RESUMO
OBJECTIVE: This study is a non-randomized pragmatic trial to assess the feasibility and acceptability of the Primary Care Intervention for Posttraumatic stress disorder (PCIP) (Srivastava et al., 2021), an Integrated Behavioral Health Care treatment for PTSD in adolescents. METHOD: Following routine clinic procedures, youth who were suspected of having trauma-related mental health symptoms were referred by their primary care providers to integrated care social workers for evaluation. The integrated care social workers referred the first 23 youth whom they suspected of having PTSD to the research study. Twenty youth consented to the study and 19 completed the pre-assessment (17 female; mean age = 19.32, SD = 2.11; range 14-22 years). More than 40% identified as Black and a third as Hispanic/Latinx. PCIP mechanisms and clinical outcomes were assessed pre- and post-treatment, and at one-month follow-up. Participants and therapists completed post-treatment qualitative interviews to assess feasibility and acceptability, and treatment sessions were audio recorded to assess fidelity. RESULTS: Findings suggest high acceptability, satisfaction, and feasibility of the PCIP delivered in "real-life" safety net pediatric primary care. Integrated care social workers had high treatment fidelity. Despite the small sample size, there was significant improvement in symptom scores of anxiety (g = 0.68, p = 0.02) and substance use (g = 0.36, p = 0.04) from pre to post, and depression symptoms (g = 0.38, p = 0.04) from pre to follow-up. Qualitative data from patients who completed exit interviews and integrated social workers indicated high satisfaction with the treatment, with some participants reporting that the integrated intervention was more acceptable and less stigmatizing than seeking mental health care outside of primary care. CONCLUSIONS: The PCIP may improve treatment engagement and access for vulnerable youth. Promising findings of high acceptability, feasibility, and initial clinical effectiveness suggest that PCIP warrants larger-scale study as part of routine care in pediatric integrated care.
Assuntos
Transtornos de Estresse Pós-Traumáticos , Humanos , Feminino , Adolescente , Criança , Adulto Jovem , Adulto , Transtornos de Estresse Pós-Traumáticos/terapia , Estudos de Viabilidade , Serviços de Saúde , Transtornos de Ansiedade , Atenção Primária à SaúdeRESUMO
BACKGROUND: Almost 80% of adolescents in the US have experienced a traumatic event, and approximately 7% have post-traumatic stress disorder. However, there is a lack of validated and feasible assessments for assessing traumatic stress symptoms in pediatric primary care, and traumatic stress symptoms are routinely unidentified. This study aimed to develop, pilot test, and assess the psychometric properties of the Adolescent Primary Care Traumatic Stress Screen (APCTSS), a five-item yes/no screener for post-traumatic stress symptoms in adolescents designed for use in pediatric primary care. METHODS: The APCTSS was developed by pediatricians, psychiatrists, psychologists, and social workers who all provide care to trauma-affected adolescent patients. The providers sought to create a developmentally appropriate tool that accurately reflected DSM-5 posttraumatic stress symptoms and that was feasible and acceptable for use in pediatric primary care. To develop the APCTSS, they combined and adapted the UCLA Post-traumatic Stress Disorder (PTSD) Reaction Index for DSM-5 with the adult Primary Care PTSD Screen for DSM-5. Next, 213 adolescent medicine patients were universally approached during routine clinic visits and 178 agreed to participate and were enrolled. The 178 patients were aged 13-22 (M=18.4, SD=2.3), 64.4% female; 62.1% Black or African-American, and 20.7% Hispanic/Latinx. Patients completed APCTSS, Patient Health Questionnaire for Adolescents (PHQ-A), and the Child PTSD Symptom Scale for DSM-5 Interview (CPSS-5-I), and 61 completed the Traumatic Events Screening Inventory for Children (TESI-C). RESULTS: 56.7% reported a criterion A trauma, 30.1% met criteria for DSM-5 PTSD, 7.4% met criteria for subsyndromal PTSD symptoms, and 19.0% for post-event impairing symptoms. Validity and reliability testing indicated that the APCTSS was internally consistent, had good concurrent and discriminant validity, and demonstrated good sensitivity and specificity in identifying adolescents at high risk for post-trauma symptoms. Over half of patients (56.0%) who screened positive on the APCTSS (score ≥2) would not have been identified as having a mental health concern using the PHQ-A, including 60.8% of patients who had probable PTSD, subsyndromal PTSD, or post-event impairing symptoms. CONCLUSIONS: Many youth with trauma-related mental health symptoms are unidentified in pediatric primary care, which is a missed opportunity for early identification and may contribute to a host of poor outcomes. The development of an effective and feasible traumatic stress screening tool for youth primary care may improve early intervention, and the health and well-being of trauma affected youth.
