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Kahn NF, Kidd KM, Hodax JK, Goldenberg ME, Asante PG, Kyweluk MA, Christakis DA, Pratt W, Richardson LP, Sequeira GM. Telemedicine-Based Provision of Adolescent Gender-Affirming Medical Care to Promote Equitable Access. Telemed J E Health 2024. [PMID: 38597959 DOI: 10.1089/tmj.2023.0575] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Purpose: To explore transgender and nonbinary (TNB) young adults' (1) interest in receiving gender-affirming medications through telemedicine before age 18 years and (2) willingness to initiate this care with primary care providers (PCPs). Methods: Data were from a survey of TNB young adults who had not received gender-affirming medications before age 18 years. Chi-square and Wald tests identified demographic differences in telemedicine interest and willingness to initiate medications with their PCP as minors. Results: Among 280 respondents, 82.5% indicated interest in telemedicine and 42.0% were willing to initiate medications with their PCP. Black/African American respondents were more likely to indicate interest in telemedicine than White and multiracial respondents. Respondents from rural areas were more likely to indicate willingness to initiate medications with their PCP than those from urban areas. Conclusions: Telemedicine expansion and further support for PCPs may represent critical opportunities to promote equitable access to adolescent gender-affirming care.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Kacie M Kidd
- West Virginia University School of Medicine, Department of Pediatrics, Morgantown, West Virginia, USA
| | - Juanita K Hodax
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | | | - Peter G Asante
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | | | - Dimitri A Christakis
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Wanda Pratt
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Laura P Richardson
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
| | - Gina M Sequeira
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- University of Washington School of Medicine, Department of Pediatrics, Seattle, Washington, USA
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Kahn NF, Katzman K, Danzo S, McCarty CA, Richardson LP, Ford CA. Triadic Collaboration Between Adolescents, Caregivers, and Health-Care Providers to Promote Healthy Behavior. J Adolesc Health 2024; 74:358-366. [PMID: 37855752 DOI: 10.1016/j.jadohealth.2023.08.054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/02/2023] [Accepted: 08/31/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To further elucidate the various aspects of the triadic relationship between health-care providers (HCP), adolescents, and caregivers during adolescent health-care visits, with the goal of helping HCPs better understand how they can best support adolescents to choose healthy behaviors. METHODS Adolescents (ages 13-18 years) and caregivers of adolescents were recruited to participate in qualitative interviews regarding preferences for provider interactions around health behavior change. Data analysis was conducted using inductive thematic analysis to identify and describe patterns of themes across the dataset. RESULTS Thirty one adolescents and 30 caregivers participated. Fourteen themes emerged in the analysis regarding adolescent and caregiver preferences for direct and indirect relationships between adolescents, caregivers, and HCPs in promoting healthy behavior. These themes were organized into a triadic collaboration framework to promote healthy behavior using an adolescent-centered and caregiver-involved approach. DISCUSSION This study supports findings of previous research on triadic interactions between HCPs, adolescents, and caregivers while deepening our understanding of the HCP's role in helping adolescents to choose healthy behaviors. These themes are representative of the continuing shift toward an adolescent-centered and caregiver-involved approach to adolescent health care and provide further guidance to HCPs on how to work collaboratively with both adolescents and caregivers to promote healthy behaviors and improve health outcomes.
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Affiliation(s)
- Nicole F Kahn
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.
| | - Katherine Katzman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Sarah Danzo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Carolyn A McCarty
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Laura P Richardson
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
| | - Carol A Ford
- Depatment of Pediatrics, University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Sequeira GM, Asante PG, Bocek K, Kahn NF, Sethness JL, Hodax JK, Kidd KM, Pratt W, Christakis DA, Richardson LP. Evaluating an Electronic Consultation Platform to Support Pediatric Primary Care Providers in Caring for Transgender and Nonbinary Adolescents. Telemed J E Health 2024; 30:595-600. [PMID: 37624647 PMCID: PMC10877380 DOI: 10.1089/tmj.2023.0266] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 08/27/2023] Open
Abstract
Background: An electronic consultation (e-consult) platform was implemented to support pediatric primary care providers (PCPs) in providing gender-affirming care to transgender and nonbinary (TNB) adolescents. Following implementation, a study was conducted to (1) explore how access to this e-consult platform impacts PCP confidence and referral patterns, (2) describe the content of questions, and (3) evaluate PCP's perspectives regarding platform usability. Methods: Following each submission, providers completed a 17-item survey. A total of 20 providers submitted 38 e-consults and 26 follow-up surveys between October 2021 and December 2022. Results: All PCPs reported a high overall value and increased confidence caring for TNB adolescents. Nearly one in five (19%) felt it allowed them to avoid submitting a specialty referral. Mean System Usability Scale score was 78.2 indicating good usability. Conclusion: This e-consult platform shows great promise in increasing PCP confidence providing gender-affirming care adolescents. More widespread utilization could help improve access to care and decrease specialty care referrals.
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Affiliation(s)
- Gina M. Sequeira
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Peter G. Asante
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kevin Bocek
- Seattle Children's Hospital, Seattle, Washington, USA
| | | | - Janis L. Sethness
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Juanita K. Hodax
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kacie M. Kidd
- West Virginia University, Morgantown, West Virginia, USA
| | - Wanda Pratt
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Dimitri A. Christakis
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Laura P. Richardson
- Seattle Children's Hospital, Seattle, Washington, USA
- Division of Adolescent Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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Fields EL, Louis-Jacques J, Kas-Osoka O, Holland-Hall C, Richardson LP, Ott M, Leslie LK, Pitts SAB. Child Health Needs and the Adolescent Medicine Workforce Supply: 2020-2040. Pediatrics 2024; 153:e2023063678D. [PMID: 38300009 DOI: 10.1542/peds.2023-063678d] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 02/02/2024] Open
Abstract
Adolescent medicine (AM) subspecialists provide primary, subspecialty, and consultative care to adolescents and young adults (AYAs). Given insufficient numbers of AM subspecialists to care for all AYAs, the workforce supports AYAs health care capacity through education, research, advocacy, and the development of policies and programs sensitive to their unique needs. A modeling project funded by the American Board of Pediatrics Foundation was developed to forecast the pediatric subspecialty workforce in the United States from 2020 to 2040 on the basis of current trends in each subspecialty. The model predicts workforce supply at baseline and across alternative scenarios, and reports results in headcount and headcount adjusted for percentage of time spent in clinical care, termed "clinical workforce equivalent." For the AM subspecialty, several scenarios were considered that modified the number of fellows and/or clinical time. The baseline model predicted low growth nationally (27% and 13% increase in total AM subspecialists and AM subspecialists per 100 000 children, respectively) and declines in AM workforce relative to population growth in census divisions with existing geographic workforce disparities. In the alternative scenarios, fellow number and clinical time changes did not significantly change predictions relative to the baseline model, but a 12.5% decrease in fellows predicted a 40% reduction in the workforce from baseline with a widening of geographic workforce disparities. On the basis of the expansive clinical and nonclinical roles of AM subspecialists and these forecasted workforce challenges, significant educational, practice, and policy changes will be necessary to bolster the supply of well-trained clinicians addressing the dynamic health care needs of AYAs.
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Affiliation(s)
| | | | - Oriaku Kas-Osoka
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Cynthia Holland-Hall
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Laura P Richardson
- Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington
| | - Mary Ott
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Sarah A B Pitts
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Kahn NF, Asante PG, Coker TR, Kidd KM, Christakis DA, Richardson LP, Sequeira GM. Demographic Differences in Gender Dysphoria Diagnosis and Access to Gender-Affirming Care Among Adolescents. LGBT Health 2024. [PMID: 38190267 DOI: 10.1089/lgbt.2023.0273] [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] [Indexed: 01/10/2024] Open
Abstract
Purpose: The goal of this article was to identify demographic differences in receipt of gender dysphoria (GD) diagnosis and access to gender-affirming care (GAC) among adolescents whose gender identity and/or pronouns differed from their sex assigned at birth. Methods: Data were from 2444 patients who were 13-17 years old and had a documented gender identity and/or pronouns that differed from their sex assigned at birth in the electronic health record. Adjusted logistic regression models explored associations between demographic characteristics (sex assigned at birth, gender identity, race and ethnicity, language, insurance type, rural status) and presence of GD diagnosis and having accessed GAC. Results: The average predicted probability (Pr) of having received a GD diagnosis was 0.62 (95% confidence interval [CI] = 0.60-0.63) and of having accessed GAC was 0.48 (95% CI = 0.46-0.50). Various significant demographic differences emerged. Notably, Black/African American youth were the least likely to have received a GD diagnosis (Pr = 0.43, 95% CI = 0.33-0.54) and accessed GAC (Pr = 0.32, 95% CI = 0.22-0.43). Although there were no significant differences in GD diagnosis by insurance type, youth using Medicaid, other government insurance, or self-pay/charity care were less likely to have accessed GAC compared with youth using commercial/private insurance. Conclusion: Results indicate significant differences in both receipt of GD diagnosis and accessing GAC by various demographic characteristics, particularly among Black/African American youth. Identification of these differences provides an opportunity to further understand potential barriers and promote more equitable access to GAC among adolescents who desire this care.
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Affiliation(s)
- Nicole F Kahn
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Peter G Asante
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
| | - Tumaini R Coker
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, School of Medicine, West Virginia University, Morgantown, West Virginia, USA
| | - Dimitri A Christakis
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Laura P Richardson
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Gina M Sequeira
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington, USA
- Seattle Children's Hospital, Seattle, Washington, USA
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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Kahn NF, Sequeira GM, Reyes V, Garrison MM, Orlich F, Christakis DA, Aye T, Conard LAE, Dowshen N, Kazak AE, Nahata L, Nokoff NJ, Voss RV, Richardson LP. Mental Health of Youth With Autism Spectrum Disorder and Gender Dysphoria. Pediatrics 2023; 152:e2023063289. [PMID: 37909059 DOI: 10.1542/peds.2023-063289] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Youth with either autism spectrum disorder (ASD) or gender dysphoria (GD) alone have also been shown to be at greater risk for mental health (MH) concerns; however, very little research has considered how cooccurring ASD and GD may exacerbate MH concerns. The purpose of this study was to examine associations between ASD, GD, and MH diagnoses (anxiety, depression, eating disorder, suicidality, and self-harm) among US adolescent populations. METHODS This is a secondary analysis of a large administrative dataset formed by 8 pediatric health system members of the PEDSnet learning health system network. Analyses included descriptive statistics and adjusted mixed logistic regression models testing for associations between combinations of ASD and GD diagnoses and MH diagnoses as recorded in the patient's electronic medical record. RESULTS Based on data from 919 898 patients aged 9 to 18 years, adjusted mixed logistic regression indicated significantly greater odds of each MH diagnosis among those with ASD alone, GD alone, and cooccurring ASD/GD diagnoses compared with those with neither diagnosis. Youth with cooccurring ASD/GD were at significantly greater risk of also having anxiety (average predicted probability, 0.75; 95% confidence interval, 0.68-0.81) or depression diagnoses (average predicted probability, 0.33; 95% confidence interval, 0.24-0.43) compared with youth with ASD alone, GD alone, or neither diagnosis. CONCLUSIONS Youth with cooccurring ASD/GD are more likely to also be diagnosed with MH concerns, particularly anxiety and depression. This study highlights the need to implement developmentally appropriate, gender-affirming MH services and interventions for youth with cooccurring ASD/GD.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Gina M Sequeira
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | | | - Michelle M Garrison
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Felice Orlich
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Tandy Aye
- Stanford School of Medicine, Stanford, California
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
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Sequeria GM, Guler J, Reyes V, Asante PG, Kahn N, Anan Y, Bocek K, Kidd K, Christakis D, Pratt W, Richardson LP. Adolescent and Caregiver Perspectives on Receiving Gender-Affirming Care in Primary Care. Pediatrics 2023; 152:e2023062210. [PMID: 37697934 PMCID: PMC10698727 DOI: 10.1542/peds.2023-062210] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Transgender and gender-diverse (TGD) adolescents experience barriers to receiving gender-affirming care. Delivering services in the pediatric primary care setting may help facilitate improved access. With this study, we aimed to explore TGD adolescents' and caregivers' experiences receiving primary care services and their perspectives regarding gender-affirming care delivery in pediatric primary care. METHODS TGD adolescents aged 14 to 17 and caregivers of TGD adolescents currently receiving gender-affirming medical care participated in 1-hour-long, semi-structured, individual, virtual interviews. Each interview was recorded and transcribed. Transcripts were then individually coded, and themes were generated iteratively by using a reflexive thematic analysis framework. Recruitment of each group continued until thematic saturation was reached. RESULTS A total of 33 participants (15 adolescents and 18 caregivers) completed interviews. Adolescent participants (mean age of 15.7 years) predominantly identified as transmasculine or trans male (73%), and caregiver participants were predominantly mothers (83.3%). Four themes were identified, which included (1) barriers, such as microaggressions and poor psychosocial support, (2) benefits, such as existing trusted relationships with primary care providers (PCPs) and convenience, (3) improvement strategies, such as training and interdisciplinary collaboration, and (4) opportunities for integrating primary care and specialty gender-affirming care. CONCLUSIONS TGD adolescents and their caregivers reported previous negative interactions with PCPs; however, some desired to receive gender-affirming care in this setting, citing increased convenience, efficiency, and availability. Participants highlighted an ongoing need for further work to provide resources, education, and training to PCPs and their staff and improve PCP-to-specialist communication and collaboration.
