Behavioral Assessment Tool Research Articles

An acceptability and feasibility investigation of a community-based motor program for autistic children with moderate and high support needs

BackgroundGeneral motor impairments are ubiquitous in Autism and are positively correlated with autism symptom severity. This study assessed the feasibility and acceptability of a 13-week community-based motor program for autistic children with moderate and high support needs (MHS). MethodIn this exploratory single arm within-subject study, 10 autistic children with MHS, ages 4–10 years, completed a community-based motor program delivered in a one-on-one format by therapists. Feasibility was determined through recruitment, retention, attendance, enjoyment, engagement and useability of motor, physical activity (PA), and behavioural assessment tools. Thematic analysis evaluated post-intervention semi-structured parent interviews. ResultsHigh program attendance and retention were demonstrated, and therapists reported child engagement and enjoyment were high. Identified themes revealed parents perceived unexpected substantial positive impacts including improvements in social, motor, and behavioural outcomes. They highly valued both the program and the therapeutic relationships fostered within it. Although parents of the children with the higher support needs reported the most substantial improvements, these children were unable to score on motor assessments due to difficulties following instructions and off-task behaviours. Additionally, only four participants wore an accelerometer-based PA monitor. ConclusionsThis community-based motor program was considered feasible and acceptable by the children’s parents, and qualitative findings provided valuable insights into clinical practice for children with MHS. However, recruitment challenges and assessment tools being unfeasible for children with higher support needs led to low participant numbers. Future evaluations should explore alternative assessment measures and study designs, given the challenges associated with studying such a heterogenous and complex group.

Insights into the relationship between professional values and caring behavior among nurses in neonatal intensive care units

ObjectiveProfessional values are crucial for delivering high-quality care in neonatal intensive care units while caring behavior impacts nurses’ performance and well-being. The purpose of this study was to assess the relationship between professional values and caring behavior among nurses in neonatal intensive care units.MethodsA cross-sectional study involving 172 nurses was conducted using the Nursing Professional Value Scale and Caring Behaviors Assessment Tool. The study was carried out between 1 October and 5 December 2023.ResultsNurses demonstrated a moderate to high degree of professional commitment, with a mean professional value score of 91.1 ± 11.1. The mean score for caring behavior was 99.7 ± 12.4. The highest-rated domain was setting up a supporting, protective, and corrective environment, with a mean score of 22.8 ± 2.7. A low positive relationship was found between the supportive, protective, and corrective environment domain and nurses’ professional value (r = 0.18, p = 0.017), as well as between overall caring behavior and nurses’ professional value (r = 0.16, p = 0.038).ConclusionThe results indicate a favorable relationship between professional values and caring behavior, especially in areas like establishing a supportive workplace. However, both professional value and caring behavior needs improvement in certain aspect. Enhancing these aspects could further strengthen their relationship, ultimately improving the quality of care provided to newborn patients and their families.Practice implicationsTo cultivate a positive work environment and instill caring behaviors and professional values among NICU nurses, it is imperative to allocate sufficient time and resources. This investment is necessary for nurturing a culture of care, improving patient outcomes, and fostering a supportive environment for NICU nurses, newborn, and their families.

Modelling Petrol Prices in Kenya from 2014 to 2023 Using Sarimax Model: A Case Study of Nairobi County

