Impact of Automated Information Sharing on Health Care Delivery to Youths in Foster Care.

Children in foster care have higher health care costs and poor care coordination, often due to inconsistent information exchanged between health care and child welfare systems. This study implemented secure automated information sharing and detected improvements in time spent gathering information, health care services delivered, and billing practices at participating health care systems.

Development and Preliminary Validation of a Multidimensional Psychosocial Assessment Strategy for Young Adults With Cancer.

OBJECTIVE: Regular psychosocial assessment is a best-practice guideline for young adult oncology care, but multipurpose, multidimensional, developmentally appropriate patient-reported outcome measurement strategies for young adults with cancer are lacking. This study reported on the development and preliminary validation of the Young Adult Psychosocial Assessment Strategy (YA-PAS), a tool designed to meet this clinical need. METHODS: The YA-PAS was developed based on the literature and clinician feedback. 20 young adults with cancer participated in cognitive interviews to provide feedback on complexity, readability, and applicability to inform measure refinement. Following refinements, 100 young adults with a history of cancer participated in an observational study including a preliminary evaluation of YA-PAS factor structure, internal consistency, test-retest reliability, construct and criterion validity, feasibility, and acceptability. RESULTS: Cognitive interviews and psychometric evaluation informed modifications and resulted in a measure with 9 domains (anxiety, depression, cognitive functioning, post-traumatic stress, family stressors, support, social isolation, self-efficacy for symptom management, and self-efficacy for medication management) and nonscoring items assessing substance use, life stressors, resources, educational/vocational status, and relationship status. 8 of 9 domains demonstrated acceptable internal consistency (Cronbach's α ≥ 0.70), substantial (r = 0.61-0.80) or almost perfect (r > 0.80) test-retest reliability, and evidence of domain and cut-point validity. 89% of participants were able to complete the YA-PAS within 20 min and 87% were satisfied with the measure. CONCLUSIONS: The YA-PAS demonstrated promising psychometric properties, feasibility, and acceptability. Clinical implications and research recommendations are discussed.

Opportunities for Enhanced Transition of Care Preparation for Adolescents and Emerging Adults With Type 1 Diabetes: Use of the READDY Transition Tool.

There is an ongoing need to determine best practices for effective transition from pediatric to adult care for adolescents and emerging adults (EAs) with type 1 diabetes given the potential for poor health outcomes post-transfer. This study evaluated self-reported confidence ratings as measured by the Readiness of Emerging Adults with Diabetes Diagnosed in Youth (READDY) tool among adolescents and EAs with type 1 diabetes and the association of the confidence ratings with clinical and demographic characteristics, as well as provider documentation of relevant anticipatory guidance topics. The READDY is a diabetes-specific tool used to collect patient-reported confidence in transition preparation topics to target educational interventions. These interventions are divided into four domains: Diabetes Knowledge, Health System Navigation, Insulin Self-Management, and Health Behaviors. A retrospective chart review was conducted of patients 15-24 years of age with type 1 diabetes who completed the READDY survey between January 2017 and January 2018 at a single center. Overall patient-reported confidence levels were high. However, adolescents and EAs endorsed their lowest levels of confidence on items assessing knowledge of alcohol, tobacco, sexual health, and the impact of diabetes on pregnancy (females only), with the percentages of low scores of 20.7, 25.9, 35.9, and 42.9%, respectively. Documentation of provider counseling about screening and prevention of diabetes comorbidities, alcohol use, and tobacco use was associated with scores in the higher range for the corresponding item in the READDY survey. These findings highlight an opportunity to create interventions related to developmentally important topics for adolescents and EAs with type 1 diabetes to enhance successful transition preparation.

Developmental Service Referrals and Utilization Among Young Children in Protective Custody.

Children in foster care are at high risk for developmental delay. In this retrospective cohort study of young children presenting to a foster care clinic, 77% were not receiving developmental services and 75% failed developmental screening. Of those potentially eligible, 60% were not referred for developmental services.

Strategies for Assessing and Modeling Depressive Symptoms in Longitudinal Studies of Adolescents.