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Affiliation(s)
- Gina M Sequeria
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Jessy Guler
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | | | - Peter G Asante
- University of Washington School of Medicine, Seattle, Washington
| | - Nicole Kahn
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Yomna Anan
- Seattle Children's Hospital, Seattle, Washington
| | - Kevin Bocek
- Seattle Children's Hospital, Seattle, Washington
| | - Kacie Kidd
- West Virginia University, Morgantown, West Virginia
| | - Dimitri Christakis
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Wanda Pratt
- University of Washington School of Medicine, Seattle, Washington
| | - Laura P Richardson
- Seattle Children's Hospital, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
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Kahn NF, Sequeira GM, Garrison MM, Orlich F, Christakis DA, Aye T, Conard LAE, Dowshen N, Kazak AE, Nahata L, Nokoff NJ, Voss RV, Richardson LP. Co-occurring Autism Spectrum Disorder and Gender Dysphoria in Adolescents. Pediatrics 2023; 152:e2023061363. [PMID: 37395084 DOI: 10.1542/peds.2023-061363] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 07/04/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Autism spectrum disorder (ASD) and gender dysphoria (GD) frequently cooccur. However, existing research has primarily used smaller samples, limiting generalizability and the ability to assess further demographic variation. The purpose of this study was to (1) examine the prevalence of cooccurring ASD and GD diagnoses among US adolescents aged 9 to 18 and (2) identify demographic differences in the prevalence of cooccurring ASD and GD diagnoses. METHODS This secondary analysis used data from the PEDSnet learning health system network of 8 pediatric hospital institutions. Analyses included descriptive statistics and adjusted mixed logistic regression testing for associations between ASD and GD diagnoses and interactions between ASD diagnosis and demographic characteristics in the association with GD diagnosis. RESULTS Among 919 898 patients, GD diagnosis was more prevalent among youth with an ASD diagnosis compared with youth without an ASD diagnosis (1.1% vs 0.6%), and adjusted regression revealed significantly greater odds of GD diagnosis among youth with an ASD diagnosis (adjusted odds ratio = 3.00, 95% confidence interval: 2.72-3.31). Cooccurring ASD/GD diagnoses were more prevalent among youth whose electronic medical record-reported sex was female and those using private insurance, and less prevalent among youth of color, particularly Black and Asian youth. CONCLUSIONS Results indicate that youth whose electronic medical record-reported sex was female and those using private insurance are more likely, and youth of color are less likely, to have cooccurring ASD/GD diagnoses. This represents an important step toward building services and supports that reduce disparities in access to care and improve outcomes for youth with cooccurring ASD/GD and their families.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Gina M Sequeira
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Michelle M Garrison
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Felice Orlich
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
| | - Tandy Aye
- Stanford School of Medicine, Stanford, California
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, Washington
- University of Washington, Seattle, Washington
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Anan YH, Kahn NF, Garrison MM, McCarty CA, Richardson LP. Associations Between Sleep Duration and Positive Mental Health Screens During Adolescent Preventive Visits in Primary Care. Acad Pediatr 2023; 23:1242-1246. [PMID: 36905952 DOI: 10.1016/j.acap.2023.02.013] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 02/16/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE The purpose of this paper was to understand associations between low sleep duration (<8.ßhours) and positive mental health screens among adolescents (ages 13...18) seen for preventive visits in primary care. METHODS Data were from two randomized controlled trials testing the efficacy of an electronic health risk behavior screening and feedback tool for adolescent preventive visits. Participants (n.ß=.ß601) completed screeners at baseline, 3 months, and 6 months which included sleep duration in hours and the Patient Health Questionnaire 9 and Generalized Anxiety Disorder 7 screeners for depression and anxiety, respectively. Main analyses included adjusted logistic regressions testing associations between low sleep duration and positive mental health screens. RESULTS Adjusted models showed that low sleep duration was associated with significantly greater odds of a positive depression screen (OR.ß=.ß1.58, 95% CI: 1.06...2.37) but not with a positive anxiety screen or co-occurring positive depression and anxiety screens. However, follow-up analyses indicated an interaction between sleep duration and anxiety in the association with a positive depression screen, such that the association between low sleep and a positive depression screen was driven by those who did not screen positive for anxiety. CONCLUSIONS As pediatric primary care guidelines for sleep continue to evolve, further research, training, and support for sleep screening are warranted to ensure effective early intervention for sleep and mental health problems during adolescence.
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Affiliation(s)
- Yomna H Anan
- Center for Child Health, Behavior & Development (YH Anan, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Research Institute, Wash.
| | - Nicole F Kahn
- Division of Adolescent Medicine (NF Kahn, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Hospital, Wash
| | - Michelle M Garrison
- Center for Child Health, Behavior & Development (YH Anan, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Research Institute, Wash; Department of Health Systems and Population Health (MM Garrison), University of Washington School of Public Health, Seattle; Division of Child & Adolescent Psychiatry (MM Garrison), Seattle Children...s Hospital, Wash
| | - Carolyn A McCarty
- Center for Child Health, Behavior & Development (YH Anan, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Research Institute, Wash; Division of Adolescent Medicine (NF Kahn, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Hospital, Wash
| | - Laura P Richardson
- Center for Child Health, Behavior & Development (YH Anan, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Research Institute, Wash; Division of Adolescent Medicine (NF Kahn, MM Garrison, CA McCarty, and LP Richardson), Seattle Children...s Hospital, Wash
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Sequeira GM, Kahn NF, Ricklefs C, Collin A, Asante PG, Pratt W, Christakis D, Richardson LP. Barriers Pediatric PCP's Identify To Providing Gender-Affirming Care For Adolescents. J Adolesc Health 2023; 73:367-374. [PMID: 37294258 PMCID: PMC10802986 DOI: 10.1016/j.jadohealth.2023.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE Both affirming environments and access to gender-affirming medical care have a positive impact on the mental health of transgender and gender diverse (TGD) youth, however, many TGD youth experience barriers in accessing this care. Pediatric primary care providers (PCPs) can play an important role in expanding access to gender-affirming care for TGD youth; however, few currently provide this care. The purpose of this study was to explore pediatric PCPs' perspectives regarding barriers they experience to providing gender-affirming care in the primary care setting. METHODS Pediatric PCPs who had sought out support from the Seattle Children's Gender Clinic were recruited via email to participate in semistructured, one-hour Zoom interviews. All interviews were transcribed and then subsequently analyzed in Dedoose qualitative analysis software using a reflexive thematic analysis framework. RESULTS Provider participants (n = 15) represented a wide range of experiences with respect to years in practice, number of TGD youth seen, and practice location (urban, rural, suburban). PCPs identified both health system and community-level barriers to providing gender-affirming care to TGD youth. Health system-level barriers included: (1) lack of foundational knowledge and skills, (2) limited clinical decision-making support, and (3) health system design limitations. Community-level barriers included (1) community and institutional biases, (2) provider attitudes regarding gender-affirming care provision, and (3) challenges identifying community resources to support TGD youth. DISCUSSION A multitude of health system and community-level barriers must be overcome in the pediatric primary care setting to ensure that TGD youth receive timely, effective, and more equitable gender-affirming care.
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Affiliation(s)
- Gina M Sequeira
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington.
| | - Nicole F Kahn
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Colbey Ricklefs
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Arin Collin
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Peter G Asante
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Wanda Pratt
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Dimitri Christakis
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
| | - Laura P Richardson
- Department of Pediatrics, University of Washington, Seattle, Washington; Seattle Children's Research Institute, Seattle, Washington
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11
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Lucas R, Kahn N, Bocek K, Tordoff DM, Karrington B, Richardson LP, Sequeira GM. Telemedicine Utilization Among Transgender and Gender-Diverse Adolescents Before and After the COVID-19 Pandemic. Telemed J E Health 2023; 29:1304-1311. [PMID: 36791325 DOI: 10.1089/tmj.2022.0382] [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] [Indexed: 02/17/2023] Open
Abstract
Introduction: Little is known about how expansion of telemedicine services during the COVID-19 pandemic has affected access to gender-affirming care for transgender and gender-diverse (TGD) youth. The purpose of this study was to explore differences in demographic characteristics and visit completion rates at a multidisciplinary gender clinic before and after telemedicine implementation in March 2020 and among telemedicine users and nonusers. Methods: Data were from electronic health records of Seattle Children's Gender Clinic (SCGC) patients seen between April 2019 and February 2021. We assessed differences in demographic characteristics and care utilization (i.e., encounter type and status) between April 2019 and February 2020 (pre-telemedicine) and April 2020 and February 2021 (post-telemedicine). Results: Of the 1,051 unique patients seen at SCGC during this time period, majority groups were as follows: 62% identified as transmasculine/male, 68% were non-Hispanic White, and 76% resided within 50 miles of the clinic. Statistically significant differences were observed in patient pronouns and insurance type when comparing the pre- and post-telemedicine periods (p < 0.01). Half (52%) of post-telemedicine period encounters were conducted through telemedicine, and telemedicine encounters were significantly more likely to be completed (72% vs. 50%) and less likely to be canceled (21% vs. 46%) compared with in-person encounters. Conclusions: Telemedicine services facilitated continued access to gender-affirming care services for TGD youth during the COVID-19 pandemic. Although the introduction of telemedicine did not exacerbate demographic disparities in access to this care, further research and interventions are warranted to address the ongoing disparities in access to gender-affirming care for youth of color and rural youth.
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Affiliation(s)
- Ruby Lucas
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Nicole Kahn
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kevin Bocek
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Diana M Tordoff
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Baer Karrington
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Laura P Richardson
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Gina M Sequeira
- Department of Pediatrics, Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
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12
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Kahn NF, Anan YH, Bocek KM, Christakis DA, Richardson LP, Pratt W, Sequeira GM. Understanding Transgender and Gender-Diverse Youth's Experiences Receiving Care via Telemedicine: Qualitative Interview Study. JMIR Pediatr Parent 2023; 6:e42378. [PMID: 36745775 PMCID: PMC10055384 DOI: 10.2196/42378] [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] [Received: 09/01/2022] [Revised: 02/01/2023] [Accepted: 02/04/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Access to virtual care has increased since the beginning of the COVID-19 pandemic, yet little is known about transgender and gender-diverse (TGD) youth's experiences and perspectives on receiving care via telemedicine. OBJECTIVE The purpose of this study was to explore these experiences to (1) inform necessary changes to the provision of pediatric gender-affirming care and (2) help providers and health systems determine if and how telemedicine should be made available post pandemic. METHODS Youth (aged 14-17 years) who completed a telemedicine visit in the Seattle Children's Gender Clinic were invited to participate in a semistructured interview exploring perceived advantages or disadvantages of telemedicine and preferred visit modalities. Interview transcriptions were analyzed by 2 research team members using an inductive thematic analysis framework. RESULTS A total of 15 TGD youth completed an interview. Commonly cited advantages of telemedicine were convenience and comfort with having visits in their own environments. Reported disadvantages included technical issues, discomfort with the impersonal nature, lack of familiarity with the platform, and privacy concerns. Overall, slightly more youth preferred in-person visits over telemedicine, referencing both specific characteristics of the clinical visit (ie, initial vs return and complexity) and proximity to the clinic as reasons for this preference. Although a plurality of TGD youth preferred in-person visits, they also recognized the value of telemedicine and the impact it may have in facilitating access to care. CONCLUSIONS Given the variations in needs and visit complexity, our study supports the provision of both in-person and telemedicine modalities as options for pediatric gender-affirming care.
