Seasonal Trends in Emergency Department Visits for Mental and Behavioral Health Conditions Among Children and Adolescents Aged 5-17 Years - United States, January 2018-June 2023.

Mental and behavioral health conditions among school-aged children, including substance use disorders and overall emotional well-being, are a public health concern in the United States. Timely data on seasonal patterns in child and adolescent conditions can guide optimal timing of prevention and intervention strategies. CDC examined emergency department (ED) visit data from the National Syndromic Surveillance Program for 25 distinct conditions during January 2018-June 2023 among U.S. children and adolescents aged 5-17 years, stratified by age group. Each year, during 2018-2023, among persons aged 10-14 and 15-17 years, the number and proportion of weekly ED visits for eight conditions increased in the fall school semester and remained elevated throughout the spring semester; ED visits were up to twice as high during school semesters compared with the summer period. Among children aged 5-9 years, the number and proportion of visits increased for five mental and behavioral health conditions. Seasonal increases in ED visits for some conditions among school-aged children warrant enhanced awareness about mental distress symptoms and the challenges and stressors in the school environment. Systemic changes that prioritize protective factors (e.g., physical activity; nutrition; sleep; social, community, or faith-based support; and inclusive school and community environments) and incorporate preparedness for increases in conditions during back-to-school planning might improve child and adolescent mental health.

Improving community-based mental health care for children: a commentary.

In their article, "Improving Community-Based Mental Health Care for Children," Garland and colleagues explore and confront quality issues that are endemic to outpatient specialty mental health care for children in the United States. Their article presents evidence supporting the lack of effectiveness of usual care and draws on implementation science to explore areas for improving the quality of outpatient mental health care for young people. This commentary accepts these basic arguments and strategies, explores policy options that support the suggested reforms, and examines evidence-based programs in a broader context that draws on the systems of care approach. Specific issues addressed in this commentary include workforce capacity, policy options for improving care quality, provider incentives, systematic implementation supports, strategies to incorporate evidence-based approaches into practice, youth-guided and family-driven care, and the need to expand the definition of evidence-based practice to include the concepts of community-defined evidence and practice-based evidence.

Correlates of perceived care comfort with an EMS professional having a legal conviction.

OBJECTIVES: The first objective was to examine the outcome of how comfortable a potential EMS-caller would be receiving care from an out-of-hospital-care EMS professional who might have a legal conviction. A second objective was to test for correlates that would explain this outcome. METHODS: In the autumn of 2010, a structured phone survey was conducted. To maximize geographical representation across the contiguous United States, a clustered, stratified sampling strategy was used based upon US Postal Service zip codes. RESULTS: Of the 2,443 phone calls made, 1,051 (43%) full survey responses were obtained. Data cleaning efforts reduced the total to 929 in the final model regression analysis. Results revealed significant public discomfort in receiving care from EMS professionals who may have such a conviction. In addition, respondents who are less educated and older more strongly (1) agree that EMS professionals should have their licenses revoked for wrong doing; (2) agree EMS professionals should be screened before being hired; (3) perceive EMS credentials to be important; (4) support a lawsuit for improper care; and (5) are collectively less comfortable with being cared for by an EMS professional who may have a legal conviction. Reliable scales were found for future research use. CONCLUSION: There is significant public discomfort in receiving care from EMS professionals who may have a legal conviction. The results of this study provide increased impetus for the careful screening of EMS professionals before they are hired or allowed to be volunteers. Beyond this due diligence, the results serve as a reminder for increased EMS provider awareness of the importance of exhibiting professionalism when dealing with the public.

Sustaining and expanding systems of care to provide mental health services for children, youth and families across America.

The Substance Abuse and Mental Health Services Administration has been instrumental in supporting the development and implementation of systems of care to provide services to children and youth with serious mental health conditions and their families. Since 1993, 173 grants have been awarded to communities in all 50 states, Puerto Rico, Guam, the District of Columbia, and 21 American Indian/Alaska Native communities. The system of care principles of creating comprehensive, individualized services, family-driven and youth-guided care and cultural and linguistic competence, supported by a well-trained and competent workforce, have been successful in transforming the field of children's mental health and facilitating the integration of child-serving systems. This approach has achieved positive outcomes at the child and family, practice and system levels, and numerous articles have been published using data collected from system of care communities, demonstrating the effectiveness of this framework. This article will describe lessons learned from implementing the system of care approach, and will discuss the importance of expanding and sustaining systems of care across the country.

