Pediatric Health Services Research Articles

Geographic Variation in Acute Pediatric Mental Health Utilization.

To identify locations with higher need for acute pediatric mental health (MH) interventions or services and describe these communities' socio-demographic characteristics. This single-center retrospective study included patients 5 to 18 years old with an emergency department (ED) or hospital admission between 2017 and 2019 for a primary known MH diagnosis or symptoms. We extracted visit data from the electronic medical record, mapped patients to their home census tract, calculated normalized visit rates by census tract, and performed spatial analysis to identify nonrandom geographic clusters and outliers of high utilization. Census tract utilization rates were stratified into quartiles, and socioeconomic and demographic characteristics obtained from the US Census Bureau were compared using analysis of variance, chi-square tests, and multivariable analysis. There were 10,866 qualifying visits across 617 census tracts. ED and hospital admission rates ranged from 2.7 to 428.6 per 1000 children. High utilization clusters localized to neighborhoods with lower socioeconomic status (p < .05). Southern regions with high utilizers were more likely to have fewer children per neighborhood, higher rates of teen births, and lower socioeconomic status. Multivariate analysis showed regions with high utilizers had fewer children per neighborhood, lower median household income, and more families that lacked computer access. ED and hospital utilization for pediatric MH concerns varied significantly by neighborhood and demographics. Divergent social factors map onto these locations and are related to MH utilization. Leveraging geography can be a powerful tool in the development of targeted, culturally tailored interventions to decrease acute pediatric MH utilization and advance child MH equity.

Priorities in tackling non-communicable diseases in children and adolescents in China

China was one of the top ten fast-track countries towards achieving the UN Millennium Development Goals 4 and 5 by 2015, and has since made substantial progress in child and adolescent health. 1 Qiao J Wang Y Li X et al. A Lancet Commission on 70 years of women's reproductive, maternal, newborn, child, and adolescent health in China. Lancet. 2021; 397: 2497-2536 Summary Full Text Full Text PDF PubMed Google Scholar Over the past decades, the country has undergone an epidemiological transition towards non-communicable diseases (NCDs). The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has estimated that disability-adjusted life-years (DALYs) caused by NCDs among children and adolescents aged 0–19 years in China exceeded 13 million in 2019, accounting for 50·30% of all-cause DALYs among children and adolescents aged 0–19 years in China. This loss of healthy life-years necessitates a more effective and equitable approach that is responsive to the country's increasing NCD burden. To address this enormous challenge, prevention and timely diagnosis of, and early intervention for, NCDs should be a prominent focus of paediatric health services in China. Given the long-term burden of NCDs, such a focus is crucial in achieving progress towards the UN Sustainable Development Goals (SDGs), WHO's Global Strategy for Women's, Children's and Adolescents' Health (2016–2030), and Healthy China 2030. 2 WHOThe Global Strategy for Women's, Children's and Adolescents' Health (2016–2030): survive, thrive, transform. https://www.everywomaneverychild.org/global-strategy/#Date: September, 2015 Date accessed: August 26, 2020 Google Scholar , 3 The State Council of the People's Republic of ChinaHealthy China 2030. http://www.gov.cn/zhengce/2016-10/25/content_5124174.htmDate: October, 2016 Date accessed: November 13, 2022 Google Scholar

“They go hand in hand”: a patient-oriented, qualitative descriptive study on the interconnectedness between chronic health and mental health conditions in transition-age youth

BackgroundTransition-age youth (TAY) with chronic health conditions frequently experience co-occurring mental health conditions. However, little is known about the perspectives of TAY with co-occurring diagnoses preparing to exit pediatric health and mental health services. Research is needed to understand the impact of a mental health condition on transition readiness and self-management in TAY with chronic health conditions.MethodsTAY (aged 16–20 years) with co-occurring chronic health and mental health conditions were recruited in Alberta, Canada. Nine semi-structured individual interviews were completed by phone or videoconference, and transcribed verbatim. Guided by qualitative description, we analyzed the data using thematic analysis in partnership with five young adults with lived experience in the health/mental health systems.ResultsParticipants shared their experiences living with simultaneous physical and mental health concerns and preparing for transition to adult care. Our analysis revealed three overarching themes: 1) “they’re intertwined”: connections between chronic health and mental health conditions in TAY, 2) impact of mental health on transition readiness and self-management, and 3) recommendations for service provision from the perspectives of TAY.ConclusionsOur findings highlighted the myriad ways in which physical and mental health are connected as TAY prepare for service transitions using specific examples and powerful metaphors. TAY endorsed the importance of providers discussing these connections in routine clinical care. Future research should involve co-designing and evaluating educational material addressing this topic with diverse TAY, caregivers, and service providers.

