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Machtinger EL, Eberhart NK, Ashwood JS, Jones M, Sanchez M, Lightfoot M, Kuo A, Malika N, Leba NV, Williamson S, McCaw B. Clinic Readiness for Trauma-Informed Health Care Is Associated With Uptake of Screening for Adverse Childhood Experiences. Perm J 2024; 28:100-110. [PMID: 38234229 PMCID: PMC10940236 DOI: 10.7812/tpp/23.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are strongly correlated with many of the most common causes of preventable illness, preventable death, and health disparities. In January 2020, California launched the first statewide initiative to integrate ACE screening throughout its Medicaid system. A key element of the initiative was the California ACEs Learning and Quality Improvement Collaborative, a 48-clinic, 16-month learning collaborative. This evaluation aimed to determine whether developing a trauma-informed environment of care was associated with uptake of ACE screening. METHODS Participants included 40 of 48 clinics that participated in the statewide learning collaborative. Clinics completed an assessment of progress in 5 essential components of trauma-informed health care at baseline and 1-year follow-up. Clinics tracked data on ACE screens completed on an ongoing basis and submitted data quarterly. A hierarchical linear model was used to examine the association between change in readiness for trauma-informed health care and change in quarterly screens. RESULTS Readiness for trauma-informed health care increased for all participating clinics over the course of the learning collaborative. The average number of quarterly screens also increased, with considerable variability among clinics. Clinics with larger increases in readiness for trauma-informed health care had larger increases in quarterly screens. DISCUSSION The findings align with long-standing recommendations for trauma screening to occur in the context of trauma-informed environments of care. CONCLUSION A trauma-informed clinic is the foundation for successful adoption of ACE screening. ACE screening initiatives should include education and sufficient support for clinics to embrace a trauma-informed systems change process.
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Affiliation(s)
| | | | | | - Maggie Jones
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Monika Sanchez
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Anda Kuo
- University of California, San Francisco, CA, USA
| | | | | | | | - Brigid McCaw
- University of California, San Francisco, CA, USA
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Leitch L, McCaw B. Time to Move Forward: Resilience and Trauma-Informed Care. Perm J 2024; 28:188-192. [PMID: 37862407 PMCID: PMC10940242 DOI: 10.7812/tpp/23.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Affiliation(s)
| | - Brigid McCaw
- University of California, San Francisco, San Francisco, CA, USA
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Luo S, Feng X, Lin L, Li J, Chen W, Guo VY. Association of adverse and positive childhood experiences with health-related quality of life in adolescents. Public Health 2024; 228:92-99. [PMID: 38340507 DOI: 10.1016/j.puhe.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/28/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To investigate the independent impacts of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) on the health-related quality of life (HRQOL) of Chinese adolescents, and to explore the potential moderating role of PCEs in the association between ACEs and HRQOL. STUDY DESIGN This was a cross-sectional study. METHODS We surveyed 6982 students aged 11-20 in Guangzhou, China, from November to December 2021. Adolescents self-reported their ACEs, PCEs, and HRQOL by the Childhood Trauma Questionnaire Short Form, the Adverse Childhood Experiences-International Questionnaire, the Benevolent Childhood Experiences Scale, and the Paediatric Quality of Life Inventory Version 4.0, respectively. Multivariable linear regressions were performed to examine the associations between ACEs, PCEs, and HRQOL controlled for adolescents' age, gender, single-child status, boarding school attendance, primary caregivers, as well as parental age and occupational status. Likelihood-ratio tests were further applied to explore the moderating role of PCEs. RESULTS In the models that considered both ACEs and PCEs, ACEs were significantly associated with lower HRQOL scores in all dimensions, summary scales, and total scale (β = -13.88, 95% confidence interval [CI]: -14.82, -12.94 for total scale). Conversely, exposure to an above-average number of PCEs was associated with higher HRQOL scores in all measured aspects (β = 7.20, 95%CI: 6.57, 7.84 for total scale). PCEs significantly moderated the association between ACEs and all HRQOL dimensions, summary scales, and total scale, except school functioning. CONCLUSION ACEs and PCEs exert independent and opposite impacts on adolescents' HRQOL. PCEs could mitigate the negative impacts of ACEs. Enhancing resilience, like PCEs, may contribute to improving the HRQOL among adolescents who have exposed to ACEs.
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Affiliation(s)
- S Luo
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, China
| | - X Feng
- Guangzhou Huangpu District Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - L Lin
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, China
| | - J Li
- Department of Biostatistics, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, China
| | - W Chen
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, China
| | - V Y Guo
- Department of Epidemiology, School of Public Health, Sun Yat-Sen University, 74 Zhongshan 2nd Road, Guangzhou, Guangdong, China.
