Evaluating Health-Related Quality of Life and School Attendance in a Multidisciplinary School Program for Youth with Significant Medical Needs.

Many youth with significant medical needs have difficulty attending traditional schools due to academic, physical, and psychosocial challenges. To meet the needs of these youth and prepare them for a successful transition to a traditional school, a multidisciplinary school program (MSP) provides support in these three domains. The aims of this program evaluation are to describe the operation of the novel MSP, characterize participants, and determine the impact of participation as related to school attendance and health-related quality of life (HRQoL). Attendance in the MSP was significantly higher than school attendance estimates provided by caregivers prior to participation in the program. Youth reported significant improvement in physical functioning and total HRQoL. Caregivers reported significant improvement in academic functioning and total HRQoL of youth. The MSP represents a unique educational model for youth with significant medical issues that also provides physical and psychosocial support. Initial findings highlight the potential positive impact of this model for this population of youth.

The Scarcity of Literature on the Psychological, Social, and Emotional Effects of Gastroparesis in Children.

Gastroparesis (GP) is a chronic, gastric dysmotility disorder with significant morbidity and mortality. The hallmark of GP is the delayed emptying of the contents of the stomach in the absence of any mechanical obstruction. Patients most commonly report chronic symptoms of nausea, vomiting, feeling full quickly when eating, bloating, and abdominal pain. Treatments are limited with relatively poor efficacy. As such, children with GP are at significant risk for the development of psychological co-morbidities. In this paper, we provide a topical review of the scientific literature on the psychological, social, and emotional impacts of gastroparesis in pediatric patients. We aim to document the current state of research, identify gaps in our knowledge with appropriate recommendations for future research directions, and highlight the unique challenges pediatric patients with GP and their families may face as they manage this disease. Based on the current review, research into the psychosocial impacts in children with GP is essentially non-existent. However, when considering research in children with other chronic digestive diseases, children with GP are likely to face multiple psychosocial challenges, including increased risk for anxiety and depression, stigma, and reduced quality of life. These significant gaps in the current understanding of effects of GP across domains of childhood functioning allow for ample opportunities for future studies to address psychosocial outcomes.

High Levels of Stress Due to the SARS-CoV-2 Pandemic among Parents of Children with and without Chronic Conditions across the USA.

BACKGROUND: The 2020 SARS-CoV-2 pandemic led to community-wide measures affecting parents and children such as school/daycare closures, job losses, and interruptions in medical care for children with chronic diseases. This is the first study to describe the level of stress and mental health of parents of either healthy children or children with chronic conditions, during the 2020 pandemic. METHODS: A representative sample of US parents was recruited from 10-17 April 2020. Parents completed online questionnaires about the past 7 days, including the Perceived Stress Scale, Resilient Coping Scale, Self-Efficacy Scale, Kansas Marital Satisfaction Scale, Parental Stress Scale, PROMIS Anxiety and Depression scales and various other pandemic-related stress questions Results: Levels of stressors (e.g., job loss, school closures, etc.) were high during this time (e.g., 79% of children attended home/online school) and parents reported being moderately to highly stressed. Rates of clinical anxiety (44.6%) and depression (42.2%) were high. Parents of children with chronic conditions reported higher levels of stress and worse mental health, but did not differ from other parents in dealing with stress or interruptions in work, child schooling, and marital satisfaction. DISCUSSION: The COVID-19 pandemic has introduced unprecedented levels of stress for parents, especially those of children with chronic conditions. Mental health effects are expected to continue for months/years and preparation is needed to meet an increasing demand for mental health care.

Anxiety and Depression in Eosinophilic Esophagitis: A Scoping Review and Recommendations for Future Research.