СУЧАСНИЙ СТАН ДИТЯЧОЇ ПСИХІАТРІЇ В УКРАЇНІ: ОСВІТА ТА ПРАКТИКА

The article discusses the challenges that Ukrainian paediatric mental health services faced during the COVID-19 pandemic and the full-scale invasion of military forces to Ukraine. The features of the psychiatric service organization, such as the concentration of these services in large cities exacerbated by the staff shortages, lowlevel telehealth facilities development, and lack of mental health education on the community level that were exacerbated by stigma in the society negatively affected the access to specialized child mental health services during the pandemic. The situation significantly worsened due to war, that was related to the unprecedented rate of violence toward the civil population, destruction of critical infrastructure, lack of access to medication, and evacuation of medical personnel that in turn resulted in a crisis in Ukrainian child and adolescent psychiatry To address these challenges, a recent paper highlight the need for systemic reforms and collaboration among experts in the field of child healthcare, medical education, social services, and government agencies. The author recommends creating a comprehensive training program for child psychiatrists and incorporating child psychiatry into the postgraduate training of medical professionals, providing training in child psychiatry for pediatricians and family doctors and promoting digital services. Furthermore, the authors propose deinstitutionalization for child psychiatric services and their movement to multidisciplinary childcare facilities with the developing of community- based forms of psychiatric and psychological care for children to ensure better access to mental healthcare services and their destigmatization.

APA’s Government, Policy, and Advocacy Update (January 2022)

Back to table of contents Previous article Next article Government & LegalFull AccessAPA’s Government, Policy, and Advocacy Update (January 2022)Search for more papers by this authorPublished Online:23 Dec 2022https://doi.org/10.1176/appi.pn.2023.01.1.44APA, Partners Detail Year-End Requests to Congressional LeadershipIn December, APA and its partner organizations, collectively known as the Group of Six, sent a letter to House and Senate leaders requesting action on several proposals to ensure patients have access to quality and affordable health care. The letter was addressed to Reps. Nancy Pelosi (D-Calif.) and Kevin McCarthy (R-Calif.), and Sens. Chuck Schumer (D-N.Y.) and Mitch McConnell (R-Ky).The Group of Six includes APA, the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, and the American Osteopathic Association.The letter outlines numerous actions that the groups urged Congress to take, including the following:Avert cuts to Medicare physician payments.Senate passage of the Improving Seniors’ Timely Access to Care Act (HR 3173), which the House already passed. The legislation would standardize and streamline the prior authorization approval process in the Medicare Advantage program.Extend Medicare telehealth flexibilities through at least 2024, including coverage for audio-only services, to ensure Medicare beneficiaries can continue to access virtual care.Extend funding for the Teaching Health Centers Graduate Medical Education program.Additionally, the letter outlined numerous actions Congress should take to address the mental health and substance use disorder crisis. The Group of Six urged Congress to promote the integration of mental health services with primary care, strengthen the mental health workforce by increasing funding for graduate medical education, increase funding to community health and mental health centers to enhance prevention and early intervention, and enforce the federal mental health parity law.APA and its partner organizations’ letter to Congress Leadership. APA Sends Letter Supporting Bill To Address Children’s Mental HealthIn a letter, APA and its partner organizations expressed support for the Investing in Kids’ Mental Health Now Act (S. 4747), introduced by Sens. Robert Casey (D-Pa.) and Rob Portman (R-Ohio). The bill would incentivize states to increase Medicaid reimbursement for pediatric mental health and substance use disorder treatment services, providing direct support to the pediatric mental health workforce and improving access to children’s mental health care.“Medicaid is the single largest payer of children’s mental health services in the United States, yet states often struggle to maintain an adequate network due to lower reimbursement rates for pediatric mental and behavioral services and an ongoing shortage of pediatric mental health professionals,” the letter stated. “These longstanding issues translate to delayed access to mental health care for children covered by Medicaid across the country.” ■APA’s letter to Senators Robert Casey, and Robert Portman. ISSUES NewArchived