RESUMO
STUDY OBJECTIVE: To assess attendance of an initial follow-up visit after long-acting reversible contraception (LARC) insertion and whether follow-up was associated with a higher likelihood of method continuation in adolescents and young adults (AYAs). DESIGN: Retrospective chart review including patients receiving LARC (etonogestrel 68 mg implant, levonorgestrel 52 mg intrauterine device, or copper intrauterine device) between January 1, 2014, and August 1, 2017. SETTING: An urban adolescent center providing primary care and reproductive health services. PARTICIPANTS: A total of 331 patients 13-28 years of age. INTERVENTIONS: Attendance of a follow-up visit 4-8 weeks after LARC insertion. MAIN OUTCOME MEASURES: Follow-up was defined as visits addressing LARC method or routine physical examinations in the adolescent center or affiliated school-based health clinics. Continuation and discontinuation were defined as documented presence or removal, respectively, of device at various time points. Descriptive analyses, χ2 test, Fisher exact test, t test, and survival analysis were used. RESULTS: Approximately one-third (29.3%) of the patients attended a follow-up visit. Follow-up was associated with a higher likelihood of LARC removal in the first year (hazard ratio [HR] = 2.10, 95% confidence interval [CI] 1.33-3.32). At 500 days post-insertion and beyond, there was no difference in LARC continuation between AYAs who followed-up and those who did not (HR = 1.07, 95% CI 0.67-1.71). CONCLUSION: Few AYAs attended an initial follow-up visit after LARC placement. These visits were associated with an increased likelihood of LARC removal in the first year; however, this association was not observed long term. More information is needed to determine how to approach follow-up this population.
Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Contracepção Reversível de Longo Prazo/métodos , Visita a Consultório Médico/estatística & dados numéricos , Adolescente , Estudos de Casos e Controles , Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepcionais Femininos/administração & dosagem , Desogestrel/administração & dosagem , Feminino , Humanos , Dispositivos Intrauterinos , Levanogestrel/administração & dosagem , Cooperação do Paciente , Estudos RetrospectivosRESUMO
STUDY OBJECTIVE: Sexual minority women are more likely than heterosexual peers to have a teen pregnancy, though little is known about origins of this disparity. Our objective was to describe teen pregnancy experiences among sexual minority women and elucidate potential risk factors. DESIGN: As a part of the SexuaL Orientation, Gender Identity, and Pregnancy Experiences (SLOPE) study, in-depth semistructured interviews and surveys were conducted. SETTING: Across the United States. PARTICIPANTS: Interviews were conducted with 10 sexual minority cisgender women, ages 21-66 years, who experienced a teen pregnancy. MAIN OUTCOME MEASURES: Interview transcripts were analyzed using immersion/crystallization and template organizing style approaches. The themes were contextualized using survey data and organized into a conceptual model. RESULTS AND CONCLUSION: Participants first became pregnant between ages 12 and 19 years; all pregnancies were described as unintentional. Half of the pregnancies resulted from sexual assault. Most of the remaining pregnancies resulted from consensual sex with a boyfriend or regular partner with whom the participant reported inconsistent or no contraceptive use. Five primary themes emerged from participants' interviews: (1) sexuality; (2) life history and contextual factors before pregnancy; (3) abuse and assault; (4) reactions to the pregnancy; and (5) pregnancy outcomes. Future research should assess each theme to explore its contribution to the higher burden of teen pregnancies among sexual minority compared with heterosexual women; such data can inform public health prevention campaigns and evidenced-based curricula for health care providers who care for adolescents.
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Gravidez na Adolescência/psicologia , Minorias Sexuais e de Gênero/psicologia , Adolescente , Adulto , Experiências Adversas da Infância , Idoso , Criança , Maus-Tratos Infantis/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Gravidez não Planejada , Pesquisa Qualitativa , Fatores de Risco , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
Adolescents experience some of the highest rates of unintended pregnancy among women of all reproductive age groups. And despite the fact that adolescents often receive care in pediatric hospital settings, evaluation of pregnancy risk is inconsistent. Pregnancy risk assessments can identify opportunities to deliver reproductive health services, allow earlier pregnancy diagnoses, and reduce morbidity and mortality for medically complex adolescent patients and their pregnancies. In this commentary we discuss some of the challenges and potential solutions to performing pregnancy risk assessments in pediatric hospital settings.
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Gravidez não Planejada , Medição de Risco , Adolescente , Feminino , Hospitais Pediátricos , Humanos , Gravidez , Testes de GravidezRESUMO
PURPOSE: To identify provider and practice characteristics associated with long-acting reversible contraception (LARC, either progesterone contraceptive implants or intrauterine devices [IUDs]) provision among adolescent health care providers. METHODS: We used data from a previously conducted survey of US providers on reproductive health to predict provision of any form of LARC as well as progesterone contraceptive implants or IUDs specifically using Chi-square and multivariate logistic regressions. RESULTS: One third of providers reported any LARC provision. In logistic regressions, residency training in obstetrics/gynecology or family medicine (rather than internal medicine/pediatrics) was the strongest predictor of LARC provision, particularly for IUDs. CONCLUSIONS: A minority of providers reported offering IUDs or contraceptive implants, most of whom had received procedural women's health training. Increasing the number of providers offering this type of contraception may help to prevent adolescent pregnancies and may be most easily accomplished via training in contraceptive implant provision.