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Williams RC. Des expériences négatives de l'enfance à la santé relationnelle précoce : les conséquences pour la pratique clinique. Paediatr Child Health 2023; 28:377-393. [PMID: 37744761 PMCID: PMC10517240 DOI: 10.1093/pch/pxad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023] Open
Abstract
Les enfants grandissent et se développent dans un environnement de relations. Des relations sécuritaires, stables et bienveillantes contribuent à consolider la résilience et à atténuer les répercussions des expériences négatives. La promotion de la santé relationnelle en pratique clinique recentre l'attention accordée aux expériences négatives de l'enfance sur les expériences positives de l'enfance. Cette approche, qui évalue les forces et les atouts d'une famille, peut être intégrée à la fois aux rendez-vous réguliers de l'enfant en santé et aux soins surspécialisés. Il est optimal de réaliser de telles interventions pendant la période prénatale ou le plus rapidement possible avant l'âge de trois ans, mais il n'est jamais trop tard pour les entreprendre. Le présent document de principes décrit comment les cliniciens peuvent adopter une approche de santé relationnelle lors de chacune de leurs rencontres médicales s'ils comprennent ce qu'est le stress toxique et ses effets sur le cerveau en développement, les relations familiales et le développement de l'enfant; à quel point les relations, expériences et comportements positifs peuvent en atténuer les effets et renforcer la résilience; quels sont les signes observables de la santé relationnelle et des risques relationnels dans les interactions entre les parents et l'enfant; quelles sont les caractéristiques de relations thérapeutiques de confiance avec les familles et comment en optimiser les avantages par les échanges et la pratique clinique.
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Affiliation(s)
- Robin C Williams
- Société canadienne de pédiatrie, groupe de travail de la petite enfance, Ottawa (Ontario), Canada
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Williams RC. From ACEs to early relational health: Implications for clinical practice. Paediatr Child Health 2023; 28:377-393. [PMID: 37744756 PMCID: PMC10517248 DOI: 10.1093/pch/pxad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/20/2023] [Indexed: 09/26/2023] Open
Abstract
Children grow and develop in an environment of relationships. Safe, stable, nurturing relationships help build resilience and buffer the negative impact of adverse experiences. Promoting relational health in clinical practice shifts the focus from adverse childhood experiences (ACEs) to positive childhood experiences (PCEs). This approach evaluates a family's strengths and assets, and can be incorporated into both well-child and subspecialty care. While the optimal window for such interventions is in the prenatal period or as early as possible within the first 3 years of life, it is never too late to start. This statement describes how clinicians can bring a relational health approach to any medical encounter by understanding: what toxic stress is and how it can affect the developing brain, family relationships, and child development; how positive relationships, experiences, and behaviours can help buffer such effects and build resilience; observable signs of relational health and risk in parent-child interactions; the attributes of trustful, therapeutic relationships with families; and how to optimize these benefits through conversation and clinical practice.
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Affiliation(s)
- Robin C Williams
- Canadian Paediatric Society, Early Years Task Force, Ottawa, Ontario, Canada
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Eapen V, Stylianakis A, Scott E, Milroy H, Bowden M, Haslam R, Stathis S. Stemming the tide of mental health problems in young people: Challenges and potential solutions. Aust N Z J Psychiatry 2023; 57:482-488. [PMID: 36377648 DOI: 10.1177/00048674221136037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
One in five people experience clinically relevant mental health problems before the age of 25 years. Furthermore, in Australia, one in seven children are reported to experience a mental health disorder. Consequently, there has been a steady increase in demand for mental health services for children and young people, and this has been compounded by the COVID-19 pandemic. Unfortunately, currently many children and young people with mental health difficulties are not accessing appropriate and/or timely care, with individuals and families finding it increasingly difficult to access and navigate suitable services. In part, this is related to the fragmented and isolated manner in which child mental health services are operating. To address the current issues in access to appropriate child and adolescent mental health care in Australia, a novel Integrated Continuum of Connect and Care model is proposed to integrate relevant services along a tiered care pathway. The aim of this model is to facilitate timely access to mental health services that meet the specific needs of each child/young person and their family. This model will function within co-located service hubs that integrate health care through a comprehensive assessment followed by a link up to relevant services. The Integrated Continuum of Connect and Care has the potential to pave the way for unifying the fragmented child and youth mental health system in Australia.
