Management of High Acuity Patients in Pediatric Medical Settings: The Role of Consultation/Liaison Psychologists During the Growing Mental Health Crisis.

Since the onset of the COVID-19 pandemic, consultation/liaison (C/L) psychologists had to drastically shift their practices to care for psychiatrically acute pediatric patients admitted to medical settings. The aim of the current study was to provide an updated state of the field surrounding these changes and their implications for clinical practice. Psychologists and psychology post-doctoral fellows completed an anonymous, 51-item survey distributed via a national professional organization listserv. The results review responses, by percentages, about C/L team composition and practice patterns, as they relate to suicide risk assessments, transfers to inpatient psychiatric and other levels of care, intervention for boarding patients, and disposition and safety planning. Thematically coded qualitative responses regarding impact and management of high acuity patients are also summarized. The state of the field outlined by this survey suggests an increase in C/L assessments and interventions delivered to pediatric patients with acute psychiatric needs, as well as a reverberating effects on provider wellness. Ensuring providers establish competency for this subset of patients is vital to the continued provision of optimal patient care and to sustained provider wellness. Considerations for the field are explored.

Universal and Trauma-Specific Care Suggestions for Pediatric Primary Care Settings.

Trauma exposure and other adverse life events are common experiences among youth and present long-standing mental and physical health consequences. Given the ongoing lack of sufficient mental health services, pediatricians play a critical role in supporting trauma-exposed youth. We propose both universal precaution and trauma-specific strategies for pediatric primary care settings. Universal interventions include recommendations to make health care systems more trauma-informed, reduce trauma or re-traumatization in the medical setting, eliminate potential bias, and focus on a strengths-based approach to support diverse youth and families. Trauma-specific strategies include screening for trauma-related symptomatology and risk stratification to link youth to appropriate levels of care. Specific assessment tools, resources, and materials are provided. [Pediatr Ann. 2023;52(11):e418-e421.].

Profiles of Suicidal Ideation Among Black Male Adolescents: Examination of Individual and Socioecological Predictors.

OBJECTIVE: The current study utilized latent profile analysis to identify distinct profiles of suicidal ideation among Black male adolescents and compared profiles on socioecological determinants of suicide and psychological symptoms. METHOD: A sample of 457 Black male adolescents (mean age = 15.31, SD = 1.26) completed self-report measures of suicidal ideation, racial discrimination, community violence exposure, anxiety symptoms, depressive symptoms, and posttraumatic stress symptoms. RESULTS: Results of the latent profile analysis revealed a three-profile model: a low ideation profile, with low levels of all forms of suicidal ideation; a general death ideation profile with elevated general thoughts of death and dying; and a high, concealed ideation profile with high levels on all suicidal ideation items, except communicating the ideation to others. ANOVAs revealed that levels of psychological symptoms were significantly different for each profile, with the high, concealed ideation profile showing the highest levels. The low ideation profile had significantly lower scores than the two other profiles on community violence exposure, but the other two profiles did not differ significantly from one another. Further, the general death ideation profile had significantly higher scores on racial discrimination than the other two profiles, but the other two profiles did not differ significantly from one another. CONCLUSIONS: The current study supports recent socio-cultural theories of suicidal ideation and behavior in Black youth and highlights the need for increased access to care and services for Black boys who are exposed to socioecological factors that heighten suicidal ideation.

Changes in Gatekeeper Beliefs Following ASIST and Relation to Subsequent Gatekeeper Suicide Prevention Behaviors.

This study examines relations between suicide prevention gatekeeper beliefs and actual helping behaviors following participation in Applied Suicide Intervention Skills Training (ASIST). Participants (n = 434) completed measures examining suicide-related beliefs and behaviors using a naturalistic pre-post design. All beliefs demonstrated significant change from pre- to posttest. Regression analyses indicate that beliefs about perceived barriers to action and the controllability of suicide predicted identification of high-risk youth; perceived barriers to action were also negatively related to helping responses and referrals 6-9 months post training. Self-efficacy was not related to suicide prevention behaviors at follow-up. The importance of anchoring training curriculums and measurement to health behavior change theories is discussed.

