Adolescent Suicide Risk Screening: A Secondary Analysis of the SHIELD Randomized Clinical Trial.

OBJECTIVE: To evaluate the effectiveness of adolescent suicide risk screening to increase initiation of mental health services via a secondary analysis using data from the SHIELD (Screening in High Schools to Identify, Evaluate and Lower Depression) randomized clinical trial, which evaluated school-based screening for major depressive disorder (MDD). STUDY DESIGN: Students in 14 Pennsylvania high schools were randomized by grade to either the usual school practice of targeted referral for behavior raising a concern for suicide risk or universal screening using the Patient Health Questionnaire-9 (PHQ-9), with any response >0 to item 9 regarding suicide risk considered positive. Students identified in either arm were referred to the Student Assistance Program (SAP), which is mandated in all Pennsylvania schools. The SAP determined follow-up. Study groups were compared using mixed-effects logistic regression. RESULTS: The participants comprised 12 909 students, with 6473 (50.1%) randomized to universal screening. The study group was 46% female and 43% Hispanic or non-Hispanic Black. Adolescents in the universal screening arm had 7.1-fold greater odds (95% CI, 5.7-8.8) of being identified as at risk for suicide, 7.8-fold greater odds (95% CI, 4.6-13.1) of follow-up needs, and 4.0-fold greater odds (95% CI, 2.0-7.9) of initiating mental health treatment. CONCLUSIONS: Although the PHQ-9 is a MDD screening tool, its use in universal screening increased identification and treatment initiation for adolescents at risk for suicide. This confirms the value of universal screening and suggests that a suicide-specific risk assessment would have even greater impact on treatment initiation for identified youth. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03716869.

The association between state-based provisional attendance periods and adolescent middle school-entry vaccination coverage.

The rise of vaccine-preventable disease outbreaks calls for a deeper understanding of the impact of policy on school-entry vaccine compliance. Provisional attendance policies vary by state but permit under-vaccinated students a limited period to attend school while receiving their immunizations. The primary objective of this study was to clarify the relationship between annual immunization coverage and state provisional policies for a single-dose of school-entry-required adolescent vaccinations: tetanus, diphtheria, pertussis (Tdap), meningococcal conjugate (MCV4), and human papillomavirus (HPV). From June 22, 2020 to August 20, 2020, the Immunization Action Coalition and state-level Department of Health (DOH) webpages were reviewed with email confirmation with a DOH representative to determine provisional period policy. Vaccination coverage for Tdap, MCV4, and HPV were obtained from the Center for Disease Control's National Immunization Survey. Overall, 49 states and D.C. legally mandate exclusion of vaccine noncompliant adolescents, and the majority of jurisdictions assign responsibility for exclusion to local school officials (84%). Complete provisional period data was obtained for 46/51 jurisdictions. The effect of provisional period length categorized as 0 days (18 jurisdictions, 35.3%), 1 to 30 days (18 jurisdictions, 35.3%), 31+ days (10 jurisdictions, 19.6%), and "unclear" (5 jurisdictions with incomplete data, 9.8%) had no significant association with annual adolescent vaccination coverage for Tdap (p = 0.82), MCV4 (p = 0.08), and HPV (p = 0.76). Provisional policies may not increase vaccination coverage as anticipated. Unintended consequences, such as increased nonmedical exemptions and increased demands on clinical providers, are additional factors to consider.

"I wouldn't even know what to do," Adolescent and Parent Perspectives on Identifying, Understanding, and Seeking Help for Adolescent Depression.

Within the context of a randomized clinical trial (RCT) of school-based depression screening, the study objective was to understand parent and adolescent perspectives on school-based depression screening and barriers to help-seeking for adolescent depression. From May-Nov. 2019, separate focus groups were held with adolescents (8 groups, n = 52) and parents (6 groups, n = 36). Two coders individually coded 20% of transcripts to establish interrater reliability (adolescent k = 0.76 and parent k = 0.80). Remaining transcripts were then separately coded and reviewed to develop three themes: (1) Both recognized depression as a serious issue that needed to be addressed in schools, but had confidentiality and communication concerns; (2) Both parents and adolescents believed the majority of adolescents would seek help with depression from friends more than any other source; and (3) Neither adolescents nor parents could clearly describe steps to take if their peers (adolescents) or adolescents (parents) were depressed. We intend to address identified barriers and concerns in the context of the larger RCT.