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Affiliation(s)
- Valsamma Eapen
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, UNSW Sydney, Australia, Sydney, NSW, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Academic Unit of Infant Child and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anthea Stylianakis
- Discipline of Psychiatry and Mental Health, Faculty of Medicine, UNSW Sydney, Australia, Sydney, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
- Academic Unit of Infant Child and Adolescent Psychiatry Services (AUCS), South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Elizabeth Scott
- Faculty of Medicine and Health, Brain and Mind Centre, Sydney University, Sydney, NSW, Australia
| | - Helen Milroy
- Perth Children's Hospital, Nedlands, WA, Australia
- Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Michael Bowden
- Perinatal, Child and Youth, Mental Health Branch, NSW Health, St Leonards, NSW, Australia
- Department of Psychiatry, Faculty of Medicine and Health, Western Clinical School, The University of Sydney, Camperdown, NSW, Australia
| | - Ric Haslam
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
- The Royal Children's Hospital Melbourne, Parkville, VIC, Australia
| | - Stephen Stathis
- Mental Health, Alcohol and Other Drugs Branch, Queensland Health, Brisbane, QLD, Australia
- Department of Psychiatry, Child and Youth Mental Health Services, Children's Health Queensland Hospital and Health Service, South Brisbane, QLD, Australia
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Crouch E, Srivastav A, McRell AS. Examining Racial/Ethnic Differences in Positive Childhood Experiences Among Respondents in a Southern State. J Child Adolesc Trauma 2022; 15:1191-1198. [PMID: 36439661 PMCID: PMC9684383 DOI: 10.1007/s40653-022-00453-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 06/16/2023]
Abstract
Adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) may impact brain development in children and adolescents into adulthood. While prior research demonstrated racial-ethnic disparities in ACEs, less is known about racial and ethnic differences in PCEs, particularly among adults. To better understand racial and ethnic differences in positive childhood experiences, this study (1) examined the prevalence of PCEs in an adult population in South Carolina (SC), a representative southern US state and (2) examined whether PCE exposure differed across racial and ethnic groups. Data were drawn from the 2019 SC Behavioral Risk Factor Surveillance System survey (BRFSS). Descriptive statistics and bivariate analyses were used to calculate frequencies, proportions and unadjusted associations for each variable. Multivariable regression models were used to examine the association between race/ethnicity and PCEs. Our analyses revealed that people of color were less likely to be supported by friends, have an adult who took interest in them, and have a family who stood by them during difficult times. Education and poverty were significantly associated with feeling safe and protected, supported by friends, and having a family that stood by them during difficult times. Conclusions: Findings from this study may be used to promote health equity in early childhood through programs, policies, and practices that seek to address historic, systemic, and intergenerational trauma.
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Affiliation(s)
- Elizabeth Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, SC Columbia, USA
- Department of Health Services Policy & Management, University of South Carolina, Discovery Building Suite 345, Columbia, USA
| | - Aditi Srivastav
- Children’s Trust of South Carolina, 1330 Lady Street, Suite 310, SC 29201 Columbia, USA
| | - Amanda Stafford McRell
- Children’s Trust of South Carolina, 1330 Lady Street, Suite 310, SC 29201 Columbia, USA
- College of Social Work, University of South Carolina, Hamilton College, 1512 Pendleton St, SC 29208 Columbia, USA
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Moonen X, Festen D, Bakker-van Gijsel E, Vervoort-Schel J. A Dutch Perspective on Two Health Related Issues Regarding Children and Adolescents with Intellectual Disabilities. Int J Environ Res Public Health 2022; 19:11698. [PMID: 36141966 PMCID: PMC9517279 DOI: 10.3390/ijerph191811698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
In this opinion article, we want to inspire readers by highlighting recent Dutch developments about two important health related issues regarding the quality of life of children and adolescents with intellectual disabilities. Firstly we focus on the prevention, treatment and reduction of (disability-related) somatic and psychological problems by specialized physicians for people with intellectual disabilities. Secondly, we emphasize the importance of the prevention of adverse childhood experiences and the promotion of protective and compensatory experiences. Subsequently, we stress the need for trauma informed care to support children and adolescents with intellectual disabilities who encounter adverse events. A specialized and multidisciplinary approach is advised as is the need for promoting healthy (family) relations with a focus on (co)regulation and connection as a basis for recovery.
