analysis, the maximum likelihood factoring and Promax rotation resulted in a four-factor structure, which with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.8 explained 54.74% of total variance. CONCLUSION The HoNOSCA appears to be of value, and easy to use in routine settings. Our findings suggest further investigation with a larger sample.
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Affiliation(s)
- Grace Nduku Wambua
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Manasi Kumar
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Fredrik Falkenström
- grid.5640.70000 0001 2162 9922Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | - Pim Cuijpers
- grid.16872.3a0000 0004 0435 165XDepartment of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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10
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Overview of Ten Child Mental Health Clinical Outcome Measures: Testing of Psychometric Properties with Diverse Client Populations in the U.S. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:197-225. [PMID: 34482501 PMCID: PMC8850232 DOI: 10.1007/s10488-021-01157-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2021] [Indexed: 11/11/2022]
Abstract
While many standardized assessment measures exist to track child mental health treatment outcomes, the degree to which such tools have been adequately tested for reliability and validity across race, ethnicity, and class is uneven. This paper examines the corpus of published tests of psychometric properties for the ten standardized measures used in U.S. child outpatient care, with focus on breadth of testing across these domains. Our goal is to assist care providers, researchers, and legislators in understanding how cultural mismatch impacts measurement accuracy and how to select tools appropriate to the characteristics of their client populations. We also highlight avenues of needed research for measures that are in common use. The list of measures was compiled from (1) U.S. state Department of Mental Health websites; (2) a survey of California county behavioral health agency directors; and (3) exploratory literature scans of published research. Ten measures met inclusion criteria; for each one a systematic review of psychometrics literature was conducted. Diversity of participant research samples was examined as well as differences in reliability and validity by gender, race or ethnicity, and socio-economic class. All measures showed adequate reliability and validity, however half lacked diverse testing across all three domains and all lacked testing with Asian American/Pacific Islander and Native American children. ASEBA, PSC, and SDQ had the broadest testing.
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11
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Hussong AM, Midgette AJ, Thomas TE, Coffman JL, Cho S. Coping and Mental Health in Early Adolescence during COVID-19. Res Child Adolesc Psychopathol 2021; 49:1113-1123. [PMID: 33856611 PMCID: PMC8048334 DOI: 10.1007/s10802-021-00821-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2021] [Indexed: 11/28/2022]
Abstract
The current longitudinal study examines changes in overall mental health symptomatology from before to after the COVID-19 outbreak in youth from the southeastern United States as well as the potential mitigating effects of self-efficacy, optimism, and coping. A sample of 105 parent-child dyads participated in the study (49% boys; 81% European American, 1% Alaska Native/American Indian, 9% Asian/Asian American; 4% Black/African American; 4% Latinx; and 4% other; 87% mothers; 25% high school graduate without college education; 30% degree from 4-year college; 45% graduate or professional school). Parents completed surveys when children were aged 6-9, 8-12, 9-13, and 12-16, with the last assessments occurring between May 13, 2020 and July 1, 2020 during the COVID-19 outbreak. Children also completed online surveys at ages 11-16 assessing self-efficacy, optimism, and coping. Multi-level modeling analyses showed a within-person increase in mental health symptoms from before to after the outbreak after controlling for changes associated with maturation. Symptom increases were mitigated in youth with greater self-efficacy and (to some extent) problem-focused engaged coping, and exacerbated in youth with greater emotion-focused engaged and disengaged coping. Implications of this work include the importance of reinforcing self-efficacy in youth during times of crisis, such as the pandemic, and the potential downsides of emotion-focused coping as an early response to the crisis for youth.
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Affiliation(s)
- Andrea M Hussong
- Department of Psychology and Neuroscience, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA.
| | - Allegra J Midgette
- Department of Psychology and Neuroscience, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Taylor E Thomas
- Department of Psychology and Neuroscience, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer L Coffman
- Department of Human Development and Family Studies, University of North Carolina At Greensboro, Greensboro, NC, USA
| | - Su Cho
- Department of Psychology and Neuroscience, University of North Carolina At Chapel Hill, Chapel Hill, NC, USA
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12
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Bate J, Pham PT, Borelli JL. Be My Safe Haven: Parent-Child Relationships and Emotional Health During COVID-19. J Pediatr Psychol 2021; 46:624-634. [PMID: 34283892 PMCID: PMC8344797 DOI: 10.1093/jpepsy/jsab046] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 04/07/2021] [Accepted: 04/21/2021] [Indexed: 01/01/2023] Open
Abstract
Objective Since March 2020, millions of children have been confined to their homes and restricted from in-person activities, radically changing the dynamics of parent–child relationships. This study examines the association between coronavirus disease 2019 (COVID-19) impact and the mental health of parents and school-aged children; specifically, whether qualities of the parent–child relationship moderated the relationship between parents’ emotional health (EH) and children’s emotional and behavioral health (EBH). Methods Data from this Internet-based study of a community sample were collected in March–May 2020. Parents (N = 158, 92.4% White, 96.2% female) reported on COVID-19 impacts, their own EH, perceptions of their relationship with their eldest child between 6 and 12 years-old, and the EBH of that child. Results Responses to questions about COVID-19 impact were assigned weighted values and used to create a COVID-19 impact scale. Hierarchical linear regressions revealed that greater COVID-19 impact was associated with greater parents’ EH issues only, and parents’ EH was a significant positive predictor of children’s EBH. Positive qualities and conflict in the parent–child relationship moderated the link between parents’ and children’s EH. At higher levels of relationship conflict and lower levels of positivity, there were stronger positive associations between parents’ and children’s EH. Parent–child relationship quality did not moderate the association between parents’ EH and children’s behavioral health (BH). Conclusions These cross-sectional study results suggest that beyond focusing on symptom management, families may benefit from supports targeting the parent–child relationship. Insights and implications for practitioners are discussed.
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Affiliation(s)
- Jordan Bate
- Ferkauf Graduate School of Psychology, Yeshiva University
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13
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Jellinek M, Bergmann P, Holcomb JM, Riobueno-Naylor A, Dutta A, Haile H, Sturner R, Howard B, Murphy JM. Recognizing Adolescent Depression with Parent- and Youth-Report Screens in Pediatric Primary Care. J Pediatr 2021; 233:220-226.e1. [PMID: 33548264 DOI: 10.1016/j.jpeds.2021.01.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To compare the use of the parent-report Pediatric Symptom Checklist (PSC-17P) and youth-report Patient Health Questionnaire-9 Modified for Teens (PHQ-9M) in compliance with recent quality standards for adolescent depression screening. STUDY DESIGN Parents of 5411 pediatric outpatients (11.0-17.9 years old) completed the PSC-17P, which contains scales that assign categorical risk for overall (PSC-17P-OVR), internalizing (PSC-17P-INT), externalizing (PSC-17P-EXT), and attention (PSC-17P-ATT) problems. Adolescents completed the PHQ-9M, which assesses depressive symptoms. Both forms were completed online within 24 hours of each other before pediatric well-child visits. RESULTS A total of 9.9% of patients (n = 535) were at risk on the PSC-17P-OVR, 14.3% (n = 775) were at risk on the PSC-17P-INT, and 17.0% (n = 992) were at risk on either or both scales (PSC-17P-OVR and/or PSC-17P-INT). Using the PHQ-9M cut-off score of 10 (moderate-very severe depression), an additional 2.4% (n = 131) were classified as at risk, with 66.8% (n = 263) of all PHQ-9M positives (n = 394) also coded as at risk by the PSC-17P-OVR and/or PSC-17P-INT scales. Using a PHQ-9M cut-off score of 15 (severe-very severe depression), only 29 patients (21.8% of the PHQ-9M positives) not identified by the PSC-17P-OVR and/or PSC-17P-INT were classified as being at risk. CONCLUSIONS The combined PSC-17P-OVR and/or PSC-17P-INT scales identified 17% of adolescents as at risk for depression, including about two-thirds to three-quarters of adolescents classified as at risk on the PHQ-9M. These findings support using the PSC-17P to meet quality standards for depression as well as overall screening in pediatrics. Primary care clinicians can add the PHQ-9M to identify additional adolescents who may self-report depressive symptoms.
