The relationship between integrated pediatric psychology and primary care visit length, revenue, content over 24 months.

Introduction: Integrating behavioral health providers into pediatric primary care to provide behavioral health (BH) services is both effective and efficient; however, the impact of pediatric integrated services on the operational and financial outcomes of primary care provider (PCP) visits has not been thoroughly investigated. The present study examined whether length of practice integration predicts the relationship between BH content addressed in a PCP visit, visit length, and revenue generation. Method: A total of 1,209 pediatric encounters with 25 PCPs across 7 primary care offices in a predominantly rural health system were abstracted for the presence or absence of BH content, visit length, duration of integration, and revenue. χ2 analyses and the generalized linear model framework were used to address the study objectives. Results: Integration was associated with more PCP visits with a BH topic discussed at 6-11 months of integration but not at 14-24 months. Visits with a BH topic were longer than medical-only visits and shorter when a practice was integrated for 6-11 months but not at 14-24 months of integration. Public insurance and integration were associated with lower revenue generation per minute. Visit content was not associated with PCP revenue. Discussion: Results suggest a relationship between integration and the operational and financial outcomes of PCP visits. This study shows that initial efficiencies or improvements (e.g., time, cost, content) associated with integrating BH may be lost over time. Future studies should evaluate sustainability in relation to program impact. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Annual Research Review: Ecological momentary assessment studies in child psychology and psychiatry.

BACKGROUND: Enhancements in mobile phone technology allow the study of children and adolescents' everyday lives like never before. Ecological momentary assessment (EMA) uses these advancements to allow in-depth measurements of links between context, behavior, and physiology in youths' everyday lives. FINDINGS: A large and diverse literature now exists on using EMA to study mental and behavioral health among youth. Modern EMA methods are built on a rich tradition of idiographic inquiry focused on the intensive study of individuals. Studies of child and adolescent mental and behavioral health have used EMA to characterize lived experience, document naturalistic within-person processes and individual differences in these processes, measure familiar constructs in novel ways, and examine temporal order and dynamics in youths' everyday lives. CONCLUSIONS: Ecological momentary assessment is feasible and reliable for studying the daily lives of youth. EMA can inform the development and augmentation of traditional and momentary intervention. Continued research and technological development in mobile intervention design and implementation, EMA-sensor integration, and complex real-time data analysis are needed to realize the potential of just-in-time adaptive intervention, which may allow researchers to reach high-risk youth with intervention content when and where it is needed most.

Perspectives on Monitoring Youth with Ongoing Mental Health Problems in Primary Health Care: Family Physicians Are "Out of the Loop".

Children's mental health (CMH) problems often recur. Following specialized mental health treatment, youth may require monitoring and follow-up. For these youth, primary health care is highly relevant, as family physicians (FPs) are the only professionals who follow patients across the lifespan. The current study gained multiple perspectives about (1) the role of FPs in caring for youth with ongoing/recurring CMH problems and (2) incorporating routine mental health monitoring into primary health care. A total of 33 interviews were conducted, including 10 youth (aged 12-15) receiving CMH care, 10 parents, 10 CMH providers, and 3 FPs. Using grounded theory methodology, a theme of FPs being "out of the loop" or not involved in their patient's CMH care emerged. Families perceived a focus on the medical model by their FPs and believed FPs lacked mental health expertise. Findings indicate a need for improved collaboration between CMH providers and FPs in caring for youth with ongoing CMH problems.

Replication and robustness in developmental research.

Replications and robustness checks are key elements of the scientific method and a staple in many disciplines. However, leading journals in developmental psychology rarely include explicit replications of prior research conducted by different investigators, and few require authors to establish in their articles or online appendices that their key results are robust across estimation methods, data sets, and demographic subgroups. This article makes the case for prioritizing both explicit replications and, especially, within-study robustness checks in developmental psychology. It provides evidence on variation in effect sizes in developmental studies and documents strikingly different replication and robustness-checking practices in a sample of journals in developmental psychology and a sister behavioral science-applied economics. Our goal is not to show that any one behavioral science has a monopoly on best practices, but rather to show how journals from a related discipline address vital concerns of replication and generalizability shared by all social and behavioral sciences. We provide recommendations for promoting graduate training in replication and robustness-checking methods and for editorial policies that encourage these practices. Although some of our recommendations may shift the form and substance of developmental research articles, we argue that they would generate considerable scientific benefits for the field. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Complejidad, conflicto armado y vulnerabilidad de niños y niñas desplazados en Colombia / Complexity, armed conflict, and vulnerability of displaced children in Colombia

