COVID-19 and Adolescent Outpatient Mental Health Service Utilization.

OBJECTIVE: The COVID-19 pandemic created challenges in accessing mental health (MH) services when adolescent well-being declined. Still, little is known about how the COVID-19 pandemic affected outpatient MH service utilization for adolescents. METHODS: Retrospective data were collected from electronic medical records of adolescents aged 12-17 years at Kaiser Permanente Mid-Atlantic States, an integrated health care system from January 2019 to December 2021. MH diagnoses included anxiety, mood disorder/depression, anxiety and mood disorder/depression, attention-deficit/hyperactivity disorder, or psychosis. We used interrupted time series analysis to compare MH visits and psychopharmaceutical prescribing before and after the COVID-19 onset. Analyses were stratified by demographics and visit modality. RESULTS: The study population of 8121 adolescents with MH visits resulted in a total of 61,971 (28.1%) of the 220,271 outpatient visits associated with an MH diagnosis. During 15,771 (7.2%) adolescent outpatient visits psychotropic medications were prescribed. The increasing rate of MH visits prior to COVID-19 was unaffected by COVID-19 onset; however, in-person visits declined by 230.5 visits per week (P < .001) from 274.5 visits per week coupled with a rise in virtual modalities. Rates of MH visits during the COVID-19 pandemic differed by sex, mental health diagnosis, and racial and ethnic identity. Psychopharmaceutical prescribing during MH visits declined beyond expected values by a mean of 32.8 visits per week (P < .001) at the start of the COVID-19 pandemic. CONCLUSIONS: A sustained switch to virtual visits highlights a new paradigm in care modalities for adolescents. Psychopharmaceutical prescribing declined requiring further qualitative assessments to improve the quality of access for adolescent MH.

Family Structure and Adolescent Mental Health Service Utilization During the COVID-19 Pandemic.

PURPOSE: This study evaluated the relationship between sociodemographic factors including family structure and mental health service (MHS) utilization before and during the COVID-19 pandemic. We also investigated the moderation effects of the COVID-19 pandemic on MHS utilization. METHODS: Our retrospective cohort study analyzed adolescents aged 12-17 years with a mental health diagnosis as identified in the electronic medical record enrolled in Kaiser Permanente Mid-Atlantic States in Maryland and Virginia, a comprehensive integrated health system. We used logistic regression models with an interaction term for the COVID-19 pandemic year to determine the relationship between family structure and adolescent MHS utilization ≥ one outpatient behavioral health visit within the measurement year, while adjusting for age, chronic medical condition (= physical illness lasting > 12 months), mental health condition, race, sex, and state of residence. RESULTS: Among 5,420 adolescents, only those in two-parent households significantly increased MHS utilization during COVID-19 compared to the prepandemic year (McNemar's χ2 = 9.24, p < .01); however, family structure was not a significant predictor. Overall, the odds of adolescents using MHS were associated with a 12% increase during COVID-19 (odds ratio 1.12, 95% confidence interval [CI]: 1.02-1.22, p < .01). Higher odds of using MHS was associated with chronic medical condition (adjusted odds ratio = 1.15; 95% CI: 1.05-1.26, p < .01) and with White adolescents compared to all racial/ethnic minorities. The odds ratio of females using MHS compared to their male counterparts increased by 63% (ratio of adjusted odds ratio = 1.63; 95% CI: 1.39-1.91, p < .01) during the COVID-19 pandemic. DISCUSSION: Individual-level demographic factors served as predictors of MHS utilization with effects moderated by COVID-19.

An Association Between Maternal Intimate Partner Physical Violence and a Loaded Firearm in the Home.