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Pessoal de Saúde , Acessibilidade aos Serviços de Saúde , Dispositivos Intrauterinos Medicados , Gravidez na Adolescência/prevenção & controle , Adolescente , Adulto , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Gravidez , Progesterona , Estados Unidos , Adulto JovemRESUMO
PURPOSE: Adolescents are at high risk for unintended pregnancy and abortion. The purpose of this study was to understand whether providers caring for adolescents have the knowledge to counsel accurately on medication abortion, a suitable option for many teenagers seeking to terminate a pregnancy. METHODS: Using an online questionnaire, a survey related to medication abortion was administered to U.S. providers in the Society for Adolescent Health and Medicine. We conducted χ(2) analyses to evaluate the knowledge of medication abortion by reported adolescent medicine fellowship training, and to compare responses to specific knowledge questions by medication abortion counseling. Furthermore, we examined the relationship between providers' self-assessed and actual knowledge using ANOVA. RESULTS: We surveyed 797 providers, with a 54% response rate. Almost 25% of respondents incorrectly believed that medication abortion was not very safe, 40% misidentified that it was < 95% effective, and 32% did not select the correct maximum recommended gestational age (7-9 weeks). Providers had difficulty identifying that serious complications of medication abortion are rare. Those who counseled on medication abortion had more accurate information in all knowledge categories, except for expected outcomes. Medication abortion knowledge did not differ by adolescent medicine fellowship completion. Only 32% of respondents had very good knowledge, and self-assessed knowledge minimally predicted actual knowledge (r(2) = .08). CONCLUSIONS: Knowledge regarding medication abortion safety, effectiveness, expected outcomes, and complications is suboptimal even among adolescent medicine fellowship trained physicians, and self-assessment poorly predicts actual knowledge. To ensure pregnant teenagers receive accurate counseling on all options, adolescent medicine providers need better education on medication abortion.
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Abortivos/uso terapêutico , Aborto Induzido , Medicina do Adolescente/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Abortivos/efeitos adversos , Aborto Induzido/efeitos adversos , Aborto Induzido/métodos , Aborto Induzido/psicologia , Adolescente , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Inquéritos e Questionários , Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Adolescents are at high risk of unintended pregnancy due to contraceptive nonuse and inconsistent use. STUDY DESIGN: We examined associations between contraception and mistimed/unwanted birth among adolescents. For contraceptive nonusers, we analyzed factors contributing to unintended birth. RESULTS: Half of adolescents with unintended births did not use contraception at conception. Those ambivalent about pregnancy reported fewer unwanted [relative risk (RR)=0.06] compared to wanted births. Amongst contraceptive nonusers, difficulty accessing birth control was the only factor associated with more unwanted birth (RR=3.05). For Black adolescents, concerns of side effects (RR=7.03), access issues (RR=10.95) and perceived sterility (RR=3.20) were associated with unwanted birth. For younger teens, falsely perceived subfertility increased unwanted birth (RR=2.74), whereas access issues were significant for older teens (RR=3.97). CONCLUSIONS: Access issues and misconceptions around contraceptive side effects and fertility place adolescents at higher risk for unintended pregnancy, especially among younger and Black teens. Ambivalence represents an additional area for intervention.
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Comportamento do Adolescente , Comportamento Contraceptivo , Nascido Vivo/psicologia , Gravidez na Adolescência/psicologia , Gravidez não Desejada/psicologia , Adolescente , Comportamento do Adolescente/etnologia , Negro ou Afro-Americano/psicologia , Fatores Etários , Anticoncepção/efeitos adversos , Anticoncepção/psicologia , Comportamento Contraceptivo/etnologia , Feminino , Seguimentos , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Acessibilidade aos Serviços de Saúde , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/psicologia , Educação de Pacientes como Assunto , Vigilância da População , Gravidez , Gravidez na Adolescência/etnologia , Gravidez na Adolescência/prevenção & controle , Gravidez não Desejada/etnologia , Estudos Retrospectivos , Autorrelato , Estados UnidosRESUMO
PURPOSE: Legislation that restricts abortion access decreases abortion. It is less well understood whether these statutes affect unintended birth. Given recent increases in teen pregnancy and birth, we examined the relationship between legislation that restricts abortion access and unintended births among adolescent women. METHODS: Using 2000-2005 Pregnancy Risk Assessment Monitoring System data, we examined the relationship between adolescent pregnancy intention and policies affecting abortion access: mandatory waiting periods, parental involvement laws, and Medicaid funding restrictions. Logistic regression controlled for individual characteristics, state-level factors, geographic regions, and time trends. Subgroup analyses were done for racial, ethnic, and insurance groups. RESULTS: In our multivariate model, minors in states with mandatory waiting periods were more than two times as likely to report an unintended birth, with even higher risk among blacks, Hispanics, and teens receiving Medicaid. Medicaid funding restrictions were associated with higher rates of unwanted birth among black teens. Parental involvement laws were associated with a trend toward more unwanted births in white minors and fewer in Hispanic minors. CONCLUSIONS: Mandatory waiting periods are associated with higher rates of unintended birth in teens, and funding restrictions may especially affect black adolescents. Policies limiting access to abortion appear to affect the outcomes of unintended teen pregnancy. Subsequent research should clarify the magnitude of such effects, and lead to policy changes that successfully reduce unintended teen births.