The requirement for petrol price information is crucial for majority of enterprises. This is because fluctuations in petrol prices impact inflation hence affecting daily lives of citizens. In analyzing the prices of petrol, researchers have employed several models but encountered various limitations. These limitations include; the Error Correction Model can examine only one co-integrating association. The Vector Autoregression (VAR) model does not account for the structural changes in the data. Additionally, the AutoRegressive Integrated Moving Average (ARIMA) model does not take into consideration the seasonal component in the data. The Generalized Autoregressive Conditional Heteroskedasticity (GARCH) model assumes that over time the volatility is constant. Moreover, the Seasonal Autoregressive Integrated Moving Average (SARIMA) model does not integrate the external factors. Hence in this study Seasonal Autoregressive Integrated Moving Average with Exogenous Variables (SARIMAX) model was employed since it captures seasonality in data and incorporates the exogenous variables. The research’s aim was to model prices of petrol in Kenya for the period between 2014 to 2023 with exchange rates as an external factor. Secondary data was obtained from Energy and Petroleum Regulatory Authority (EPRA), Kenya National Bureau of Statistics (KNBS) and Central Bank of Kenya (CBK) websites. R software was used to analyze the data. By the use of historical data of petrol prices and exchange rates, the study sought to fit the best Seasonal Autoregressive Integrated Moving Average with Exogenous Variables (SARIMAX) model, validate the model and predict the petrol prices. The petrol price data was found to be non-stationary using Augmented Dickey Fuller test (ADF). Regular differencing was conducted to make the data stationary. Seasonal differencing due to seasonality component available in the data was also performed. Best SARIMAX model was chosen from various SARIMAX models according to Box-Jenkins methodology which uses least Akaike Information Criterion (AIC) value. SARIMAX (0,1,1)(2,1,2)<sub>12</sub> model was selected since it had least Akaike Information Criterion (AIC) value of 656.3733 and the model validated using the hold out technique. The forecasts errors from the training set were; Mean Squared Error (MSE)=10.4970, Root Mean Square Error (RMSE)=3.239911, Mean Absolute Percentage Error (MAPE)=2.309268% while those from the testing set were; Mean Squared Error (MSE)=3271.1012, Root Mean Square Error (RMSE)=57.193542, Mean Absolute Percentage Error (MAPE)=26.695390%. There was less error in the training set than in the testing set as it was expected hence the model suited the data well and could be used for future predictions. The model was then used for five year forecast into the future. This study’s findings will offer sound suggestions to policymakers, businesses and consumers. This study recommends a model to be fitted using other factors affecting petrol prices and fitting Fourier terms, Behavioral Assessment Tools (BATS) and Trigonometric Box-Cox ARMA Trend Seasonal (TBATS) models.

Enhancing the Preanesthesia Evaluation: Consensus Development of the Cannabis Use and Behaviors Assessment Tool (CUBAT)

PurposeThis project aimed to develop an evidence-based preanesthesia cannabis use assessment tool to acquire complete and accurate patient history and develop a best-informed, individualized anesthesia and analgesia care plan. DesignModified Delphi. MethodsUsing an evidence synthesis and multistage, modified Delphi process, eight experts from across the United States developed a consensus-based tool to aid in developing a best-informed, individualized plan for anesthesia and analgesia care. FindingsTwo survey rounds integrated informed evidence-based tool revisions. The final tool included instructions for use, a glossary of terms, and seven key assessment items aimed at gathering the most influential information regarding cannabis use. ConclusionsThe Cannabis Use and Behaviors Assessment Tool is a first-of-its-kind tool providing an essential framework for preanesthesia cannabis use assessment.

Observer 8: Outliers, Attention, and Situated Knowledge in a Qualitative Behavioral Assessment of Laboratory Mouse Welfare

This article explores how an innovative animal welfare methodology (Qualitative Behavior Assessment) negotiates subjectivism and objectivism in its distinctive epistemology, as it strives to produce a certain kind of laboratory mouse—a complex, social subject. Through an ethnographic study of the development of a Qualitative Behavior Assessment (QBA) tool for laboratory mouse welfare, I show how QBA foregrounds the animal’s lived emotional experience by using qualitative language to assess their welfare, while also relying on statistical methods of validation. Drawing on Mol et al.’s understanding of care as something that parses, handles, and balances diverse “goods,” I argue that QBA practitioners’ care for the data must balance competing priorities and values. I take particular interest in what makes a “good” assessor as they transform between subject and object. When two observers are found to be outliers, with their divergent judgments marring the successful statistical validation of the QBA mouse tool, the situated nature of knowledge is brought to the fore. I argue that turning to the embodied practice of attention, as distinct from care, helps us understand why, and raises questions about the epistemic culture of conventional animal welfare science and the extent to which the human observer risks reification within QBA’s formal methodological practice.