Studying age-related change in psychosocial behavior is difficult because manifestation differs with development. While the use of age-appropriate measurement instruments addresses developmental differences, changes in measurement also challenge researchers' ability to study developmental trajectories. Leveraging 8-occasion data from 262 girls (baseline ages 11 and 17 years) participating in a cross-sequential study spanning childhood to adulthood, this paper (1) highlights the needs of developmental researchers seeking to measure change across large swaths of development, (2) forwards an initial formula to convert Beck Depression Inventory-II scores into Children's Depression Inventory scores and facilitate longitudinal analysis and understanding of how depression develops across adolescence, and (3) suggests collection and analysis of new data that would better facilitate researcher's linking of child-, adolescent-, and adult-oriented measurement instruments.

Is Sexual Abuse a Unique Predictor of Sexual Risk Behaviors, Pregnancy, and Motherhood in Adolescence?

This study tested sexual abuse as a unique predictor of subsequent adolescent sexual behaviors, pregnancy, and motherhood when in company with other types of maltreatment (physical abuse, neglect) and alternative behavioral, family, and contextual risk factors in a prospective, longitudinal study of maltreated (n = 275) and comparison (n = 239) nulliparous females aged 14-19 years old assessed annually through 19 years old. Hierarchical regression was used to disentangle risk factors that account for the associations of maltreatment type on risky sexual behaviors at 19 years old, adolescent pregnancy, and adolescent motherhood. Findings indicate that sexual and physical abuse remain significant predictors of risky sexual behaviors, and that sexual abuse remains a significant predictor of adolescent motherhood when alternative explanatory variables are controlled.

Relationship between cancer-related traumatic stress and family milestone achievement in adolescent and young adult survivors of childhood cancer.

Late physical and emotional effects of cancer treatment pose a burden for adolescent and young adult survivors of childhood cancer, including family milestone achievement. This brief report examined links between ongoing cancer-related post-traumatic stress symptoms (CR-PTSS) and family milestone achievement. Survivors (n = 51; Mage  = 24.73, SD = 8.20) completed CR-PTSS and family formation questionnaires. Descriptive statistics, univariate parameter-constraints, and correlation analyses examined relations among study variables. Ongoing intrusive thoughts and hyperarousal were negatively linked to family identity development and family achievement. Findings from the present study provide support that ongoing CR-PTSS may be a barrier to family formation.

Examining the Validity of Self-reported Primary and Secondary Exposure to Cigarette Smoke in Adolescent Girls: The Utility of Salivary Cotinine as a Biomarker.

BACKGROUND: Studies of cigarette use and exposure often rely on either self-report or cotinine assay. In adolescence it is not clear how well assays and self-report correspond, or what effect estrogen exposure has on cotinine. OBJECTIVES: This study sought to identify optimal cut-points for salivary cotinine thresholds for girls with primary, secondary, and no smoke exposure, and whether menarche and hormone contraceptive use are important for interpreting salivary cotinine. METHODS: This longitudinal prospective study recruited 262 healthy adolescent girls who participated in three annual interviews across 24 months. Salivary cotinine assays and self-report of primary and secondary smoke exposure, menarcheal status, and hormone contraceptive use were collected. RESULTS: No adolescents reported primary smoke exposure without secondary exposure. Optimal cut-points for distinguishing primary smoke exposure from secondary-only and no smoke exposure were 1.05 and 3.01 ng/ml, respectively based on receiver operator curves (ROC); no reliable cut-point for secondary-only versus no smoke exposure was identified. The ideal salivary cotinine cut-point to distinguish primary smoke exposure varied by hormone contraceptive use and was 2.14 ng/ml for those using progesterone contraceptives, higher than that of girls using estrogen contraceptives and those not using hormone contraceptives. CONCLUSIONS: This study is the first to examine variance in salivary cotinine cut-points based on hormone exposure for adolescent girls, with findings indicating that hormone contraceptive use in particular may be a key consideration when identifying adolescent smoking. The use of previously recommended salivary cotinine cut-points of 3.85 ng/ml or higher may overestimate nonsmokers.