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Affiliation(s)
- Nicole F Kahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Yomna H Anan
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Kevin M Bocek
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States
| | - Dimitri A Christakis
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Laura P Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, WA, United States
| | - Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States.,Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
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13
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Sequeira GM, Kahn NF, Bocek KM, Shafii T, Asante PG, Christakis DA, Pratt W, Richardson LP. Pediatric Primary Care Providers' Perspectives on Telehealth Platforms to Support Care for Transgender and Gender-Diverse Youths: Exploratory Qualitative Study. JMIR Hum Factors 2023; 10:e39118. [PMID: 36719714 PMCID: PMC9929719 DOI: 10.2196/39118] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/29/2022] [Revised: 10/20/2022] [Accepted: 11/07/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Access to gender-affirming care services for transgender and gender-diverse youths is limited, in part because this care is currently provided primarily by specialists. Telehealth platforms that enable primary care providers (PCPs) to receive education from and consult specialists may help improve the access to such services. However, little is known about PCPs' preferences regarding receiving this support. OBJECTIVE This study aimed to explore pediatric PCPs' perspectives regarding optimal ways to provide telehealth-based support to facilitate gender-affirming care provision in the primary care setting. METHODS PCPs who had previously requested support from the Seattle Children's Gender Clinic were recruited to participate in semistructured, 1-hour web-based interviews. Overall, 3 specialist-to-PCP telehealth modalities (tele-education, electronic consultation, and telephonic consultation) were described, and the participants were invited to share their perspectives on the benefits and drawbacks of each modality, which modality would be the most effective, and the most important characteristics or outcomes of a successful platform. Interviews were transcribed and analyzed using a reflexive thematic analysis framework. RESULTS The interviews were completed with 15 pediatric PCPs. The benefits of the tele-education platform were developing a network with other PCPs to facilitate shared learning, receiving comprehensive didactic and case-based education, having scheduled education sessions, and increasing provider confidence. The drawbacks were requiring a substantial time commitment and not allowing for real-time, patient-specific consultation. The benefits of the electronic consultation platform were convenient and efficient communication, documentation in the electronic health record, the ability to bill for provider time, and sufficient time to synthesize information. The drawbacks of this platform were electronic health record-related difficulties, text-based communication challenges, inability to receive an answer in real time, forced conversations with patients about billing, and limitations for providers who lack baseline knowledge. With respect to telephonic consultation, the benefits were having a dialogue with a specialist, receiving compensation for PCP's time, and helping with high acuity or complex cases. The drawbacks were challenges associated with using the phone for communication, the limited expertise of the responding providers, and the lack of utility for nonemergent issues. Regarding the most effective platform, the responses were mixed, with 27% (4/15) preferring the electronic consultation, 27% (4/15) preferring tele-education, 20% (3/15) preferring telephonic consultation, and the remaining 27% (4/15) suggesting a hybrid of the 3 models. CONCLUSIONS A diverse suite of telehealth-based training and consultation services must be developed to meet the needs of PCPs with different levels of experience and training in gender-affirming care. Beyond the widely used telephonic consultation model, electronic consultation and tele-education may provide important alternative training and consultation opportunities to facilitate greater PCP independence and promote wider access to gender-affirming care.
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Affiliation(s)
- Gina M Sequeira
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Nicole F Kahn
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Kevin M Bocek
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Taraneh Shafii
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Peter G Asante
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Dimitri A Christakis
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Wanda Pratt
- Information School, University of Washington, Seattle, WA, United States
| | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
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14
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Al-Shimari F, Kahn NF, McCarty CA, Parker EO, Richardson LP, Shafii T. Provider Use of Time Alone With Adolescents: Differences by Health Concern. J Adolesc Health 2022; 71:508-511. [PMID: 35779999 PMCID: PMC10843781 DOI: 10.1016/j.jadohealth.2022.05.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE To examine associations between reports of sensitive health behaviors and the provision of time alone by a clinician during adolescent well visits. METHODS Data were collected from 547 adolescents who completed a well visit at one of eight clinics. Adjusted mixed logistic regression was used to examine whether reports of sexual behavior, substance use, disordered eating, mental health concerns, and demographic characteristics were associated with time alone. RESULTS Sexual behavior was found to be significantly associated with time alone, while substance use, disordered eating, a positive depression screen, and suicidal ideation were not. Older adolescents and males were more likely to report time alone, while race/ethnicity had no association with time alone. DISCUSSION Clinicians may be prioritizing time alone for behavioral concerns differently than for other sensitive behaviors.
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Affiliation(s)
- Fatima Al-Shimari
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Nicole F Kahn
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington.
| | - Carolyn A McCarty
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Elizabeth O Parker
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Laura P Richardson
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Taraneh Shafii
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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15
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McCarty CA, Parker E, Zhou C, Katzman K, Stout J, Richardson LP. Electronic Screening, Feedback, and Clinician Training in Adolescent Primary Care: A Stepped-Wedge Cluster Randomized Trial. J Adolesc Health 2022; 70:234-240. [PMID: 34404610 DOI: 10.1016/j.jadohealth.2021.07.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 03/19/2021] [Revised: 06/25/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE The aim of this study is to test the effects of an electronic screening and feedback tool and training for primary care clinicians on care and adolescent health behaviors. METHODS We conducted a stepped-wedge cluster randomized trial with six clinics randomly assigned to sequential crossover from control to intervention periods with clinician training between periods. Adolescents (ages 13-18) with a well visit during the control periods (n = 135) received usual care, while adolescents during the intervention periods (n = 167) received the electronic screening and feedback tool prior to their well visit, with results sent to their clinicians. Adolescents completed surveys at baseline, 1 day, 3 months, 6 months, and 12 months. Linear mixed effects models were used to examine associations between outcomes and treatment, controlling for time as a fixed effect and clinic as a random effect. All analyses employed intent-to-treat analyses and utilized multiple imputations for missing data. RESULTS Adolescents who received the intervention had a higher rate of counseling for their endorsed risk behaviors during the well visit (45% vs. 33%, Wald's T = 2.29, p = .02). There were no significant intervention effects on adolescent satisfaction with the clinician or perception of patient centeredness. The intervention was associated with a small but statistically significant reduction in overall risk score relative to control at 3 months (-.63, 95% confidence interval [-1.07, -.19], Cohen's d = .21), but not at 6 or 12 months. CONCLUSIONS The results suggest that electronic screening and feedback may be associated with small reductions in risk behaviors at 3 months but that changes do not persist at longer term follow-up.
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Affiliation(s)
- Carolyn A McCarty
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington.
| | - Elizabeth Parker
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington
| | - Chuan Zhou
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Katherine Katzman
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington
| | - Jim Stout
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Laura P Richardson
- Seattle Children's Research Institute, Center for Child Health Behavior, and Development, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
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16
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Gersh E, Richardson LP, Coker TR, Inwards-Breland DJ, McCarty CA. Same, opposite and both-sex attracted adolescents' mental health, safe-sex practices and substance use. J Gay Lesbian Ment Health 2022; 26:196-211. [PMID: 36249124 PMCID: PMC9555790 DOI: 10.1080/19359705.2021.1967826] [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] [Indexed: 01/03/2023]
Abstract
This study examined mental health, substance use, and sexual health across sexual attraction groups. 428 adolescents recruited from school-based health centers completed self-report measures. 72% were only opposite-sex attracted, 19% both-sex attracted, 3% same-sex attracted, 4% not sure. Reported partners did not always align with reported attraction. Compared to opposite-sex attracted youth, 1) both-sex attracted youth had significantly higher rates of marijuana use (OR=1.75, p=.04), depressive symptoms (OR=2.62, p=.001) and inconsistent condom use (OR=1.71, p=.05); 2) the "not sure" group had higher anxiety symptoms (OR=4, p=.01). This study highlights the importance of considering sexual attraction in providing quality care to young people.
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Affiliation(s)
- Elon Gersh
- Centre for Youth Mental health, University of Melbourne, Australia
| | - Laura P Richardson
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | - Tumaini R Coker
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
| | | | - Carolyn A McCarty
- Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle, Washington
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17
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Kahn NF, McCarty CA, Evans YN, Richardson LP. The Parent's Role in Adolescent Care-Seeking: Building Research Evidence to Mobilize This Untapped Resource. J Adolesc Health 2022; 70:5-6. [PMID: 34930570 DOI: 10.1016/j.jadohealth.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 10/19/2022]
Affiliation(s)
- Nicole F Kahn
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington.
| | - Carolyn A McCarty
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Yolanda N Evans
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington
| | - Laura P Richardson
- Division of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Pediatrics, University of Washington, Seattle, Washington; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
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18
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Ford CA, Bourgeois F, Buckelew SM, Emans SJ, English A, Evans YN, Irwin CE, Richardson LP, Sherer S, Short S, Sieving RE, Simpson T, Tanaka D, White K. Twenty-First Century Cures Act Final Rule and Adolescent Health Care: Leadership Education in Adolescent Health (LEAH) Program Experiences. J Adolesc Health 2021; 69:873-877. [PMID: 34666958 DOI: 10.1016/j.jadohealth.2021.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Carol A Ford
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Fabienne Bourgeois
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts
| | - Sara M Buckelew
- Department of Pediatrics, University of California at San Francisco/Benioff Children's Hospitals, San Francisco, California
| | - S Jean Emans
- Department of Pediatrics, Harvard Medical School/Boston Children's Hospital, Boston, Massachusetts
| | - Abigail English
- Center for Adolescent Health & the Law, Chapel Hill, North Carolina
| | - Yolanda N Evans
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Charles E Irwin
- Department of Pediatrics, University of California at San Francisco/Benioff Children's Hospitals, San Francisco, California
| | - Laura P Richardson
- Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington
| | - Sara Sherer
- Department of Pediatrics, University of Southern California/Children's Hospital of Los Angeles, Los Angeles, California
| | - Sonja Short
- Department of Medical Informatics, University of Minnesota/Fairview Health System, Eagan, Minnesota
| | - Renee E Sieving
- School of Nursing and Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Tina Simpson
- Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Diane Tanaka
- Department of Pediatrics, University of Southern California/Children's Hospital of Los Angeles, Los Angeles, California
| | - Krishna White
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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19
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Sequeira GM, Kidd KM, Rankine J, Miller E, Ray KN, Fortenberry JD, Richardson LP. Gender-Diverse Youth's Experiences and Satisfaction with Telemedicine for Gender-Affirming Care During the COVID-19 Pandemic. Transgend Health 2021; 7:127-134. [PMID: 35586577 PMCID: PMC9051870 DOI: 10.1089/trgh.2020.0148] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Purpose Telemedicine holds potential to improve access to gender-affirming care for gender-diverse youth (GDY), but little is known about youth's perspectives regarding its use. The purpose of this study was to explore GDY's experiences and satisfaction with telemedicine for gender-affirming care during the COVID-19 pandemic. Methods An online, cross-sectional survey was completed by 12-17-year-old GDY after a telemedicine gender clinic visit. Demographic characteristics, responses to a 12-item telemedicine satisfaction scale, and items assessing interest in future telemedicine use were analyzed using descriptive statistics. Open-ended items exploring GDY's experiences were coded qualitatively to identify key themes. Results Participants' (n=57) mean age was 15.6 years. A majority were satisfied with telemedicine (85%) and willing to use it in the future (88%). Most GDY preferred in-person visits for their first gender care visit (79%), with fewer preferring in-person for follow-up visits (47%). Three key themes emerged from the open-ended comments: (1) benefits of telemedicine including saving time and feeling safe; (2) usability of telemedicine such as privacy concerns and technological difficulties; and (3) telemedicine acceptability, which included comfort, impact on anxiety, camera use, and patient preference. Conclusions Despite their preference for in-person visits, a majority of GDY were satisfied and comfortable with telemedicine, and expressed their interest in continuing to have telemedicine as an option for care. Pediatric gender care providers should continue services through telemedicine while implementing protocols related to privacy and hesitation regarding camera use. While adolescents may find telemedicine acceptable, it remains unclear whether telemedicine can improve access to gender-affirming care.