Leading Volunteers Effectively: Development and Preliminary Validation of the Volunteer Leader Behavior Scale

Volunteers are integral to civic and social life, and leadership is integral to keeping volunteers satisfied and committed. However, volunteer leadership research is hindered by the dispersion of leadership theories and the absence of a specialized leader behavior assessment tool. To address this, we developed and validated a four-dimensional scale for evaluating the behaviors of leaders of volunteers. Using confirmatory factor analyses, we confirmed a four-factor, hierarchical model in an Australian emergency volunteer sample. Concurrent validity was confirmed in relation to satisfaction with leadership, overall satisfaction with volunteering experience, and affective organizational commitment. Further details of quantitative studies for scale evaluation are provided. This study provides researchers and practitioners with a valid and reliable instrument to assess different aspects of effective leader behaviors within the volunteering context. Implications, limitations, and future research directions are discussed.

An Update on Curing Coma Campaign.

The Curing Coma Campaign (CCC) and its contributing collaborators identified multiple key areas of knowledge and research gaps in coma and disorders of consciousness (DoC). This step was a crucial effort and essential to prioritize future educational and research efforts. These key areas include defining categories of DoC, assessing DoC using multimodal approach (e.g., behavioral assessment tools, advanced neuroimaging studies), discussing optimal clinical trials' design and exploring computational models to conduct clinical trials in patients with DoC, and establishing common data elements to standardize data collection. Other key areas focused on creating coma care registry and educating clinicians and patients and promoting awareness of DoC to improve care in patients with DoC. The ongoing efforts in these key areas are discussed.

“Internet Utilization among College Students in China: The Role of Ideological and Political Education in Fostering Academic Performance"

This study investigates internet addiction among third year college students in Yantai City, China, using a Sequential Explanatory Mixed Methods Design. The research locale includes four purposefully selected universities (A, B, C, and D) in Y district. A sample of 380 3rd year college students completed the researcher-made Internet Behavior and Academic Performance Assessment Tool (IBAPAT). Furthermore, 12 students participated in a semi-structured interview. Statistical analysis using descriptive statistics, correlation analysis, ANOVA, and MANOVA were used to generate findings based on the collected quantitative data. Meanwhile, thematic analysis of interviews with ideological and political education students was conducted to generate themes and patterns within qualitative data. Objectives include assessing internet addiction prevalence, patterns of utilization, and correlations with academic performance. The study aims to contribute to theoretical research on network ideological and political education, guide social forces, and enhance college students' all-round development. Ethical considerations ensure participant consent, confidentiality, and data protection. The findings will inform interventions to mitigate internet addiction among college students.

Cultural adaptation and validation of the caring behaviors assessment tool into Spanish

BackgroundThe aim of the research was to translate, culturally adapt and validate the Caring Behaviors Assessment (CBA) tool in Spain, ensuring its appropriateness in the Spanish cultural context.MethodsThree-phase cross-cultural adaptation and validation study. Phase 1 involved the transculturation process, which included translation of the CBA tool from English to Spanish, back-translation, and refinement of the translated tool based on pilot testing and linguistic and cultural adjustments. Phase 2 involved training research assistants to ensure standardized administration of the instrument. Phase 3 involved administering the transculturally-adapted tool to a non-probabilistic sample of 402 adults who had been hospitalized within the previous 6 months. Statistical analyses were conducted to assess the consistency of the item-scale, demographic differences, validity of the tool, and the importance of various caring behaviors within the Spanish cultural context. R statistical software version 4.3.3 and psych package version 2.4.1 were used for statistical analyses.ResultsThe overall internal consistency of the CBA tool was high, indicating its reliability for assessing caring behaviors. The subscales within the instrument also demonstrated high internal consistency. Descriptive analysis revealed that Spanish participants prioritized technical and cognitive aspects of care over emotional and existential dimensions.ConclusionsThe new version of the tool proved to be valid, reliable and culturally situated, which will facilitate the provision of objective and reliable data on patients beliefs about what is essential in terms of care behaviors in Spain.