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Affiliation(s)
- Michael Jellinek
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Juliana M Holcomb
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Alexa Riobueno-Naylor
- Department of Counseling, Developmental, and Educational Psychology, Lynch School of Education and Human Development, Boston College, Boston, MA
| | - Anamika Dutta
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Haregnesh Haile
- Department of Psychology, The Catholic University of America, Washington, DC
| | - Raymond Sturner
- Department of Pediatrics, The John Hopkins University School of Medicine, Baltimore, MD; Center for Promotion of Child Development through Primary Care, Baltimore, MD
| | - Barbara Howard
- Department of Pediatrics, The John Hopkins University School of Medicine, Baltimore, MD; Total Child Health, Baltimore, MD
| | - J Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
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Murphy JM, Stepanian S, Riobueno-Naylor A, Holcomb JM, Haile H, Dutta A, Giuliano CP, Bernstein SC, Joseph B, Shui AM, Jellinek MS. Implementation of an Electronic Approach to Psychosocial Screening in a Network of Pediatric Practices. Acad Pediatr 2021; 21:702-709. [PMID: 33285307 DOI: 10.1016/j.acap.2020.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE A network of 18 pediatric practice locations serving predominantly commercially insured patients implemented the electronic administration of the Pediatric Symptom Checklist-17 parent-report (PSC-17P) for all 5.50- to 17.99-year-old children seen for well child visits (WCVs) and wrote up the results as a quality improvement project. The current study investigated this screening over 2 years to assess its implementation and risk rates over time. METHODS Parents completed the PSC-17P electronically before the visit and the scored data were immediately available in the patient's chart. Using billing and screening data, the study tracked rates of overall and positive screening during the first-year baseline (4 months) and full implementation phases of the project in the first (8 months) and second (12 months) year. RESULTS A total of 35,237 patients completed a WCV in the first year. There was a significant improvement in PSC-17P screening rates from the first-year baseline (26.3%) to full implementation (89.3%; P < .001) phases. In the second year, a total of 40,969 patients completed a WCV and 77.9% (n = 31,901) were screened, including 18,024 patients with screens in both years. PSC-17P screening rates varied significantly across the 18 locations and rates of PSC-17P risk differed significantly by practice, insurance type, sex, and age. CONCLUSIONS The current study demonstrated the feasibility of routine psychosocial screening over 2 years using the electronically administered PSC-17P in a network of pediatric practices. This study also corroborated past reports that PSC-17 risk rates differed significantly by insurance type (Medicaid vs commercial), sex, and age group.
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Affiliation(s)
- J Michael Murphy
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (JM Murphy, MS Jellinek), Harvard Medical School, Boston, Mass.
| | - Salpi Stepanian
- Department of Clinical and Quality Programs (S Stepanian, CP Giuliano, SC Bernstein), Affiliated Pediatric Practices, Dedham, Mass
| | - Alexa Riobueno-Naylor
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass
| | - Juliana M Holcomb
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass
| | - Haregnesh Haile
- Department of Psychology (H Haile), The Catholic University of America, Washington, DC
| | - Anamika Dutta
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass
| | - Christopher P Giuliano
- Department of Clinical and Quality Programs (S Stepanian, CP Giuliano, SC Bernstein), Affiliated Pediatric Practices, Dedham, Mass
| | - Shelly C Bernstein
- Department of Clinical and Quality Programs (S Stepanian, CP Giuliano, SC Bernstein), Affiliated Pediatric Practices, Dedham, Mass; Department of Pediatrics (SC Bernstein, MS Jellinek), Harvard Medical School, Boston, Mass
| | | | - Amy M Shui
- Biostatistics Center (AM Shui), Massachusetts General Hospital, Boston, Mass
| | - Michael S Jellinek
- Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (JM Murphy, MS Jellinek), Harvard Medical School, Boston, Mass; Department of Pediatrics (SC Bernstein, MS Jellinek), Harvard Medical School, Boston, Mass
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Abstract
This study evaluated whether children with higher adverse childhood experiences (ACE) scores had alterations in immune cell gene expression profiles. RNA sequencing was conducted on dried blood spot samples from 37 generally healthy English-speaking children (age 5-11) who were recruited from well-child visits at a university-affiliated pediatric practice. The Whole Child Assessment was used to assess ACE exposure. Primary analyses examined an a priori-specified composite of 19 pro-inflammatory gene transcripts. Secondary analyses examined a 34-gene composite assessing Type I interferon response, and used Transcript Origin Analyses to identify cellular mechanisms. After controlling for age, body mass index percentile, sex, race/ethnicity, current insurance status, and household smoking exposure, pro-inflammatory gene expression was elevated by 0.094 log2 RNA expression units with each Child-ACE total score point (p = .019). Type I interferon gene expression was similarly upregulated (0.103; p = .008). Transcript origin analyses implicated CD8+ T cell as the primary sources of gene transcripts upregulated, and nonclassical (CD16+) monocytes as sources of downregulated transcripts. These preliminary analyses suggest that parent-reported ACE exposures are associated with increased expression of both inflammatory and interferon gene transcripts in children's circulating blood cells.
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Jeffrey J, Klomhaus A, Enenbach M, Lester P, Krishna R. Self-Report Rating Scales to Guide Measurement-Based Care in Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am 2020; 29:601-629. [PMID: 32891365 DOI: 10.1016/j.chc.2020.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Measurement-based care involves the practice of systematically administrating rating scales to patients in order to use the collected information to enhance clinical evaluation, monitor treatment progress, and directly inform decisions relating to each patient's treatment. Rating scales must be psychometrically validated and efficiently administered within the practice setting. Brief rating scales that are available within the public domain may help to optimize workflows and prevent response fatigue. Clinicians should also have a sufficient understanding of the underlying psychometric properties of rating scales to accurately interpret changes in scores over time and use these results to appropriately direct care.
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Affiliation(s)
- Jessica Jeffrey
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, Nathanson Family Resilience Center, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, A8-153, Los Angeles, CA 90095, USA.
| | - Alexandra Klomhaus
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, Nathanson Family Resilience Center, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, A8-153, Los Angeles, CA 90095, USA; Department of Biostatistics, UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA 90095, USA
| | - Michael Enenbach
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, Nathanson Family Resilience Center, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, A8-153, Los Angeles, CA 90095, USA; Department of Psychiatry & Biobehavioral Sciences, Division of Child and Adolescent Psychiatry, Jane and Terry Semel Institute of Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, 48-270, Los Angeles, CA 90095, USA
| | - Patricia Lester
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, Nathanson Family Resilience Center, Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, 760 Westwood Plaza, A8-153, Los Angeles, CA 90095, USA
| | - Rajeev Krishna
- Psychiatry and Behavioral Health, Nationwide Children's Hospital, Psychiatry T5, 700 Children's Drive, Columbus, OH 43205, USA
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McLaurin-Jiang S, Cohen GM, Brown CL, Edwards P, Albertini LW. Integrated Mental Health Training Relates to Pediatric Residents' Confidence with Child Mental Health Disorders. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2020; 44:299-304. [PMID: 31965516 DOI: 10.1007/s40596-020-01182-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/09/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The primary aim of this study was to determine the association of an integrated mental health training model on pediatric residents' use of (1) secondary screens, (2) mental health referrals, (3) psychotropic medications, and (4) follow-up appointments for mental health concerns. The secondary aim was to determine resident confidence managing mental health conditions. METHODS Visits of children ages 6-18 years old with either a positive primary mental health screen or a mental health diagnosis in pre- and post-intervention years (N = 113 and N = 251, respectively) at a single-site continuity clinic were included. Authors also surveyed alumni from pre- and post- intervention years (N = 46) about their confidence with managing mental health disorders. The authors used chi-squared and t-tests to compare visit characteristics between years and multivariable logistic regression to determine correlates of mental health management. RESULTS Post-intervention residents more often used secondary screening tools (adjusted odds ratio 5.61, 95% confidence interval 2.08-15.17). There were no differences in referrals, prescribing psychotropic medications, or follow-up visits. Post-intervention graduates reported higher confidence with diagnosis, screening, medication management, and follow-up for mental health disorders. CONCLUSIONS After transitioning to an integrated mental health model, residents were more likely to use secondary screens and post-intervention graduates reported higher confidence with managing mental health disorders.