School Nurse Perspectives on COVID-19.

Pennsylvania responded to the COVID-19 pandemic by closing schools and moving to online instruction in March 2020. We surveyed Pennsylvania school nurses (N = 350) in May 2020 to assess the impact of COVID-19 on nurses' concerns about returning to school and impact on practice. Data were analyzed using χ2 tests and regression analyses. Urban school nurses were more concerned about returning to the school building without a COVID-19 vaccine than rural nurses (OR = 1.58, 95% CI [1.05, 2.38]). Nurses in urban locales were more likely to report being asked for guidance on COVID-19 (OR = 1.69, 95% CI [1.06, 2.68]), modify communication practices (OR = 2.33, 95% CI [1.42, 3.82]), and be "very/extremely concerned" about their safety (OR = 2.16, 95% CI [1.35, 3.44]). Locale and student density are important factors to consider when resuming in-person instruction; however, schools should recognize school nurses for their vital role in health communication to assist in pandemic preparedness and response.

Major Depressive Disorder Screening Remains Low Even Among Privately Insured Adolescents.

OBJECTIVE: To determine if screening for major depressive disorder (MDD) increased in a national sample of privately insured adolescents following the US Preventive Services Task Force 2009 endorsement of universal screening for adolescent MDD. STUDY DESIGN: This was a retrospective cohort study of 12- to 14-year-old adolescents, continuously insured from 2010 to 2014 based on the MarketScan database. The primary outcome was the frequency of MDD screening, defined by International Classification of Diseases, Ninth Revision or Current Procedural Terminology code within the context of a well-visit. Multivariable analysis identified factors associated with MDD screening. RESULTS: Adolescents (n = 413 080) were 49% female and 89% urban, and 21% had a family history of depression. Adolescents averaged 2.9 ± 1.6 well-visits during the 5-year study period. Of the cohort, 1.8% had MDD screening coded. Coding for MDD screening was more likely for urban residents (OR, 1.95; 95% CI, 1.69-2.25; P < .001), those with conduct disorder (OR, 1.37; 95% CI, 1.14-1.64; P < .001), and adolescents with more well visits (OR, 1.25; 95% CI, 1.21-1.31; P < .001). Coding for MDD screening was 96% less likely for those switching between multiple provider types for well-visits compared with pediatric providers. A family history of depression did not influence coding for MDD screening. CONCLUSIONS: MDD screening remains insufficient to address the youth mental health crisis. Furthermore, this study captures those adolescents most able to receive such services, given their continuous enrollment in private insurance. Disparities persist, with adolescents who are rural, less frequently seen, and with poor continuity of care less likely to receive screening.

Variability in State-Based Recommendations for Management of Alpha Thalassemia Trait and Silent Carrier Detected on the Newborn Screen.

We conducted an inventory of state-based recommendations for follow-up of alpha thalassemia silent carrier and trait identified on newborn screen. We found wide variability in the nature and timing of these recommendations. We recommend a standardized recommendation to guide pediatricians in evidenced-based care for this population.

Risk-Based Questionnaires Fail to Detect Adolescent Iron Deficiency and Anemia.

OBJECTIVE: To evaluate the predictive ability of screening questionnaires to identify adolescent women at high-risk for iron deficiency or iron deficiency anemia who warrant objective laboratory testing. STUDY DESIGN: Cross-sectional study of 96 female individuals 12-21 years old seen at an academic medical center. Participants completed an iron deficiency risk assessment questionnaire including the 4 Bright Futures Adolescent Previsit Questionnaire anemia questions, along with depression, attention, food insecurity, and daytime sleepiness screens. Multiple linear regression controlling for age, race, and hormonal contraception use compared the predictive ability of 2 models for adolescent iron deficiency (defined as ferritin <12 mcg/L) and anemia (hemoglobin <12 g/dL). Model 1, the Bright Futures questions, was compared with model 2, which included the 4 aforementioned screens and body mass index percentile. RESULTS: Among participants, 18% (17/96) had iron deficiency and 5% (5/96) had iron deficiency anemia. Model 1 (Bright Futures) poorly predicted ferritin and hemoglobin values (R2 = 0.03 and 0.08, respectively). Model 2 demonstrated similarly poor predictive ability (R2 = 0.05 and 0.06, respectively). Mean differences for depressive symptoms (0.3, 95% CI -0.2, 0.8), attention difficulty (-0.1, 95% CI -0.5, 0.4), food insecurity (0.04, 95% CI -0.5, 0.6), daytime sleepiness (0.1, 95% CI -0.1, 0.3), and body mass index percentile (-0.04, 95% CI -0.3, 0.2) were not significantly associated with ferritin in model 2. Mean differences for hemoglobin were also nonsignificant. CONCLUSIONS: Risk-based surveys poorly predict objective measures of iron status using ferritin and hemoglobin. Next steps are to establish the optimal timing for objective assessment of adolescent iron deficiency and anemia.