ICF Core-Set Autism Brief 기반 자폐성장애 영유아 언어 행동 평가 도구 개발에 대한 델파이 조사*

The purpose of this study is to develop a verbal behavior assessment tool for asd children using ICF Core Set-Autism Children Brief and verify the validity. Two rounds of Delphi survey on validity of items from IICF Core Set-Autism Children Brief was undertaken by 9 panels who are professionals in applied behavior analysis. As a result, 22 items were identified to be suitable among 48 items. For developmental level suitability, pre-talking and watching were the most suitable items for pre-listener level and listener level and speaker level were found to share common items such as memory function, intellectual function, pay attention, overall psychosocial functions. We discussed about implications that verbal behavior assessment tool for asd children should consider based on the results.

Behavioral pain scale may not be reliable in awake non-verbal intensive care patients: a case control study

BackgroundThe evaluation of pain in patients, unable of oral communication, often relies on behavioral assessment. However, some critically ill patients, while non-verbal, are awake and have some potential for self-reporting. The objective was to compare the results of a behavioral pain assessment with self-reporting in awake, non-verbal, critically ill patients unable to use low-tech augmentative and alternative communication tools.MethodsProspective cohort study of intubated or tracheotomized adult, ventilated patients with a RASS (Richmond Agitation Sedation Scale) of -1 to + 1 and inadequate non-verbal communication skills in a surgical intensive care unit of a tertiary care university hospital. For pain assessment, the Behavioral Pain Scale (BPS) was used. Self-reporting of pain was achieved by using an eye tracking device to evaluate the Numeric Rating Scale (NRS) and the pain/discomfort item of the EuroQol EQ-5D-5 L (EQ-Pain). All measurements were taken at rest.ResultsData was collected from 75 patients. Neither the NRS nor the EQ-Pain (r < .15) correlated with the BPS. However, NRS and EQ-Pain were significantly correlated (r = .78, p = < 0.001), indicating the reliability of the self-reporting by these patients. Neither the duration of intubation/tracheostomy, nor cause for ICU treatment, nor BPS subcategories had an influence on these results.ConclusionsBehavioral pain assessment tools in non-verbal patients who are awake and not in delirium appear unreliable in estimating pain during rest. Before a behavioral assessment tool such as the BPS is used, the application of high-tech AACs should be strongly considered.Trial registrationGerman Clinical Trials Register, Registration number: DRKS00021233. Registered 23 April 2020 - Retrospectively registered, https://drks.de/search/en/trial/DRKS00021233.

Observational Behavioral Coding in the Pediatric Emergency Department: Development of the Emergency Department Child Behavior Coding System

BackgroundDespite improvements over the past decade, children continue to experience significant pain and distress surrounding invasive procedures in the emergency department (ED). To assess the impact of newly developed interventions, we must create more reliable and valid behavioral assessment tools that have been validated for the unique settings of pediatric EDs. ObjectiveThis study aimed to create and test the Emergency Department Child Behavior Coding System (ED-CBCS) for the assessment of child distress and nondistress behaviors surrounding pediatric ED procedures. MethodsVia an iterative process, a multidisciplinary expert panel developed the ED-CBCS, an advanced time-based behavioral coding measure. Inter-rater reliability and concurrent validity were examined using 38 videos of children aged from 2 to 12 years undergoing laceration procedures. Face, Legs, Activity, Cry, Consolability (FLACC) scale scores were used to examine concurrent validity. ResultsThe final ED-CBCS included 27 child distress and nondistress behaviors. Time-unit κ values from 0.64 to 0.98 and event alignment κ values from 0.62 to 1.00 indicated good to excellent inter-rater reliability for all but one of the individual codes. ED-CBCS distress (B = 1.26; p < 0.001) and nondistress behaviors (B = –0.69, p = 0.025) were independently significantly associated with FLACC scores, indicating concurrent validity. ConclusionsWe developed a psychometrically sound tool tailored for pediatric ED procedures. Future work could use this measure to better identify behavioral targets and test the effects of interventions to relieve pediatric ED pain and distress.