Este trabajo tiene como objetivo realizar una reflexión acerca de la vulnerabilidad de los niños y niñas víctimas del conflicto armado en Colombia. Para ello se recurriro al principio de auto-eco-organización y de Bucle inter-retroactivo. La violencia es un fenómeno complejo de múltiples interacciones, de características no-lineales y tendencia auto-eco-organizativa que afecta la noción de sujeto y altera el modo como los niños y niñas interpretan el mundo y sus interacciones.

This paper aims to carry out a reflection on the vulnerability of children, who are victims of the armed conflict in Colombia. This was used at the beginning of the self-eco-organization and the inter-retroactive loop. Violence is a complex phenomenon of multiple interactions, non-linear features, and a self-eco-organizational tendency, which affects the notion of subject and alters the way that children interpret the world and their interactions.

Screening for feeding disorders. Creating critical values using the behavioural pediatrics feeding assessment scale.

The aim of the current study was to discriminate between clinical and non-clinical samples on the Behavioural Pediatrics Feeding Assessment Scale (BPFAS). The objective was to present a cut-off value, that was derived statistically, which could be used to screen for feeding disorders. A sample of five hundred and seventy-three families with a target child ranging in age from 20 to 85 months took part in the current study. Sixty-four children had a known diagnosis of a feeding disorder and were embedded into a typically developing sample of families that had not sought professional intervention. All families completed the BPFAS in order to provide a known database to measure discriminative statistics. The Receiver Operating Characteristic (ROC) analysis indicated that the cut off value for the BPFAS was a Child Frequency score of 61 and a Child Problem score of six. This offered an 87% accuracy rate at these values. The current study offered definitive evidence that the BPFAS was accurate (both sensitive and specific) to determine differences between clinical and non-clinical samples in the United Kingdom. It is therefore advocated that BPFAS should be adopted in future studies exploring the impact of feeding disorders and problems in both clinical and research settings.

Assessing resilience: a review of measures across the life course.

Through this systematic review the authors analyze scales used to measure resilience in individuals across the life course. The scales were obtained according to a priori inclusion criteria through searches using electronic databases, cited references, and requests to human services researchers currently engaged in research utilizing a resiliency theory framework. Eleven measurement tools meeting study inclusion criteria were located within the existing literature. Currently validated instruments measure specific populations and vary in length and format. The need for an analytical approach to measuring resilience is long overdue. This assessment is intended to aid social work practitioners working with populations that have faced adversity.

Construct validation of the Greek version of the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC).

BACKGROUND: The Children's Assessment of Participation and Enjoyment (CAPE) and the Preferences for Activities of Children (PAC) are 2 measures of children's participation in various activities. The purpose of this study was the validation of the Greek version of "CAPE & PAC." METHODS: The questionnaires were translated and pilot tested on a sample of 25 individuals. The reliability and validity of the questionnaires were tested on 302 individuals (253 typical population, 49 disabled), 6-21 years of age. The construct validity of the instruments was examined the directional hypothesis by comparing known groups with existing differences. An exploratory factor analysis was conducted to determine the validity of the typology of activities. The reliability was examined by checking the internal consistency of the instruments. RESULTS: The comparison between divergent groups confirmed the predicted differences of the mean scores and the validity of the instruments. Seven factors (categories of activities) emerged from the factor analysis. The acceptable range of Cronbach alpha for the PAC scale indicated high consistency. CONCLUSION: This study provides evidence that partially support the validity and reliability of "CAPE & PAC" instruments to use in Greek population. Further investigation is recommended for both clinical and research purposes.

Assessment of behavioral and emotional problems in infancy: a systematic review.