Developing a Health Care System for Children in Foster Care.

In 2012, the Comprehensive Health Evaluations for Cincinnati's Kids (CHECK) Center was launched at Cincinnati Children's Hospital Medical Center to provide health care for over 1,000 children placed into foster care each year in the Cincinnati community. This consultation model clinical program was developed because children in foster care have been difficult to manage in the traditional health care setting due to unmet health needs, missing medical records, cumbersome state mandates, and transient and impoverished social settings. This case study describes the history and creation of the CHECK Center, demonstrating the development of a successful foster care health delivery system that is inclusive of all community partners, tailored for the needs and resources of the community, and able to adapt and respond to new information and changing systems.

Children in nonparental care: health and social risks.

Approximately 2.3 million children in the United States live separately from both parents; 70-90% of those children live with a relative. Compared with children living with one or both parents, children in nonparental care are in poorer health, are at heightened risk for experiencing disruptions and instability in caregiving, and are vulnerable to other social antecedents of child health (e.g., neglect, poverty, maltreatment). Given the significant impact of adversity in childhood on health across the lifespan, which is increased among children in nonparental care, it is informative to consider the health risks of children living in nonparental care specifically. Research examining the contributions of poverty, instability, child maltreatment, and living in nonparental care, including meta-analyses of existing studies, are warranted. Longitudinal studies describing pathways into and out of nonparental care and the course of health throughout those experiences are also needed. Despite these identified gaps, there is sufficient evidence to indicate that attention to household structure is not only relevant but also essential for the clinical care of children and may aid in identifying youth at risk for developing poor health across the lifespan.

Morningness-Eveningness and Physical Activity in Adolescent Girls: Menarche as a Transition Point.

This study identified trajectories of morningness-eveningness (M-E) and physical activity when chronological (i.e., time since birth) versus gynecological (i.e., time since menarche) age is used to indicate maturation. Piecewise models were fit for girls (N = 262, ages 11-19) using chronological or gynecological age as the time metric. Girls stayed up later (i.e., eveningness) as they approach menarche. After menarche no change in M-E was observed. In contrast, no change in M-E was detected with chronological age. No change in physical activity was observed before menarche, and physical activity declined after menarche. With chronological age, physical activity declined as girls got older. Gynecological age may be more appropriate than chronological age as a metric for understanding changes in M-E and physical activity.

Inside the 8p23.1 duplication syndrome; eight microduplications of likely or uncertain clinical significance.

The 8p23.1 duplication syndrome (8p23.1 DS) is a recurrent genomic condition with an estimated prevalence of 1 in 58,000. The core 3.68 Mb duplication contains 32 genes of which five are currently candidates for the phenotypic features. Here we describe four patients and five families with eight microduplications of 8p23.1 ranging from 187 to 1082 kb in size and one atypical duplication of 4 Mb. These indicate that a minimal region of overlap (MRO) in medial 8p23.1 can give rise to features of 8p23.1 DS including developmental delay, dysmorphism, macrocephaly and otitis media, but not congenital heart disease (CHD). This MRO spans 776 kb (chr8:10,167,881-10,943,836 hg19) and contains SOX7 and seven of the other 32 core 8p23.1 DS genes. In centromeric 8p23.1, microduplications including GATA4 can give rise to non-syndromic CHD but the clinical significance of two smaller centromeric microduplications without GATA4 was uncertain due to severe neurological profiles not usually found in 8p23.1 DS. The clinical significance of three further 8p23.1 microduplications was uncertain due to additional genetic factors without which the probands might not have come to medical attention. Variable expressivity was indicated by the almost entirely unaffected parents in all five families and the mildly affected sibling in one. Intronic interruptions of six genes by microduplication breakpoint intervals had no apparent additional clinical consequences. Our results suggest that 8p23.1 DS is an oligogenetic condition largely caused by the duplication and interactions of the SOX7 and GATA4 transcription factors.

Characterizing the longitudinal relations between depressive and menstrual symptoms in adolescent girls.