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Affiliation(s)
- Gina M. Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Kacie M. Kidd
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jacquelin Rankine
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kristin N. Ray
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - J. Dennis Fortenberry
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
- Department of Adolescent Medicine, Seattle Children's Hospital, Seattle, Washington, USA
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20
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Emans SJ, Ford CA, Irwin CE, Richardson LP, Sherer S, Sieving RE, Simpson T. Early COVID-19 Impact on Adolescent Health and Medicine Programs in the United States: LEAH Program Leadership Reflections. J Adolesc Health 2020; 67:11-15. [PMID: 32402799 PMCID: PMC7177083 DOI: 10.1016/j.jadohealth.2020.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/16/2020] [Indexed: 11/04/2022]
Affiliation(s)
- S. Jean Emans
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Carol A. Ford
- Children’s Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania,Address correspondence to: Carol A. Ford, M.D., Division of Adolescent Medicine, Department of Pediatrics, University of Pennsylvania, Children’s Hospital of Philadelphia, Buerger Building, 12th Floor, Philadelphia, PA 19104-4399.
| | - Charles E. Irwin
- University of California, San Francisco, San Francisco, California
| | | | - Sara Sherer
- Children’s Hospital of Los Angeles and the University of Southern California, Los Angeles, California
| | | | - Tina Simpson
- University of Alabama at Birmingham, Birmingham, Alabama
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21
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Luk JW, Parker EO, Richardson LP, McCarty CA. Sexual attraction and experiences in the primary care setting: Examining disparities in satisfaction with provider and health self-efficacy. J Adolesc 2020; 81:96-100. [PMID: 32408116 DOI: 10.1016/j.adolescence.2020.04.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/24/2020] [Accepted: 04/26/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To test whether sexual minority males and females report lower satisfaction with primary care providers and lower health self-efficacy relative to heterosexual males and females. METHODS Data from 535 adolescents who participated in one of two randomized clinical trials conducted in a primary care setting were analyzed. Multiple linear regressions controlling for demographic characteristics and treatment condition were used to examine sexual attraction differences in indicators of satisfaction with provider and health self-efficacy. RESULTS Sexual minority and heterosexual youth both endorsed high satisfaction with providers. Relative to heterosexual males, sexual minority males reported lower self-efficacy in reaching their health goals. Relative to heterosexual females, sexual minority females reported lower confidence in positively impacting their own health, and lower self-efficacy in setting goals and working actively to improve their health. CONCLUSIONS Sexual minority youth may benefit from additional support from health care providers to enhance their health self-efficacy and reach their health goals.
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Affiliation(s)
- Jeremy W Luk
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
| | | | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, WA, USA; Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Carolyn A McCarty
- Seattle Children's Research Institute, Seattle, WA, USA; Division of Adolescent Medicine, Department of Pediatrics, University of Washington, Seattle, WA, USA
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Lyon AR, Whitaker K, Richardson LP, French WP, McCauley E. Collaborative Care to Improve Access and Quality in School-Based Behavioral Health. J Sch Health 2019; 89:1013-1023. [PMID: 31612501 DOI: 10.1111/josh.12843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/06/2018] [Revised: 07/27/2018] [Accepted: 08/12/2018] [Indexed: 06/10/2023]
Abstract
BACKGROUND Collaborative care (CC) is a well-established approach for the delivery of accessible behavioral health services in integrated health care settings. Substantial evidence supports its effectiveness in improving the quality and outcomes of adult services, and growing research indicates utility with child and adolescent populations. METHODS To date, studies examining CC models for youth have focused exclusively on primary-care settings. Nevertheless, as the most common integrated service delivery setting for youth, the education sector is an equally important context for improving access to behavioral health services for children and adolescents. RESULTS We provide a narrative review of the literature on CC, describes the relevance of CC to schools, and details its alignment with contemporary movements in education and school-based behavioral health. CONCLUSIONS Potential adaptations of the CC model for use in schools are detailed to improve: (1) behavioral health service accessibility, (2) the capacity of schools to provide behavioral health services, and (3) school service effectiveness through use of evidence-based practices. Although little research has explored the applicability of CC in the education sector, the model holds potential promise to improve the quality and efficiency of school-based behavioral health services.
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Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
| | - Kelly Whitaker
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
| | - Laura P Richardson
- University of Washington/Seattle Children's Research Institute, 2001 8th Avenue, Suite 400, M/S CW8-6, Seattle, WA, 98121
| | - William P French
- University of Washington, 4800 Sand Point Way NE, M/S OA.5.154, PO Box 5371, Seattle, WA, 98145
| | - Elizabeth McCauley
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115
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Richardson LP, Zhou C, Gersh E, Spielvogle H, Taylor JA, McCarty CA. Effect of Electronic Screening With Personalized Feedback on Adolescent Health Risk Behaviors in a Primary Care Setting: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e193581. [PMID: 31074815 PMCID: PMC6512281 DOI: 10.1001/jamanetworkopen.2019.3581] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Health risk behaviors are a leading cause of morbidity during adolescence. Screening and counseling for health risk behaviors are recommended but infrequently performed. OBJECTIVE To test the effect of an electronic screening and feedback tool on clinician counseling and adolescent-reported health risk behaviors. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial compared electronic screening and feedback on an intention-to-treat basis with usual care among 300 youths 13 to 18 years of age at 5 pediatric clinics in the Pacific Northwest. Outcomes were assessed via electronic survey at 1 day and 3 months after the initial visit. Study data collection occurred from March 13, 2015, to November 29, 2016, and statistical analysis was conducted between February 6, 2017, and June 20, 2018. INTERVENTIONS Youths in the intervention group (n = 147) received electronic screening and personalized feedback with clinician clinical decision support. Youths in the control group (n = 153) received standard screening and counseling as provided by their clinic. MAIN OUTCOMES AND MEASURES Youths' report of receipt of counseling during the visit and risk behaviors at 3 months. RESULTS In the final study sample of 300 youths (intervention group, 75 girls and 72 boys; mean [SD] age, 14.5 [1.4 years]; and control group, 80 girls and 73 boys; mean [SD] age, 14.5 [1.4] years), 234 (78.0%) were aged 13 to 15 years. After adjusting for age, sex, and random effect of clinic, youths in the intervention group were more likely to receive counseling for each of their reported risk behaviors than were youths in the control group (adjusted rate ratio, 1.32; 95% CI, 1.07-1.63). Youths in the intervention group had a significantly greater reduction (β = -0.48; 95% CI, -0.89 to -0.02; P = .02) in their risk behavior scores at 3 months when compared with youths in the control group. CONCLUSIONS AND RELEVANCE Electronic screening of health risk behavior with clinical decision support and motivational feedback to teens can improve care delivery and outcomes. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02360410.
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Affiliation(s)
- Laura P. Richardson
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
| | - Elon Gersh
- Department of Research and Translation, Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Heather Spielvogle
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | | | - Carolyn A. McCarty
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
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24
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McCarty CA, Gersh E, Katzman K, Lee CM, Sucato GS, Richardson LP. Screening and brief intervention with adolescents with risky alcohol use in school-based health centers: A randomized clinical trial of the Check Yourself tool. Subst Abus 2019; 40:510-518. [PMID: 30883284 DOI: 10.1080/08897077.2019.1576090] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: This study aimed to compare care delivery and alcohol and marijuana use for adolescents with risky alcohol use who received a school-based health center (SBHC) visit with and without the Check Yourself tool, an electronic tool that gives motivational feedback on substance use and summarizes results for providers. Methods: We conducted a randomized controlled trial with 148 adolescents aged 13-18 who met criteria for moderate- to high- risk alcohol use, recruited from urban SBHCs. Participants were randomized to receive their SBHC visit with (n = 73) or without (n = 75) the Check Yourself screening and feedback tool. All SBHC providers received a brief training on motivational interviewing. Results: Adolescents who received the Check Yourself tool + SBHC visit reported higher levels of alcohol (67%) and marijuana (73%) counseling from the provider during their visit, compared with those who received a SBHC visit without the tool (40% and 45%, respectively, Ps < .005), and had higher motivation to decrease marijuana use relative to those who did not (P = .02). Relative to baseline, adolescents in both groups reduced their typical number of drinks of alcohol, maximum number of drinks of alcohol, and hours high on marijuana over time (Ps < .02) at 2-month follow-up. Conclusion: When adolescent patients are given an electronic screening and feedback tool, it can prompt providers to increase counseling of adolescents with substance use risk. Overall, participants who had a visit with a trained provider reported high satisfaction with care and decreased the amount of alcohol use over 2 months, suggesting that SBHCs are an excellent venue for delivery of brief substance use interventions.
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Affiliation(s)
- Carolyn A McCarty
- Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Elon Gersh
- Orygen, the National Centre of Excellence in Youth Mental Health, Department of Research and Translation, Melbourne, Australia.,University of Melbourne, Centre for Youth Mental Health, Melbourne, Australia
| | - Katherine Katzman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Christine M Lee
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Gina S Sucato
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - Laura P Richardson
- Department of Pediatrics, University of Washington, Seattle, Washington, USA.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
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25
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Bardach NS, Burkhart Q, Richardson LP, Roth CP, Murphy JM, Parast L, Gidengil CA, Marmet J, Britto MT, Mangione-Smith R. Hospital-Based Quality Measures for Pediatric Mental Health Care. Pediatrics 2018; 141:peds.2017-3554. [PMID: 29853624 PMCID: PMC6317537 DOI: 10.1542/peds.2017-3554] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with a primary mental health condition account for nearly 10% of pediatric hospitalizations nationally, but little is known about the quality of care provided for them in hospital settings. Our objective was to develop and test medical record-based measures used to assess quality of pediatric mental health care in the emergency department (ED) and inpatient settings. METHODS We drafted an evidence-based set of pediatric mental health care quality measures for the ED and inpatient settings. We used the modified Delphi method to prioritize measures; 2 ED and 6 inpatient measures were operationalized and field-tested in 2 community and 3 children's hospitals. Eligible patients were 5 to 19 years old and diagnosed with psychosis, suicidality, or substance use from January 2012 to December 2013. We used bivariate and multivariate models to examine measure performance by patient characteristics and by hospital. RESULTS Eight hundred and seventeen records were abstracted with primary diagnoses of suicidality (n = 446), psychosis (n = 321), and substance use (n = 50). Performance varied across measures. Among patients with suicidality, male patients (adjusted odds ratio: 0.27, P < .001) and African American patients (adjusted odds ratio: 0.31, P = .02) were less likely to have documentation of caregiver counseling on lethal means restriction. Among admitted suicidal patients, 27% had documentation of communication with an outside provider, with variation across hospitals (0%-38%; P < .001). There was low overall performance on screening for comorbid substance abuse in ED patients with psychosis (mean: 30.3). CONCLUSIONS These new pediatric mental health care quality measures were used to identify sex and race disparities and substantial hospital variation. These measures may be useful for assessing and improving hospital-based pediatric mental health care quality.
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Affiliation(s)
- Naomi S. Bardach
- Department of Pediatrics, University of California San Francisco, San Francisco, California;
| | - Q Burkhart
- RAND Corporation, Santa Monica, California;
| | - Laura P. Richardson
- Department of Pediatrics, University of Washington, Seattle, Washington;,Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
| | | | - J. Michael Murphy
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston, Massachusetts;,Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Courtney A. Gidengil
- Harvard Medical School, Harvard University, Boston, Massachusetts;,RAND Corporation, Boston, Massachusetts;,Division of Infectious Diseases, Boston Children’s Hospital, Boston, Massachusetts
| | - Jordan Marmet
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; and
| | - Maria T. Britto
- Department of Pediatrics, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Seattle, Washington;,Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
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26
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Parast L, Bardach NS, Burkhart Q, Richardson LP, Murphy JM, Gidengil CA, Britto MT, Elliott MN, Mangione-Smith R. Development of New Quality Measures for Hospital-Based Care of Suicidal Youth. Acad Pediatr 2018; 18:248-255. [PMID: 29100860 DOI: 10.1016/j.acap.2017.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 04/12/2017] [Revised: 09/09/2017] [Accepted: 09/23/2017] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To develop, validate, and test the feasibility of implementation of 4 new quality measures assessing emergency department (ED) and inpatient care for suicidal youth. METHODS Four quality measures were developed to assess hospital-based care for suicidal youth. These measures, focused on counseling caregivers about restricting access to lethal means of self-harm and benefits and risks of antidepressant medications, were operationalized into 2 caregiver surveys that assessed ED and inpatient quality, respectively. Survey field tests included caregivers of youth who received inpatient and/or ED care for suicidality at 1 of 2 children's hospitals between July 2013 and June 2014. We examined the feasibility of obtaining measure scores and variation in scores. Multivariate models examined associations between quality measure scores and 4 validation metrics: modified Child Hospital Consumer Assessments of Health Care Providers and Systems, communication composites, hospital readmissions, and ED return visits. RESULTS Response rates were 35% (ED) and 31% (inpatient). Most caregivers reported receiving counseling to restrict their child's access to lethal means of self-harm (90% in the ED and 96% in the inpatient setting). In the inpatient setting, caregivers reported higher rates of counseling on benefits (95%) of newly prescribed antidepressants than risks (physical adverse effects 85%, increased suicidality 72%). Higher scores on the latter measure were associated with higher nurse (P < .001) and doctor (P < .01) communication composite scores. Measure scores were not associated with readmissions or ED return visits. CONCLUSIONS These new quality measures evaluate key aspects of care for suicidal youth, and they may facilitate assessing quality of care for this vulnerable population.