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Affiliation(s)
- Skyler McLaurin-Jiang
- The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Gail M Cohen
- Wake Forest School of Medicine, Winston-Salem, NC, USA
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18
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Process and outcome of child psychotherapies offered in Kenya: a mixed methods study protocol on improving child mental health. BMC Psychiatry 2020; 20:263. [PMID: 32460714 PMCID: PMC7251869 DOI: 10.1186/s12888-020-02611-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 04/20/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Child and adolescent mental health problems account for a significant proportion of the local and global burden of disease and is recognized as a growing public health concern in need of adequate services. Studies carried out in Kenya suggest a need for a robust service for the treatment, prevention, and promotion of child and adolescent mental health. Despite a few existing services to provide treatment and management of mental health disorders, we need more knowledge about their effectiveness in the management of these disorders. This paper describes a study protocol that aims to evaluate the process and outcomes of psychotherapies offered to children and adolescents seeking mental health services at the Kenyatta National Hospital in Kenya. METHODS This study will use a prospective cohort approach that will follow adolescent patients (12-17 years of age) receiving mental health services in the youth clinics at the Kenyatta National Hospital for a period of 12 months. During this time a mixed methods research will be carried out, focusing on treatment outcomes, therapeutic relationship, understanding of psychotherapy, and other mental health interventions offered to the young patients. In this proposed study, we define outcome as the alleviation of symptoms, which will be assessed quantitatively using longitudinal patient data collected session-wise. Process refers to the mechanisms identified to promote change in the adolescent. For example, individual participant or clinician characteristics, therapeutic alliance will be assessed both quantitatively and qualitatively. In each session, assessments will be used to reduce problems due to attrition and to enable calculation of longitudinal change trajectories using growth curve modeling. For this study, these will be referred to as session-wise assessments. Qualitative work will include interviews with adolescent patients, their caregivers as well as feedback from the mental health care providers on existing services and their barriers to providing care. CONCLUSION This study aims to understand the mechanisms through which change takes place beyond the context of psychotherapy. What are the moderators and through which mechanisms do they operate to improve mental health outcomes in young people?
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19
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Arauz-Boudreau A, Riobueno-Naylor A, Haile H, Holcomb JM, Lucke CM, Joseph B, Jellinek MS, Murphy JM. How an Electronic Medical Record System Facilitates and Demonstrates Effective Psychosocial Screening in Pediatric Primary Care. Clin Pediatr (Phila) 2020; 59:154-162. [PMID: 31808350 DOI: 10.1177/0009922819892038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Using questionnaires, administrative claims, and chart review data, the current study explored the impact of using an electronic medical record system to administer, score, and store the Pediatric Symptom Checklist (PSC-17) during annual pediatric well-child visits. Within a sample of 1773 Medicaid-insured outpatients, the electronic system demonstrated that 90.5% of cases completed a PSC-17 screen electronically, billing codes indicating a screen was administered agreed with the existence of a questionnaire in the chart in 98.8% of cases, the classification of risk based on PSC-17 scores agreed with the classification of risk based on the Current Procedural Terminology code modifiers in 72.9% of cases, and 90.0% of clinicians' progress notes mentioned PSC-17 score in treatment planning. Using an electronic approach to psychosocial screening in pediatrics facilitated the use of screening information gathered during the clinical visit and allowed for enhanced tracking of outcomes and quality monitoring.
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Affiliation(s)
- Alexy Arauz-Boudreau
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Michael S Jellinek
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - J Michael Murphy
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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20
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Matthan NR, Wylie-Rosett J, Xue X, Gao Q, Groisman-Perelstein AE, Diamantis PM, Ginsberg M, Mossavar-Rahmani Y, Barger K, Lichtenstein AH. Effect of a Family-Based Intervention on Nutrient Biomarkers, Desaturase Enzyme Activities, and Cardiometabolic Risk Factors in Children with Overweight and Obesity. Curr Dev Nutr 2020; 4:nzz138. [PMID: 31922084 PMCID: PMC6943838 DOI: 10.1093/cdn/nzz138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 11/21/2019] [Accepted: 11/29/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Developing dietary strategies to prevent excess weight gain during childhood is critical to stem the current obesity epidemic and associated adverse cardiometabolic consequences. OBJECTIVES We aimed to assess how participation in a family-based weight-management intervention affected nutrient biomarkers and cardiometabolic risk factors (CMRFs) in children (7-12 y old; n = 321) with baseline BMI z score (BMIz) ≥85th percentile. METHODS This was a secondary analysis from a randomized-controlled, parallel-arm clinical trial. Families of children, recruited from a largely Hispanic population, were assigned to Standard Care (SC; American Academy of Pediatrics overweight/obesity recommendations), or SC + Enhanced Program (SC + EP; 8 skill-building cores, monthly support sessions, targeted diet/physical activity strategies). Nutrient biomarkers (plasma carotenoids, fat-soluble vitamins, RBC fatty acid profiles, desaturase indexes) and CMRFs were measured in archived blood samples collected at baseline and the end of the 1-y intervention. RESULTS Children in both groups had significantly lower trans fatty acid and higher pentadecylic acid (15:0), PUFA n-3, and β-carotene concentrations, indicative of decreased hydrogenated fat and increased dairy, vegetable oil, fish, and fruit/vegetable intake, respectively. Similar changes were seen in de novo lipogenesis and desaturase indexes, as well as CMRFs (BMIz, lipid profile, inflammation, adipokines, liver enzymes) in both groups. Using multiple logistic regression, increase in carotenoids and decrease in endogenously synthesized SFA, MUFA, PUFA n-6, and desaturase indexes were associated with improvements in BMIz, blood pressure, lipid profile, glucose metabolism, inflammatory biomarkers, adipokines, and liver enzymes. Trans fatty acids were associated with improvements in BMIz, glucose metabolism, and leptin, with less favorable effects on inflammatory markers and adiponectin. CONCLUSIONS Providing targeted family-based behavioral counseling, as part of SC, can help overweight/obese children adopt healthier eating patterns that are associated with modest improvements in BMIz and several CMRFs. Limited additional benefit was observed with SC + EP. These results provide critical data to design subsequent interventions to increase the impact of family-based obesity prevention programs.This trial was registered at clinicaltrials.gov as NCT00851201.
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Affiliation(s)
- Nirupa R Matthan
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Judith Wylie-Rosett
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Xiaonan Xue
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Qi Gao
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Pamela M Diamantis
- Department of Pediatrics, Albert Einstein College of Medicine, Jacobi Medical Center, Bronx, NY, USA
| | - Mindy Ginsberg
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kathryn Barger
- Biostatistics and Data Management Core Unit, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Alice H Lichtenstein
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
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Broder-Fingert S, Kuhn J, Sheldrick RC, Chu A, Fortuna L, Jordan M, Rubin D, Feinberg E. Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol. Trials 2019; 20:728. [PMID: 31842963 PMCID: PMC6915979 DOI: 10.1186/s13063-019-3853-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 10/25/2019] [Indexed: 12/11/2022] Open
Abstract
Background Delivery of behavioral interventions is complex, as the majority of interventions consist of multiple components used either simultaneously, sequentially, or both. The importance of clearly delineating delivery strategies within these complex interventions—and furthermore understanding the impact of each strategy on effectiveness—has recently emerged as an important facet of intervention research. Yet, few methodologies exist to prospectively test the effectiveness of delivery strategies and how they impact implementation. In the current paper, we describe a study protocol for a large randomized controlled trial in which we will use the Multiphase Optimization Strategy (MOST), a novel framework developed to optimize interventions, i.e., to test the effectiveness of intervention delivery strategies using a factorial design. We apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation. Methods/design The MOST framework contains three distinct phases: Preparation, Optimization, and Evaluation. The Preparation phase for this study occurred previously. The current study consists of the Optimization and Evaluation phases. Children aged 3-to-12 years old who are detected as “at-risk” for behavioral health disorders (n = 304) at a large, urban federally qualified community health center will be referred to a Family Partner—a bicultural, bilingual member of the community with training in behavioral health and systems navigation—who will perform FN. Families will then be randomized to one of 16 possible combinations of FN delivery strategies (2 × 2 × 2× 2 factorial design). The primary outcome measure will be achieving a family-centered goal related to behavioral health services within 90 days of randomization. Implementation data on the fidelity, acceptability, feasibility, and cost of each strategy will also be collected. Results from the primary and secondary outcomes will be reviewed by our team of stakeholders to optimize FN delivery for implementation and dissemination based on effectiveness, efficiency, and cost. Discussion In this protocol paper, we describe how the MOST framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation. Trial registration ClinicalTrials.gov, NCT03569449. Registered on 26 June 2018.