Behavioral and emotional problems are highly prevalent in early childhood and represent an important focus of practice for clinical child and pediatric psychologists. Although psychological or psychiatric disorders are not typically diagnosed in children under the age of 2 years, recent research has demonstrated the appropriateness of assessing behavioral and emotional problems during the first 2 years of life (defined throughout as "infancy"). The current paper provides a systematic review of assessment procedures used to identify behavioral and emotional problems during infancy. Existing assessment procedures for infants take the form of parent- or caregiver-report questionnaires, observational coding procedures, and diagnostic classification systems. The questionnaires and observational coding procedures both had substantial psychometric evidence for use with infants, although observational coding may have limited utility in clinical practice. The classification systems have less empirical support for use with infants, and further research is necessary to demonstrate the appropriateness of these procedures with infants. Utilizing the reviewed procedures to assess behavioral and emotional problems in infants can have a substantial impact in research and practice settings, and further research is needed to determine the usefulness of these procedures in developing, testing, and implementing preventive and early intervention programs for infants and their families.

Factor structure of self-regulation in preschoolers: testing models of a field-based assessment for predicting early school readiness.

The importance of early self-regulatory skill has seen increased focus in the applied research literature given the implications of these skills for early school success. A three-factor latent structure of self-regulation consisting of compliance, cool executive control, and hot executive control was tested against alternative models and retained as best fitting. Tests of model equivalence indicated that the model held invariant across Head Start and private child-care samples. Partial invariance was supported for age and gender. In the validity model, because of a substantial amount of shared variance among latent factors, we included a second-order factor explaining the two types of executive control. Higher order executive control positively predicted teacher report of learning behaviors and social competence in the classroom. These findings are discussed in light of their practical and theoretical significance.

Theoretical and statistical derivation of a screener for the behavioral assessment of executive functions in children.

The problem of valid measurement of psychological constructs remains an impediment to scientific progress, and the measurement of executive functions is not an exception. This study examined the statistical and theoretical derivation of a behavioral screener for the estimation of executive functions in children from the well-established Behavior Assessment System for Children (BASC). The original national standardization sample of the BASC-Teacher Rating Scales for children ages 6 through 11 was used (N = 2,165). Moderate-to-high internal consistency was obtained within each factor (.80-.89). A panel of experts was used for content validity examination. A confirmatory factor analysis model with 25 items loading on 4 latent factors (behavioral control, emotional control, attentional control, and problem solving) was developed, and its statistical properties were examined. The multidimensional model demonstrated adequate fit, and it was deemed invariant after configural, metric, and scalar measurement invariance tests across sex and age. Given its strong psychometric properties, with further tests of item validity, this instrument promises future clinical and research utility for the screening of executive functions in school-age children.

Rehabilitation and future participation of youth following spinal cord injury: caregiver perspectives.

STUDY DESIGN: Cross-sectional survey. OBJECTIVES: To examine caregivers' perspectives on the effectiveness of rehabilitative support experienced by youth with spinal cord injury (SCI) during acute rehabilitation and after community reintegration in terms of their community participation. SETTING: Data collection took place at the three Shriners SCI hospitals: Chicago, Philadelphia, and Northern California. METHODS: A total of 132 primary caregivers of youth with SCI completed a survey on what their child had experienced during and after rehabilitation to enhance their community participation. RESULTS: Caregivers found technical support from staff (41%), motivation and encouragement from staff (25%), and education (17%) to be the most important factors during rehabilitation for encouraging their child's future participation in school or community activities. Caregivers found involvement in activities (30%), personal resilience (22%) and interactions with others with disabilities (13%) to be important experiences since rehabilitation in terms of their child's participation in school and community activities. Caregivers who responded that something they experienced during rehabilitation was helpful to participation had children who had been injured longer and who were older at time of injury. In addition, caregivers who reported that something they have experienced since their child's rehabilitation has been helpful in terms of participation also had children who were older at time of injury. CONCLUSIONS: Findings from this study can be used to help professionals tailor rehabilitation programs to better meet the needs of youth with SCI and their families, thereby increasing chances of successful reintegration back into their communities.

Assessment of caring and its effects in young people: development of the Multidimensional Assessment of Caring Activities Checklist (MACA-YC18) and the Positive and Negative Outcomes of Caring Questionnaire (PANOC-YC20) for young carers.