A loaded firearm in the home increases the risk of firearm-related mortality. Furthermore, firearms are often used in fatal cases of intimate partner physical violence (IPPV) during pregnancy and in the postpartum period. Young children are often caught in the crossfire. Although firearms are more prevalent in homes with IPPV compared with homes without IPPV, little is known about the relationship between a loaded firearm and maternal IPPV. The objective was to determine whether maternal IPPV in the context of additional psychosocial factors is associated with a loaded firearm in the home. We analyzed population-based survey data (2004-2011) from the Centers for Disease Control and Prevention (CDC) Pregnancy Risk Assessment Monitoring System (PRAMS) in eight states for which questions on firearms were included. Chi-square analysis of independence was used to determine differences between mothers reporting both IPPV and a loaded firearm to mothers reporting IPPV only or a loaded firearm only. Multivariable weighted logistic regression examined the association between IPPV and presence of a loaded firearm in the home (adjusting for sociodemographic and psychosocial factors). Of the 43,845 mothers in our sample, 5.3% mothers reported storing a loaded firearm in the home and 6.7% reported maternal IPPV. Among mothers reporting IPPV, 5% also reported a loaded firearm. When adjusting for sociodemographic characteristics only, maternal IPPV was significantly associated with storing a loaded firearm in the home (adjusted odds ratio [aOR] = 1.39; 95% confidence interval [CI] = [1.01, 1.91]). However, after additionally considering psychosocial factors, there was no longer a statistically significant association between maternal IPPV and storing a loaded firearm in the home (aOR = 1.31; 95% CI = [0.93, 1.84]). Contextual factors play an important role in understanding the complex relationship between maternal IPPV and the presence of a loaded firearm in the home, and maternal IPPV should be considered in efforts to promote firearm safety.

Assessment of Pediatric Residents' Attitudes toward Anticipatory Counseling on Gun Safety.

INTRODUCTION: Guns remain a major cause of injury and death among children. We determined pediatric residents' familiarity with gun safety campaigns and their gun safety counseling practices. We determined pediatric residents' comfort with the Asking Saves Kids (ASK) campaign, which recommends that parents ask about gun safety and storage where their children play. METHODS: Cross-sectional 27-item electronic survey was distributed to three pediatric residency programs in Baltimore, Maryland, USA. Residents were asked to respond to statements using a seven-point Likert scale on familiarity with three gun safety campaigns and their attitudes toward gun safety counseling. RESULTS: 82% of respondents were not familiar with gun safety programs. 23% reported not counseling. 87% believed it is a good idea to ask about guns in a home but only 64% were comfortable recommending their patients' parents to ask about guns. 59% were personally comfortable asking about guns in the home. 15% believed their patients' parents would be comfortable asking about guns in the homes of friends and families. CONCLUSIONS: The residents in this survey supported the idea of gun safety anticipatory guidance but discussing firearms can be problematic. Educational programs and strategies are needed to support physicians' counselling on gun safety.

Content of Infant Safe Sleep Counseling and Maternal Reported Practices in an Urban Clinic.

OBJECTIVE: Sudden Infant Death Syndrome is a leading cause of mortality in infants, and pediatric providers can influence caregiver infant safe sleep practices. We described the content of safe sleep counseling by pediatric providers and examined pediatric provider and caregiver factors that may be related to the delivery of safe sleep counseling. METHODS: A sample of mothers and providers enrolled in the Safe Start Study, a randomized controlled trial assessing a safe sleep intervention, were audio-recorded during the 2-week well child visits (WCV) at a large urban pediatric practice in Baltimore, Maryland from October 2015 to April 2017. Provider counseling content related to infant sleep was transcribed and coded based on American Academy of Pediatrics (AAP) policy statement Grade A recommendations. Maternal reported infant sleep practices were defined by items on an interviewer administered survey. Multivariate logistic regression analyses were used to examine the relation between maternal reported infant sleep practices and provider counseling. RESULTS: Most, 92%, of WCVs included at least 1 safe sleep topic, but there was inconsistency in content delivered based on AAP recommendations. Yet, only 12% of WCVs included all 4 components of ABC counseling. Maternal report of infant sleeping with a person or an object in sleep space was associated with decreased odds of receiving counseling on alone no person, no objects (adjusted odds ratio: 0.34, 95% confidence interval: 0.13, 0.90). CONCLUSIONS: Pediatric provider counseling on safe sleep is inconsistent across AAP recommendations demonstrating a need for enhanced provider education and a more standardized approach to assess infant sleep practices.