The Sensitivity of Adolescent School-Based Hearing Screens Is Significantly Improved by Adding High Frequencies.

High frequency hearing loss (HFHL), often related to hazardous noise, affects one in six U.S. adolescents. Yet, only 20 states include school-based hearing screens for adolescents. Only six states test multiple high frequencies. Study objectives were to (1) compare the sensitivity of state school-based hearing screens for adolescents to gold standard sound-treated booth testing and (2) consider the effect of adding multiple high frequencies and two-step screening on sensitivity/specificity. Of 134 eleventh-grade participants (2013-2014), 43 of the 134 (32%) did not pass sound-treated booth testing, and 27 of the 43 (63%) had HFHL. Sensitivity/specificity of the most common protocol (1,000, 2,000, 4,000 Hz at 20 dB HL) for these hearing losses was 25.6% (95% confidence interval [CI] = [13.5, 41.2]) and 85.7% (95% CI [76.8, 92.2]), respectively. A protocol including 500, 1,000, 2,000, 4,000, 6,000 Hz at 20 dB HL significantly improved sensitivity to 76.7% (95% CI [61.4, 88.2]), p < .001. Two-step screening maintained specificity (84.6%, 95% CI [75.5, 91.3]). Adolescent school-based hearing screen sensitivity improves with high frequencies.

Adolescent anemia screening during ambulatory pediatric visits in the United States.

The Centers for Disease Control and Prevention recommends anemia screening for reproductive age women every 5-10 years and annually for those with risk factors. Due to the lower risk of anemia among males, screening for men is recommended only if risk factors exist. The study objective was to examine health care professionals' current anemia screening patterns for male and female adolescents. Data are from the 2001 -2004 National Ambulatory Medical Care Survey, a nationally representative sample of ambulatory visits to primary care practices. The frequency of anemia screening during preventive care visits by 12-21-year-olds was estimated by sex using a reported hemoglobin/hematocrit or complete blood count as an indicator of screening. Multivariable logistic regression identified patient, provider and practice-level factors associated with screening. During the study period, 1,263 preventive care visits occurred for 12-21 year-olds. In bivariate analysis, higher odds of anemia screening were observed for both younger females (OR 1.85; 95 % CI 1.09-3.14) and older males [1.83 (1.02-3.26)] compared to older females (≥ 16 years). In the multivariable model, odds of screening increased with non-white race [3.29 (1.84-5.88)], tobacco use [3.57 (1.94-6.58)], longer visit length [1.03 (1.01-1.06)], and practice site acceptance of managed care plans [2.08 (1.04-4.14)]. Patient sex and age were not statistically significant predictors of screening. Although anemia is more prevalent among older adolescent females, they were not more likely to be screened. This suggests providers are not targeting groups at highest risk of anemia for screening.

Evaluating the Impact of Aevidum on Mental Health Knowledge, Attitudes, and Help-Seeking Behaviors in High School Students: A Mixed-Methods Study.