Development of a modified C-BARQ for evaluating behavior in working dogs.

Current high demand for effective odor detection dogs calls for the development of reliable methods for measuring performance-related behavioral phenotypes in these highly specialized working animals. The Canine Behavioral Assessment & Research Questionnaire (C-BARQ) is a widely used behavioral assessment tool among working dog organizations with a demonstrated ability to predict success/failure of dogs in training. However, this instrument was developed originally to study the prevalence of behavior problems in the pet dog population, and it therefore lacks the capacity to measure specific behavioral propensities that may also be important predictors of working dog success. The current paper examines the factor structure, internal reliability, and content validity of a modified version of the C-BARQ designed to evaluate four new domains of canine behavior in addition to those encompassed by the original C-BARQ. These domains, labeled Playfulness, Impulsivity, Distractibility, and Basophobia (fear of falling), respectively, describe aspects of canine behavior or temperament which are believed to contribute substantially to working dog performance. Exploratory factor analysis (EFA) of owner/handler questionnaire responses based on a sample of 1,117 working odor detection dogs. A total of 15 factors were extracted by EFA, 10 of which correspond to original C-BARQ factors. The remaining 5 comprise the four new domains- Playfulness, Impulsivity, Distractibility, and Basophobia- as well as a fifth new factor labeled Food focus. The resulting Working Dog Canine Behavioral Assessment & Research Questionnaire (WDC-BARQ) successfully expands the measurement capacities of the original C-BARQ to include dimensions of behavior/temperament of particular relevance to many working dog populations.

Solving the Autism Puzzle: Creating a Broad-Spectrum Tool to Improve Care Delivery in the Clinical Setting

PurposeThe purpose of this quality improvement (QI) project was to develop and implement an assessment tool to identify a patient’s specific needs due to autism spectrum disorder (ASD). The use of an individualized plan of care related to sensory and behavioral differences correlates with improved experiences in the perioperative setting for patients with ASD. DesignMixed methods, pre-post survey, retrospective data comparison. MethodsMetrics planned to evaluate intervention outcomes included: (1) Comparison of pre and postsurvey data obtained from perioperative staff members following ASD education, (2) Evaluation of the number of behavior response team calls made compared to retrospective data, and (3) Survey response data from families assessing the perceived experience of perioperative stay. FindingsTwo hundred and fifty staff members responded to the learning needs survey; 164 in the preperiod and 86 in the postperiod. The perioperative process for these patients improved from the pre- to the postperiod in its ability to meet the needs of patients with autism (P < .001). Overall, respondents rated the sensory aids and the behavioral and sensory assessment tool as very useful (Median = 5, IQR = 2) and stated that they are likely to continue to use the tools in the future when caring for patients with autism (Median = 5, IQR = 1). ConclusionsThe caregivers of study patients felt they had a high level of satisfaction with their surgery or procedure experience. Health care providers also reported increased confidence working with individuals with ASD in the perioperative environment and satisfaction with the intervention program.

Examining relationships between behavior, social environment, and trait factors on mood and anxiety state during social isolation and pseudo-confinement

Background:Extended duration in isolated, confined, and extreme (ICE) environments like space can have detrimental impacts on behavioral health. During the COVID-19 pandemic, large portions of the public were required to social distance, presenting unique circumstances of social isolation and pseudo-confinement. Methods:An internet-based survey was conducted from April to December 2020 of individuals (N = 39 participants, n=1302 survey entries) social distancing. Explanatory multi-level models were constructed to examine relationships between well-being state (anxiety, mood) and observed traits/mental health background, behaviors, and social environment. Results:Significant factors (p < 0.1) with protective relationships to well-being state (decreased anxiety, increased positive mood) included: mood level trait, self-perceived extroversion, hours of sleep, number of meals, time spent outdoors, time spent exercising, time spent on video games, and living alone. Factors with significant protective relationships to anxiety alone included: self-perceived introversion, being required to social distance, and time spent on cooking. Conversely, significant factors with risk relationships to well-being state (increased anxiety, decrease mood) included: time spent on schoolwork and living with individuals who were not family or friends; number of adults in the residence had a significant risk relationship to anxiety alone. Trait measures had the largest effect sizes (self-perceived extroversion explained the largest percentage of variance in outcomes), while behavioral and social environment factors had relatively small effect sizes. Discussion:Trait measures continue to be dominant in gauging potential resilience to ICE conditions, but the protective relationships observed from behavioral and social factors warrant continued exploration and personalization per individual. Statistical significance should not be equated to practical relevance. The relationships examined can inform the development, prioritization, and personalization of behavioral health tools for civilians in ICE environments on Earth and future spaceflight missions.