A Scoping Review of Associations Between Cannabis Use and Anxiety in Adolescents and Young Adults.

Cannabis and anxiety are both rising issues that impact young people. This review seeks to explore the association between anxiety and cannabis in adolescents and young adults (AYA). A database search was run retrospectively from July 2020 through calendar year 2013. Articles had to present outcomes examining cannabis use and symptoms of anxiety, be written in English, contain samples with ≥ 50% who are age 25 or younger, and be published in a peer-reviewed journal. Forty-seven studies were identified that examined the relationship between anxiety and cannabis use. Twenty-three studies found a positive association that greater anxiety among AYA was associated with greater cannabis use. In contrast, seven studies found a negative association that greater anxiety was related to less cannabis use. And finally, 17 studies found no clear association between anxiety and cannabis use. Further research is needed to better understand the relationship between anxiety and cannabis use.

Identifying Bereavement-Related Markers of Mental and Behavioral Health Problems Among Clinic-Referred Adolescents.

Objective: This study examined bereavement-related risk markers (number of deaths, cause of death, and relationship to deceased) of mental and behavioral health problems (suicidal thoughts or behaviors, self-injury, depression, posttraumatic stress, and substance use) in a national sample of clinic-referred bereaved adolescents. Method: Participants included 1281 bereaved youth aged 12-21 years (M=15, SD=1.8; 62.1% female), from the National Child Traumatic Stress Network Core Data Set. Results: Generalized linear mixed-effects regression models controlling for demographics and other traumas revealed that youth bereaved by multiple deaths had higher posttraumatic stress scores than youth bereaved by a single death (Estimated difference ±SE=3.36 ± 1.11, p=0.003). Youth bereaved by suicide were more likely to report experiencing suicidal thoughts or behaviors (AOR=1.68, p=0.049) and alcohol use (AOR=2.33, p<0.001) than youth bereaved by natural causes. Youth bereaved by homicide were at greater risk for substance use than youth bereaved by natural death (AOR=1.76, p=0.02). Compared to parentally bereaved youth, youth who lost a peer were more likely to use alcohol (AOR=2.32, p=0.02) or other substances (AOR=2.41, p=0.01); in contrast, parentally bereaved youth were more likely to experience depression compared to those who experienced the death of an adult relative or unrelated adult (range of AOR: 0.40 to 0.64, p-values<0.05). Conclusion: These bereavement-related contextual factors can serve as early markers of mental and behavioral health problems among bereaved youth.

The Prevalence and Longitudinal Patterns of Continuous Community Violence Exposure and Trauma-Related Symptoms in Adolescent Male Serious Offenders.

The current study examined the longitudinal patterns of continuous exposure to community violence (ECV) and associated symptoms in serious adolescent male offenders. Using data from the Pathways to Desistance Study (Schubert et al., 2004), the current study examined the prevalence of continuous ECV and the stability in exposure over a 3-year period in 1,170 adolescent male offenders (M age at baseline = 16.05 years, SD = 1.15). The results revealed variability in adolescent offenders' ECV and trauma-related symptoms. A latent class analysis identified three classes of participants at each time point: "witnessed with hostility," "dually exposed [i.e., high probability of both witnessing and victimization] with anxiety and hostility," and "no/low exposure with anxiety and hostility." Participants in the witnessed with hostility class reported more baseline ECV than those in the other classes, ds = 0.62-1.37, and more violent offenses than those in the dually exposed with anxiety and hostility class, d = 0.48. In addition, participants in the witnessed with hostility class were older, d = 0.10, and reported more violent offenses at baseline, d = 0.07, than those in the no/low exposure class; however, participants in the no/low exposure class reported spending more time in secure settings with no community access than those in the witnessed with hostility class, d = 0.20. A latent transition analysis over a 3-year period revealed relatively high stability in ECV and trauma-related symptoms over time, with a large proportion of participants remaining in the same violence and trauma class at each transition.