PURPOSE: To compare Aevidum's school mental health curriculum vs the curriculum plus Aevidum clubs in a mixed-methods study including pre/post surveys, a randomized clinical trial, and qualitative interviews. DESIGN: Concurrent mixed-methods: Aim 1) pre-post surveys evaluated curriculum only vs curriculum plus club schools separately regarding changes in knowledge, help-seeking, and school culture; Aim 2) randomized clinical trial compared curriculum only to curriculum plus club schools; Aim 3) qualitative school staff interviews enhanced understanding of school culture changes. SETTING: Curriculum delivered to 9th graders at ten Pennsylvania high schools; 5 schools randomized to start clubs. SUBJECTS: Students (surveys), staff (interviews). INTERVENTION: Aevidum curriculum plus/minus club. MEASURES: Aim 1, mixed effects linear and logistic regression models for longitudinal data were used to analyze survey items at each time point. Aim 2, the same regression models were used, except models included a fixed-effect for group and group by time interaction effect. Aim 3, interviews were transcribed; a codebook was developed followed by thematic analysis. RESULTS: Pre-survey 2557 respondents; 49% female, 86% non-Hispanic white. Post-survey 737 (29% response rate). Aim 1, pre-post (Likert responses, larger numbers favorable) demonstrated increased student knowledge to identify depression (4.26 [4.19-4.33] to 4.59 [4.47-4.71], P < .001) and help a friend access support (4.30 [4.21-4.38] to 4.56 [4.40-4.71], P = .001). Help-seeking increased for phone helplines (1.61 [1.57-1.66] to 1.78 [1.70-1.86], P < .001), crisis textlines (1.60 [1.55-1.64] to 1.78 [1.70-1.86], P < .001), internet/websites (1.80 [1.75-1.85] to 1.99 [1.90-2.08], P < .001), school counselors (P = .005) and teachers (.013). Aim 2, no significant differences in knowledge, help-seeking or culture between curriculum only vs curriculum plus club schools. Aim 3, staff (n = 17) interviews supported reduced stigma and increased mental health referrals. CONCLUSIONS: Aevidum's curriculum improved mental health knowledge and help-seeking; adding the club did not significantly change responses. Staff identified positive school culture impacts. Limitations include the lower post-survey response.

Lessons Learned from an Academic Partnership to Review Pennsylvania Network for Student Assistance Services' Annual Survey.

INTRODUCTION: Pennsylvania's Student Assistance Program (SAP) began in the mid-1980s to address student barriers to academic success. SAP teams, groups of trained school and community professionals, review referrals, and connect students to services. State leadership conducts an annual SAP team survey, but capacity to evaluate data and affect change is limited. In 2020, leadership partnered with [institution name] to collaboratively review the survey data. METHODS: Frequencies and percentages were calculated. Open responses were coded. Logistic regression models evaluated the association between SAP team size, team meeting frequency, and team maintenance. RESULTS: The 2019 to 2020 survey had 1003 respondents. Median number of SAP team members was 8 (range 1-21). The majority (54%) indicated their SAP team met once per week/cycle for 30 to 90+ minutes. Larger teams met more often. Annual team maintenance occurred for 38% of teams, and was more common for larger teams. SAP team members identified mental health (68%), trauma (44%), and parent engagement (36%) as top training needs. CONCLUSIONS: An academic partnership successfully provided the capacity to review SAP survey responses, and informed evidenced-based discussion of best practice guidelines and realignment of staff professional development opportunities.

Impact of Wellness Policy Review, Wellness Council Activity, and Student Health Objectives on Overall School Wellness Climate.

BACKGROUND: The whole school, whole community, whole child (WSCC) model suggests wellness councils, ongoing review of wellness policy, and a plan for evaluating set objectives are some of the key features needed to support school wellness infrastructure. This study explored the relationship between implementation of these infrastructure features and overall school wellness environment assessment scores among a sampling of Pennsylvania schools. METHODS: The Healthy Champions program provides Pennsylvania schools an opportunity to self-assess their wellness environments across several school wellness topics. Staff enrolled their school in the program by completing a self-report electronic assessment. Enrollment data from the 2020/2021 program year were analyzed using the Kruskal-Wallis test and linear fixed model to identify the impact of varied implementation levels across 3 wellness infrastructure activities. Interactions between these variables and overall assessment score were also analyzed. RESULTS: Of the 645 Pennsylvania schools enrolled and analyzed, we observed higher mean wellness environment assessment scores (∆ 0.74 95% CI 0.40-1.07; p < 0.001) among schools that reported some frequency of all 3 wellness infrastructure activities, compared to schools that reported no frequency for the activities. IMPLICATIONS: Schools with existing policies and practices related to the 3 wellness infrastructure activities should consider the degree of implementation to best support overall wellness in their school setting. Additional research to explore implementation barriers and supports is needed. CONCLUSIONS: Analyses indicated that overall wellness environment assessment scores are impacted by implementation thresholds for wellness council meeting frequency, revision of wellness policy, and review of student health promotion objectives.