Testing a Theory-Driven Intervention with/without Care Manager Support on Physicians’ ADHD Practices: Rethinking What Works

Objective: To understand the benefits of an intensive 6-months-long training program (with or without assistance of an embedded care manager) on primary care providers’ (PCPs’) adoption of evidence-based practices for diagnosing and managing Attention-Deficit/Hyperactivity Disorder (ADHD). Methods: Following an intensive weekend training in primary care pediatric mental health service delivery, 47 PCPs were randomly assigned to 6 months of ongoing educational support via twice-monthly conference calls, either with or without additional assistance of a care manager. In addition to the impact of a care manager, basic science-derived predictors of behavior change were examined to explore impact on PCPs’ initial and subsequent intentions/decisions to adopt 11 specific changes in ADHD practices. Effects of practice obstacles on PCPs’ practice decisions, both initially and over 6 months, were also examined. Results: PCPs’ initial and subsequent decisions to employ program-targeted ADHD evidence-based practices increased over time and were significantly predicted by underlying hypothesized predictors. Additional support of a care manager had minimal effects on PCPs’ initial and subsequent decisions to apply specific evidence-based ADHD practices. Of note, PCPs’ initial worries/perceptions concerning practice obstacles decreased significantly over time, likely due to twice-monthly support calls. Conclusions: With intensive and sustained support, PCPs will adopt most evidence-based practices for ADHD diagnosis and treatment. Many initially anticipated obstacles dissipated over time. Additional support of care managers had little impact on PCPs’ longitudinal decisions to adhere to ADHD practice guidelines. Basic science predictors of behavior change are robust correlates of PCPs’ practice changes and should be more routinely applied to understand and improve training outcomes in multiple areas of health service delivery.

Religious-spiritual coping in family caregivers of Brazilian children and adolescents with cancer

ABSTRACT The aim of this study was to understand how family caregivers of Brazilian children and adolescents with cancer experience and use religious-spiritual coping. This is a qualitative study carried out with 23 participants (being 21 women and two men; age average of 35,9 years old). Semi-structured interviews were virtually conducted, recorded, fully transcribed, organized and analyzed using a thematic-reflective analysis. The results found to allow us to indicate that positive and negative religious-spiritual coping affects the quality of life, physical and emotional health of family members, reverberating in the way they deal with and understand cancer in children and adolescents. The data found demonstrate that paediatric oncology health services and professionals should consider religious-spiritual coping and be prepared to meet the demands of this nature that may arise.

Clinical Profile and Induction Outcome of Children with T-cell Acute Lymphoblastic Leukemia and T-cell Lymphoblastic Lymphoma

Objective: To study the clinical profile and induction outcome in children diagnosed with T-cell acute lymphoblastic leukaemia and lymphoblastic lymphoma.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Paediatric Oncology Unit, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2012 to Dec 2020.&#x0D; Methodology: One hundered and twenty-one diagnosed patients of T-ALL and LBL were evaluated with bone marrow biopsy and Contrast-enhanced CT scan of the active region after induction chemotherapy with Dexamethasone, Vincristine, Asparaginase and Daunorubicin along with intrathecal Methotrexate. This was carried out on days-8 and 29 to determine the early remission status and end of induction response, respectively.&#x0D; Results: Out of 121 patients, 99(81.8 %) had T–ALL, while 22(18.18%) had LBL. Day-8 assessment showed that 94(77.7%) patients were rapid early responders, 24(19.4%) were slow early responders, while 3(2.4%) patients expired before the day eight assessment. Day-29 bone marrow assessment of 88 T-ALL patients showed complete remission in 77 patients (87.5%), incomplete remission in 5(5.68%) patients and treatment failure in 2(2.27%) patients. 20(93.1%) patients with LBL achieved remission by Day-29, while 2 (0.02%) LBL patients died before the Day-29 assessment.&#x0D; Conclusion: The remission induction rates and mortality rates in our setup are encouraging and comparable to international data. Further improvements can be made by early management of the affected cases and more accessible pediatric oncology health services.