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Affiliation(s)
| | | | | | - Laura P Richardson
- Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Wash
| | - J Michael Murphy
- Department of Psychiatry, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Courtney A Gidengil
- Harvard Medical School, Boston, Mass; RAND Corporation, Boston, Mass; Division of Infectious Diseases, Boston Children's Hospital, Boston, Mass
| | - Maria T Britto
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Rita Mangione-Smith
- Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Wash
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27
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Gersh E, Richardson LP, Katzman K, Spielvogle H, Arghira AC, Zhou C, McCarty CA. Adolescent Health Risk Behaviors: Parental Concern and Concordance Between Parent and Adolescent Reports. Acad Pediatr 2018; 18:66-72. [PMID: 28870652 DOI: 10.1016/j.acap.2017.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Received: 05/22/2017] [Revised: 08/22/2017] [Accepted: 08/27/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE We investigated which adolescent health risk behaviors are of concern to parents generally, according to adolescent age, gender, and in the context of perceived risk. We compared adolescent and parent reports of the presence of health-risk behaviors and factors predicting agreement. METHODS Three hundred adolescents aged 13 to 18 years (mean, 14.5 years; 52% female) who presenting for well care completed an electronic screening tool used to assess health-risk behaviors. Parents completed parallel measures of their child's behavior and parental concern. Adolescent and parent reports were compared using McNemar test. Hierarchical linear regression was used to examine predictors of agreement. RESULTS High parental concern was most commonly reported for screen time and diet. When parents identified their adolescent as at-risk, high parental concern was near universal for mental health but less commonly reported for substance use. There were no differences in parental concern according to adolescent gender. Parents of older adolescents expressed more concern regarding physical activity and alcohol. Compared with adolescents, parents were more likely to report risk regarding anxiety, fruit and vegetable consumption, and physical activity, and less likely to report risk regarding screen time, sleep, and marijuana use. Younger adolescent age and higher family relationship quality were predictive of stronger parent-adolescent agreement. CONCLUSIONS Parents in well-care visits commonly have concerns about adolescent lifestyle behaviors. Although parents are more likely to report concern when they know about a behavior, parental concern is not always aligned with parental awareness of risk, particularly for substance use. Parent report of higher prevalence of some risk behaviors suggests their input might assist in risk identification.
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Affiliation(s)
- Elon Gersh
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Laura P Richardson
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics, University of Washington, Seattle, Wash
| | - Katherine Katzman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Heather Spielvogle
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Adriana Cristina Arghira
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash
| | - Chuan Zhou
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics, University of Washington, Seattle, Wash
| | - Carolyn A McCarty
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Wash; Department of Pediatrics, University of Washington, Seattle, Wash.
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Abstract
BACKGROUND Adolescents' wide use of technology opens up opportunities to integrate technology into health visits and health care. In particular, technology has the potential to influence adolescent behavior change by offering new avenues for provider communication and support for healthy choices through many different platforms. However, little information exists to guide the integration of technology into adolescent health care, especially adolescents' perspectives and preferences for what they find useful. OBJECTIVE This qualitative study aimed to take a broad approach to understanding adolescents' use of technology for supporting their overall health and to understand whether and how adolescents envision using technology to enhance their health and clinical care, particularly in communicating with their provider. METHODS Adolescents (13-18 years) were recruited to participate in semi-structured, in-depth individual interviews. Potential participants were approached in-person through the Seattle Children's Hospital Adolescent Medicine Clinic while they were waiting for consultation appointments, through outreach to youth who expressed interest in other local research study activities, and via flyers in waiting rooms. Interviews were recorded, transcribed, and analyzed using a thematic analysis approach. RESULTS Thirty-one adolescents (58% female, M= 15.2 years) were interviewed and described 3 main uses of technology: (1) to gather information, (2a) to share their own experiences and (2b) view others' experiences in order to gain social support or inspiration, and (3) to track behaviors and health goals. Perceived benefits and potential downsides were identified for technology use. Teens desired to use technology with their provider for 3 main reasons: (1) have questions answered outside of visits, (2) have greater access to providers as a way to build relationship/rapport, and (3) share data regarding behaviors in between visits. Social media was not a preferred method for communicating with providers for any of the youth due to concerns about privacy and intrusiveness. CONCLUSIONS Although youth are avid users of technology in general, in regard to technology for health, they display specific use preferences especially in how they wish to use it to communicate with their primary care provider. Healthcare providers should offer guidance to youth with regard to how they have used and plan to use technology and how to balance potential positives and negatives of use. Technology developers should take youth preferences into account when designing new health technology and incorporate ways they can use it to communicate with their healthcare provider.
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Affiliation(s)
- Ana Radovic
- Children's Hospital of Pittsburgh of UPMC, Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Carolyn A McCarty
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Katherine Katzman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Laura P Richardson
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
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29
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Affiliation(s)
- Heather Spielvogle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Carolyn A McCarty
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle
| | - Laura P Richardson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington, Seattle
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30
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Zieve GG, Richardson LP, Katzman K, Spielvogle H, Whitehouse S, McCarty CA. Adolescents' Perspectives on Personalized E-Feedback in the Context of Health Risk Behavior Screening for Primary Care: Qualitative Study. J Med Internet Res 2017; 19:e261. [PMID: 28729236 PMCID: PMC5544900 DOI: 10.2196/jmir.7474] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/23/2017] [Accepted: 05/25/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Electronic health screening tools for primary care present an opportunity to go beyond data collection to provide education and feedback to adolescents in order to motivate behavior change. However, there is limited research to guide feedback message development. OBJECTIVE The aim of this study was to explore youth perceptions of and preferences for receiving personalized feedback for multiple health risk behaviors and reinforcement for health promoting behaviors from an electronic health screening tool for primary care settings, using qualitative methodology. METHODS In total, 31 adolescents aged 13-18 years completed the screening tool, received the electronic feedback, and subsequently participated in individual, semistructured, qualitative interviews lasting approximately 60 min. Participants were queried about their overall impressions of the tool, perceptions regarding various types of feedback messages, and additional features that would help motivate health behavior change. Using thematic analysis, interview transcripts were coded to identify common themes expressed across participants. RESULTS Overall, the tool was well-received by participants who perceived it as a way to enhance-but not replace-their interactions with providers. They appreciated receiving nonjudgmental feedback from the tool and responded positively to information regarding the consequences of behaviors, comparisons with peer norms and health guidelines, tips for behavior change, and reinforcement of healthy choices. A small but noteworthy minority of participants dismissed the peer norms as not real or relevant and national guidelines as not valid or reasonable. When prompted for possible adaptations to the tool, adolescents expressed interest in receiving follow-up information, setting health-related goals, tracking their behaviors over time, and communicating with providers electronically between appointments. CONCLUSIONS Adolescents in this qualitative study desired feedback that validates their healthy behavior choices and supports them as independent decision makers by neutrally presenting health information, facilitating goal setting, and offering ongoing technological supports.
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Affiliation(s)
- Garret G Zieve
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | - Laura P Richardson
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Katherine Katzman
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Heather Spielvogle
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Sandy Whitehouse
- Division of Adolescent Medicine, BC Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Carolyn A McCarty
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
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31
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Richardson LP, McCarty CA, Radovic A, Suleiman AB. Research in the Integration of Behavioral Health for Adolescents and Young Adults in Primary Care Settings: A Systematic Review. J Adolesc Health 2017; 60:261-269. [PMID: 28087267 PMCID: PMC5973784 DOI: 10.1016/j.jadohealth.2016.11.013] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [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] [Received: 01/19/2016] [Revised: 11/12/2016] [Accepted: 11/17/2016] [Indexed: 12/30/2022]
Abstract
Despite the recognition that behavioral and medical health conditions are frequently intertwined, the existing health care system divides management for these issues into separate settings. This separation results in increased barriers to receipt of care and contributes to problems of underdetection, inappropriate diagnosis, and lack of treatment engagement. Adolescents and young adults with mental health conditions have some of the lowest rates of treatment for their conditions of all age groups. Integration of behavioral health into primary care settings has the potential to address these barriers and improve outcomes for adolescents and young adults. In this paper, we review the current research literature for behavioral health integration in the adolescent and young adult population and make recommendations for needed research to move the field forward.
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Affiliation(s)
- Laura P. Richardson
- University of Washington Department of Pediatrics,Seattle Children’s Research Institute Center for Child Health, Behavior and Development
| | - Carolyn A. McCarty
- University of Washington Department of Pediatrics,Seattle Children’s Research Institute Center for Child Health, Behavior and Development
| | - Ana Radovic
- University of Pittsburgh School of Medicine Department of Pediatrics,Children’s Hospital of Pittsburgh of UPMC
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Wright DR, Haaland WL, Ludman E, McCauley E, Lindenbaum J, Richardson LP. The Costs and Cost-effectiveness of Collaborative Care for Adolescents With Depression in Primary Care Settings: A Randomized Clinical Trial. JAMA Pediatr 2016; 170:1048-1054. [PMID: 27654449 DOI: 10.1001/jamapediatrics.2016.1721] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Depression is one of the most common adolescent chronic health conditions and can lead to increased health care use. Collaborative care models have been shown to be effective in improving adolescent depressive symptoms, but there are few data on the effect of such a model on costs. OBJECTIVE To evaluate the costs and cost-effectiveness of a collaborative care model for treatment of adolescent major depressive disorder in primary care settings. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted between April 1, 2010, and April 30, 2013, at 9 primary care clinics in the Group Health system in Washington State. Participants were adolescents (age range, 13-17 years) with depression who participated in the Reaching Out to Adolescents in Distress (ROAD) collaborative care intervention trial. INTERVENTIONS A 12-month collaborative care intervention included an initial in-person engagement session, delivery of evidence-based treatments, and regular follow-up by master's level clinicians. Youth in the usual care control condition received depression screening results and could access mental health services and obtain medications through Group Health. MAIN OUTCOMES AND MEASURES Cost outcomes included intervention costs and per capita health plan costs, calculated from the payer perspective using administrative records. The primary effectiveness outcome was the difference in quality-adjusted life-years (QALYs) between groups from baseline to 12 months. The QALYs were calculated using Child Depression Rating Scale-Revised scores measured during the clinical trial. Cost and QALYs were used to calculate an incremental cost-effectiveness ratio. RESULTS Of those screened, 105 youths met criteria for entry into the study, and 101 were randomized to the intervention (n = 50) and usual care (n = 51) groups. Overall health plan costs were not significantly different between the intervention ($5161; 95% CI, $3564-$7070) and usual care ($5752; 95% CI, $3814-$7952) groups. Intervention delivery cost an additional $1475 (95% CI, $1230-$1695) per person. The intervention group had a mean daily utility value of 0.78 (95% CI, 0.75-0.80) vs 0.73 (95% CI, 0.71-0.76) for the usual care group. The net mean difference in effectiveness was 0.04 (95% CI, 0.02-0.09) QALY at $883 above usual care. The mean incremental cost-effectiveness ratio was $18 239 (95% CI, dominant to $24 408) per QALY gained, with dominant indicating that the intervention resulted in both a net cost savings and a net increase in QALYs. CONCLUSIONS AND RELEVANCE Collaborative care for adolescent depression appears to be cost-effective, with 95% CIs far below the strictest willingness-to-pay thresholds. These findings support the use of collaborative care interventions to treat depression among adolescent youth. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01140464.
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Affiliation(s)
- Davene R Wright
- Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Washington
| | - Wren L Haaland
- Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Washington
| | - Evette Ludman
- Group Health Research Institute, Seattle, Washington
| | - Elizabeth McCauley
- Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Washington4Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | | | - Laura P Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle, Washington3Group Health Research Institute, Seattle, Washington4Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
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33
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Lyon AR, Whitaker K, French WP, Richardson LP, Wasse JK, McCauley E. Collaborative Care in Schools: Enhancing Integration and Impact in Youth Mental Health. Adv Sch Ment Health Promot 2016; 9:148-168. [PMID: 28392832 PMCID: PMC5383210 DOI: 10.1080/1754730x.2016.1215928] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Collaborative Care is an innovative approach to integrated mental health service delivery that focuses on reducing access barriers, improving service quality, and lowering healthcare expenditures. A large body of evidence supports the effectiveness of Collaborative Care models with adults and, increasingly, for youth. Although existing studies examining these models for youth have focused exclusively on primary care, the education sector is also an appropriate analog for the accessibility that primary care offers to adults. Collaborative Care aligns closely with the practical realities of the education sector and may represent a strategy to achieve some of the objectives of increasingly popular multi-tiered systems of supports frameworks. Unfortunately, no resources exist to guide the application of Collaborative Care models in schools. Based on the existing evidence for Collaborative Care models, the current paper (1) provides a rationale for the adaptation of Collaborative Care models to improve mental health service accessibility and effectiveness in the education sector; (2) presents a preliminary Collaborative Care model for use in schools; and (3) describes avenues for research surrounding school-based Collaborative Care, including the currently funded Accessible, Collaborative Care for Effective School-based Services (ACCESS) project.