Associations between youth suicide rates and state school personnel suicide prevention training requirements.

Objective: As youth spend the majority of their time in school, school personnel suicide prevention training has gained support as an approach to mitigate rising youth suicide rates. This study examined associations between state school personnel suicide prevention training requirements (i.e., mandatory/non-mandatory and annual/not annual), year of legislation enactment (2013 or earlier/2014 or later), and changes in youth suicide rates by state from 2007-09 to 2016-18. Methods: School personnel suicide prevention training requirement data were collected through state-specific Department of Education websites while state-specific youth suicide rates were collected from the Center for Disease Control and Prevention's 2020 National Vital Statistics Report. Data were analyzed using a mixed effects linear regression model. Results: Training is mandated in 40/50 (80 %) states; 19/50 (38 %) require annual training. All states demonstrated increases in youth suicide rates from 2007-09 to 2016-18 (mean increase 3.9/100,000 [sd = 1.8]), but the change did not differ significantly by state requirements for mandatory (p = 0.44) or annual (p = 0.70) training, nor for year of enactment of legislation (p = 0.45). Conclusions: School personnel suicide prevention training requirements were not associated with changes in the youth suicide rate, though study results are limited in that data was not available on how successfully schools implemented the required trainings.

Cooking with the Community: Addressing Food Insecurity Through Equipment Provision and Professional Instruction.

Introduction: Food insecurity is a common problem with many associated negative downstream health impacts. Despite government sponsored and private supports, many individuals struggle with making healthy, nutritious meals. Penn State's Cooking with the Community program was constructed with the objective of providing cooking equipment and instructions to increase knowledge of healthy cooking techniques and consumption of under-utilized food pantry ingredients. Methods: Four cooking demonstrations were held over an 8-month study period in 2021 designed to educate participants on under-utilized and seasonally available ingredients. Each demonstration was professionally led by a chef who taught cooking skills and the use of different equipment, which were subsequently gifted to the participants. Participants were surveyed before and after each demonstration to assess cooking perceptions and comfort using Likert scales. Final analysis was completed in 2022 using mixed effects models to analyze changes between pre- and post-demonstration. Results: There were 34 total participants. Statistically significant improvements were seen in confidence in cooking (mean increase=0.5; SD=0.2; p=0.031; 95% CI=0.1, 1.0), preparation of a simple recipe (mean increase=0.6; SD=0.2; p=0.013; 95% CI=0.1, 1.0), and cooking new foods (mean increase=0.6; SD=0.3; p=0.026; 95% CI=0.1, 1.1). Conclusions: Cooking with the Community provides valuable information on how cooking confidence may be boosted within vulnerable populations by providing cooking equipment and professional instructions on its use.

Parent and child opinion on the use of standing desks in the classroom.

Objective: Standing desks present a novel approach to reduce sedentary time in the classroom and address cardiovascular risk factors at an early age. In the context of designing a standing desk study, parents and children were surveyed regarding their perceptions and current use of standing desks and other flexible seating. Methods: Survey administered from January 31st to February 26th, 2024 to a convenience cohort of 50 parent-child pairs presenting for well or acute care at a pediatrics clinic affiliated with an academic institution (Hershey, Pennsylvania, United States). Logistic regression examined parent support of and child willingness to use a standing desk in the classroom. Results: Parents were primarily non-Hispanic, white females above 40 years of age. Child participants mean age and grade level were 10.5 years and 5th grade respectively. Among parents, 85 % (39/46) were supportive of their child's use of a standing desk in the classroom, with 4 declining to answer. For children, almost half, 48 % (24/50), were willing to use a standing desk. Acceptability decreased for child body mass index (BMI) ≥85th percentile versus BMI <85th percentile (parent acceptability OR = 0.07 [95 % CI: 0.01-0.63; p = 0.018]; child acceptability: OR = 0.13 [95 % CI 0.03-0.51, p = 0.003]). Conclusions: Most parents and children are amenable to use of a standing desk in the classroom. Additional information for children with elevated BMI and their parents may be required to address reservations about standing. This study was limited by its small sample size, which may not generalize to other populations.

Variability of state school-based hearing screening protocols in the United States.