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Affiliation(s)
- Sarabeth Broder-Fingert
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA. .,Boston University School of Medicine, Boston, MA, USA.
| | - Jocelyn Kuhn
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA
| | | | - Andrea Chu
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Lisa Fortuna
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Medicine, Boston, MA, USA
| | | | - Dana Rubin
- Boston University School of Medicine, Boston, MA, USA.,DotHouse Health Center, Dorchester, MA, USA
| | - Emily Feinberg
- Boston Medical Center, 801 Albany Street, Boston, MA, 02114, USA.,Boston University School of Medicine, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA.,DotHouse Health Center, Dorchester, MA, USA
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Carson MC, Montaño Z, Kelman AR, Coffey DM, Javier JR. Promoting Behavioral Health Equity Through Implementation of the Incredible Years Within Primary Care. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2019; 5:390-401. [PMID: 35342773 PMCID: PMC8945250 DOI: 10.1037/tps0000212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Mental health disparities continue to be a concern for racial and ethnic minorities in the United States. Further, approximately 20% of children in the United States have a mental health disorder with less than half of these youth receiving mental health treatment (Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015; Stancin & Perrin, 2014; U.S. Surgeon General, 1999). Integrated primary care has been identified as an ideal place where youth and families can receive mental health services. There is evidence supporting that when psychologists are in primary care, behavioral health outcomes improve and the costs per patient are reduced (Chiles, Lambert, & Hatch, 1999). The objective of this paper is to describe the steps taken to colocate The Incredible Years Parenting Program (IY; Webster-Stratton & Reid, 2010) an evidence-based parenting group, in a pediatric primary care setting at a major metropolitan children's hospital. The parenting group was delivered as a prevention and early intervention program for an underserved population, specifically focused on parents of children ages 3-6 years, to reduce health disparities and improve access to needed behavioral health care. A case study illustrates the potential benefits to mental health and physical health outcomes through colocation, and ultimately integration, of behavioral health services in primary care. Policy implications for sustainability of group parenting interventions in primary care, the impact on decreasing health disparities, and future directions along this line of research are discussed.
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Affiliation(s)
| | - Zorash Montaño
- Children's Hospital Los Angeles, Los Angeles, California
| | - Alex R Kelman
- Children's Hospital Los Angeles, Los Angeles, California
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Kameg BN. Management of mental health conditions in refugee youth: An overview for the psychiatric-mental health nurse practitioner. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 32:179-186. [PMID: 31523884 DOI: 10.1111/jcap.12253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/07/2019] [Accepted: 09/01/2019] [Indexed: 11/29/2022]
Abstract
TOPIC In 2017, there were a total of 70 million forcibly displaced individuals or refugees, worldwide. Unfortunately, over 50% of refugees are under the age of 18 years. Refugee youth are at-risk for a variety of mental health conditions. PURPOSE The purpose of this report is to provide psychiatric-mental health nurse practitioners (PMHNPs) with an understanding of unique cultural implications in refugee youth, risk factors towards the development of psychiatric illness, and means to identify those at-risk for sequelae or those meeting diagnostic criteria. Also presented are foundational treatment and management implications to ensure the provision of culturally sensitive and efficacious care to this unique population. SOURCES USED Utilizing PubMed, CINAHL, and PsycINFO, a literature review was conducted to identify relevant publications pertaining to mental health issues in refugee youth spanning from 2013 to present. Reference lists of identified articles were also searched. CONCLUSIONS A variety of risk and protective factors are discussed, spanning from premigration, during flight, and postsettling periods. PMHNPs must be proficient in screening and diagnosis of mental health conditions in refugee youth and implementation of pharmacological and psychotherapeutic interventions. PMHNPs must also be well versed in community-based resources that can be utilized to promote optimal outcomes.
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Affiliation(s)
- Brayden N Kameg
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
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Behavior Problems in Physically Ill Children in Rwanda. J Dev Behav Pediatr 2019; 40:642-650. [PMID: 31369465 PMCID: PMC6824509 DOI: 10.1097/dbp.0000000000000698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Childhood behavior problems are underidentified in low- and middle-income countries. This study sought to systematically screen for behavior problems among children receiving medical care in Rwanda and investigate factors associated with behavior problems in this cohort. METHODS The Pediatric Symptom Checklist (PSC) was translated into Kinyarwanda, following best practices. Children aged 5.9 to 16 years admitted to the inpatient ward of a referral hospital or seen in the outpatient department (OPD) were screened using the PSC. All PSC-positive children and every third PSC-negative child were referred for definitive assessment by a child mental health specialist. RESULTS Among 300 eligible children, 235 were recruited; none refused. PSC scores were positive in 74 of 234 cases (32%, 95% confidence interval 26%-38%); a total of 28 of 74 (40%) PSC-positive children completed mental health assessments. Of these, 16 (57% of those assessed, and 7% of the 235 who were screened) required treatment or further assessment; none of the PSC-negative children did. Screening sensitivity was 100%, and specificity was 71%, with favorable receiver operating characteristics curve and internal consistency. In a multivariate analysis, higher PSC scores were associated with OPD care, central nervous system trauma or infection, and indices of malnutrition and with the use of traditional, complementary, and alternative medicine (TCAM). CONCLUSION Behavior problems are common among Rwanda children seen in a referral hospital, particularly in the OPD, and are associated with use of TCAM. The Kinyarwanda PSC showed favorable screening characteristics and resulted in some 7% of children accessing needed mental health care.
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Zima BT, McCreary M, Kenan K, Churchey-Mims M, Chi H, Brady M, Davies J, Rompala V, Leventhal B. Development and Evaluation of Two Integrated Care Models for Children Using a Partnered Formative Evaluation Approach. Ethn Dis 2018; 28:445-456. [PMID: 30202198 DOI: 10.18865/ed.28.s2.445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To describe the development and evaluation of two integrated care models using a partnered formative evaluation approach across a private foundation, clinic leaders, providers and staff, and a university-based research center. Design Retrospective cohort study using multiple data sources. Setting Two federal qualified health care centers serving low-income children and families in Chicago. Participants Private foundation, clinic and academic partners. Interventions Development of two integrated care models and partnered evaluation design. Main Outcome Measures Accomplishments and early lessons learned. Results Together, the foundation-clinic-academic partners worked to include best practices in two integrated care models for children while developing the evaluation design. A shared data collection approach, which empowered the clinic partners to collect data using a web-based tool for a prospective longitudinal cohort study, was also created. Conclusion Across three formative evaluation stages, the foundation, clinic, and academic partners continued to reach beyond their respective traditional roles of project oversight, clinical service, and research as adjustments were collectively made to accommodate barriers and unanticipated events. Together, an innovative shared data collection approach was developed that extends partnered research to include data collection being led by the clinic partners and supported by the technical resources of a university-based research center.
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Affiliation(s)
- Bonnie T Zima
- UCLA Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Kristen Kenan
- Department of Pediatrics, University of Illinois at Chicago, IL
| | | | - Hannah Chi
- Erie West Town Family Health Center, Chicago, IL
| | | | | | | | - Bennett Leventhal
- Department of Psychiatry, University of California at San Francisco, CA
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Wylie-Rosett J, Groisman-Perelstein AE, Diamantis PM, Jimenez CC, Shankar V, Conlon BA, Mossavar-Rahmani Y, Isasi CR, Martin SN, Ginsberg M, Matthan NR, Lichtenstein AH. Embedding weight management into safety-net pediatric primary care: randomized controlled trial. Int J Behav Nutr Phys Act 2018; 15:12. [PMID: 29357894 PMCID: PMC5778780 DOI: 10.1186/s12966-017-0639-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 12/21/2017] [Indexed: 01/27/2023] Open
Abstract
Background Implementing evidence-based recommendations for treating pediatric overweight and obesity is challenging in low-resource settings. We conducted a randomized controlled trial to evaluate the effects of implementing the American Academy of Pediatrics overweight/obesity recommendations using a Standard Care approach alone or with the addition of an enhanced program in a safety-net pediatric primary care setting (located in Bronx, New York, United States). Methods In a 12-month trial, families of children (age 7–12 years; body mass index ≥85th American percentile for age and sex; 74% self-identified as Hispanic/Latino; n = 360) were randomly assigned to receive Standard Care Alone or Standard Care + Enhanced Program. An English/Spanish bilingual staff provided the Standard Care Alone consisting of quarterly semi-structured pediatrician visits targeting family-based behavioral changes. The Standard Care + Enhanced Program was enriched with eight Skill-Building Core and monthly Post-Core Support sessions. Results The mean body mass index Z-score declined in both arms (P < 0.01) with no significant difference between the Standard Care Alone (0.12 kg [SE: 0.03]) and Standard Care + Enhanced Program (0.15 kg [SE: 0.03]) arm (P = 0.15). Compared to the Standard Care Alone, the Standard Care + Enhanced Program resulted in significantly greater improvements in total cholesterol (P = 0.05), low-density lipoprotein cholesterol (P = 0.04), aspartate aminotransferase (P = 0.02), and alanine transaminase (P = 0.03) concentrations. Conclusions Safety-net primary care settings can provide efficacious pediatric weight management services. Targeted family-based behavioral counseling helps overweight/obese children achieve a modest body mass index Z-score improvement. A more intensive lifestyle intervention program may improve some metabolic parameters. Trial registration ClinicalTrials.gov Identifier: NCT00851201. Registered 23 February 2009. Electronic supplementary material The online version of this article (10.1186/s12966-017-0639-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith Wylie-Rosett
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA.
