Integrated behavioral health services in pediatric primary care and emergency department utilization for suicide risk.

Introduction: Universal screening for suicide risk in primary care settings is a promising avenue for preventing self-harm and improving health outcomes. Triaging youth to an appropriate level of care, including diverting lower-risk patients from the emergency department (ED) is a meaningful goal. Previous research indicates integrated behavioral health (IBH) may prevent unnecessary admission to the ED on the day of suicide risk screening. We hypothesized that youth who received an IBH consultation the same day as suicide risk screening would be less likely to be admitted to the ED, but more likely to contact IBH services and utilize primary care in the following month. Methods: We conducted a retrospective chart review of 3,649 youth aged 10-18 years who were screened with the Ask Suicide-Screening Questions (ASQ) in two pediatric primary care practices. We collected demographic data, ASQ and Patient Health Questionnaire-9 (PHQ-9) scores, as well as patient contacts with IBH, the ED, and medical primary care the day of screening and the following 31 days. We conducted a series of logistic regressions and chi-square analyses to determine whether contact with IBH on the same day as positive suicide risk screenings predicted same-day admission to the ED, IBH contact, and medical primary care utilization. Results: Among the 7,982 ASQ scores, 1,380 (18%) were non-acute and 87 ASQs (1%) screened acutely positive. Over 90% of positive screens were diverted from the ED regardless of IBH contact. None of the patients died from suicide. Same-day IBH was associated with higher likelihood of general ED visits for all positive screens (acute and non-acute together). None of the positive screens that received an IBH consultation on the same day as screening were admitted to the ED in the subsequent month. Contact with IBH the same day as screening positively predicted utilization of IBH and medical primary care services in the subsequent month, especially for youth with minority race and ethnicity identities. Discussion: In the context of clinics with IBH and systematic risk assessment processes, most youth who screen positive for suicide risk are diverted from the ED. However, contrary to our hypothesis, our study showed that youth who received same-day IBH consultations were more likely to be admitted to the ED compared to peers who did not receive IBH consultations. These findings suggest that systematic suicide screening combined with IBH consultations in pediatric primary care can effectively identify risk levels and triage patients to appropriate care.

Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence.

Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included.

Revictimization Patterns Among Unhoused Youth.

Young people experiencing houselessness are at high risk for revictimization. As has been identified in other populations, symptoms of psychological distress may be an indirect pathway by which initial victimization may increase risk for later revictimization among youth experiencing houselessness. The current study used cross-sectional mediation analyses to examine the hypothesis that there would be an indirect effect of interpersonal victimization that occurred before young people left home on subsequent victimization while experiencing houselessness, through posttraumatic stress disorder (PTSD) and depression symptoms. Youth (N = 245) residing in a shelter provided responses during an in-person interview screening prior to participating in a larger clinical study. Relevant to the current study, youth reported victimization experiences before and after leaving home (Childhood Trauma and Juvenile Victimization Questionnaires, respectively), and PTSD and depression symptoms on the Mini International Neuropsychiatric Interview. Results replicated and extended previous findings determining high rates of victimization among houseless young people both before (92%) and after (75%) leaving home. Further, exposure to more types of childhood victimization significantly predicted likelihood of experiencing more types of victimization after leaving home. Significant indirect effects of childhood victimization risk on revictimization after leaving home were found, occurring through both PTSD and depression symptoms. Results are discussed in terms of existing theories of revictimization, with particular emphasis on the state-dependence theory of victimization. These findings have implications for intervention with young people experiencing houselessness, particularly with regard to addressing the consequences of childhood victimization and trauma-informed support systems.

Dependence in adult relationships: Latent classes of relational dependence and associated outcomes in women exposed to intimate partner abuse.

OBJECTIVE: Studies applying a betrayal trauma theory (BTT) framework to adult abuse have measured dependence by asking about the closeness of the victim-offender relationship. However, women's experiences of dependence may vary even in close victim-offender relationships, such as in the case of abuse perpetrated by intimate partners. This investigation assessed whether subgroups of women who were abused by intimate partners could be identified based on dependence characteristics. Further, we evaluated whether high-dependence subgroups were more likely to experience outcomes associated with BTT. METHOD: Using latent class analysis (LCA), we examined classes of dependence in a non-treatment-seeking community sample of 236 women who reported intimate partner abuse (IPA) to police. The validity of the dependence classes was evaluated from a BTT perspective using the classes to predict empirically supported betrayal-trauma outcomes. RESULTS: Low-, medium-, and high-dependence subgroups emerged when dependence characteristics were analyzed using LCA. As hypothesized, greater dependence was linked with increased likelihood of women maintaining the relationship with the offender, higher self-report dissociation scores, and greater service disengagement. Counter to study hypotheses, dependence subgroups were unrelated to women's revictimization and self-reported memory for the target IPA incident 12 months later. CONCLUSION: Findings suggest that dependence can vary even in close adult relationships. Further, we identified links between dependence subgroups and outcomes predicted by BTT. Implications for BTT research and IPA victim support and intervention are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Community-Engaged Research: Exploring a Tool for Action and Advocacy.

Trauma psychologists seeking to engage in evidence-based advocacy and action may benefit from methods that prioritize public problem solving. Community-engaged research (CEnR) is one such method, characterized by reciprocal and mutually beneficial partnerships between academic researchers and community organizations to address public problems. The CEnR framework is designed and implemented in the context of researcher-community partnership; as such, the findings from this approach promise to be responsive to the real-world concerns of communities seeking to address trauma. This manuscript first articulates the rationale for CEnR in evidence-based advocacy and action. Next, we provide illustrations from our research team's CEnR focus on access to victim service and legal information following interpersonal traumas. We describe how CEnR positioned our team to be responsive in a quickly evolving sociopolitical context while providing data needed for community partners and trauma researchers alike to advocate for survivors and victim services. With this example as a jumping-off point, we discuss potential systemic changes that could foster increased use of CEnR strategies to address trauma-related problems in our communities.

A randomized-control trial testing the impact of a multidisciplinary team response to older adult maltreatment.

Forensic center multidisciplinary teams (MDTs) have emerged to address older adult maltreatment; however, little research is available on this approach. The current study employed a randomized-control design to test the impact of a victim-focused, forensic center MDT relative to usual care (UC) on older adult victim and criminal justice outcomes. Cases of abuse, neglect, and/or financial exploitation involving a perpetrator in a position of trust were randomly assigned to MDT or UC. Outcomes were assessed via interviews with older adult victims, system-based advocates' surveys, and administrative data. According to system-based advocates, MDT had a better prognosis, higher across-agency coordination, and more types of engaged services relative to UC. Administrative data indicated low rates of APS case openings and prosecution. Findings provide support for continued use of MDTs following older adult maltreatment and highlight difficulties engaging older adults given the complex social and material circumstances often related to maltreatment.

After Older Adult Maltreatment: Service Needs and Barriers.

Little research is available specific to the service needs or related barriers of maltreated older adults. Further, no studies have asked at-risk older adults directly for their perspectives on service needs and barriers. As part of a larger study, a sample of 40 diverse older adults (M age = 76 years) were recruited from the population of older adults who were involved in an abuse, neglect, and/or financial exploitation case where the offender was in a position of trust to the victim. Responses to open-ended questions about participants' service needs and reasons for not seeking services were thematically coded. The majority of older adults expressed needing more help than currently received, with needs including transportation, housing, food, household assistance, and medical and mental health care. Participants also described reasons their service needs were not being met. The study elaborates on the specifics and descriptive statistics of the themes that emerged. Implications for older-adult victim services, as well as broader older-adult services, are discussed.