Hopelessness and Delinquent Behavior as Predictors of Community Violence Exposure in Ethnic Minority Male Adolescent Offenders.

Justice-involved boys from urban communities are disproportionately impacted by community violence exposure (ECV) and despite decades of research, rates of ECV in youth continue to increase particularly for youth involved in the juvenile justice system. Despite the increased risk of exposure, the majority of research focuses on what may protect youth from the deleterious outcomes associated with violence exposure, rather than strategies that may prevent the violence exposure from occurring. The current study seeks to shift the focus of research in this area to examining factors that may predict future violence exposure. Specifically, the purpose of the current study is to examine the role of hopelessness as a predictor of the risk for violence exposure in a sample of 831 justice-involved, urban boys ages 14-18 (52.2% African American, 42.1% Hispanic, 5.7% other). Results revealed that baseline levels of low aspirations and hopelessness towards the future indirectly predicted violence exposure 1 year later through engagement in delinquent behavior. Clinical implications for targeting youth with elevated risk and preventing future violence exposure are discussed.

Out of the Mouths of Babes: Links Between Linguistic Structure of Loss Narratives and Psychosocial Functioning in Parentally Bereaved Children.

This study examined links between the language bereaved children use to describe the death of their caregiver and children's psychological/behavioral functioning and coping strategies. Participants included 44 children (54.5% male) aged 7 to 12 (M = 9.05) years who were bereaved by the death of a caregiver. Children were assessed via self- and caregiver-report measures and an in-person interview regarding the loss of their caregiver. Children's loss narratives gathered through in-person interviews were transcribed and subjected to textual analysis. Linguistic categories included pronouns and verb tense. Drawing from linguistic and self-distancing theories, we hypothesized that children's use of language reflecting self-distancing (third-person pronouns and past tense) or social connectedness (first-person plural pronouns) would be negatively associated with psychological/behavioral distress and avoidant coping. Similarly, we expected that children's use of self-focused language (first-person singular pronouns and present tense) would be positively associated with psychological/behavioral distress and avoidant coping. As hypothesized, preliminary findings suggest that children who employed more self-distancing language and used more social connectedness words reported less avoidant coping, rs = .40-.42. Also as hypothesized, children who employed more self-focused language had higher levels of self-reported posttraumatic stress symptoms, r = .54, and avoidant coping, r = .54, and higher parent-reported psychological/behavioral distress, r = .43. Implications for theory-building, risk screening, and directions for future research with bereaved youth are discussed.

Validation of the Persistent Complex Bereavement Disorder (PCBD) Checklist: A Developmentally Informed Assessment Tool for Bereaved Youth.

The inclusion of Persistent Complex Bereavement Disorder (PCBD) in the DSM-5 appendix signifies a call for research regarding the distinguishing features and clinical utility of proposed PCBD criteria. Rigorously constructed tools for assessing PCBD are lacking, especially for youth. This study evaluated the validity and clinical utility of the PCBD Checklist, a 39-item measure designed to assess PCBD criteria in youth aged 8 to18 years. Test construction procedures involved: (a) reviewing the literature regarding developmental manifestations of proposed criteria, (b) creating a developmentally informed item pool, (c) surveying an expert panel to evaluate the clarity and developmental appropriateness of candidate items, (d) conducting focus groups to evaluate the comprehensibility and acceptability of items, and (e) evaluating psychometric properties in 367 bereaved youth (Mage = 13.49, 55.0% female). The panel, clinicians, and youth provided favorable content validity and comprehensibility ratings for candidate items. As hypothesized, youth who met full PCBD criteria, Criterion B (e.g., preoccupation with the deceased and/or circumstances of the death), or Criterion C (e.g., reactive distress and/or social/identity disruption) reported higher posttraumatic stress and depressive symptoms than youth who did not meet these criteria, ηp2 = .07-.16. Youth who met Criterion C reported greater functional impairment than youth who did not, ηp2 = .08-.12. Youth who qualified for the "traumatic bereavement specifier" reported more frequent posttraumatic stress symptoms than youth who did not, ηp2 = .04. Findings support the convergent, discriminant, and discriminant-groups validity, developmental appropriateness, and clinical utility of the PCBD Checklist.