The Building Bridges Initiative: residential and community-based providers, families, and youth coming together to improve outcomes.

The Building Bridges Initiative (BBI) provides a framework for achieving positive outcomes for youth and families served in residential and community programs. Founded on core principles, an emerging evidence base, and acknowledged best practices, the BBI emphasizes collaboration and coordination between providers, families, youth, advocates, and policymakers to achieve its aims. Examples are presented of successful state, community, and provider practice changes, and available tools and resources to support all constituencies in achieving positive outcomes.

Testing for correlates of intent to leave one's job versus intent to leave one's occupation among cancer registrars.

The present investigation involved a field study of cancer registrars (CRs), who collect data used by the National Cancer Institute and the Centers for Disease Control and Prevention to study trends in cancer incidence and outcomes. Because of the forecasted shortage of CRs due to the aging of the CR workforce, the professional organization of CRs needed to research the factors related to the recruitment and retention of this workforce. From a national database of 3,393 CRs, data regarding intent to leave one's job and occupation, along with occupational commitment, were obtained from a sample of 374 CRs to meet this research need. The focus of this field study was to assess patterns of association between the correlates of "intent to leave" variables, including measures of job satisfaction and occupational commitment. Results showed that satisfaction with job rewards, interpersonal relations, and fringe benefits had a stronger negative relationship to intent to leave one's job compared with intent to leave one's occupation. Affective and normative occupational commitment facets had a stronger negative relationship to intent to leave one's occupation compared with intent to leave one's job. Beyond demographic control and perceptual variables, these attitudinal job satisfaction and occupational commitment variables together explained the greatest amount of variance in both "intent to leave" measures.

Exploring relationships to three types of occupation perceptions: forced to stay in occupation, voluntary occupation withdrawal intent, and involuntary occupation withdrawal.

This study explored the relationships of demographic, work perception, work attitude, and limited occupation alternative variables to three distinct types of occupation perceptions: forced to stay in occupation (FTSO), voluntary occupation withdrawal intent (VOWI), and involuntary occupation withdrawal (IOW). An online sample of massage therapists and bodywork practitioners constituted the study sample. Hierarchical regression analyses for each occupation perception utilized slightly different sample sizes (i.e., FTSO, n = 1,982; VOWI, n = 2,039; IOW, n = 2,028) to test the study hypotheses. Regression results suggested some differential correlates for each perception, including the following: education level was negatively related to FTSO whereas occupation identification was positively related to FTSO, realistic expectations were negatively related to VOWI, and years in practice was positively related to IOW. Perceived limited occupational alternatives were positively related to FTSO but negatively related to VOWI. There were also common correlates across these perceptions. For example, work exhaustion had a positive relationship to FTSO, VOWI, and IOW. Affective occupational commitment was positively related to FTSO but negatively related to VOWI and IOW. Social desirability response bias had a consistently negative but minimal impact on these occupation perceptions. Despite acknowledged limitations, this study is unique in comparing such occupation perceptions and hopefully will stimulate additional research using other allied health samples.

Exploring professional-related outcome differences between phlebotomy technicians, medical laboratory technicians, and medical technologists.

As part of a large scale practice analysis on Phlebotomy Technicians (PBTs), Medical Laboratory Technicians (MLTs), and Medical Technologists (MTs), additional data on four "home made measures" of professional-related outcomes, i.e., professional development, quality assurance monitoring, employer reimbursement, and types of continuing education, were also collected. In order to maximize data use from the overall sample of 3,097 respondents (constituting only 18% of the population surveyed), pairwise deletion of data was utilized. No a priori differences between PBTs, MLTs and MTs on these outcomes were hypothesized, and none were found for professional development and employer reimbursement. The finding that PBTs were lower than MLTs and MTs on quality assurance monitoring was interpreted as being job expected. Despite the study limitations, professional development for not just laboratory professionals but all allied health professionals remains an important recruitment and retention issue, as demand for all health services is expected to increase.

Outcomes of a randomized trial of continuum of care services for children in a child welfare system.

The Connecticut Department of Children and Families Title IV-E waiver demonstration evaluated whether the well-being of children approved for residential mental health services could be improved, and lengths of stay in restrictive placements reduced, by providing case rate payments to community agencies to provide continuum of care services. Children between ages 7 and 15 were randomly assigned to either the demonstration group (n = 78) or to usual state-supported services (n = 79). One-year outcome results indicated that in a situation that is less costly, improvement in outcomes occurred in less restrictive settings. Continuum of care services were more effective in 1) returning children to in-home placements, 2) reducing the length of stay in restrictive placements, and (3) utilizing higher levels of case management through coordination among agencies and family support services.