Widening Racial Disparities During COVID-19 Telemedicine Transition: A Study of Child Mental Health Services at Two Large Children’s Hospitals

To examine whether racial disparities in access to pediatric mental health care were affected during the COVID-19 telemedicine transition at both The Children's Hospital of Philadelphia (CHOP) and Boston Children's Hospital (BCH). Electronic health records were queried for all unique outpatient visits from a pre-pandemic period in 2019 and a within-pandemic period in 2020. Changes in the proportion of patients were compared based on insurance status, clinic location, and racial identification. Hypotheses were tested via logistic regression analyses. At CHOP, from 2019 to 2020, the proportion of racially minoritized patients significantly declined within a 1-month period from 62% to 51%, whereas the proportion of White-identifying patients increased from 38% to 49% (β= 0.47; z= 3.60; p=.0003), after controlling for insurance status and clinic location. At BCH, the proportion of racially minoritized patients significantly declined within a longer 6-month period between 2019 and 2020, from 62% to 59%, whereas the proportion of White-identifying patients increased from 38% to 41% (β= 0.13; z= 2.8; p= .006), after controlling for insurance status. At CHOP and BCH, the COVID-19 telemedicine transition exacerbated pre-existing racial disparities in pediatric mental health services. Our findings suggest that racially minoritized patients receiving services in urban areas may be particularly at risk for losing access when telemedicine is implemented. Although there are limitations to this racial dichotomization, examining differences between White and racially minoritized patients can highlight ways in which White-identifying individuals have disproportionately received enhanced access to healthcare resources.

Strategies and tools to aid the transition between paediatric and adult health services for young adults with neurodevelopmental disorders: a scoping review protocol

IntroductionThe transition from paediatric to adult healthcare comes with risk and vulnerability for young adults with neurodevelopmental disorders and their carers. Deficits in health, social and disability systems and the...

Finnish Population Study Yields New Way to Identify Youth at Risk for Serious Mental Illness

Finnish Population Study Yields New Way to Identify Youth at Risk for Serious Mental Illness

Feasibility of Screening Programs for Domestic Violence in Pediatric and Child and Adolescent Mental Health Services: A Literature Review.

Each year, 275 million children worldwide are exposed to domestic violence (DV) and suffer negative mental and physical health consequences; however, only a small proportion receive assistance. Pediatricians and child psychiatrists can play a central role in identifying threatened children. We reviewed experiences of DV screening in pediatric and child and adolescent mental health services (CAMHS) to understand its feasibility and provide clues for its implementation. We performed bibliographic research using the Sapienza Library System, PubMed, and the following databases: MEDLINE, American Psychological Association PsycArticles, American Psychological Association PsycInfo, ScienceDirect, and Scopus. We considered a 20-year interval when selecting the articles and we included studies published in English between January 2000 and March 2021. A total of 23 out of 2335 studies satisfied the inclusion criteria. We found that the prevalence of disclosed DV ranged from 4.2% to 48%, with most prevalence estimates between 10% and 20%. Disclosure increases with a detection plan, which is mostly welcomed by mothers (70–80% acceptance rates). Written tools were used in 55% of studies, oral interviews in 40%, and computer instruments in 20%. Mixed forms were used in three studies (15%). The most used and effective tool appeared to be the Conflict Tactics Scale (CTS) (30% of studies). For young children, parental reports are advisable and written instruments are the first preference; interviews can be conducted with older children. Our research pointed out that the current literature does not provide practical clinical clues on facilitating the disclosure in pediatric clinics and CAMHS. Further studies are needed on the inpatient population and in the field of children psychiatry.