Nurses’ assessment and management practices of pain among intensive care patients in King Khalid Hospital, Kharj, Riyadh

BackgroundPain is a disagreeable combination of sensory and emotional sensations. Employing behavioral pain assessment tools is strongly associated with improved identification of pain. PurposeThe main purpose of the study is to investigate Nurses’ Assessment and Management Practices of Pain among Intensive Care Patients in King Khalid Hospital, Kharj, Riyadh. Materials and methodsA self-administered questionnaire was employed in a descriptive cross-sectional study. The study focused on nurses employed in the intensive care unit at King Khalid Hospital in Al-Kharj Province. The researchers utilized convenience sampling to recruit participants. Out of the total 48 nurses approached 45 of them provided responses, leading to a response rate of 94%. The Critically Ill questionnaire was utilized to gather information regarding the treatment and evaluation of pain in patients who were in critical condition. Descriptive statistics and inferential statistics were employed to analyze the collected data. Principal resultsit was found that 88% of them utilized instruments to evaluate pain in patients who could express themselves. Among these instruments, the numeric rating scale was the most commonly employed. Furthermore, 77% of the nurses (35 in total) used a pain assessment tool for patients who were unable to communicate, with the Adult Nonverbal Pain Scale being the most frequently used tool in this case. The nurses' perception of the significance of pain assessment was positively associated with the regular utilization of pain assessment tools. Additionally, the nurses considered the use of pain assessment tools with patients who could communicate as more important compared to using such tools with patients who could not communicate. ConclusionsMost ICU nurses utilized nurses' pain assessment instruments to assess the discomfort levels of both patients who could communicate and those who couldn't express themselves effectively. By employing such tools, nurses can improve patient outcomes, ensure effective pain management, and demonstrate a high standard of professional care.

A Scoping Review of Early Childhood Caries Experience Assessment Tools Used for Studies in Nigeria

This scoping review provides an overview of the tools used to assess for early childhood caries (ECC) in Nigeria. A search of the literature in African Journals Online, Google Scholar, Medline, and Cochrane database was conducted in June 2023 using the PRISMA-ScR guidelines. A combination of keywords related to caries risk assessment, preschool children, and evaluation tools was used for the search. Studies reported in English and assessing ECC were extracted. Descriptive statistics were used to summarise the information on study characteristics, types of caries assessment tools, and study outcome. Caries assessment tools were divided into behavioural, social, and biological. After screening 964 potential studies, 16 were included in the review. ECC assessment tools were categorised into behavioural (snacking, frequency of consumption of refined carbohydrate in-between-meals, dental service utilisation, frequency of tooth brushing, use of fluoridated toothpaste, breast and bottle feeding patterns and duration), biological (birth rank, age, sex, anthropometric measures, molecular characterisation of isolated organisms, presence of plaque), and social (socioeconomic status of the child’s household, mother’s level of education, maternal income, occupation of the father, maternal decision-making ability). Twelve studies used behavioural assessment tools, 11 used biological, and 11 used social tools. Furthermore, 11 (70.1%) used a combination of tools, four (25.0%) used only biological tools, and one (6.2%) used only behavioural tools to assess ECC experience. No study screened for the risk of caries. In conclusion, we identified the need for comprehensive studies to identify the risk indicators of ECC in Nigeria. This will support the development of a caries risk assessment tool appropriate for the country context.