Further testing the impact of shift schedule on task scale variables for medical laboratory professionals.

Using a broader sample of medical laboratory professionals, this study extended prior work by Blau and Lunz testing the impact of shift schedule on task scales. Overall the results supported the study hypothesis-i.e., medical laboratory professionals on a fixed day shift have lower job content routinization (higher task enrichment) than fixed evening and night and rotating shifts. Future research issues and study limitations are briefly discussed.

Task scales performed and testing for scale differences among phlebotomy technicians, medical laboratory technicians, and medical technologists.

A large-scale practice analysis was undertaken by the American Society for Clinical Pathology Board of Registry to help maintain the validity of its certification examinations. The complete data sample of 1152 practicing phlebotomy technicians, medical laboratory technicians, and medical technologists was found to be demographically representative of the overall sample of 3097 respondents. The first study goal was to identify reliable task scales performed by phlebotomy technicians, medical laboratory technicians, and medical technologists. Thirty-eight task scales were initially found. Second, discriminant analysis was used to predict membership in one of these certification groups based on a more parsimonious combination of task scales. Task scale distinctions among phlebotomy technicians, medical laboratory technicians, and medical technologists were found. Study implications and limitations are discussed.

Evidence-based treatments in the field: a brief report on provider knowledge, implementation, and practice.

This study examined familiarity, perceived effectiveness, and implementation of evidence-based treatments for children in community settings. A sample of service providers in agencies affiliated with federal programs to improve children's mental health services was identified using a snowball sampling procedure. Forty-four percent of the sample (n = 616) responded to a Web-based survey designed to collect data on evidence-based treatments. High familiarity with, relatively high-perceived effectiveness, and generally high use of evidence-based treatments were reported. Partial implementation of treatment protocols within the context of few agency mandates and widely ranging supports for the implementation of evidence-based treatments was found. Results support the inclusion of more complex models of diffusion, dissemination and implementation in research, and development efforts for evidence-based treatments.

A brief note on further investigating correlates of work exhaustion for medical technologists.

Using a sample of 184 medical technologists (MTs) over a three-year period, this study found support for the hypothesis that downsizing leads to higher job loss insecurity and task load perceptions, which both lead to increased work exhaustion. As such this study extends previous research on MT work exhaustion by Blau, Tatum and Ward-Cook. Study limitations and future research issues are briefly discussed.

Testing a measure of cyberloafing.

Using a primary sample of medical technologists (MTs) and a second validation sample, the results of this study showed initial support for a three-factor measure of cyberloafing. The three scales were labeled browsing-related, non-work-related e-mail, and interactive cyberloafing. MTs who perceived unfair treatment in their organization (i.e., lower organizational justice) were more likely to exhibit all three types of cyberloafing. MTs who did not care as much about punctuality and attendance (i.e., higher time abuse) were more likely to display browsing-related and non-work-related e-mail cyberloafing. Finally, MTs who perceived an inability to control their work environment (i.e., powerlessness) were more likely to display interactive cyberloafing. Study limitations and suggestions for future research are discussed.

Testing for the impact of correlates on medical technologists' intent to leave their jobs.

This study used a sample of 209 repeat-respondent medical technologists over a 4-year period to investigate correlates of intent to leave one's job. Correlates measured included two job search behaviors (i.e., preparatory and active) and three job search motives (i.e., gain leverage, leave employer, and family related). Results showed that active job search and the leave employer job search motives were each positively related to final intent to leave one's job. The gain leverage job search motive was negatively related to final intent to leave one's job. In addition, job satisfaction was negatively related, while only initial job loss insecurity was positively related, to final intent to leave one's job.

Exploring the impact of certification activity, years of laboratory experience, highest degree held, occupational commitment, and job loss insecurity on intent to leave occupation for medical technologists.

This study used a sample of 205 repeat-respondent medical technologists over a 3-year period to explore the impact of certification activity, years of laboratory experience, highest degree held, occupational commitment, and job loss insecurity on intent to leave occupation. Results showed that 3-year certification activity was related to lower intent to leave the occupation and that it accounted for significant variance in explaining intent to leave the occupation beyond all other controlled-for variables. Implications for health care organizations hiring certified medical laboratory professionals or sponsoring the certification of current staff are briefly discussed.

Why do Emergency Medical Services (EMS) Professionals Leave EMS?