| | - Adriana E Groisman-Perelstein
- Department of Pediatrics, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, 10461, USA
| | - Pamela M Diamantis
- Department of Pediatrics, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Pkwy S, Bronx, NY, 10461, USA
| | - Camille C Jimenez
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Viswanathan Shankar
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Beth A Conlon
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Carmen R Isasi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Sarah N Martin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Mindy Ginsberg
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY, 10461, USA
| | - Nirupa R Matthan
- Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St, Boston, MA, 02111, USA
| | - Alice H Lichtenstein
- Cardiovascular Nutrition Laboratory, JM USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington St, Boston, MA, 02111, USA
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Abstract
This paper puts the case for accessible multidisciplinary mental health services for children and young people to managers, purchasers and GPs, in a framework of national and international statutes and guidance. The essential differences between the disciplines are explained, based on detailed advice from mental health colleagues in nursing, teaching, social work, psychology, child psychotherapy and child and adolescent psychiatry.
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Tucker JM, Howard K, DeLaFuente K, Cadieux A, Yee KE. Changes in psychosocial health during a 7-week paediatric weight management program. Clin Obes 2017; 7:393-401. [PMID: 28871630 DOI: 10.1111/cob.12215] [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] [Received: 01/27/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
Abstract
Youth with obesity are at increased risk of psychosocial symptoms; however, little is known regarding the impact of paediatric weight management (PWM) on psychosocial health. The aim of the study was to investigate changes in psychosocial health among children who completed a 7-week PWM program. Participants aged 5 to 16 years with a BMI ≥85th percentile completed a 7-week, family-centred PWM program focused on health behaviour education, exercise and mentored goal setting. The Paediatric Symptom Checklist (PSC) was assessed via parent report to evaluate psychosocial symptoms before and after the program, and subscales were calculated for internalizing (PSC-IS), externalizing (PSC-ES) and attention symptoms (PSC-AS). At baseline, positive screen rates for psychosocial symptoms among the 317 patients included 16.1% for PSC, 14.1% for PSC-ES, 18.6% for PSC-IS and 12.3% for PSC-AS. Among program completers, total PSC scores improved in those with normal (p = 0.010) and elevated p < .001 psychosocial symptoms at baseline. Youth with positive screens for elevated PSC subscales improved their subscale scores, on average, and the majority reduced scores to below elevated levels for PSC (54.2%), PSC-ES (64.7%), PSC-IS (78.3%) and PSC-AS (64.7%). Improvements in PSC remained significant after adjusting for BMI changes during treatment, but BMI differed across PSC-change groups, including BMI increases among participants with PSC deterioration (0.33 ± 0.64 kg m-2 ) (P = 0.035) and BMI decreases among patients with no reliable PSC change (-0.26 ± 1.04 kg m-2 ) (P = 0.038) or reliable PSC improvement (-0.22 ± 0.74 kg m-2 ) (P = 0.025). Youth with positive screens for psychosocial symptoms can improve emotional and behavioural functioning during short-term PWM. Future research is needed to elucidate mechanisms and long-term outcome durability.
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Affiliation(s)
- J M Tucker
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, Lansing, MI, USA
| | - K Howard
- Department of Pediatrics and Human Development, Michigan State University, Lansing, MI, USA
- Health Net of West Michigan, Grand Rapids, MI, USA
| | - K DeLaFuente
- Spectrum Health Healthier Communities, Grand Rapids, MI, USA
| | - A Cadieux
- Healthy Weight Center, Helen DeVos Children's Hospital, Grand Rapids, MI, USA
- Department of Pediatrics and Human Development, Michigan State University, Lansing, MI, USA
| | - K E Yee
- Department of Movement Science, Grand Valley State University, Allendale, MI, USA
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Lavigne JV, Feldman M, Meyers KM. Screening for Mental Health Problems: Addressing the Base Rate Fallacy for a Sustainable Screening Program in Integrated Primary Care. J Pediatr Psychol 2016; 41:1081-1090. [PMID: 27289070 DOI: 10.1093/jpepsy/jsw048] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 05/04/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The Affordable Care Act has stimulated interest in screening for psychological problems in primary care. Given the scale with which screening might occur, the implications of a problem known as the base rate fallacy need to be considered. METHODS The concepts of sensitivity and specificity, positive and negative predictive value, and the base rate fallacy are discussed. The possibility that a screening program may not improve upon random selection is reviewed, as is the possibility that sequential screening might be useful. RESULTS AND DISCUSSION Developing effective screening programs for pediatric mental health problems is highly desirable, and properly addressing the high rate of false positives may improve the likelihood that such programs can be sustained. Consideration needs to be given to the use of sequential screening, which has both advantages and disadvantages, depending upon the type of problem to be screened for and the availability of resources for follow-up evaluations.
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Affiliation(s)
- John V Lavigne
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago Feinberg School of Medicine, Northwestern University
| | - Marissa Feldman
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago Feinberg School of Medicine, Northwestern University
| | - Kathryn Mendelsohn Meyers
- Department of Child and Adolescent Psychiatry, Ann & Robert H. Lurie Children's Hospital of Chicago Feinberg School of Medicine, Northwestern University
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Lavigne JV, Meyers KM, Feldman M. Systematic Review: Classification Accuracy of Behavioral Screening Measures for Use in Integrated Primary Care Settings. J Pediatr Psychol 2016; 41:1091-1109. [DOI: 10.1093/jpepsy/jsw049] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 05/04/2016] [Indexed: 11/14/2022] Open
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Johnson SD. Substance abuse and parenting among African American mothers of adolescents. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2015; 32:455-463. [PMID: 26417152 PMCID: PMC4583070 DOI: 10.1007/s10560-015-0383-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Sharon D. Johnson
- School of Social Work, University of Missouri-St. Louis, 204 Bellerive Hall, One University Drive, St. Louis, Missouri 63121-4499, 314-516-6817, 314-516-6416 (fax)
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Coverdale JH, Roberts LW, Balon R, Beresin EV, Tait GR, Louie AK. Integrated Care in Community Settings and Psychiatric Training. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2015; 39:419-421. [PMID: 26036348 DOI: 10.1007/s40596-015-0363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 04/30/2015] [Indexed: 06/04/2023]
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Kovacic K, Sood MR, Mugie S, Di Lorenzo C, Nurko S, Heinz N, Ponnambalam A, Beesley C, Sanghavi R, Silverman AH. A multicenter study on childhood constipation and fecal incontinence: effects on quality of life. J Pediatr 2015; 166:1482-7.e1. [PMID: 26008173 DOI: 10.1016/j.jpeds.2015.03.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 01/16/2015] [Accepted: 03/09/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To describe the effects of childhood functional constipation compared with functional constipation plus fecal incontinence on quality of life, evaluating effects on physical, psychosocial, and family functioning. STUDY DESIGN This prospective, multicenter study collected data from 5 regional children's hospitals. Children meeting Rome III criteria for functional constipation were included. Parents completed the following 5 instruments: Pediatric Quality of Life Inventory (PedsQL), PedsQL-Family Impact Module, Functional Disability Inventory-Parent Version, Pediatric Inventory for Parents (PIP), and Pediatric Symptom Checklist-Parent Report. RESULTS Families of 410 children aged 2-18 years (mean [SD], 7.8 [3.5] years; 52% male) were included. Children with functional constipation+fecal incontinence had worse quality of life than children with functional constipation alone (PedsQL Total Score, P ≤ .03). Older children with functional constipation + fecal incontinence had lower quality of life than their younger counterparts (PedsQL Total Score, P ≤ .047). Children with functional constipation+fecal incontinence had worse family functioning (PedsQL-Family Impact Module Total Score, P ≤ .012), greater parental stress (PIP-F Total Score, P ≤ .016; PIP-D Total Score, P ≤ .013), and poorer psychosocial functioning (Pediatric Symptom Checklist Total Score, P ≤ .003). There were no statistically significant between-group differences in physical functioning based on the functional Disability Inventory. CONCLUSION Fecal incontinence significantly decreases quality of life compared with functional constipation alone in children. Older children with functional constipation+fecal incontinence may be at particular risk. Strategies for early identification and treatment of constipation along with diagnosis and treatment of related adjustment difficulties may mitigate the negative impact of this highly prevalent condition.