BACKGROUND: Many children, adolescents and young people are involved in caring for parents, siblings, or other relatives who have an illness, disability, mental health problem or other need for care or supervision. The aim was to develop two new instruments for use in research with young carers to assess caring activities and their psychological effects. METHOD: Two studies are reported. In study 1, 410 young carers were recruited via The Princess Royal Trust for Carers database of UK projects and asked to complete an initial item pool of 42 and 75 questionnaire items to assess caring activities and caring outcomes respectively. In study 2 a further 124 young carers were recruited. RESULTS: Following exploratory principal components analysis in study 1, 18 items were chosen to compose the Multidimensional Assessment of Caring Activities Checklist (MACA-YC18), and 20 items chosen to compose the Positive and Negative Outcomes of Caring Scales (PANOC-YC20). In study 2, normative and convergent validity data on the two instruments are reported. CONCLUSION: The MACA-YC18 is an 18-item self-report measure that can be used to provide an index of the total amount of caring activity undertaken by the young person, as well as six sub-scale scores for domestic tasks, household management, personal care, emotional care, sibling care and financial/practical care. The PANOC-YC20 is a 20-item self-report measure that can be used to provide an index of positive and negative outcomes of caring.

Healthcare decisions: a review of children's involvement.

Children's rights, their ability to consent to treatment and their involvement in healthcare decisions have received considerable attention in recent years. There is some evidence to suggest that when children are involved in the decision-making process, they retain a sense of control over their situation. However there are still unresolved issues related to a child's right to decide and nurses may be confused about the extent to which children can and should be involved in decision-making. A code of practice for involving children in decisions was first suggested in 2001 and there is still a need for a consistent, structured and robust method of ensuring that children are included in the decision-making process at all stages of their health care.

Infant Mental Health assessment: the use of DC 0-3 in an outpatient child psychiatric clinic in Scandinavia.

The study focuses on Infant Mental Health data from an outpatient psychiatric clinic using the "Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood" (DC 0-3) and parental questionnaires, CBCL and ITSC. In total, 138 infants (aged 0-3) went through the diagnostic procedure. Sixty-eight per cent were diagnosed within Axis I, with regulatory disorder, disorder of affect and traumatic stress disorder being the most frequent diagnoses. In addition, 48% were classified as having a relationship disorder according to Axis II, with an additional 40% being considered to be at risk of developing a relationship disorder. The mothers' and fathers' ratings of their children's externalized and sensitivity problems were in agreement with the clinicians, but the ratings of internalized problems as well as relationship problems presented a more complex pattern.

Estudio epidemiológico de los trastornos del aprendizaje en escolares: en una consulta de neuropediatría / Epidemeologic study of learning disorders in a neuropediatric outpatient clinic

Los Trastornos del Aprendizaje (TA) son trastornos del desarrollo infantil que se manifiestan principalmente en dificultades para aprender, por lo tanto son inseparables del contexto escolar, socio-cultural y familiar en el que se presentan y constituyen motivos de consulta frecuentes. En algunos casos es posible determinar una patología o una alteración del desarrollo, pero en la mayoría de los casos, las condiciones familiares, escolares y socio-culturales originan su aparición o determinan su gravedad. Identificar y clasificar los trastornos del aprendizaje más frecuentes, su distribución por género, grupo de edad, antecedentes personales, académicos y socioculturales y su correlación clínica. Se desarrolló un estudio descriptivo, prospectivo y transversal, que buscó determinar la asociación de los principales antecedetes personales, académicos y socioculturales en niños de 7 a 12 años con trastornos de aprendizaje. Para la clasificación de los TA se utilizó el métodos DSM-IV. Se estudiaron 31 casos con edades comprendidas entre 9 y 11 años. Todos los casos fueron clasificados como del tipo inespecífico, con un alto índice de antecedentes perinatales asociados, con adecuadas oportunidades académicas y condiciones socioculturales deficientes. Los TA presentan una alta relación con familiares con TA. Los eventos perinatales juegan un papel importante como factor predisponente. Un adecuado desarrollo psicomotor y un examen neurológico normal no descartan su diagnóstico; generalmente no se identifican durante la preescolaridad y comúnmente están asociados a cambios de conducta.