The prevalence of hearing loss has increased among United States children. As schools commonly perform hearing screens, we sought to contrast current United States school-based hearing screening protocols. State department of health and education websites were reviewed to assess school hearing screening protocols for the fifty states and the District of Columbia. Individuals listed on these websites were contacted as necessary to confirm and/or acquire relevant data. School-based hearing screening is currently required in 34/51 (67 %) states. Of these 34 states, 28 (82 %) mandate grades for screening, but only 20 (59 %) require screening beyond 6th grade. Pure tone audiometry is the most common screening method (33/34 [97 %]). A majority of states screen at 1, 2 and 4 kHz usually at 20 or 25 dB hearing level. Six states recommend or require testing at 6 or 8 kHz, which is necessary to detect high-frequency hearing loss. The results indicate that United States school-based hearing screens vary significantly. They focus on low frequencies with few testing adolescents for whom high-frequency hearing loss has increased. Disparities in hearing loss detection are likely, particularly considering the evolution of hazardous noise exposures and rising prevalence of hearing loss.

Evaluation of a stakeholder advisory board for an adolescent mental health randomized clinical trial.

INTRODUCTION: Community engagement in research is widely accepted as best practice, despite gaps in existing frameworks to evaluate its process, context, and impact on research. The Screening in High Schools to Identify, Evaluate, and Lower Depression (SHIELD) study evaluated the use of a school-based major depressive disorder screening tool in the identification of symptoms and treatment initiation among adolescents, and was developed, implemented, and disseminated in partnership with a Stakeholder Advisory Board (SAB). We summarize outcomes of the evaluation strategy applied through our partnership with the SAB and explore gaps in the available engagement evaluation tools for mixed stakeholder populations including youth. METHODS: SHIELD study SAB members (n = 13; adolescents, parents, mental health and primary care providers, and professionals from education and mental health organizations) advised on study design, implementation, and dissemination over a three-year period. Both SAB members and study team members (i.e., clinician researchers, project managers) were invited to quantitatively and qualitatively evaluate stakeholder engagement after each project year. At the conclusion of the study, SAB members and study team members were asked to evaluate the application of engagement principles in overall stakeholder engagement across the study period, using portions of the Research Engagement Survey Tool (REST). RESULTS: SAB members and study team members responded similarly when evaluating engagement process (i.e., valued on team, voice represented); means ranged from 3.9 to 4.8 out of 5 points across all three project years. Reported engagement within study-specific engagement activities (i.e., meetings, study newsletter) varied from year to year, with some discrepancy between SAB member and study team evaluations. Using REST, SAB members reported the alignment of their experience with key engagement principles the same or higher than study team members. Qualitative feedback at the conclusion of the study generally matched quantitative measures; adolescent SAB members, however, reported disengagement from stakeholder activities that was not accurately or effectively captured in evaluation strategies employed across the study period. CONCLUSIONS: Challenges exist in effectively engaging stakeholders and evaluating their engagement, particularly among heterogenous groups that include youth. Evaluation gaps should be addressed through the development of validated instruments that quantify the process, context, and impact of stakeholder engagement on study outcomes. Consideration should be given to collecting parallel feedback from stakeholders and study team members to fully understand the application and execution of engagement strategy.

We conducted a study (Screening in High Schools to Identify, Evaluate, and Lower Depression) to understand if an adolescent major depressive disorder screening tool delivered in the school setting aided in the identification of symptoms and treatment. We planned and conducted this study with the guidance of a stakeholders, including adolescents.At the end of each study year, we sent an evaluation survey to stakeholders to understand their experience, such as how appropriately the study included stakeholders and their perspectives. We also surveyed the team leading the study to understand their perspectives about stakeholder involvement. In general, both stakeholders and the study team reported feeling positive about stakeholder involvement; However, some stakeholders felt less involved as the study moved forward, and for some activities stakeholders and study team did not agree on how much the stakeholders were involved in study activities. Additionally, adolescent stakeholders reported low involvement in the study when completing the final evaluation, which, unfortunately, was not captured in the evaluations conducted in earlier study years.By evaluating the experiences of stakeholders, along with gathering perspectives of the study team, we were able to understand how well we involved stakeholders. However, additional questions remain unanswered, such as how best to involve adolescents as stakeholders, and how involving stakeholders impacted the results of our study. Evaluation tools to best understand these impacts are needed across the field of community-engaged research to answer these questions for future studies.