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Wright DR, Katon WJ, Ludman E, McCauley E, Oliver M, Lindenbaum J, Richardson LP. Association of Adolescent Depressive Symptoms With Health Care Utilization and Payer-Incurred Expenditures. Acad Pediatr 2016; 16:82-9. [PMID: 26456002 PMCID: PMC4715622 DOI: 10.1016/j.acap.2015.08.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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] [Received: 01/10/2015] [Revised: 07/18/2015] [Accepted: 08/29/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Screening adolescents for depression is recommended by the US Preventive Services Task Force. We sought to evaluate the impact of positive depression screens in an adolescent population on health care utilization and costs from a payer perspective. METHODS We conducted depression screening among 13- to 17-year-old adolescents enrolled in a large integrated care system using the 2- and 9-item Patient Health Questionnaires (PHQ). Health care utilization and cost data were obtained from administrative records. Chi-square, Wilcoxon rank sum, and t tests were used to test for statistical differences in outcomes between adolescents on the basis of screening status. RESULTS Of the 4010 adolescents who completed depression screening, 3707 (92.4%) screened negative (PHQ-2 <2 or PHQ-9 <10), 186 (3.9%) screened positive for mild depression (PHQ-9 10-14), and 95 (2.4%) screened positive for moderate to severe depression (PHQ-9 ≥15). In the 12 months after screening, screen-positive adolescents were more likely than screen-negative adolescents to receive any emergency department visit or inpatient hospitalization, and they had significantly higher utilization of outpatient medical (mean ± SD, 8.3 ± 1.5 vs 3.5 ± 5.1) and mental health (3.8 ± 9.3 vs 0.7 ± 3.5) visits. Total health care system costs for screen-positive adolescents ($5083 ± $10,489) were more than twice as high as those of screen-negative adolescents ($2357 ± $7621). CONCLUSIONS Adolescent depressive symptoms, even when mild, are associated with increased health care utilization and costs. Only a minority of the increased costs is attributable to mental health care. Implementing depression screening and evidence-based mental health services may help to better control health care costs among screen-positive adolescents.
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Affiliation(s)
- Davene R. Wright
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145,. Seattle Children's Research Institute Center for Child Health, Development, and Behavior, Seattle WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145
| | - Wayne J. Katon
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle WA. Address: Box 356560, Seattle, WA 98195-6560
| | - Evette Ludman
- Group Health Research Institute, Seattle, WA. Address: 1730 Minor Avenue, Suite 1600, Seattle, WA 98101
| | - Elizabeth McCauley
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145,. Seattle Children's Research Institute Center for Child Health, Development, and Behavior, Seattle WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145, University of Washington School of Medicine, Department of Psychiatry and Behavioral Sciences, Seattle WA. Address: Box 356560, Seattle, WA 98195-6560
| | - Malia Oliver
- Group Health Research Institute, Seattle, WA. Address: 1730 Minor Avenue, Suite 1600, Seattle, WA 98101
| | - Jeffrey Lindenbaum
- Group Health Research Institute, Seattle, WA. Address: 1730 Minor Avenue, Suite 1600, Seattle, WA 98101
| | - Laura P. Richardson
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145,. Seattle Children's Research Institute Center for Child Health, Development, and Behavior, Seattle WA. Address: PO Box 5371, MS CW 8-6, Seattle, WA 98145
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Richardson LP, Ludman E, McCauley E, Lindenbaum J, Larison C, Zhou C, Clarke G, Brent D, Katon W. Collaborative care for adolescents with depression in primary care: a randomized clinical trial. JAMA 2014; 312:809-16. [PMID: 25157724 PMCID: PMC4492537 DOI: 10.1001/jama.2014.9259] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Up to 20% of adolescents experience an episode of major depression by age 18 years yet few receive evidence-based treatments for their depression. OBJECTIVE To determine whether a collaborative care intervention for adolescents with depression improves depressive outcomes compared with usual care. DESIGN Randomized trial with blinded outcome assessment conducted between April 2010 and April 2013. SETTING Nine primary care clinics in the Group Health system in Washington State. PARTICIPANTS Adolescents (aged 13-17 years) who screened positive for depression (Patient Health Questionnaire 9-item [PHQ-9] score ≥10) on 2 occasions or who screened positive and met criteria for major depression, spoke English, and had telephone access were recruited. Exclusions included alcohol/drug misuse, suicidal plan or recent attempt, bipolar disorder, developmental delay, and seeing a psychiatrist. INTERVENTIONS Twelve-month collaborative care intervention including an initial in-person engagement session and regular follow-up by master's-level clinicians. Usual care control youth received depression screening results and could access mental health services through Group Health. MAIN OUTCOMES AND MEASURES The primary outcome was change in depressive symptoms on a modified version of the Child Depression Rating Scale-Revised (CDRS-R; score range, 14-94) from baseline to 12 months. Secondary outcomes included change in Columbia Impairment Scale score (CIS), depression response (≥50% decrease on the CDRS-R), and remission (PHQ-9 score <5). RESULTS Intervention youth (n = 50), compared with those randomized to receive usual care (n = 51), had greater decreases in CDRS-R scores such that by 12 months intervention youth had a mean score of 27.5 (95% CI, 23.8-31.1) compared with 34.6 (95% CI, 30.6-38.6) in control youth (overall intervention effect: F2,747.3 = 7.24, P < .001). Both intervention and control youth experienced improvement on the CIS with no significant differences between groups. At 12 months, intervention youth were more likely than control youth to achieve depression response (67.6% vs 38.6%, OR = 3.3, 95% CI, 1.4-8.2; P = .009) and remission (50.4% vs 20.7%, OR = 3.9, 95% CI, 1.5-10.6; P = .007). CONCLUSIONS AND RELEVANCE Among adolescents with depression seen in primary care, a collaborative care intervention resulted in greater improvement in depressive symptoms at 12 months than usual care. These findings suggest that mental health services for adolescents with depression can be integrated into primary care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01140464.
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Affiliation(s)
- Laura P Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle
| | - Evette Ludman
- Group Health Research Institute, Seattle, Washington
| | - Elizabeth McCauley
- Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle4Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | | | - Cindy Larison
- Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine, Seattle2Seattle Children's Research Institute Center for Child Health, Behavior, and Development, Seattle
| | - Greg Clarke
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - David Brent
- University of Pittsburgh, Pittsburgh, Pennsylvania7Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
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Chrisman SP, Richardson LP. Prevalence of diagnosed depression in adolescents with history of concussion. J Adolesc Health 2014; 54:582-6. [PMID: 24355628 PMCID: PMC3999295 DOI: 10.1016/j.jadohealth.2013.10.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [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] [Received: 06/25/2013] [Revised: 10/07/2013] [Accepted: 10/08/2013] [Indexed: 11/15/2022]
Abstract
PURPOSE Previous studies in adults have suggested concussion and other brain injury presents a risk factor for depression. The goal of our study was to analyze the association between previous concussion and current depression diagnosis in a large nationally representative adolescent data set. METHODS Retrospective cohort study using the National Survey of Children's Health 2007-2008, a nationally representative survey conducted via random digit dialing. Data were obtained by parental report. We included youth 12-17 years old without a current concussion (N = 36,060), and evaluated the association between previous concussion (binary) and current depression diagnosis (binary) using multiple logistic regression to control for age, sex, parental mental health, and socioeconomic status. RESULTS After controlling for age, sex, parental mental health, and socioeconomic status, history of concussion was associated with a 3.3-fold greater risk for depression diagnosis (95% CI: 2.0-5.5). Other factors significantly associated with depression diagnosis included poor or fair parental mental health (OR: 3.7, 95% CI: 2.8-4.9), and older age (15-17 years vs. 12-14 years, OR: 1.4, 95% CI: 1.1-1.8). Sex of the subject was not significantly related to depression diagnosis. Being above 200% of the poverty level was associated with approximately a 50% decreased risk of depression diagnosis (95% CI: 35%-70%). CONCLUSIONS History of concussion was associated with a higher prevalence of diagnosed depression in a large nationally representative adolescent data set. Clinicians should screen for depression in their adolescent patients with concussion. Future studies should confirm this association using prospective methodology and examine potential treatment approaches.
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Affiliation(s)
- Sara P.D. Chrisman
- University of Washington, Department of Pediatrics, Division of Adolescent Medicine,Seattle Children’s Hospital, Center for Child Health Behavior and Development
| | - Laura P. Richardson
- University of Washington, Department of Pediatrics, Division of Adolescent Medicine,Seattle Children’s Hospital, Center for Child Health Behavior and Development
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Bardach NS, Coker TR, Zima BT, Murphy JM, Knapp P, Richardson LP, Edwall G, Mangione-Smith R. Common and costly hospitalizations for pediatric mental health disorders. Pediatrics 2014; 133:602-9. [PMID: 24639270 PMCID: PMC3966505 DOI: 10.1542/peds.2013-3165] [Citation(s) in RCA: 150] [Impact Index Per Article: 15.0] [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: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Inpatient pediatric mental health is a priority topic for national quality measurement and improvement, but nationally representative data on the patients admitted or their diagnoses are lacking. Our objectives were: to describe pediatric mental health hospitalizations at general medical facilities admitting children nationally; to assess which pediatric mental health diagnoses are frequent and costly at these hospitals; and to examine whether the most frequent diagnoses are similar to those at free-standing children's hospitals. METHODS We examined all discharges in 2009 for patients aged 3 to 20 years in the nationally representative Kids' Inpatient Database (KID) and in the Pediatric Health Information System (free-standing children's hospitals). Main outcomes were frequency of International Classification of Diseases, Ninth Revision, Clinical Modification-defined mental health diagnostic groupings (primary and nonprimary diagnosis) and, using KID, resource utilization (defined by diagnostic grouping aggregate annual charges). RESULTS Nearly 10% of pediatric hospitalizations nationally were for a primary mental health diagnosis, compared with 3% of hospitalizations at free-standing children's hospitals. Predictors of hospitalizations for a primary mental health problem were older age, male gender, white race, and insurance type. Nationally, the most frequent and costly primary mental health diagnoses were depression (44.1% of all mental health admissions; $1.33 billion), bipolar disorder (18.1%; $702 million), and psychosis (12.1%; $540 million). CONCLUSIONS We identified the child mental health inpatient diagnoses with the highest frequency and highest costs as depression, bipolar disorder, and psychosis, with substance abuse an important comorbid diagnosis. These diagnoses can be used as priority conditions for pediatric mental health inpatient quality measurement.
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Affiliation(s)
- Naomi S. Bardach
- Department of Pediatrics, University of California at San Francisco, San Francisco, California
| | - Tumaini R. Coker
- Children’s Discovery and Innovation Institute and Mattel Children’s Hospital University of California at Los Angeles, Los Angeles, California;,RAND Corporation, Santa Monica, California
| | - Bonnie T. Zima
- Department of Psychiatry and Biobehavioral Science, University of California at Los Angeles, Los Angeles, California
| | - J. Michael Murphy
- Child Psychiatry Service, Massachusetts General Hospital, Boston, Massachusetts;,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Penelope Knapp
- Department of Psychiatry, University of California at Davis, Davis, California
| | - Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington;,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; and
| | - Glenace Edwall
- Minnesota State Health Access Data Assistance Center, Minneapolis, Minnesota
| | - Rita Mangione-Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington;,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; and
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Breland DJ, McCarty CA, Zhou C, McCauley E, Rockhill C, Katon W, Richardson LP. Determinants of mental health service use among depressed adolescents. Gen Hosp Psychiatry 2014; 36:296-301. [PMID: 24417955 PMCID: PMC4517666 DOI: 10.1016/j.genhosppsych.2013.12.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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] [Received: 08/15/2013] [Revised: 11/29/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Evaluate determinants of mental health service use among depressed adolescents. METHOD We assessed mental health services use over the 12 months following screening among 113 adolescents (34 males, 79 females) from an integrated healthcare system who screened positive for depression (Patient Health Questionnaire-9 score ≥11). Youth characteristics (demographics, depression severity, and co-morbidity) and parent characteristics (parent history of depression, parent-report of youth externalizing and internalizing problems) were compared among youth who had received mental health services and those who had not. Multivariate regression was used to evaluate the strongest factors associated with mental health service use. RESULTS Overall, 52% of adolescents who screened positive for depression received mental health service in the year following screening. Higher parent-reported youth internalizing problems (OR 5.37, CI 1.77-16.35), parental history of depression/anxiety (OR 4.12, CI 1.36-12.48) were significant factors associated with mental health service use. Suicidality and functional impairment were not associated with increased mental health services use. CONCLUSION Parental factors including recognition of the adolescent's internalizing symptoms and parental experience with depression/anxiety are strongly associated with mental health service use for depressed adolescents. This highlights the importance of educating parents about depression and developing systems to actively screen and engage youth in treatment for depression.