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Affiliation(s)
- Xavier Moonen
- Ben Sajet Center, Zwanenburgwal 206, 1011 JH Amsterdam, The Netherlands
- Department of Child Development and Education, University of Amsterdam, 1018 WS Amsterdam, The Netherlands
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands
| | - Dederieke Festen
- Erasmus MC, University Medical Center Rotterdam, Postbus 2040, 3000 CA Rotterdam, The Netherlands
| | | | - Jessica Vervoort-Schel
- Ben Sajet Center, Zwanenburgwal 206, 1011 JH Amsterdam, The Netherlands
- Department of Child Development and Education, University of Amsterdam, 1018 WS Amsterdam, The Netherlands
- Koraal Center of Expertise, De Hondsberg, Hondsberg 5, 5062 JT Oisterwijk, The Netherlands
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Felter J, Baker A, Lieberman L, Fein J, Reidy MC, Showstark M. Adverse Childhood Experiences and Trauma-Informed Care. J Physician Assist Educ 2022; 33:264-269. [PMID: 35917473 DOI: 10.1097/jpa.0000000000000449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Jeanne Felter
- Jeanne Felter, PhD, LPC , is chair and an associate professor in the Department of Counseling and Behavioral Health at Thomas Jefferson University in Philadelphia, Pennsylvania
- Amy Baker, MS, PA-C , is director and a professor in the Physician Assistant Program at West Chester University in West Chester, Pennsylvania
- Leslie Lieberman, MSW , is senior director of training and organizational development for the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Joel Fein, MD, MPH , is a professor of pediatrics and emergency medicine at the Perelman School of Medicine, University of Pennsylvania, and an attending physician in emergency medicine and co-director of the Center for Violence Prevention at Children's Hospital of Philadelphia in Philadelphia, Pennsylvania
- Mary Clare Reidy, RN, MPH , is director of collaborative partnerships at the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Mary Showstark, MPAS, PA-C , is an adjunct assistant professor at the Yale School of Medicine/ Yale Institute for Global Health at Yale University in New Haven, Connecticut
| | - Amy Baker
- Jeanne Felter, PhD, LPC , is chair and an associate professor in the Department of Counseling and Behavioral Health at Thomas Jefferson University in Philadelphia, Pennsylvania
- Amy Baker, MS, PA-C , is director and a professor in the Physician Assistant Program at West Chester University in West Chester, Pennsylvania
- Leslie Lieberman, MSW , is senior director of training and organizational development for the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Joel Fein, MD, MPH , is a professor of pediatrics and emergency medicine at the Perelman School of Medicine, University of Pennsylvania, and an attending physician in emergency medicine and co-director of the Center for Violence Prevention at Children's Hospital of Philadelphia in Philadelphia, Pennsylvania
- Mary Clare Reidy, RN, MPH , is director of collaborative partnerships at the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Mary Showstark, MPAS, PA-C , is an adjunct assistant professor at the Yale School of Medicine/ Yale Institute for Global Health at Yale University in New Haven, Connecticut
| | - Leslie Lieberman
- Jeanne Felter, PhD, LPC , is chair and an associate professor in the Department of Counseling and Behavioral Health at Thomas Jefferson University in Philadelphia, Pennsylvania
- Amy Baker, MS, PA-C , is director and a professor in the Physician Assistant Program at West Chester University in West Chester, Pennsylvania
- Leslie Lieberman, MSW , is senior director of training and organizational development for the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Joel Fein, MD, MPH , is a professor of pediatrics and emergency medicine at the Perelman School of Medicine, University of Pennsylvania, and an attending physician in emergency medicine and co-director of the Center for Violence Prevention at Children's Hospital of Philadelphia in Philadelphia, Pennsylvania
- Mary Clare Reidy, RN, MPH , is director of collaborative partnerships at the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Mary Showstark, MPAS, PA-C , is an adjunct assistant professor at the Yale School of Medicine/ Yale Institute for Global Health at Yale University in New Haven, Connecticut
| | - Joel Fein
- Jeanne Felter, PhD, LPC , is chair and an associate professor in the Department of Counseling and Behavioral Health at Thomas Jefferson University in Philadelphia, Pennsylvania
- Amy Baker, MS, PA-C , is director and a professor in the Physician Assistant Program at West Chester University in West Chester, Pennsylvania
- Leslie Lieberman, MSW , is senior director of training and organizational development for the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Joel Fein, MD, MPH , is a professor of pediatrics and emergency medicine at the Perelman School of Medicine, University of Pennsylvania, and an attending physician in emergency medicine and co-director of the Center for Violence Prevention at Children's Hospital of Philadelphia in Philadelphia, Pennsylvania