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Affiliation(s)
- Katja Kovacic
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | - Manu R Sood
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | - Suzanne Mugie
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH
| | - Carlo Di Lorenzo
- Division of Pediatric Gastroenterology, Nationwide Children's Hospital, Columbus, OH
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA
| | - Nicole Heinz
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA
| | - Ananthasekar Ponnambalam
- Division of Pediatric Gastroenterology, University of South Alabama Children's and Women's Hospital, Mobile, AL
| | - Christina Beesley
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
| | - Rina Sanghavi
- Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Alan H Silverman
- Center for Pediatric Neurogastroenterology, Motility, and Autonomic Disorders, Medical College of Wisconsin, Milwaukee, WI
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Factor analysis of the pediatric symptom checklist in a population of children with voiding dysfunction and/or nocturnal enuresis. J Clin Psychol Med Settings 2014; 21:72-80. [PMID: 24158241 DOI: 10.1007/s10880-013-9375-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The research objective was to identify the factor structure of the pediatric symptom checklist (PSC) in children with voiding dysfunction and/or nocturnal enuresis who were seen in a pediatric urology clinic. Retrospective chart reviews were conducted for 498 consecutive patients, ages 6-16, who were seen over a 13-month period. The PSC, a 35-item measure used to screen for psychosocial difficulties, was completed by the patient's caregiver. Confirmatory factor analyses using three previous models were conducted. A four factor model comprised of internalizing, externalizing, attention problems, and chronic illness factors represented the best fit to the data. Within this population, the PSC appears to capture internalizing and externalizing problems, difficulties with attention, and possible side effects of a medical condition. This information could aid clinicians in assessing adjustment difficulties within this population and concurrently allow researchers to examine whether these specific factors are related to other relevant outcomes.
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Predictors of Compliance to Gluten-Free Diet in Children with Celiac Disease. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:248402. [PMID: 27351010 PMCID: PMC4897434 DOI: 10.1155/2014/248402] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/10/2014] [Accepted: 06/18/2014] [Indexed: 12/27/2022]
Abstract
Aim. To identify the predictors of compliance to gluten free diet in children with celiac disease. Methods. 134 children in the study group were assessed for dietary compliance followed by a questionnaire based interview. Psychosocial parameters were assessed by standard Pediatric Symptom Checklist (PSC). Dietary compliant and noncompliant groups were compared and assessed for factors affecting the dietary compliance. Predictability of all of these factors was assessed using binary logistic regression analysis with backward elimination to find out the best predictors of compliance. Results. In the study group, 88 (65.67%) were found to be strictly compliant. Factors that were found to be significantly associated with compliance were age at presentation, nuclear families, mother's education, and parents having better knowledge of celiac disease. Parents' and child's attitude towards his having to follow a restrictive diet and child's feelings were also shown to be significantly associated with compliance. Binary logistic regression analysis with backward elimination demonstrated that age at presentation, family type, child's attitude, and child's behaviour made a significant contribution to prediction. Conclusions. These results will contribute to the current body of research by providing health care practitioners with a framework for better dietary instruction to ensure maximum adherence to GFD.
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Sakaguchi K, Yagi T, Maeda A, Nagayama K, Uehara S, Saito-Sakoguchi Y, Kanematsu K, Miyawaki S. Association of problem behavior with sleep problems and gastroesophageal reflux symptoms. Pediatr Int 2014; 56:24-30. [PMID: 23937680 DOI: 10.1111/ped.12201] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 07/29/2013] [Accepted: 08/02/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are few large-scale epidemiologic studies examining the associations between sleep problems, gastroesophageal reflux disease (GERD) symptoms, lifestyle and food habits and problem behaviors (PB) in adolescents. The aim of this study was to evaluate the associations among these factors in Japanese adolescents. METHODS A cross-sectional survey of 1840 junior high school students was carried out using questionnaires. The subjects were classified into PB or normal behavior (NB) groups using the Pediatric Symptom Checklist (PSC). The scores of the sleep-related factors, sleep bruxism, lifestyle and food habits, and GERD symptoms were compared. Logistic regression analysis was used to determine the factors related to PB. RESULTS Mean subject age was 13.3 ± 1.8 years. The PB group had significantly longer sleep latency and higher GERD symptom score (P < 0.001). Furthermore, the PB group was significantly more likely to experience absence of the mother at dinner time, skip breakfast, and have <30 min of conversation among family at dinner time. The PB group had significantly higher frequencies of sleep bruxism, difficulty falling asleep within 30 min, nightmares, feeling of low sleep quality, daytime somnolence, and daytime lack of motivation. Feelings of low sleep quality had the strongest association with PB, with an adjusted odds ratio of 12.88 (95% confidence interval: 8.99-18.46). CONCLUSIONS PB in adolescents are associated with sleep problems, including sleep bruxism, as well as lifestyle and food habits and GERD symptoms.
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Affiliation(s)
- Katsuyoshi Sakaguchi
- Department of Orthodontics, Field of Developmental Medicine, Health Research Course, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Klassen BJ, Porcerelli JH, Sklar ER, Markova T. Pediatric Symptom Checklist Ratings by Mothers with a Recent History of Intimate Partner Violence: A Primary Care Study. J Clin Psychol Med Settings 2013; 20:473-7. [DOI: 10.1007/s10880-012-9354-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paalman CH, Terwee CB, Jansma EP, Jansen LMC. Instruments measuring externalizing mental health problems in immigrant ethnic minority youths: a systematic review of measurement properties. PLoS One 2013; 8:e63109. [PMID: 23704892 PMCID: PMC3660354 DOI: 10.1371/journal.pone.0063109] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 03/28/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Little is known about reliability and validity of instruments measuring externalizing mental health problems in immigrant ethnic minority youths. AIMS To provide an overview of studies on measurement properties of instruments measuring these problems in immigrant ethnic minority youths, their methodological quality and results. METHODS A systematic review of the literature in MEDLINE, EMbase, PsycINFO and Cochrane Library was performed. Evaluation of methodological quality of studies found was done by using the 'COSMIN-checklist'. Full text, original articles, published in English after 1990 were included. Articles had to concern the development or evaluation of the measurement properties of self-reported, parent-reported and/or teacher- or clinician-reported questionnaires assessing or screening externalizing mental health problems in immigrant ethnic minority youths. Specific results of analyses on (an) immigrant ethnic minority group had to be given. RESULTS Twenty-nine studies evaluating 18 instruments met our criteria. Most studies concerned instruments with known validity in Western populations, tested mainly in African Americans. Considering methodological quality, inequivalences between ethnicities were found, self-reports seemed to perform better, and administration of an instrument influenced reliability and validity. CONCLUSION It seems that the majority of instruments for assessing externalizing problems in immigrant ethnic minority youths is currently not sufficiently validated. Further evaluating existing instruments is crucial to accurately assess and interpreted externalizing problems in immigrant ethnic minority youths.
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Affiliation(s)
- Carmen H Paalman
- Department of Child and Adolescent Psychiatry, VU University Medical Centre, Amsterdam, The Netherlands.
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Berger-Jenkins E, McCord M, Gallagher T, Olfson M. Effect of routine mental health screening in a low-resource pediatric primary care population. Clin Pediatr (Phila) 2012; 51:359-65. [PMID: 22157425 DOI: 10.1177/0009922811427582] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Evelyn Berger-Jenkins
- Department of Pediatrics, Division of General Pediatrics, Columbia University, New York, NY 10032, USA.