OBJECTIVE: The objective was to determine why Emergency Medical Technician (EMT)-Basics and Paramedics leave the Emergency Medical Services (EMS) workforce. METHODS: Data were collected through annual surveys of nationally registered EMT-Basics and Paramedics from 1999 to 2008. Survey items dealing with satisfaction with the EMS profession, likelihood of leaving the profession, and likelihood of leaving their EMS job were assessed for both EMT-Basics and Paramedics, along with reasons for leaving the profession. Individuals whose responses indicated that they were not working in EMS were mailed a special exit survey to determine the reasons for leaving EMS. RESULTS: The likelihood of leaving the profession in the next year was low for both EMT-Basics and Paramedics. Although overall satisfaction levels with the profession were high, EMT-Basics were significantly more satisfied than Paramedics. The most important reasons for leaving the profession were choosing to pursue further education and moving to a new location. A desire for better pay and benefits was a significantly more important reason for EMT-Paramedics' exit decisions than for EMT-Basics. CONCLUSIONS: Given the anticipated increased demand for EMS professionals in the next decade, continued study of issues associated with retention is strongly recommended. Some specific recommendations and suggestions for promoting retention are provided. Blau G , Chapman SA . Why do Emergency Medical Services (EMS) professionals leave EMS? Prehosp Disaster Med. 2016;31(Suppl. 1):s105-s111.

Social connectedness and life satisfaction: Comparing mean levels for 2 undergraduate samples and testing for improvement based on brief counseling.

OBJECTIVES: Comparing the mean levels of social connectedness and life satisfaction, and analyzing their relationship for 2 undergraduate samples, and testing for an increase in their means for a brief counseling sample. PARTICIPANTS: Between October 2013 and May 2015, 3 samples were collected: not-in-counseling (NIC; n = 941), initial counseling session (ICS; ie, triage session only; n = 168), and brief counseling (BC; ie, median of 4 additional counseling sessions; n = 28). METHODS: Online surveys measuring demographic and background control variables, social connectedness, and life satisfaction. RESULTS: NIC students exhibited higher social connectedness and life satisfaction than ICS students. Social connectedness significantly explained life satisfaction beyond controlled-for variables for both samples. There was a significant increase in social connectedness and life satisfaction for the BC sample. CONCLUSIONS: Social connectedness is an important antecedent of life satisfaction for undergraduates. Brief counseling can increase transition students' social connectedness and life satisfaction.

SAFE Homes: is it worth the cost? An evaluation of a group home permanency planning program for children who first enter out-of-home care.

OBJECTIVE: To evaluate the SAFE Homes (SH) program, a short-term group care program for children between 3 and 12 years of age who enter care for the first time. The program aims to improve case outcomes by consolidating resources to facilitate assessment and treatment planning. METHODS: The 1-year outcomes of 342 children who received SAFE Home services and 342 matched foster care (FC) control children were compared. The 684 subjects used in this report were selected from a larger pool of 909 subjects using propensity score matching to control for hidden bias in treatment group assignment. We hypothesized that SAFE Homes would result in greater continuity of care for children (e.g., fewer placements, more placements with siblings and in towns of origin), identification of more relatives for substitute care when needed, reduced use of high-cost restrictive care settings (e.g., residential, inpatient), and reduced rates of re-abuse through earlier detection and provision of services to meet child and family treatment needs. RESULTS: Prior to the initiation of the SAFE Homes program, 75% of the children who entered care in the State experienced three or more placements in the first year. The outcomes of both the SH and FC cases were significantly improved over pre-SAFE Home State statistics. The FC group, however, had comparable or better outcomes on most variables examined. In addition, the total cost for out-of-home care for the children in FC was significantly less, despite the fact that the two groups spent similar amounts of time in care (average time in care: 7 months). This finding held when the total placement cost was calculated using the State reimbursement rate of 206.00 US dollars per day for SAFE Home care (SH: 20,851 US dollars +/- 24,231 US dollars; FC: 8,441 US dollars +/- 21,126 US dollars, p < .001), and a conservative SAFE Home program fee of 85.00 US dollars per day that only considered the child care and custodial staffing costs uniquely associated with the program (SH: 13,314 US dollars +/- 21,718 US dollars; FC: 8,441 US dollars +/-21,126 US dollars, p < .001). CONCLUSION: Improvements in outcomes related to continuity of care can be attained through staff training. The SAFE Home model of care is not cost-effective for first-time placements.