Underrepresentation of Asians in pediatric health services research

Pediatric health services research is a multidisciplinary field aimed at improving the health of youth. It examines how factors, structures, and systems can be improved to deliver high-quality care to all youth and has the potential to eliminate health disparities. This comprises examinations of medical and cost effectiveness, clarification of health status concepts, modification of health services and delivery systems, and the evaluation of clinical procedures. Yet health and healthcare disparities in racially and ethnically minoritized youth remain pervasive and persistent, in large part due to the lack of representation and inclusion in health services research, including clinical trials. Indeed, a recent congressionally mandated report from the National Academies of Sciences (2022) called for the improved representation of racial and ethnic minoritized groups in health-related research and clinical trials (1). In a concerted effort to increase diversity and inclusion in pediatric clinical trials, beginning in 2022, Medicaid will provide coverage for routine costs associated with clinical trial participation.

Children's unmet need for mental health care within and outside metropolitan areas.

Rural communities experience a lack of pediatric mental health providers. It is unclear if this leads to greater unmet needs for specialty mental health services among rural children. Data from the 2016-2019 National Survey of Children's Health were used to identify children aged 6-17 years with a mental health condition. Caregiver-reported need and receipt of specialty mental health care for their child (met need, unmet need, or no need) was compared according to residence in a Metropolitan Statistical Area (MSA). The analysis included 13,021 children (14% living outside MSAs). Unmet need for mental health services was reported for 9% of children, with no difference by rural-urban residence (p=0.940). Multivariable analysis confirmed this finding and identified urban children as less likely to have no need for mental health services, compared to rural children (relative risk ratio of no need vs. met need: 0.79; 95% confidence interval: 0.65, 0.95; p=0.015). Children with mental health conditions living in rural areas (outside MSAs) did not have higher rates of unmet needs for specialty mental health services, but they had lower rates of any caregiver-reported needs for such services. Further work is needed to examine caregivers' demand for pediatric specialty mental health services.

Pediatric Clinical Classification System for use in Canadian inpatient settings.

A classification system that categorizes International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis codes into clinically meaningful categories is important for pediatric clinical and health services research using administrative data. While a Pediatric Clinical Classification System (PECCS) is available for the United States ICD-10 system (i.e, ICD-10-CM), differences in the ICD-10 system between countries limits PECCS use in Canada. To translate PECCS from ICD-10-CM to ICD-10-CA for use in Canada (PECCS-CA), and examine the utility of PECCS-CA in administrative data of pediatric hospital encounters in Ontario, Canada. PECCS was translated by mapping each ICD-10-CA code to its corresponding ICD-10-CM code, based on code description and alphanumeric code, using automated functions in Microsoft Excel. All unmatched ICD-10-CA codes were manually matched to an ICD-10-CM code. The ICD-10-CA codes were mapped to a PECCS category based on the placement of the corresponding ICD-10-CM code. Finally, in this cross-sectional study, the utility of PECCS-CA was examined in pediatric hospital encounters in children <18 years of age with an inpatient or same day surgery encounter, between April 1, 2014 to March 31, 2019 in Ontario. In total, 16,992 ICD-10-CA diagnosis codes were mapped to 781 mutually exclusive condition categories that included pediatric specific conditions and treatments in PECCS-CA. From the 781 categories, 777 (99.5%) were derived from the original PECCS, 3 (0.4%) from merging the original PECCS categories, and 1 (0.1%) was newly developed. The PECCS-CA was applied to health administrative data of 911,732 hospital encounters in children. The most prevalent condition in children was low birth weight (n = 54,100 encounters). The PECCS-CA is an open-source classification system which maps ICD-10-CA codes into 781 clinically important pediatric categories. The PECCS-CA can be used for pediatric health services and outcomes research in Canada.

Examining the Relationship Between Pediatric Behavioral Health and Parent Productivity Through a Parent-Reported Survey in the Time of COVID-19: Exploratory Study.

