Scratching Below the Surface: Screening for Posttraumatic Stress Symptoms Following Hospitalization With the Pediatric Trauma Service.

Significant progress has occurred medically for children who have experienced traumatic injuries; however, attention to their psychological adjustment has only more recently been a focus in research and clinical practice. These needs do not cease at discharge but, instead, require monitoring to determine whether further assessment and/or intervention are required. Our team, inclusive of the Psychology Service and the Trauma Service, identified 2 established screening measures (based on age) that were completed by patients during their outpatient follow-up visits postdischarge. Should a patient screen positive, the Trauma Service referred them to the Psychology Service for further evaluation and possible treatment (i.e., trauma-focused cognitive-behavioral therapy). Of 881 trauma activations, 31 (4%) patients were screened at an outpatient follow-up appointment through pediatric surgery/trauma clinic. Of these completed screening tools, 29% screened positive and warranted a referral to Psychology. Intervention was recommended for the majority of the patients evaluated; however, half of these did not return for this intervention. A collaboration between the Psychology Service and the Trauma Service is a vital step toward providing stepped care for patients after unintentional injuries. This allows for evaluation of patient needs and then a referral source to meet these identified needs. Future directions include increasing the number of screened patients, perhaps with use of technological supports (i.e., REDCap) or expansion into other clinics and consideration of ways to increase family's use of psychological intervention. LEVEL OF EVIDENCE: Therapeutic/Care management Level IV.

Feasibility, acceptability, and predictive validity of a psychosocial screening program for children and youth newly diagnosed with type 1 diabetes.

OBJECTIVE: Psychosocial screening has been recommended for pediatric patients with newly diagnosed type 1 diabetes and their families. Our objective was to assess a psychosocial screening protocol in its feasibility, acceptability to families, and ability to predict early emerging complications, nonadherent family behavior, and use of preventive psychology services. RESEARCH DESIGN AND METHODS: A total of 125 patients and their caregivers were asked to participate in a standardized screening interview after admission at a large urban children's hospital with a new diagnosis of type 1 diabetes. Medical records were reviewed for subsequent diabetes-related emergency department (ED) admissions, missed diabetes clinic appointments, and psychology follow-up within 9 months of diagnosis. RESULTS: Of 125 families, 121 (96.8%) agreed to participate in the screening, and a subsample of 30 surveyed caregivers indicated high levels of satisfaction. Risk factors at diagnosis predicted subsequent ED admissions with a sensitivity of 100% and a specificity of 98.6%. Children from single-parent households with a history of behavior problems were nearly six times more likely to be seen in the ED after diagnosis. Missed appointments were likeliest among African Americans, 65% of whom missed at least one diabetes-related appointment. Psychology services for preventive intervention were underutilized, despite the high acceptability of the psychosocial screening. CONCLUSIONS: Psychosocial screening of newly diagnosed patients with type 1 diabetes is feasible, acceptable to families, and able to identify families at risk for early emerging complications and nonadherence. Challenges remain with regards to reimbursement and fostering follow-up for preventive care.

Early risk factors for nonadherence in pediatric type 1 diabetes: a review of the recent literature.

Nonadherence to different aspects of the diabetes regimen is common. Problems early in the course of illness predict later difficulties with nonadherence; conversely, good management early on protects against later complications. Screening for early risk factors at the time of diabetes diagnosis is therefore critical for promoting the health of children with type 1 diabetes. The purpose of this paper is to review and synthesize the recent empirical literature on early risk factors for nonadherence in type 1 diabetes, with a focus on three specific adherence behaviors: insulin administration, blood glucose monitoring, and clinic attendance. Risk factors are considered within several broad categories: sociodemographic barriers that limit access to care; child and parent factors that affect adherence both directly and indirectly via their impact on the development of family teamwork; and family interactions with their health-care providers. We integrate the different findings into a "simple model" that can be used to develop efficient screening protocols that can in turn guide efforts at preventive intervention.

Drug use and criminal activity among rural probationers with DUI histories.

The present study examined whether ever being arrested for driving under the influence (DUI) was associated with higher levels of substance use and criminal activity in a sample of 800 probationers. Lifetime and 30-day histories of substance use and criminal activity were compared across three groups of probationers from rural Kentucky: those with a single DUI arrest, those with two or more DUI arrests, and those with no DUI arrests. A larger percentage of probationers with a DUI arrest reported lifetime and 30-day substance use than non-DUI offenders in almost all drug and alcohol categories. Higher prevalence of criminal activity was limited primarily to the multiple DUI arrest group. Findings add to the literature on rural substance abusers and indicate that DUI may be used as a marker to help identify opportunities for targeted substance abuse interventions.