OBJECTIVE: This study examined the association between depressive and menstrual symptoms in adolescent girls in a 3-year longitudinal study. It was hypothesized that menstrual symptoms would increase in early adolescence and decrease in later adolescence, that girls with greater depressive symptoms would report greater menstrual symptoms, and that effects would persist after adjusting for general somatic complaints. METHODS: A community sample of girls (n = 262) enrolled in an observational study by age cohort (11, 13, 15, 17 years) completed three annual visits. At each time point, girls completed the Menstrual Symptom Questionnaire, Children's Depression Inventory, and the Youth Self Report to assess general somatic complaints. RESULTS: Menstrual symptoms increased significantly across adolescence (p = .006) and began to plateau in later adolescence (p = .020). Depressive symptoms at study entry were significantly associated with menstrual symptoms (p < .001). When general somatic complaints were included in the models, the effect of depressive symptoms on menstrual symptoms remained significant for the sum score (p = .015) and the menstrual somatic symptoms subscale (p = .001). After adjusting for somatic complaints, initial report of depressive symptoms predicted change in menstrual symptoms only for girls with the lowest menstrual symptoms sum score (p = .025). Initial report of somatic complaints predicted change in menstrual symptoms (p = .020). CONCLUSIONS: Girls with higher depressive symptoms and higher somatic complaints are at greater risk for experiencing menstrual symptoms and increasing symptoms across adolescence, with a heightened vulnerability for girls with lower baseline menstrual symptoms.

Salivary cytokines in healthy adolescent girls: Intercorrelations, stability, and associations with serum cytokines, age, and pubertal stage.

Theoretically, the measurement of cytokines in saliva may have utility for studies of brain, behavior, and immunity in youth. Cytokines in saliva and serum were analyzed across three annual assessments in healthy adolescent girls (N = 114, 11-17 years at enrollment). Samples were assayed for GM-CSF, IFNγ, IL-1ß, IL-2, IL-6, IL-8, IL-10, IL-12p70, TNFα, adiponectin, and cotinine. Results revealed: (1) cytokine levels, except IFNγ and IL-10, were detectable in saliva, and salivary levels, except IL-8 and IL-1ß, were lower than serum levels; (2) salivary cytokine levels were lower in older girls and positively associated with adiponectin; (3) compared to serum levels, the correlations between salivary cytokines were higher, but salivary cytokines were less stable across years; and (4) except for IL-1ß, there were no significant serum-saliva associations. Variation in basal salivary cytokine levels in healthy adolescent girls reflect compartmentalized activity of the oral mucosal immune system, rather than systemic cytokine activity.

Longitudinal associations between smoking and depressive symptoms among adolescent girls.

Adolescence is an important period for initiation of smoking and manifestation of depression, which are often comorbid. Researchers have examined associations between depressive symptoms and smoking to elucidate whether those with increased depressive symptoms smoke more to self-medicate, whether those who smoke experience increased subsequent depressive symptoms, or both. Collectively, there have been mixed findings; however, studies have been limited by (1) cross-sectional or short-term longitudinal data or (2) the use of methods that test associations, or only one direction in the associations, rather than a fully-reciprocal model to examine directionality. This study examined the associations between smoking and depressive symptoms in a sample of adolescent girls using latent dual change scores to model (1) the effect of smoking on change in depressive symptoms, and simultaneously (2) the effect of depressive symptoms on change in smoking across ages 11-20. Data were from a cohort-sequential prospective longitudinal study (N = 262). Girls were enrolled by age cohort (11, 13, 15, and 17 years) and were primarily White (61 %) or African American (31 %). Data were restructured by age. Every 6 months, girls reported depressive symptoms and cigarette use. Results indicated that controlling for sociodemographic characteristics, higher levels of smoking predicted a greater increase in depressive symptoms across adolescence. These findings suggest that a higher level of cigarette smoking does contribute to more depressive symptoms, which has implications for prevention of depression and for intervention and future research.

Addressing Mental Health and Social Needs in Tandem to Promote Health Equity.