Learning disorders are dysfunctions of childhood development that present mainly with learning difficulties. Therefore they are inseparable from the school, socio-cultural and family context and are frequent causes for pediatric consultation. In some cases it is possible to determine a underlying pathology or a development disorder, but in most cases their appearance and severity are conditioned by family, school and socio-cultural conditions. To identify and classify the most frequent learning dysfunctions, their distribution by gender, age, personal, academic and sociocultural history, and their clinical correlation. A descriptive, prospective and transverse study was developed to determine the association of the main personal, academic and sociocultural antecedents in children from 7 to 12 years with learning disorders. Classification was assessed with the DSM-IV method. 31 children with ages 9 to 11 were studied. All cases were classified as inespecific type according to the DSM-IV method, with a high index of associated perinatal events, appropriate academic opportunities and deficient sociocultural conditions. Learning disorders are frequently associated with a positive family history. Perinatal events play an important role as predisposing factor. An adequate psychomotor development and a normal neurological exam does not exclude its diagnosis, they are not generally identified during preschool yeras and are frequently associated with behavioral changes.

Contar histórias: uma proposta de avaliação assistida da narrativa infantil / Telling stories: a proposal of dynamic assessment of the children narrative

A linguagem tem um papel central na vida humana, contribuindo para o desenvolvimento de habilidades cognitivas e sociais. Entre as formas de avaliar o comportamento linguistico infantil, as narrativas têm sido empregadas por meio de atividades como descrever figuras e recontar histórias. A avaliação feita por procedimento assistido em que o avaliador auxilia a criança, após uma fase inicial sem ajuda, testando sem auxílio novamente ao final, tem se mostrado apropriada. Investigando este procedimento, esta pesquisa avaliou a narrativa de 10 crianças de ambos os sexos, com idade entre 5 e 7 anos, frequentando uma pré-escola pública de Vitória/ES. Foi utilizado um instrumento de avaliação e intervenção assistida da narrativa, o qual avalia aspectos da narração de histórias, por meio de 2 livros de histórias, com desenhos coloridos. Todas as crianças melhoraram a produtividade da história 1 para a história 2 em pelo menos um dos aspectos avaliados. Sobre os componentes, idéias e linguagem e estrutura da narrativa, destacam-se os componentes informação sobre as personagens (90 por cento) e complexidade do vocabulário (80 por cento)pelo percentual de melhora igual ou superior a 80 por cento. O instrumento mostrou-se adequado à avaliação da narrativa infantil, envolvendo a criança durante a aplicação

Language plays a key role in human life, contributing to the development of cognitive and social skills. Among the forms of evaluating the child linguistic behavior, the narratives have been used through activities such as describing illustrations and retelling stories. The evaluation, done by dynamic assessment – including help from the examiner during the process – has proved to be appropriate. Investigating this procedure, this research tested the application of dynamic testing of the narrative in 10 children of both genders, with age between 5 and 7 years, attending to a public preschool of Vitoria/ES. The instrument used evaluates aspects of the narration of stories, using two story books, with colored ilustrations. All the children improved the productivity of the story between the first and second story in at least one of the aspects evaluated. The components “Information about the characters” (90%) and “Complexity of the Vocabulary” (80%) presented an increase of 80% or more. The instrument was proved to be appropriate to the evaluation of the narrative of the children, motivating the child to participate.

Youth reactions to participation in psychological assessment procedures.

This study investigates self-reported positive and negative reactions of youth to psychological assessment procedures. A community sample (COM) reported reactions to completing a self-report questionnaire of negative emotional states. A clinical sample (CL) reported reactions both to completion of the questionnaire and to a clinical intake. Confirmatory factor analyses (CFAs) supported distinct, relatively independent positive and negative reactions for both samples. Participants reported significantly greater positive than negative reactions. Developmental and gender differences indicated that girls reported greater positive reactions than boys and that younger children reported greater positive and negative reactions than adolescents. The CL reported greater positive reactions to the clinical intake relative to completing the questionnaire. Discussion focuses on increasing understanding of youth reactions to psychological assessments and potential implications for research and clinical practice.