- Mary Clare Reidy, RN, MPH , is director of collaborative partnerships at the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Mary Showstark, MPAS, PA-C , is an adjunct assistant professor at the Yale School of Medicine/ Yale Institute for Global Health at Yale University in New Haven, Connecticut
| | - Mary Clare Reidy
- Jeanne Felter, PhD, LPC , is chair and an associate professor in the Department of Counseling and Behavioral Health at Thomas Jefferson University in Philadelphia, Pennsylvania
- Amy Baker, MS, PA-C , is director and a professor in the Physician Assistant Program at West Chester University in West Chester, Pennsylvania
- Leslie Lieberman, MSW , is senior director of training and organizational development for the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Joel Fein, MD, MPH , is a professor of pediatrics and emergency medicine at the Perelman School of Medicine, University of Pennsylvania, and an attending physician in emergency medicine and co-director of the Center for Violence Prevention at Children's Hospital of Philadelphia in Philadelphia, Pennsylvania
- Mary Clare Reidy, RN, MPH , is director of collaborative partnerships at the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Mary Showstark, MPAS, PA-C , is an adjunct assistant professor at the Yale School of Medicine/ Yale Institute for Global Health at Yale University in New Haven, Connecticut
| | - Mary Showstark
- Jeanne Felter, PhD, LPC , is chair and an associate professor in the Department of Counseling and Behavioral Health at Thomas Jefferson University in Philadelphia, Pennsylvania
- Amy Baker, MS, PA-C , is director and a professor in the Physician Assistant Program at West Chester University in West Chester, Pennsylvania
- Leslie Lieberman, MSW , is senior director of training and organizational development for the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Joel Fein, MD, MPH , is a professor of pediatrics and emergency medicine at the Perelman School of Medicine, University of Pennsylvania, and an attending physician in emergency medicine and co-director of the Center for Violence Prevention at Children's Hospital of Philadelphia in Philadelphia, Pennsylvania
- Mary Clare Reidy, RN, MPH , is director of collaborative partnerships at the Health Federation of Philadelphia in Philadelphia, Pennsylvania
- Mary Showstark, MPAS, PA-C , is an adjunct assistant professor at the Yale School of Medicine/ Yale Institute for Global Health at Yale University in New Haven, Connecticut
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von Scheven E, Nahal BK, Kelekian R, Frenzel C, Vanderpoel V, Franck LS. Getting to Hope: Perspectives from Patients and Caregivers Living with Chronic Childhood Illness. Children (Basel) 2021; 8:children8060525. [PMID: 34205410 PMCID: PMC8235585 DOI: 10.3390/children8060525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/02/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
Promoting hope was identified in our prior work as the top priority research question among patients and caregivers with diverse childhood-onset chronic conditions. Here, we aimed to construct a conceptual model to guide future research studies of interventions to improve hope. We conducted eight monthly virtual focus groups and one virtual workshop with patients, caregivers, and researchers to explore key constructs to inform the model. Discussions were facilitated by Patient Co-Investigators. Participants developed a definition of hope and identified promotors and inhibitors that influence the experience of hope. We utilized qualitative methods to analyze findings and organize the promotors and inhibitors of hope within three strata of the socio-ecologic framework: structural, interpersonal, and intrapersonal. Participants identified three types of interventions to promote hope: resources, navigation, and activities to promote social connection. The hope conceptual model can be used to inform the selection of interventions to assess in future research studies aimed at improving hope and the specification of outcome measures to include in hope research studies. Inclusion of the health care system in the model provides direction for identifying strategies for improving the system and places responsibility on the system to do better to promote hope among young patients with chronic illness and their caregivers.
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Affiliation(s)
- Emily von Scheven
- Division of Pediatric Rheumatology, University of California San Francisco, San Francisco, CA 94158, USA; (B.K.N.); (R.K.); (C.F.)
- Correspondence: ; Tel.: +1-415-502-6627
| | - Bhupinder K. Nahal
- Division of Pediatric Rheumatology, University of California San Francisco, San Francisco, CA 94158, USA; (B.K.N.); (R.K.); (C.F.)
| | - Rosa Kelekian
- Division of Pediatric Rheumatology, University of California San Francisco, San Francisco, CA 94158, USA; (B.K.N.); (R.K.); (C.F.)
| | - Christina Frenzel
- Division of Pediatric Rheumatology, University of California San Francisco, San Francisco, CA 94158, USA; (B.K.N.); (R.K.); (C.F.)
| | - Victoria Vanderpoel
- Department of Hematology and Oncology, University of California San Francisco, San Francisco, CA 94158, USA;
| | - Linda S. Franck
- Department of Family Healthcare Nursing, University of California San Francisco, San Francisco, CA 94158, USA;
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