Compelling evidence shows that social risks and mental health are intertwined. Pediatric clinicians can maximize the effectiveness of interventions that address mental health concerns by incorporating social risks and social needs screening and interventions. Approaches that elevate the interconnectedness of social risks and mental health require (a) an understanding of the multi-level contextual factors that contribute to patient and family functioning; and (b) a culturally responsive and multidisciplinary clinical practice that targets contextual factors. Supporting families to see the value of concurrently addressing social and mental health needs may be an important step to amplify clinical practice changes.

Young people in foster care and substance use.

Adolescents are at high risk for using substances and for young people in foster care, substance use rates are estimated to be as high as 49 %. Adolescence is an important period for preventing substance use and SUD. Universal screening, brief interventions, and substance use treatment can be used to decrease substance use and substance use disorders among adolescents. Brief interventions often used with adolescents include motivational interviewing and contingency management. Of the many types of outpatient therapies utilized to treat adolescents with substance use disorder, some of the most established include cognitive behavioral therapy, family-based therapy, and a combination of different types of interventions. Medication treatment is less frequently offered to adolescents due to buprenorphine being the only drug FDA approved for youth under the age of 18. Residential treatment is also an option if lower levels of care are not adequate to safely support youth. Lastly, limited research has looked at the effectiveness of continuing care options to support youth in maintaining treatment results.

Racial and Ethnic Disparities in the Physical Health Outcomes of Children in Foster Care: A Systematic Review.

Children of color-especially Black and Indigenous children-are disproportionately overrepresented in foster care and experience barriers in accessing services and receiving physical and behavioral healthcare compared to their White counterparts. Although racial disparities in mental health outcomes of children in foster care have been examined systematically, less is known about racial disparities in their physical health outcomes. This systematic review aimed to examine disparities in physical health outcomes (i.e., general health, developmental delays and disability, chronic illness, health-compromising behaviors, all-cause mortality) of children in foster care by their race and ethnicity (PROSPERO ID: CRD42021272072). Systematic literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 6,102 unique studies identified, 24 met inclusion criteria: peer-reviewed journal article; published from 1991 to 2021; written in English; involved children in the U.S. foster care system; children were primarily in family-based placements; included health outcomes; included children's race and ethnicity; conducted quantitative analyses; and had an observational study design. There was limited evidence to suggest racial disparities among physical health domains examined, in part, due to the small number of studies, variability across study measures and designs, how race and ethnicity were categorized, and how related results were reported. Research that disaggregates results by more nuanced race and ethnicity categories, goes beyond including race and ethnicity as control variables, and uses more robust study designs to understand where racial disparities lie is necessary to inform practice and policy efforts to attain race and health equity in child welfare.

The Impact of Time Since Menarche for Depressive and Anxiety Symptom Severity in Adolescence and Young Adulthood.

PURPOSE: The study mapped depressive and anxiety symptom trajectories throughout adolescence and early adulthood, arrayed by time since menarche, a novel indicator of pubertal change and examined the effect of age of menarche and pubertal timing, more frequently used variables, on depressive and anxiety symptom severity trajectories. METHODS: Secondary analysis of a cross-sequential prospective longitudinal investigation included a community sample of 262 US, adolescent females. Participants were enrolled in age cohorts of 11, 13, 15, and 17 years. Four annual waves of data were collected. Self-report of age at menarche was categorized into pubertal timing categories. A novel measure "time since menarche" (chronological age at each wave minus age at menarche), was measured along with depressive and anxiety symptom severity. Two-piece growth curve modeling with landmark registration examined depressive and anxiety symptom severity trajectories according to time since menarche. RESULTS: There was no change (p > .05) in depression and anxiety symptom severity before menarche; however, in the years leading away from menarche, depression and anxiety symptom severity decreased (p < .05). Age at menarche was not associated with change in depressive and anxiety symptom severity (p > .05) and there were no moderating effects of pubertal timing. DISCUSSION: Depressive and anxiety symptoms decrease in the years leading away from menarche, suggesting puberty-related psychopathology may be transitory in some individuals. Time since menarche may be a clinically relevant indicator of psychological functioning in pubescent adolescent females. Future studies should examine this variable in larger samples, including more adolescents in the earlier stages of puberty.