The impact of integrating behavioral health services into pediatric subspecialty care: A systematic review.

Pediatric gastroenterology patients are at risk for co-occurring behavioral health concerns, such as depression and anxiety, compared with youth without medical conditions. The objective of this systematic review was to assess the scientific literature supporting the hypothesis that integrating behavioral health services into gastroenterology clinics could improve patient psychosocial well-being. We searched MEDLINE, EMBASE, The Cochrane Library, Web of Science, PsycINFO, and CINAHL databases and gray literature to identify studies reporting the impact of behavioral health integration on the psychosocial well-being of pediatric gastroenterology patients. Two independent coders evaluated each study for inclusion and extracted data regarding patient demographics, study design, behavioral health integration approaches, and psychosocial outcomes. Results were synthesized using narrative review procedures. Eighteen studies met the inclusion criteria. Most reported outcomes from research grant-funded randomized controlled trials or open trials investigating behavioral health interventions based on Cognitive-Behavioral Therapy, primarily with youth with irritable bowel disease or functional gastrointestinal disorders. Within the highest-quality, comparable studies, nearly 80% reported at least one statistically significant treatment effect on patient psychosocial well-being. Many studies used rigorous methods that minimize bias, but did not provide models for sustainable, programmatic behavioral health integration outside the bounds of a research study. The studies included in this review suggest that behavioral integration could have the potential to positively impact gastroenterology patients' psychosocial functioning. However, more research is needed to investigate the appropriate intensity of behavioral health services and evaluate models for integrating behavioral healthcare in pediatric gastroenterology settings beyond the research-funded clinical trial context.

Randomized pilot trial of praise text messages to improve medication adherence among adolescents and young adults with liver transplants.

BACKGROUND: AYA who have undergone liver transplantations often struggle to adhere to their post-transplant immunosuppressant medications, which can lead to serious health complications. The objective of this pilot study is to examine the acceptability and feasibility of a brief mobile health (mHealth) intervention and its impact on medication adherence among AYA liver transplant recipients. METHODS: Thirty-five AYAs (13-21 years old) were randomized to either (1) receive praise text messages whenever laboratory results indicated immunosuppressant medications within the expected range or (2) usual care. Motivation for adherence and adherence were assessed via self-report, and a MLVI was calculated based on values abstracted from the electronic health record. RESULTS: Multilevel, multivariate models showed significant associations between group assignment and some self-reported motivation and adherence outcomes but not MLVI. Specifically, AYA receiving the praise text messages were significantly more likely to report taking their prescribed doses (OR = 2.49, p = .03), taking their medicine according to the directions (OR = 2.39, p = .04), and being highly confident in taking their medication (OR = 2.46, p = .04), compared with the usual services group. Qualitative responses indicated praise texts were mostly helpful but could be improved. CONCLUSIONS: The results suggest texting patients about positive health indicators was acceptable and, with refinement, might promote AYA illness self-management.

Perspective-Taking and Empathy Mitigate Family-of-Origin Risk for Electronic Aggression Perpetration Toward Dating Partners: A Brief Report.

Electronic dating aggression among emerging adults is prevalent and has adverse consequences, yet factors that increase or decrease the risk for perpetrating electronic aggression against a romantic partner are understudied. This investigation advances the literature in two novel ways. First, based on intergenerational transmission of violence theories, we tested the link between family-of-origin aggression (FOA) history and electronic aggression toward romantic partners, using a diverse sample of emerging adults. Second, we examined whether perspective-taking and empathy each moderated the association between FOA and electronic dating aggression and explored the moderating role of gender. Participants included 359 undergraduate students (50% female; 42% White) from an urban university. Results indicated that greater FOA during childhood was associated with perpetrating greater electronic aggression against romantic partners. Furthermore, significant interactions indicated that perspective-taking and empathy separately buffered these associations. Youth from aggressive families did not exhibit increased electronic dating perpetration when they had higher perspective-taking or empathy. Males were especially sensitive to the protective effects of perspective-taking. Findings highlight potential points of intervention (i.e., cognitive and affective empathy training) to decrease electronic aggression in romantic relationships and break intergenerational cycles of aggression.