Community-based screening and triage connecting First Nations children and youth to local supports: a cross-sectional study.

BACKGROUND: First Nations children in Canada experience health inequities. We aimed to determine whether a self-report health app identified children's needs for support earlier in their illness than would typically occur. METHODS: Children (aged 8 to 18 yr) were recruited from a rural First Nation community. Children completed the Aaniish Naa Gegii: the Children's Health and Well-being Measure (ACHWM) and then met with a local mental health worker who determined their risk status. ACHWM Emotional Quadrant Scores (EQS) were compared between 3 groups of children: healthy peers (HP) who were not at risk, those with newly identified needs (NIN) who were at risk and not previously identified, and a typical treatment (TT) group who were at risk and already receiving support. RESULTS: We included 227 children (57.1% girls), and the mean age was 12.9 (standard deviation [SD] 2.9) years. The 134 children in the HP group had a mean EQS of 80.1 (SD 11.25), the 35 children in the NIN group had a mean EQS of 67.2 (SD 13.27) and the 58 children in the TT group had a mean EQS of 66.2 (SD 16.30). The HP group had significantly better EQS than the NIN and TT groups (p < 0.001). The EQS did not differ between the NIN and TT groups (p = 0.8). INTERPRETATION: The ACHWM screening process identified needs for support among 35 children, and the associated triage process connected them to local services; the similarity of EQS in the NIN and TT groups highlights the value of community screening to optimize access to services. Future research will examine the impact of this process over the subsequent year in these groups.

A screening mechanism to recognize and support at-risk Aboriginal children.

OBJECTIVES: The Aboriginal Children's Health and Well-Being Measure© (ACHWM) was developed to assess health from the perspectives of Aboriginal children. The purpose of this paper is to document the screening process, embedded within the ACHWM, and assess its effectiveness. METHODS: The ACHWM was implemented in 2014/2015 with children 8 to 18 years of age living on the Wiikwemkoong Unceded Territory. Survey responses were screened to identify potential risk, using an automated algorithm run on computer tablets. Local mental health workers conducted brief mental health assessments to identify and support children at-risk. Data were analyzed to estimate effectiveness of this screening process. RESULTS: A total of 293 children completed the ACHWM. The screening tool identified 35% with potential risk. Mental health workers confirmed 18% of all participants as being at-risk, and all were referred for support. The sensitivity of the tool was 75% while specificity was 79%. Improvements to the screening algorithm resulted in a specificity of 97% and negative predictive value of 95%, with no loss of sensitivity. CONCLUSION: Responsible population health surveys require a process to recognize and respond to answers indicative of health risks. This paper provides an example of a screening and triage process that enabled our survey team to screen responses in real time, respond to potential risk immediately, and connect participants to local support services. This process proved essential to conducting an ethical survey. The high specificity and negative predictive value make it an effective triage tool that is particularly valuable in Aboriginal communities and with higher-risk populations.

Is pressure stressful? The impact of pressure on the stress response and category learning.

We examined the basic question of whether pressure is stressful. We proposed that when examining the role of stress or pressure in cognitive performance, it is important to consider the type of pressure, the stress response, and the aspect of cognition assessed. In Experiment 1, outcome pressure was not experienced as stressful but did lead to impaired performance on a rule-based (RB) category-learning task, but not on a more procedural information-integration (II) task. In Experiment 2, the addition of monitoring pressure resulted in a modest stress response to combined pressure and impairment on both tasks. Across experiments, higher stress appraisals were associated with decreased performance on the RB, but not on the II, task. In turn, higher stress reactivity (i.e., heart rate) was associated with enhanced performance on the II, but not on the RB, task. This work represents an initial step toward integrating the stress cognition and pressure cognition literatures and suggests that integrating these fields may require consideration of the type of pressure, the stress response, and the cognitive system mediating performance.

When trying hard isn't natural: women's belonging with and motivation for male-dominated STEM fields as a function of effort expenditure concerns.

Feeling like one exerts more effort than others may influence women's feelings of belonging with science, technology, engineering, and math (STEM) and impede their motivation. In Study 1, women STEM graduate students perceived they exerted more effort than peers to succeed. For women, but not men, this effort expenditure perception predicted a decreased sense of belonging, which in turn decreased motivation. Study 2 tested whether the male-dominated status of a field triggers such effort expectations. We created a fictional "eco-psychology" graduate program, which when depicted as male-dominated resulted in women expecting to exert relatively more effort and decreased their interest in pursuing the field. Study 3 found emphasizing effort as expected (and normal) to achieve success elevated women's feelings of belonging and future motivation. Results suggest effort expenditure perceptions are an indicator women use to assess their fit in STEM. Implications for enhancing women's participation in STEM are discussed.