A qualitative analysis of participant experiences with universal school-based depression screening.

Screening in High Schools to Identify, Evaluate and Lower Depression (SHIELD) was a randomized clinical trial of school-based universal depression screening conducted with public high schools in Pennsylvania, United States. Screened adolescents were twice as likely to initiate depression treatment compared to peers who were not screened. The purpose of this qualitative study was to understand the experience of communities participating in universal screening via SHIELD. Semi-structured interviews were conducted with school staff (n = 11), parents (n = 4) and adolescents (n = 7) from April-October 2021. A codebook was developed with 20 % of audio transcripts coded for inter-rater reliability (staff k = 0.88, parents k = 0.90, adolescent k = 0.74). The two coders divided and individually coded remaining transcripts for thematic content analysis. Three themes were identified: 1) Depression screening was well-received; 2) The main challenge with screening was inadequate staffing to manage referrals; and 3) School staff suggested alternate formats and methods for future screening. In summary, school-based depression screening was well-received, but schools experienced challenges with staffing and resources to support identified adolescents and offered alternative suggestions for future screening. Schools interested in depression screening need education and capacity building focused on barriers and challenges with the process. Learning from staff who have realized this evidence-based practice in their respective districts will support next steps towards implementation.

Effects of COVID-19 pandemic on pediatric weight: A retrospective chart review.

The COVID-19 pandemic forced United States school closures in March 2020. Students moved to online learning, fostering a sedentary lifestyle. As the pandemic heightened population disparities, the impact on weight gain may also be unequally distributed. This study aimed to evaluate changes in body mass index (BMI) z-scores and weight percentiles of pediatric patients during the pandemic and associated demographics to identify those at risk for weight gain. Methods included a retrospective chart review of patients 5-18 years-old with a well-visit in the three years 2018, 2019 and 2020; first identified with a well-visit in August-September of 2020. BMI z-scores and weight percentiles were analyzed using a correlated errors regression model appropriate for longitudinal data. This longitudinal approach was used to model outcomes by patient demographics. Interaction terms with time were evaluated for each variable. Of 728 patients, mean age was 9.7 years (2018); 47 % female, 70 % white, and 23 % publicly insured. BMI z-score did not increase significantly from 2018-2019 versus 2019-2020. Weight percentile demonstrated a slight trajectory increase over these same time points. Publicly insured patients demonstrated significantly greater increase in BMI z-score versus privately insured patients (p = 0.009). Mean differences between groups increased from 0.26 in 2018 (95 % CI [0.07, 0.45]) to 0.42 in 2020 (95 % CI [0.23, 0.61]). Results were similar for weight percentile. Publicly insured pediatric patients experienced significant increase in BMI-z score and weight percentile, but over time this trajectory remained constant. The results support targeting at risk subgroups in addressing long-term impacts of the pandemic.

A Collaborative Analysis of Trends in Referrals to the Pennsylvania Student Assistance Program from 2013 to 2018.

BACKGROUND: The Student Assistance Program (SAP) is mandated kindergarten to 12th grade in Pennsylvania schools to address barriers to student academic success. Following student referral, SAP teams use a systematic process to inform recommendations for school or community-based services. To evaluate program outcomes, a review of student SAP referral trends over a 5-year period was undertaken. METHODS: The Pennsylvania Network for Student Assistance Services (PNSAS), the state leadership providing oversight of SAP, partnered with Penn State College of Medicine in a retrospective analysis of student referral data from 2013 to 2018. Public school enrollment demographics were used for comparison. Frequencies and percentages were calculated. RESULTS: Referrals (total n = 352,640) increased by 24% over the 5 years; demographics 55% male, 69% non-Hispanic white, 16% non-Hispanic black, and 10% Hispanic. Referrals were most commonly for behavioral concerns (31%). Discontinued referrals (39%) were primarily for parent refusal/no permission. Trends included rising minority and elementary referrals over the study period. CONCLUSIONS: SAP referral demographics were consistent with state public school enrollment race/ethnicity breakdown suggesting lack of systematic bias. The proportion of behavioral referrals was consistent with rising youth behavioral health needs. PNSAS must consider strategies to support rising referral numbers and trends.