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Santos LHC, Pimentel RF, Rosa LGD, Muzzolon SRB, Antoniuk SA, Bruck I. Triagem cognitiva e comportamental de crianças com dificuldades de aprendizagem escolar: um estudo preliminar. REVISTA PAULISTA DE PEDIATRIA 2012. [DOI: 10.1590/s0103-05822012000100014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Avaliar a aplicabilidade do Mini-Mental State Examination (MMSE) e da lista de sintomas pediátricos (LSP) como teste de triagem cognitiva e de problemas psicossociais em crianças com dificuldades de aprendizagem. MÉTODOS: Estudo descritivo e transversal envolvendo 103 crianças entre seis e nove anos de uma escola pública de Curitiba (PR) com prováveis dificuldades de aprendizagem, realizado de 1º de março de 2002 a 30 de junho de 2009. Os dados foram obtidos simultaneamente por uma equipe multidisciplinar na avaliação inicial, com a aplicação do MMSE, da LSP e do Wechsler Intelligence Scale for Children (WISC III). Após 2007 o Child Behavior Checklist (CBCL) e o Teacher's Report Form (TRF) foram utilizados, sendo também comparados à LSP. Os coeficientes de correlação entre os testes foram calculados, sendo significante p<0,05. RESULTADOS: Das crianças analisadas, 10% apresentavam algum tipo de dificuldade de aprendizagem, sendo 76% do sexo masculino e 24% do feminino. A faixa etária mais prevalente foi entre seis e sete anos de idade. História familiar positiva ocorreu em 45% dos casos e antecedentes obstétricos em 18%, sendo o baixo peso o mais frequente. O escore do MMSE mostrou correlação com o do WISC III (r=0,73) e o CBCL mostrou moderada correlação com o LSP (r=0,53). CONCLUSÕES: O MMSE e a LSP podem ser utilizados pelo pediatra como triagem cognitiva e de problemas psicossociais em crianças com dificuldade de aprendizagem.
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Lowenthal E, Lawler K, Harari N, Moamogwe L, Masunge J, Masedi M, Matome B, Seloilwe E, Jellinek M, Murphy M, Gross R. Validation of the Pediatric Symptom Checklist in HIV-infected Batswana. J Child Adolesc Ment Health 2011; 23:17-28. [PMID: 22685483 DOI: 10.2989/17280583.2011.594245] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE: To determine the validity of the Pediatric Symptom Checklist (PSC), a brief measure of psychosocial health, for screening HIV+ Batswana children. METHOD: Setswana versions of the parent and child PSC were administered to 509 HIV+ Batswana children (age 8-16) and their parents/guardians. Test properties were evaluated and cut-off scores were derived using receiver operating characteristic curve analysis. Scores on the parent-completed PSC and the child-completed PSC-Y were compared to parental and clinic staff reports of concern about the child's psychosocial health and to scores on the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. RESULTS: The Setswana PSC has high internal consistency (Cronbach's alpha 0.87 for the parent-completed version). Comparing PSC scores to parental reports of concern and child-reported depression symptoms, a cut-off score of 20 on the PSC and PSC-Y maximised the sensitivity and specificity. CONCLUSIONS: The PSC performed well in Setswana-speaking children and is a promising screening tool for paediatric psychosocial problems in busy clinical settings. Screening with the PSC may allow for early detection and treatment of psychosocial problems. This is likely to be of particular value for HIV+ children for whom HIV treatment non-adherence may result from untreated psychosocial dysfunction.
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Affiliation(s)
- Elizabeth Lowenthal
- Children's Hospital of Philadelphia, 3535 Market Street Room 1513, Philadelphia, PA, USA 19104
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Reed-Knight B, Hayutin LG, Lewis JD, Blount RL. Factor Structure of the Pediatric Symptom Checklist with a Pediatric Gastroenterology Sample. J Clin Psychol Med Settings 2011; 18:299-306. [DOI: 10.1007/s10880-011-9242-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sigel E, Hart J, Hoffenberg A, Dodge M. Development and psychometric properties of a violence screening tool for primary care. J Adolesc Health 2011; 48:358-65. [PMID: 21402264 DOI: 10.1016/j.jadohealth.2010.07.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 07/15/2010] [Accepted: 07/27/2010] [Indexed: 12/01/2022]
Abstract
PURPOSE The aim of this study was to develop and validate a screening tool to detect youth at risk for future violence perpetration for primary care. METHODS Youth (n = 165) aged 11-17 years enrolled during a primary care appointment. Two clinics served as study sites. Youth filled out questionnaires confidentially at baseline and at 1-year follow-up. Primary outcome was violent behavior during the preceding year. At baseline, youth answered 18 risk and protective factor questions that predicted future violence involvement. Additional violence scales were asked for a total of 47 questions. Item analysis determined which combination best predicted future violence involvement. Psychometric properties, including internal consistency, test-retest reliability, convergent validity, and predictive validity, were analyzed. RESULTS A total of 101 youth (61%) completed 1-year follow-up: 16% reported violent behavior with no difference between gender or race/ethnicity. Twenty-five baseline questions correlated with violence involvement 1 year later. After item analysis, 14 questions demonstrated the strongest psychometric functioning with Cronbach's α = .77. External validity was strong, with the 14 item violence injury protection and risk screen correlating with the aggression (.74) and victimization (.54) scales, the Strength and Difficulties Questionnaire (.39), and current violence involvement (.78). For youth aged 14-17 years, predictive validity was strongly correlated (.78) with future violence perpetration. A score of 5.0 for males and 6.0 for females revealed a sensitivity of 77%, a specificity of 98%, and a positive predictive value of 91%. Seventeen percent of youth aged 14-17 screened positive using these cutpoints. CONCLUSION A brief, 14-item questionnaire demonstrated strong psychometric functioning and performed well as a screening tool to predict future violence perpetration for youth aged 14-17.
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Affiliation(s)
- Eric Sigel
- University of Colorado Denver School of Medicine, Aurora, Colorado 80045, USA.
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Whitaker TM, Bada HS, Bann CM, Shankaran S, LaGasse L, Lester BM, Bauer CR, Hammond J, Higgins R. Serial pediatric symptom checklist screening in children with prenatal drug exposure. J Dev Behav Pediatr 2011; 32:206-15. [PMID: 21200328 PMCID: PMC3069136 DOI: 10.1097/dbp.0b013e318208ee3c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To examine screening results obtained by serial annual behavioral assessment of children with prenatal drug exposure. METHOD The Maternal Lifestyle Study enrolled children with prenatal cocaine exposure (PCE) at birth for longitudinal assessments of developmental, behavioral, and health outcomes. At 8, 9, 10, 11, and 12 years of age, caregivers rated participants on the Pediatric Symptom Checklist (PSC). Serial PSC results were compared with an established broad-based behavioral measure at 9, 11, and 13 years. PSC results were analyzed for 1081 children who had at least 2 annual screens during the 5-year time span. Most subjects (87%) had 4 or more annual screens rated by the same caregiver (80%). PSC scores (and Positive screens) over time were compared at different time points for those with and without PCE. Covariates, including demographic factors and exposures to certain other substances, were controlled. RESULTS Children with PCE had significantly higher scores overall, with more Positive screens for behavior problems than children without PCE. Children with PCE had more externalizing behavior problems. Children exposed to tobacco prenatally and postnatally also showed higher PSC scores. Over time, PSC scores differed slightly from the 8-year scores, without clear directional trend. Earlier PSC results predicted later behavioral outcomes. CONCLUSION Findings of increased total PSC scores and Positive PSC screens for behavioral concerns in this group of children with prenatal substance exposure support the growing body of evidence that additional attention to identification of mental health problems may be warranted in this high-risk group.
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Affiliation(s)
- Toni M Whitaker
- Department of Pediatrics, Boling Center for Developmental Disabilities, University of Tennessee College of Medicine, Memphis, TN 38105, USA.