Eosinophilic esophagitis (EoE) is a rapidly emerging chronic disease with limited treatments. Impacting both children and adults, EoE and its treatments have the potential to significantly reduce psychological functioning, including increasing anxiety and depression. In this paper, we provide a scoping review of the scientific literature on anxiety and depression in both pediatric and adult patients. We aim to document the current state of research, identify knowledge gaps, recognize unique challenges that EoE patients may face as they relate to psychosocial function, and offer suggestions for future research directions. Based on the current review, both adult and pediatric patients with EoE are at risk for anxiety and depression symptoms, both due to the disease process and the prevailing dietary treatments. Significant gaps exist in the current understanding of anxiety and depression in EoE, providing ample opportunity for future studies to address this important issue.

African American inner-city youth exposed to violence: coping skills as a moderator for anxiety.

The current study examined types of coping as either protective or vulnerability factors for youth exposed to community violence in a sample of 240 inner-city, African American pre- and early adolescents across sixth and seventh grade. Coping was conceptualized within a contextually relevant framework. It was predicted that avoidant coping would interact with exposure to violence to predict reductions in anxiety, cross-sectionally and longitudinally, whereas approach coping was expected to interact with violence exposure to predict increases in anxiety. Youth and parents both reported on youth exposure to community violence and anxiety symptoms; youth provided self-reports of their coping strategies. Data were analyzed by using hierarchical multiple regression analyses. As predicted, avoidant coping showed a protective function on anxiety symptoms; contrary to predictions, approach coping was unrelated to anxiety. Implications for future research on contextually and culturally relevant coping are discussed.

The Role of Psychology in Pediatric Palliative Care.

Pediatric medicine increasingly has recognized the value of integrating behavioral health in medical care, but this trend has not yet extended to pediatric palliative care. Results from a recent survey of pediatric palliative care programs across the United States indicate that team composition almost never included a psychologist. This article presents a model of collaborative care to optimize the integration of psychosocial and medical aspects of treatment in pediatric palliative care, delineating how a psychologist adds to this model. This article argues that psychology brings specialized skills in assessment, intervention, and research that fit with the premise of palliative care as a holistic approach that relieves symptoms. Systematic inclusion of psychologists on pediatric palliative care teams may help to improve effectiveness of services as well as extend the knowledge base of mental health in pediatric palliative care.

Developing a pediatric palliative care service in a large urban hospital: challenges, lessons, and successes.

BACKGROUND AND AIM: We report the process of creating a new palliative care service at a large, urban children's hospital. Our aim was to provide a detailed guide to developing an inpatient consultation service, along with reporting on the challenges, lessons, and evaluation. METHODS: We examined the hiring process of personnel and marketing strategies, a clinical database facilitated ongoing quality review and identified trends, and a survey project assessed provider satisfaction and how referring physicians used the palliative care service. RESULTS AND CONCLUSION: The pilot phase of service delivery laid the groundwork for a more effective service by creating documentation templates and identifying relevant data to track growth and outcomes. It also allowed time to establish a clear delineation of team members and distinction of roles. The survey of referring physicians proved a useful evaluation starting point, but conclusions could not be generalized because of the low response rate. It may be necessary to reconsider the survey technique and to expand the sample to include patients and families. Future research is needed to measure the financial benefits of a well-staffed inpatient pediatric palliative care service.

Social support factors as moderators of community violence exposure among inner-city African American young adolescents.

Using both surveys and the experience sampling method (ESM), community violence exposure, social support factors, and depressive and anxiety symptoms were assessed longitudinally among inner-city African American adolescents. Moderator models were tested to determine protective factors for youth exposed to community violence. Several social support factors emerged as protective-stabilizing forces for witnesses of violence both cross-sectionally and longitudinally, including maternal closeness, time spent with family, social support, and daily support (ESM). Contrary to hypotheses, several social support factors demonstrated a promotive-reactive effect such that, in conditions of high victimization, they failed to protect youth from developing symptoms. Effects did not differ by outcome or sex, though sex differences in findings emerged. Protective-stabilizing effects occurred more for witnessing violence, whereas promotive-reactive patterns occurred more for victimization. Results affirm social support factors as protective from the adverse effects of violence exposure, but they also suggest that some factors typically conceived as contributing to resilience might at times fail to protect youth in conditions of extreme risk.