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Affiliation(s)
- David J. Breland
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Carolyn A. McCarty
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Chuan Zhou
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
| | - Elizabeth McCauley
- Seattle Children’s Hospital,Psychiatry and Behavioral Medicine, University of Washington School of Medicine
| | - Carol Rockhill
- Seattle Children’s Hospital,Psychiatry and Behavioral Medicine, University of Washington School of Medicine
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences; UW School of Medicine
| | - Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital
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Rockhill CM, Katon W, Richards J, McCauley E, McCarty CA, Myaing MT, Zhou C, Richardson LP. What clinical differences distinguish depressed teens with and without comorbid externalizing problems? Gen Hosp Psychiatry 2013; 35:444-7. [PMID: 23648192 PMCID: PMC3692614 DOI: 10.1016/j.genhosppsych.2013.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 03/29/2013] [Accepted: 04/02/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study examined differences in co-occurring symptoms, psychosocial correlates, health care utilization and functional impairment in youth who screened positive for depression, stratified by whether or not they also self-reported externalizing problems. METHODS The AdoleSCent Health Study examined a random sample of youth ages 13-17 enrolled in a health care system. A total of 2291 youth (60.7% of the eligible sample) completed a brief depression screen: the two-item Patient Health Questionnaire. The current analyses focus on a subset of youth (n=113) who had a follow-up interview and screened positive for possible depression on the Patient Health Questionnaire 9 using a cutoff score of 11 or higher [1]. Youth were categorized as having externalizing behavior if their score was ≥ 7 on the Pediatric Symptom Checklist (PSC) externalizing scale [2,3]. χ(2) tests and Wilcoxon rank sum tests were used to compare groups. RESULTS Differences between groups included that youth with depression and externalizing symptoms had a higher rate of obesity and had higher self-reported functional impairment than youth with depression symptoms alone. CONCLUSIONS Adding screening for externalizing problems to existing recommendations for depression screening may help primary care providers to identify a high-risk depressed group of youth for referral to mental health services.
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Affiliation(s)
- Carol M Rockhill
- Department of Psychiatry, University of Washington, Seattle Children's Hospital, Seattle, WA 98195, USA.
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Kohen R, Myaing MT, Richards J, Zhou C, McCauley EA, Katon W, Richardson LP. Depression persistence and serotonin transporter genotype in adolescents under usual care conditions. J Child Adolesc Psychopharmacol 2013; 23:290-4. [PMID: 23647137 PMCID: PMC3657280 DOI: 10.1089/cap.2011.0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Polymorphisms of the serotonin transporter (SERT) gene have been shown to influence the risk for depression. The goal of this study was to investigate a possible effect of SERT polymorphisms on severity and course of depression symptoms in a community sample of adolescents. METHODS Community-dwelling adolescents (n=192) ages 13-17 years, who were at risk for depression, were followed for a period of 6 months. Subjects donated a saliva sample for genotyping of the 5-HTTLPR and STin2 VNTR polymorphisms of SERT. RESULTS We found no associations between SERT genotype and severity of depressive symptoms at baseline. Depression symptom severity markedly decreased over time. For 5-HTTLPR, we observed a significant interaction between time and genotype, indicating the possibility that heterozygote genotype carriers (s/l) might experience a greater reduction in depression symptoms over time compared with adolescents with the 5-HTTLPR l/l genotype. CONCLUSIONS Our study shows that for most community-dwelling adolescents, depressive symptoms decrease over time. A possible interaction effect of time and SERT genotype will require confirmation in larger studies.
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Affiliation(s)
- Ruth Kohen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Mon T. Myaing
- Seattle Children's Research Institute, Seattle, Washington
| | - Julie Richards
- Seattle Children's Research Institute, Seattle, Washington
| | - Chuan Zhou
- Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Elizabeth A. McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.,Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Wayne Katon
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.,Group Health Research Institute, Seattle, Washington
| | - Laura P. Richardson
- Seattle Children's Research Institute, Seattle, Washington.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington.,Group Health Research Institute, Seattle, Washington
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Richardson LP, McCauley E, McCarty CA, Grossman DC, Myaing M, Zhou C, Richards J, Rockhill C, Katon W. Predictors of persistence after a positive depression screen among adolescents. Pediatrics 2012; 130:e1541-8. [PMID: 23166342 PMCID: PMC3507250 DOI: 10.1542/peds.2012-0450] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [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: 11/24/2022] Open
Abstract
OBJECTIVE To examine predictors of depression persistence after a positive screening test to inform management protocols for screened youth. METHODS We conducted a cohort study of 444 youth (aged 13-17 years) from a large health care delivery system. Youth with depressive symptoms, based on a 2-item depression screen, were oversampled for the baseline interview. Baseline assessments included the Patient Health Questionnaire 9-item (PHQ-9) depression screen as well as clinical factors that were hypothesized to influence depression persistence (family history of depression, functional impairment, perceived social support, anxiety symptoms, externalizing symptoms, and medical comorbidity). Logistic regression analysis was used to examine factors associated with the persistence of depression at 6 months postbaseline. RESULTS Of 113 youth with a positive baseline screen (PHQ-9 ≥11), 47% and 35% continued to be positive at 6-week and 6-month follow-up, respectively. After controlling for treatment status, only 2 factors were significantly associated with depression persistence at 6 months: baseline depressive symptom score and continuing to have a positive screen at 6 weeks. For each 1-point increase on the PHQ-9 score at baseline, youth had a 16% increased odds of continuing to be depressed at 6 months (odds ratio: 1.16, 95% confidence interval: 1.01-1.34). Youth who continued to screen positive 6 weeks later had almost 3 times the odds of being depressed at 6 months (odds ratio: 2.89, 95% confidence interval: 1.09-7.61). CONCLUSIONS Depressive symptom severity at presentation and continued symptoms at 6 weeks postscreening are the strongest predictors of depression persistence. Patients with high depressive symptom scores and continued symptoms at 6 weeks should receive active treatment.
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Affiliation(s)
- Laura P. Richardson
- Departments of Pediatrics, and,Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington;,Group Health Research Institute, Seattle, Washington; and
| | - Elizabeth McCauley
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington;,Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington
| | - Carolyn A. McCarty
- Departments of Pediatrics, and,Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington
| | - David C. Grossman
- Group Health Research Institute, Seattle, Washington; and,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Mon Myaing
- Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington
| | - Chuan Zhou
- Departments of Pediatrics, and,Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington
| | - Julie Richards
- Group Health Research Institute, Seattle, Washington; and
| | - Carol Rockhill
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington;,Seattle Children’s Hospital Center for Child Health, Behavior and Development, Seattle, Washington
| | - Wayne Katon
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Richardson LP, Russo JE, Katon W, McCarty CA, DeVries A, Edlund MJ, Martin BC, Sullivan M. Mental health disorders and long-term opioid use among adolescents and young adults with chronic pain. J Adolesc Health 2012; 50:553-8. [PMID: 22626480 PMCID: PMC3368381 DOI: 10.1016/j.jadohealth.2011.11.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 11/15/2011] [Accepted: 11/16/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to examine the association between mental health disorders and subsequent risk for long-term opioid use among adolescents and young adults presenting with common chronic pain complaints (back pain, neck pain, headache, and arthritis/joint pain). METHODS Using claims data from January 1, 2001 to June 30, 2008, we conducted a longitudinal analysis of opioid use patterns among 13-24-year-old subjects presenting with a new episode of chronic pain. Long-term opioid use was defined as receiving >90 days of opioids within a 6-month period with no gap of >30 days in use of opioids in the 18 months after the first qualifying pain diagnosis. Mental health disorders were identified from claims in the 6 months before the first qualifying pain diagnosis. RESULTS Fifty-nine thousand seventy-seven youth met criteria for a new episode of chronic pain. Among these youth, 321 (.5%) met criteria for long-term opioid use, and 16,172 (27.4%) had some opioid use. After controlling for demographic and clinical factors, youth with preexisting mental health diagnoses had a 2.4-fold increased risk of subsequently receiving long-term opioids versus no opioids (odds ratio = 2.36, 95% confidence interval = 1.73-3.23) and a 1.8-fold increased likelihood of receiving long-term opioids versus some opioids (odds ratio = 1.83, 95% confidence interval = 1.34-2.50). CONCLUSIONS Mental health disorders are associated with increased risk for long-term opioid use among adolescents and emerging young adults. Further study is warranted to examine risks and benefits of long-term opioid use in this population.
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Affiliation(s)
- Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA,Children’s Hospital and Regional Medical Center, Seattle, WA
| | - Joan E. Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Carolyn A. McCarty
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA,Children’s Hospital and Regional Medical Center, Seattle, WA
| | | | - Mark J. Edlund
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Bradley C. Martin
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Mark Sullivan
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Ahrens KR, Katon W, McCarty C, Richardson LP, Courtney ME. Association between childhood sexual abuse and transactional sex in youth aging out of foster care. Child Abuse Negl 2012; 36:75-80. [PMID: 22265906 PMCID: PMC3322618 DOI: 10.1016/j.chiabu.2011.07.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 07/11/2011] [Accepted: 07/14/2011] [Indexed: 05/22/2023]
Abstract
PURPOSE To evaluate the association between history of childhood sexual abuse (CSA) and having transactional sex among adolescents who have been in foster care. METHODS We used an existing dataset of youth transitioning out of foster care. Independent CSA variables included self report of history of sexual molestation and rape when participants were, on average, 17 years of age. Our outcome variables were self-report of having transactional sex ever and in the past year, when participants were an average age of 19 years. Separate multiple logistic regression analyses were conducted to assess the associations between CSA variables and transactional sex variables. Initial analyses were performed on both genders; exploratory analyses were then performed evaluating each gender separately. Total N=732; 574 were included in the main analyses. RESULTS History of sexual molestation was significantly associated with increased odds of having transactional sex, both ever and in the past year (OR [95% CI]: 3.21 [1.26-8.18] and 4.07 [1.33, 12.52], respectively). History of rape was also significantly associated with increased odds of having had transactional sex ever and in the past year (ORs [95% CI]: 3.62 [1.38-9.52] and 3.78 [1.19, 12.01], respectively). Odds ratios in female-only analyses remained significant and were larger in magnitude compared with the main, non-stratified analyses; odds ratios in male-only analyses were non-significant and smaller in magnitude when compared with the main analyses. CONCLUSIONS Both CSA variables were associated with increased likelihood of transactional sex. This association appears to vary by gender. Our results suggest that policymakers for youth in foster care should consider the unique needs of young women with histories of CSA when developing programs to support healthy relationships. Health care providers should also consider adapting screening and counseling practices to reflect the increased risk of transactional sex for female youth in foster care with a history of CSA.
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Affiliation(s)
- Kym R Ahrens
- Department of Pediatrics, Seattle Children's Research Institute/University of Washington, Seattle, WA 98121, USA
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Ahrens KR, Dubois DL, Garrison M, Spencer R, Richardson LP, Lozano P. Qualitative exporation of relationships with important non-parental adults in the lives of youth in foster care. Child Youth Serv Rev 2011; 33:1012-1023. [PMID: 22661797 PMCID: PMC3363001 DOI: 10.1016/j.childyouth.2011.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Foster youth are at risk of poor adult outcomes. Research on the role of mentoring relationships for this population suggests the value of strategies that increase their access to adult sources of support, both while in foster care and as they reach adulthood. We conducted semi-structured, individual qualitative interviews with 23 former foster youth ages 18-25 regarding their relationships with supportive non-parental adults. We sought to identify factors that influence the formation, quality, and duration of these relationships and to develop testable hypotheses for intervention strategies. Findings suggest several themes related to relationship formation with non-parental adults, including barriers (e.g., youth's fears of being hurt) and facilitators (e.g., patience from the adult). Distinct themes were also identified relating to the ongoing development and longevity of these relationships. Youth also described multiple types of support and positive contributions to their development. Proposed intervention strategies include systematic incorporation of important non-parental adults into transition planning, enhanced training and matching procedures within formal mentoring programs, assistance for youth to strengthen their interpersonal awareness and skills, and the targeting of specific periods of need when linking youth to sources of adult support. Recommended research includes the development, pilot-testing, and evaluation of proposed strategies.