Commentary: Pediatric Pain Measurement, Assessment, and Evaluation

Renee C.B. Manworren, Jennifer Stinson Seminars in Pediatric Neurology Volume 23, Issue 3, August 2016, Pages 189-200 Assessment provides the foundation for diagnosis, selection of treatments, and evaluation of treatment effectiveness for pediatric patients with acute, recurrent, and chronic pain. Extensive research has resulted in the availability of a number of valid, reliable, and recommended tools for assessing children's pain. Yet, evidence suggests children's pain is still not optimally measured or treated. In this article, we provide an overview of pain evaluation for premature neonates to adolescents. The difference between pain assessment and measurement is highlighted; and the key steps to follow are identified. Information about self report and behavioral pain assessment tools appropriate for children are provided; and fac tors to be considered when choosing a specific 1 are outlined. Finally, we preview future approaches to personalized pain medicine in pediatrics that include harnessing the use of potential digital health technologies and genomics.

Implementing the DSM-5 parent/guardian-rated level 1 cross-cutting symptom measure child 6-17 in a community mental health clinic.

Despite their relevance to assessment and clinical decision-making in behavioral health, measurement tools are still rarely used in clinical settings. With an increase in undiagnosed and untreated mental health problems in children and adolescents, a southeastern US Community Health System was the ideal setting for the implementation of a behavioral health assessment tool. This quality improvement project was conducted to address the question: "Among mental health clinicians at the Community Health System, will the use of the DSM-5 parent/guardian-rated level 1 cross-cutting symptom measure 6-17 (CCSM) improve diagnosis and treatment choices of children with mental health conditions, over a 4-week period?" A convenience sample was recruited from among behavioral health counselors working at various out-patient clinics and school-based counseling sites in the Community Health System. After nurse-led training on use of the CCSM, including a PowerPoint intervention and individual coaching sessions, the five clinical participants were encouraged to use the CCSM screening tool on their patients presenting for mental health assessment. Knowledge of the tool was assessed using a pre- and post-training survey. Completed screening tools were collected from participants over the 4-week duration of the project. A chart audit comparing the project period with the previous year showed an increase in diagnosis and treatment in 6-17 year-old patients at the outpatient clinic. This project demonstrated the usefulness of the CCSM for behavioral health assessment in the child/adolescent population at the Community Health System and supported use of the intervention in other clinics.

Pain Control and Sedation in Neuro Intensive Critical Unit

Neurocritical patients who can self-report pain use the 0-10 numerical rating scale (NRS, verbal or visual form). However, critically ill patients whose nervous systems cannot express pain use the behavioral pain scale (BPS) and the critical care pain observation tool (CPOT) behavioral pain assessment tools. These tools reveal pain-related changes in movement, facial expression, posture, and physiological indicators such as heart rate, blood pressure, and respiratory rate. In pain control, it is first essential to reduce unnecessary painkillers through non-drug therapy and maximize the effect of the administered analgesics. For nonneuropathic pain, narcotic analgesics such as fentanyl, hydromorphone, morphine, and remifentanil are administered intravenously. Gabapentin, pregabalin, and carbamazepine are recommended along with narcotic analgesics for neuropathic pain control. In addition, nonnarcotic analgesics for multi-modal analgesia are used to reduce the use of narcotic analgesics or the side effects of narcotic analgesics. In the intensive care unit (ICU), the sedation-agitation scale (SAS) and the Richmond agitation-sedation scale (RASS) are used to determine the depth of sedation to be maintained during shallow or deep sedation, considering the condition of the critically ill patient. When selecting sedatives for critically ill patients, preferentially consider nonbenzodiazepines such as propofol or dexmedetomidine rather than benzodiazepines such as midazolam or lorazepam. In addition, patients use painkillers or sedatives for over a week, and neurological changes or physiological dependence may occur. Therefore, clinicians should evaluate the critically ill patient’s condition, and sedatives and painkillers should be reduced or discontinued.