BackgroundPediatric behavioral health needs skyrocketed during the COVID-19 pandemic. Parents and caregivers lacked access to well-established tools to identify risk and protective factors while also experiencing decreased access to treatment options to meet their families’ behavioral health needs.ObjectiveThe aim of this study is to investigate the associations of known pediatric behavioral health risk factors and parents’ reports of workplace productivity.MethodsA clinical research team at Brightline—a virtual, pediatric behavioral health solution—drew on standardized instruments to create a survey designed to understand pediatric behavioral health conditions, child stress, and family resilience and connection during the COVID-19 pandemic. Multivariable linear regression was used to characterize the relationship between these variables and parents’ reports of workplace productivity.ResultsParticipants (N=361) completed the survey between October 2020 and November 2021. In the multivariable model, higher pediatric stress and time spent managing children’s behavioral health needs were associated with greater productivity loss among working parents, whereas higher family connection was associated with lower productivity loss. COVID-19 diagnoses among parents and dependents, financial impact of COVID-19 on households, and family resilience were not associated with parents’ workplace productivity.ConclusionsThis survey captured child stress, family connection, and productivity as reported by parents and caregivers during the COVID-19 pandemic. Exploratory studies are the first step in understanding the relationship between these variables. The results from this study can empower parents by providing insights to help manage their child’s behavioral health concerns and identify pediatric behavioral health services to aid working parents who are caregivers.

The impact of telephone consultations due to COVID-19 on paediatric neurosurgical health services.

PurposeThe aim of the study was to evaluate the role of telephone consultations due to the pandemic in the management of paediatric neurosurgical patients and, furthermore, to examine the proportion of patients who eventually needed a face-to-face appointment and assess the underline reasons for that.MethodsThis retrospective study included all the paediatric neurosurgical patients who had a telephone appointment during a 3-month lockdown period. Overall, 319 patients (186 males and 133 females) aged 8.36 ± 4.88 (mean ± SD) had a consultation via telephone. Two hundred fifty-one (78.7%) patients had a follow-up assessment and 68 (21.3%) were new appointments.ResultsPatients were divided between two main groups. Group A included 263 patients (82.4%) whose consultation was adequate via telephone, and Group B included 56 patients (17.6%) who required a complementary face-to-face appointment. Patients who were more likely to require a supplementary appointment were patients with either dysraphism or ventriculomegaly and benign enlarged subarachnoid spaces (BESS) (43.3% and 36.4%, respectively). Interestingly, most children with hydrocephalus who underwent a cerebrospinal fluid (CSF) diversion procedure and children with Chiari I malformation were appropriately assessed via telephone (85.1% and 83.3%, respectively). Finally, children aged < 2 years (55.2%) were better managed with face-to-face appointments. No difference was noticed regarding follow-up and new appointments.ConclusionAlthough telemedicine was not unknown to neurosurgical services, the actual application of telephone or video consultations remained quite limited. It was COVID-19 pandemic who reinforced the use of telemedicine, and taking into consideration its promising results, we can safely assume that it can be incorporated into neurosurgical health care even once the pandemic crisis has resolved.

Phantom Networks Prevent Children And Adolescents From Obtaining The Mental Health Care They Need.

In October 2021, the American Academy of Pediatrics and other groups declared a national emergency in child and adolescent mental health. Despite this, pediatric mental health services remain largely inaccessible for many families. A major factor contributing to the lack of access is phantom networks, which are insurance company rosters of in-network mental health providers who, in reality, don't see patients in the network. Phantom networks compound barriers to mental health care for children and adolescents. This is particularly problematic for youth, many of whom use Medicaid, who seek time-sensitive care for severe psychiatric conditions such as psychosis or suicidality. We call on US policy makers to support nationwide legislation that establishes high-quality oversight processes for in-network provider lists.

Changes and adaptations in a national specialist paediatric mental health service in response to Covid-19

Changes and adaptations in a national specialist paediatric mental health service in response to Covid-19

Developing groups in a paediatric psychology service: Centring the voices of children and young people.

There is growing evidence for the benefits of therapeutic groups for children and young people living with chronic health conditions. As a paediatric health service, we regularly run 12 different groups, most of which are informed by a Narrative Therapy approach, with new groups routinely created to respond to the changing needs of children and young people. In this paper, we describe how we have stayed connected to our vision and values in developing and delivering group interventions, sharing our process which integrates different methods of participation and involvement to ensure young people's voices are centred. We use three of our recently introduced groups to illustrate these ideas.