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Andreas JB, O'Farrell TJ. Alcoholics Anonymous attendance following 12-step treatment participation as a link between alcohol-dependent fathers' treatment involvement and their children's externalizing problems. J Subst Abuse Treat 2008; 36:87-100. [PMID: 18715745 DOI: 10.1016/j.jsat.2008.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 04/11/2008] [Accepted: 05/05/2008] [Indexed: 11/16/2022]
Abstract
We investigated longitudinal associations between alcohol-dependent fathers' 12-step treatment involvement and their children's internalizing and externalizing problems (N = 125, M(age) = 9.8 +/- 3.1), testing the hypotheses that fathers' greater treatment involvement would benefit later child behavior and that this effect would be mediated by fathers' posttreatment behaviors. The initial association was established between fathers' treatment involvement and children's externalizing problems only, whereas Structural Equation Modeling (SEM) results supported mediating hypotheses. Fathers' greater treatment involvement predicted children's lower externalizing problems 12 months later, and fathers' posttreatment behaviors mediated this association: Greater treatment involvement predicted greater posttreatment Alcoholics Anonymous attendance, which in turn predicted greater abstinence. Finally, fathers' abstinence was associated with lower externalizing problems in children. Theoretical and practical implications of these findings are discussed.
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Affiliation(s)
- Jasmina Burdzovic Andreas
- Department of Community Health, Center for Health and Clinical Epidemiology, Brown University, 121 South Main St., Providence, RI 02912, USA.
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Abstract
The Pediatric Symptom Checklist-17 (PSC-17) is a brief form of the Pediatric Symptom Checklist that is designed to screen for behavioral health problems in primary care settings. It has been proposed to have three subscales: externalizing, internalizing, and attention problems. In the context of developing a behavioral health screening program in an inner-city primary care practice, we evaluated the construct validity of the PSC-17. A total of 331 families with children between 4 and 12 years of age who were seen for well-child care during the study were invited to complete the PSC-17 and 320 families (96.5%) did so. A confirmatory factor analysis was performed and the Comparative Fit Index and root mean square error of approximation fit statistics were calculated to determine whether the data fit the proposed three-factor model. We found that although the PSC-17 contained three subscales, several items did not load predominantly on the subscale that they were proposed to measure. Specifically, although the five items on the internalizing subscale loaded only on this subscale, only four of the seven externalizing items loaded exclusively on the externalizing subscale, and only two of the five attention items loaded exclusively on the attention problems subscale. Clinicians using the PSC-17 in urban low-income communities should recognize that the externalizing and attention problems subscales of the PSC-17 may not be valid measures of these dimensions of child behavior in this population.
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Thun-Hohenstein L, Herzog S. The predictive value of the pediatric symptom checklist in 5-year-old Austrian children. Eur J Pediatr 2008; 167:323-9. [PMID: 17492466 DOI: 10.1007/s00431-007-0494-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2006] [Revised: 03/30/2007] [Accepted: 04/03/2007] [Indexed: 11/30/2022]
Abstract
UNLABELLED In this investigation the predictive value of the pediatric symptom checklist (PSC) in relation to the child behaviour checklist (CBCL) was studied in preschool children. Thirty nursery schools in the city and province of Salzburg participated in the study and a total of 179 correctly completed questionnaires (82 male and 97 female children) were analysed. Questionnaires were completed by the parents. Data were analysed using descriptive statistics (SPSS 11.0). Predictive validity was determined by non-parametric correlations and calculations of sensitivity and specificity, as well as an ROC analysis. The mean PSC at 10.74 +/- 6.8 was found to be below both international and Austrian values for this age group and was also found to differ significantly between girls (9.33 +/- 6.2) and boys (12.4 +/- 7.1; p < 0.01). The recommended international cut-off point at 24 is too high. CBCL analysis resulted in 12.6% impaired (T value between 60 and 64) and 8.2% pathological children (T value > 64). PSC sensitivity in relation to the CBCL total score was 15.7% and specificity 98.5%. The cut-off was optimized with the help of ROC analysis and optimum specificity (80.2%) and sensitivity (81.1%) were obtained at a cut-off value of 15.5. This cut-off would allow 24.6% to be detected as impaired, which is somewhat above the frequency (20.2%) found by CBCL. CONCLUSION To summarize, the PSC is a valid psychosocial screening instrument, at least for this age group, and thus applicable for German-speaking countries.
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Affiliation(s)
- Leonhard Thun-Hohenstein
- Institute for Research and Education in Child & Adolescent Neuropsychiatry (KNIFFF), Salzburg, Austria.
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Andreas JB, O'Farrell TJ. Longitudinal associations between fathers' heavy drinking patterns and children's psychosocial adjustment. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2007; 35:1-16. [PMID: 17089075 DOI: 10.1007/s10802-006-9067-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Psychosocial adjustment in children of alcoholics (N = 114) was examined in the year before and at three follow-ups in the 15 months after their alcoholic fathers entered alcoholism treatment, testing the hypothesis that children's adjustment problems will vary over time as a function of their fathers' heavy drinking patterns. Three unique patterns of heavy drinking in alcoholic fathers were identified through cluster analysis. The results demonstrated significant and meaningful associations between these drinking patterns in fathers and adjustment problems in children over time. Overall, children whose fathers remained mostly abstinent following their treatment showed lowest and decreasing adjustment problems, while children whose fathers continued and increased heavy drinking following their treatment showed greatest and increasing adjustment problems over time.
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Affiliation(s)
- Jasmina Burdzovic Andreas
- Department of Psychiatry, Harvard Medical School, VAMC (116B1), 940 Belmont St., Brockton, MA 02301, USA.
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Armstrong MI, Boothroyd RA. Predictors of Emotional Well-Being in At-Risk Adolescent Girls: Developing Preventive Intervention Strategies. J Behav Health Serv Res 2007; 35:435-53. [PMID: 17294144 DOI: 10.1007/s11414-006-9048-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2006] [Accepted: 11/25/2006] [Indexed: 10/23/2022]
Abstract
This article examines the degree to which various demographic characteristics, personality traits, and environmental factors are associated with overall emotional well-being of 125 adolescent girls whose mothers were involved in welfare reform. Daughters participated in a 4-year, mixed method study and annually completed a structured interview protocol and a sub-group also completed a qualitative interview. The quantitative findings from the study suggest that daughters having an internal locus of control, experiencing fewer negative life events, and reporting stronger parental and teacher social support had enhanced emotional well-being over the 4-year study compared to daughters without these factors. The findings were further elaborated with examples from qualitative interviews conducted with the daughters. The findings were used to propose prevention activities using a tertiary mental health preventive intervention framework.
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Affiliation(s)
- Mary I Armstrong
- Division of State and Local Support, Department of Child and Family Studies, Louis de la Parte Florida Mental Health Institute, 13301 Bruce B. Downs Boulevard, Tampa, FL 33612-3807, USA.
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Hacker KA, Myagmarjav E, Harris V, Suglia SF, Weidner D, Link D. Mental health screening in pediatric practice: factors related to positive screens and the contribution of parental/personal concern. Pediatrics 2006; 118:1896-906. [PMID: 17079560 DOI: 10.1542/peds.2006-0026] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goals were to examine factors related to positive Pediatric Symptom Checklist scores in an urban practice and to examine the relative contribution of parental/personal concern about emotional and behavioral problems to mental health problem identification. METHODS Annual screening using the Pediatric Symptom Checklist was implemented in Cambridge Pediatrics (Cambridge, MA). A social worker was colocated in the clinic to provide therapeutic interventions for patients. A sample of 1668 screened patients between 4 years 11 months and 19 years of age was used for analysis. Bivariate and multivariate analyses were conducted to determine factors predictive of positive Pediatric Symptom Checklist scores, including demographics, socioeconomic indicators, enrollment in counseling, and parental/personal concern. Parental/personal concern, counseling, and positive Pediatric Symptom Checklist scores were examined to determine their efficacy as screening methods. RESULTS Six percent of the population had positive Pediatric Symptom Checklist scores. There were statistically significant relationships between a positive score and being in counseling, parental/personal concern, having public insurance, and living in an area with median household incomes of less than 50,000 dollars. Parental/personal concern was 40% sensitive for a positive score. A positive Pediatric Symptom Checklist score with or without parental/personal concern identified 3.8% of the population; parental/personal concern with or without a positive Pediatric Symptom Checklist score identified 4.5%. CONCLUSIONS Mental health screening can be effectively implemented in a pediatric practice. Colocated mental health professionals provide additional support. The combination of a screening tool and questions about parental/personal concern and present counseling can provide critical information about a child's mental health.
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Affiliation(s)
- Karen A Hacker
- Institute for Community Health, Cambridge Health Alliance, 163 Gore St, Cambridge, MA 02141, USA.
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