Identification, Response, and Referral of Suicidal Youth Following Applied Suicide Intervention Skills Training.

Gatekeeper training is a public health approach to suicide prevention that encourages community members to identify those at risk for suicide, respond appropriately, and refer for clinical services. Despite widespread use, few studies have examined whether training results in behavior change in participants. This study employed a naturalistic pre-post design to follow 434 participants in Applied Suicide Intervention Skills Training, finding small but significant increases in self-reported identification of at-risk youth, some helpful responses to youth, and numbers of youth referred to treatment from pre-test to 6- to 9-month follow-up. Changes in active listening and helping behaviors meant to support treatment referrals (such as convincing a youth to seek treatment) were not observed over time. Additional analyses explored predictors of self-reported skill utilization including identification as a "natural helper" and attitudes about suicide prevention.

Connectedness to family, school, peers, and community in socially vulnerable adolescents.

Youth who feel connected to people and institutions in their communities may be buffered from other risk factors in their lives. As a result, increasing connectedness has been recommended as a prevention strategy. In this study, we examined connectedness among 224 youth (ages 12-15), recruited from an urban medical emergency department, who were at elevated risk due to bullying perpetration or victimization, or low social connectedness. Regression analyses examined multiple domains of connectedness (family, school, peer, community) in relation to adjustment. Youth who felt more connected to parents reported lower levels of depressive symptoms, suicidal ideation, non-suicidal self-injury, and conduct problems, higher self-esteem and more adaptive use of free time. Youth who felt more connected to their school reported lower levels of depressive symptoms, suicidal ideation, social anxiety, and sexual activity, as well as higher levels of self-esteem and more adaptive use of free time. Community connectedness was associated with less social anxiety but more sexual activity, and peer connectedness was not related to youth adjustment in this unique sample. Findings suggest that family and school connectedness may buffer youth on a trajectory of risk, and may therefore be important potential targets for early intervention services.

Quantifying 'normal' shoulder muscle activity during abduction.

The purpose of this experiment was to obtain electromyographic (EMG) activity from a sample of healthy shoulders to allow a reference database to be developed and used for comparison with pathological shoulders. Temporal and intensity shoulder muscle activation characteristics during a coronal plane abduction/adduction movement were evaluated in the dominant healthy shoulder of 24 subjects. Surface and intramuscular fine wire electrodes recorded EMG activity from 15 shoulder muscles (deltoid x 3, trapezius x 3, subscapularis x 2, latissimus dorsi, pectoralis major, pectoralis minor, supraspinatus, infraspinatus, serratus anterior and rhomboids) at 2000 Hz for 10s whilst each subject performed 10 dynamic coronal plane abduction/adduction movements from 0 degrees to 166 degrees to 0 degrees with a light dumbbell. Results revealed that supraspinatus (-.102 s before movement onset) initiated the movement with middle trapezius (-.019 s) and middle deltoid (-.014 s) also activated before the movement onset. Similar patterns were also found in the time of peak amplitude and %MVC with a pattern emerging where the prime movers (supraspinatus and middle deltoid) were among the first to reach peak amplitude or display the highest %MVC values. In conclusion, the most reproducible patterns of activation arose from the more prime mover muscle sites in all EMG variables analysed and although variability was present, there emerged 'invariant characteristics' that were considered 'normal' for this group of non pathological shoulders. The authors believe that the methodology and certain parts of the analysis in this study can be duplicated and used by future researchers who require a reference database of muscle activity for use as a control group in comparisons to their respective pathological shoulder group.