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Affiliation(s)
- Kym R Ahrens
- Institute for Health Research and Policy, University of Illinois, Chicago, IL
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Richardson LP, McCauley E, Grossman DC, McCarty CA, Richards J, Russo JE, Rockhill C, Katon W. Evaluation of the Patient Health Questionnaire-9 Item for detecting major depression among adolescents. Pediatrics 2010; 126:1117-23. [PMID: 21041282 PMCID: PMC3217785 DOI: 10.1542/peds.2010-0852] [Citation(s) in RCA: 450] [Impact Index Per Article: 32.1] [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: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to examine the performance characteristics and validity of the Patient Health Questionnaire-9 Item (PHQ-9) as a screening tool for depression among adolescents. METHODS The PHQ-9 was completed by 442 youth (aged 13-17 years) who were enrolled in a large health care-delivery system and participated in a study on depression outcomes. Criterion validity and performance characteristics were assessed against an independent structured mental health interview (the Child Diagnostic Interview Schedule [DISC-IV]). Construct validity was tested by examining associations between the PHQ-9 and a self-report measure of functional impairment, as well as parental reports of child psychosocial impairment and internalizing symptoms. RESULTS A PHQ-9 score of 11 or more had a sensitivity of 89.5% and a specificity of 77.5% for detecting youth who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for major depression on the DISC-IV. Receiver-operator-curve analysis revealed that the PHQ-9 had an area under the curve of 0.88 (95% confidence interval: 0.82-0.94), and the cut point of 11 was optimal for maximizing sensitivity without loss of specificity. Increasing PHQ-9 scores were significantly correlated with increasing levels of functional impairment, as well as parental report of internalizing symptoms and psychosocial problems. CONCLUSIONS Although the optimal cut point is higher among adolescents, the sensitivity and specificity of the PHQ-9 are similar to those of adult populations. The brief nature and ease of scoring of this instrument make this tool an excellent choice for providers and researchers seeking to implement depression screening in primary care settings.
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Affiliation(s)
- Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
,Group Health Research Institute, Seattle, WA
,Seattle Children’s Hospital, Seattle, WA
| | - Elizabeth McCauley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
,Seattle Children’s Hospital, Seattle, WA
| | - David C. Grossman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
,Group Health Research Institute, Seattle, WA
,Department of Health Services, University of Washington School of Public Health
| | - Carolyn A. McCarty
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
,Seattle Children’s Hospital, Seattle, WA
| | | | - Joan E. Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Carol Rockhill
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
,Seattle Children’s Hospital, Seattle, WA
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Ahrens KR, Richardson LP, Courtney ME, McCarty C, Simoni J, Katon W. Laboratory-diagnosed sexually transmitted infections in former foster youth compared with peers. Pediatrics 2010; 126:e97-e103. [PMID: 20547646 PMCID: PMC3816982 DOI: 10.1542/peds.2009-2424] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [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: 11/24/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the association between having resided in foster care and risk for sexually transmitted infection (STI) during young adulthood. METHODS Multiple regression analyses were performed by using Waves I to III of the National Longitudinal Study of Adolescent Health (1994-2002) to evaluate the association between foster care status and STI biomarkers and risk behaviors. Female (N = 7563) and male participants (N = 6759) were evaluated separately. Covariates in all models included baseline age, race, ethnicity, parental education level, parental income level, and average neighborhood household income level. RESULTS Female participants who had been in foster care were more likely to have Trichomonas (odds ratio [OR]: 3.23 [95% confidence interval (CI): 1.45-7.23) but not gonorrhea or chlamydia and reported increased sexual risk behaviors compared with nonfostered peers. Male participants who had been in foster care were more likely to have both gonorrhea (OR: 14.28 [95% CI: 2.07-98.28]) and chlamydia (OR: 3.07 [95% CI: 1.36-6.96]) but not Trichomonas and did not report a higher risk for most sexual risk behaviors than nonfostered peers. CONCLUSIONS Results suggest that individuals who have been in foster care are at increased risk for STIs during young adulthood. The pattern of exposure may differ between male and female individuals. If findings are confirmed, they suggest that health care providers who work with these youth should adjust their STI screening practices. Child welfare agencies should also consider targeted interventions to reduce STI risk in this population.
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Affiliation(s)
- Kym R. Ahrens
- Department of Pediatrics, University of Washington/Seattle Children’s Hospital, Seattle, Washington
| | - Laura P. Richardson
- Department of Pediatrics, University of Washington/Seattle Children’s Hospital, Seattle, Washington
| | | | - Carolyn McCarty
- Department of Pediatrics, University of Washington/Seattle Children’s Hospital, Seattle, Washington
| | - Jane Simoni
- Department of Psychology, University of Washington, Seattle, Washington
| | - Wayne Katon
- Department of Psychiatry, University of Washington, Seattle, Washington
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Richardson LP, Rockhill C, Russo JE, Grossman DC, Richards J, McCarty C, McCauley E, Katon W. Evaluation of the PHQ-2 as a brief screen for detecting major depression among adolescents. Pediatrics 2010; 125:e1097-103. [PMID: 20368315 PMCID: PMC3100798 DOI: 10.1542/peds.2009-2712] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [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: 11/24/2022] Open
Abstract
OBJECTIVE To examine the validity of the Patient Health Questionnaire 2 (PHQ-2), a 2-item depression-screening scale, among adolescents. METHODS After completing a brief depression screen, 499 youth (aged 13-17 years) who were enrolled in an integrated health care system were invited to participate in a full assessment, including a longer depression-screening scale (Patient Health Questionnaire 9-item depression screen) and a structured mental health interview (Diagnostic Interview Schedule for Children). Eighty-nine percent (n = 444) completed the assessment. Criterion validity and construct validity were tested by examining associations between the PHQ-2 and other measures of depression and functional impairment. RESULTS A PHQ-2 score of > or =3 had a sensitivity of 74% and specificity of 75% for detecting youth who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depression on the Diagnostic Interview Schedule for Children and a sensitivity of 96% and specificity of 82% for detecting youth who met criteria for probable major depression on the Patient Health Questionnaire 9-item depression screen. On receiver operating characteristic analysis, the PHQ-2 had an area under the curve of 0.84 (95% confidence interval: 0.75-0.92), and a cut point of 3 was optimal for maximizing sensitivity without loss of specificity for detecting major depression. Youth with a PHQ-2 score of > or =3 had significantly higher functional-impairment scores and significantly higher scores for parent-reported internalizing problems than youth with scores of <3. CONCLUSIONS The PHQ-2 has good sensitivity and specificity for detecting major depression. These properties, coupled with the brief nature of the instrument, make this tool promising as a first step for screening for adolescent depression in primary care.
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Affiliation(s)
- Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, Group Health Research Institute, Seattle, WA, Children’s Hospital and Regional Medical Center, Seattle, WA
| | - Carol Rockhill
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, Children’s Hospital and Regional Medical Center, Seattle, WA
| | - Joan E. Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - David C. Grossman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, Group Health Research Institute, Seattle, WA, Department of Health Services, University of Washington School of Public Health
| | | | - Carolyn McCarty
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, Children’s Hospital and Regional Medical Center, Seattle, WA
| | - Elizabeth McCauley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, Children’s Hospital and Regional Medical Center, Seattle, WA
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Davydow DS, Richardson LP, Zatzick DF, Katon WJ. Psychiatric morbidity in pediatric critical illness survivors: a comprehensive review of the literature. ACTA ACUST UNITED AC 2010; 164:377-85. [PMID: 20368492 DOI: 10.1001/archpediatrics.2010.10] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To review the prevalence of psychiatric syndromes in pediatric critical illness survivors as well as to summarize data on vulnerabilities and pediatric intensive care unit exposures that may increase risk of developing these syndromes. DATA SOURCES MEDLINE (1966-2009), the Cochrane Library (2009, issue 3), and PsycINFO (1967-2009) as of August 9, 2009. STUDY SELECTION Case-control, cross-sectional, prospective cohort and retrospective cohort studies as well as randomized controlled trials. MAIN EXPOSURES Hospitalization for the treatment of a critical illness. MAIN OUTCOME MEASURES Assessments of psychiatric symptoms/disorders at least once after discharge. RESULTS Seventeen studies were eligible. The most commonly assessed psychiatric disorders were posttraumatic stress disorder and major depression. The point prevalence of clinically significant posttraumatic stress disorder symptoms ranged from 10% to 28% (5 studies). The point prevalence of clinically significant depressive symptoms ranged from 7% to 13% (2 studies). Preillness psychiatric and/or developmental problems and parental psychopathology were associated with vulnerability to psychiatric morbidity. Neither age nor sex of a child consistently increased vulnerability to postillness psychopathology. Exposure to increased severity of medical illness and pediatric intensive care unit service-delivery characteristics (eg, invasive procedures) were predictors of psychiatric illness in some but not all studies. Early postillness psychiatric symptoms were predictors of later psychiatric morbidity. CONCLUSIONS Psychiatric morbidity appears to be a substantial problem for pediatric critical illness survivors. Future research should include more in-depth assessment of post-critical illness depressive, anxiety, and psychotic symptoms, validate existing psychiatric instruments, and clarify how vulnerability factors, pediatric intensive care unit service-delivery characteristics, and severity of critical illnesses are associated with subsequent psychopathology.
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Affiliation(s)
- Dimitry S Davydow
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA.
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Richardson LP, Russo JE, Lozano P, McCauley E, Katon W. Factors associated with detection and receipt of treatment for youth with depression and anxiety disorders. Acad Pediatr 2010; 10:36-40. [PMID: 20129479 PMCID: PMC2839870 DOI: 10.1016/j.acap.2009.09.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [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] [Received: 02/27/2009] [Revised: 09/12/2009] [Accepted: 09/15/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Anxiety and depression are common among youth and are associated with significant morbidity. Few youth with depression are diagnosed and receive treatment for these disorders. The purpose of this study was to examine the rate of recognition and management among an insured population and the factors associated with evidence of detection among youth. METHODS Structured mental health interviews assessing depression and anxiety diagnoses were completed with a random sample of 581 youth (age range 11-17 years) from an integrated health care system. Administrative data on medical and pharmacy services were used to examine any evidence of detection by the medical system in the prior 12 months. RESULTS Fifty-one youth met criteria for an anxiety or depressive disorder. Twenty-two percent of these youth with an anxiety or depressive disorder as defined in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition had evidence of detection or treatment. Factors associated with detection and treatment included having diagnosis of a depressive disorder (with or without an anxiety disorder), more depressive symptoms, greater functional impairment, a higher number of primary care visits in the prior year, and higher parent-reported externalizing symptoms. On multivariate analysis, having more depressive symptoms and a higher number of primary care visits were significant predictors of detection and receipt of treatment. CONCLUSIONS The rate of detection and treatment of anxiety and depressive disorders is very low in this age group and suggests a need for increased focus on detection, particularly in light of recent evidence suggesting decreases in diagnosis and treatment among youth following the black box warning regarding antidepressant medications.
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Affiliation(s)
- Laura P. Richardson
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, Children's Hospital and Regional Medical Center, Seattle, WA
| | - Joan E. Russo
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Paula Lozano
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, WA
| | - Elizabeth McCauley
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, Children's Hospital and Regional Medical Center, Seattle, WA
| | - Wayne Katon
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
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Bennett AV, Lozano P, Richardson LP, McCauley E, Katon WJ. Identifying high-risk asthma with utilization data: a revised HEDIS definition. Am J Manag Care 2008; 14:450-456. [PMID: 18611096 PMCID: PMC2562616] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To develop a definition of high-risk asthma that more precisely identifies patients needing case management than the 2006 Healthcare Effectiveness Data and Information Set (HEDIS) definition. STUDY DESIGN Two-year claims-based study, with cross-sectional phone survey data, for a sample of 769 youths (age 11-17 years) with asthma. METHODS The 2006 HEDIS measure defines high-risk asthma as meeting any of the following criteria: >1 emergency department (ED) visits, > or =1 hospitalizations for asthma, > or =4 asthma medication prescriptions, or > or =4 ambulatory visits for asthma with > or =2 prescriptions for asthma medication in 1 year. We created a revised definition (> or =1 ED visits or > or =1 hospitalizations for asthma or > or =1 oral steroid prescriptions for asthma) and identified patients with high-risk asthma in year 1 according to each definition. We compared the 2 groups on demographic and clinical characteristics, and healthcare utilization and costs in years 1 and 2. RESULTS The revised definition identified 29% of the sample as having high-risk asthma, whereas the 2006 definition identified 67%. Compared with the 2006 definition, the revised definition identified patients with significantly greater asthma-related physical health problems and higher medical costs in year 1. In year 2, youths classified as high risk by the revised definition made more ED visits and were more likely to use oral steroids than those classified as high risk by the 2006 definition. CONCLUSION The revised high-risk asthma definition identifies half as many individuals and is better able to identify patients with poorly controlled asthma in the subsequent year.
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Affiliation(s)
- Antonia V Bennett
- Department of Health Services, University of Washington, Box 357660, Seattle, WA 98195-7660, USA.
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