Seasonal Trends in Emergency Department Visits for Mental and Behavioral Health Conditions Among Children and Adolescents Aged 5-17 Years - United States, January 2018-June 2023.

Mental and behavioral health conditions among school-aged children, including substance use disorders and overall emotional well-being, are a public health concern in the United States. Timely data on seasonal patterns in child and adolescent conditions can guide optimal timing of prevention and intervention strategies. CDC examined emergency department (ED) visit data from the National Syndromic Surveillance Program for 25 distinct conditions during January 2018-June 2023 among U.S. children and adolescents aged 5-17 years, stratified by age group. Each year, during 2018-2023, among persons aged 10-14 and 15-17 years, the number and proportion of weekly ED visits for eight conditions increased in the fall school semester and remained elevated throughout the spring semester; ED visits were up to twice as high during school semesters compared with the summer period. Among children aged 5-9 years, the number and proportion of visits increased for five mental and behavioral health conditions. Seasonal increases in ED visits for some conditions among school-aged children warrant enhanced awareness about mental distress symptoms and the challenges and stressors in the school environment. Systemic changes that prioritize protective factors (e.g., physical activity; nutrition; sleep; social, community, or faith-based support; and inclusive school and community environments) and incorporate preparedness for increases in conditions during back-to-school planning might improve child and adolescent mental health.

Why do Emergency Medical Services (EMS) Professionals Leave EMS?

OBJECTIVE: The objective was to determine why Emergency Medical Technician (EMT)-Basics and Paramedics leave the Emergency Medical Services (EMS) workforce. METHODS: Data were collected through annual surveys of nationally registered EMT-Basics and Paramedics from 1999 to 2008. Survey items dealing with satisfaction with the EMS profession, likelihood of leaving the profession, and likelihood of leaving their EMS job were assessed for both EMT-Basics and Paramedics, along with reasons for leaving the profession. Individuals whose responses indicated that they were not working in EMS were mailed a special exit survey to determine the reasons for leaving EMS. RESULTS: The likelihood of leaving the profession in the next year was low for both EMT-Basics and Paramedics. Although overall satisfaction levels with the profession were high, EMT-Basics were significantly more satisfied than Paramedics. The most important reasons for leaving the profession were choosing to pursue further education and moving to a new location. A desire for better pay and benefits was a significantly more important reason for EMT-Paramedics' exit decisions than for EMT-Basics. CONCLUSIONS: Given the anticipated increased demand for EMS professionals in the next decade, continued study of issues associated with retention is strongly recommended. Some specific recommendations and suggestions for promoting retention are provided. Blau G , Chapman SA . Why do Emergency Medical Services (EMS) professionals leave EMS? Prehosp Disaster Med. 2016;31(Suppl. 1):s105-s111.

Social connectedness and life satisfaction: Comparing mean levels for 2 undergraduate samples and testing for improvement based on brief counseling.

OBJECTIVES: Comparing the mean levels of social connectedness and life satisfaction, and analyzing their relationship for 2 undergraduate samples, and testing for an increase in their means for a brief counseling sample. PARTICIPANTS: Between October 2013 and May 2015, 3 samples were collected: not-in-counseling (NIC; n = 941), initial counseling session (ICS; ie, triage session only; n = 168), and brief counseling (BC; ie, median of 4 additional counseling sessions; n = 28). METHODS: Online surveys measuring demographic and background control variables, social connectedness, and life satisfaction. RESULTS: NIC students exhibited higher social connectedness and life satisfaction than ICS students. Social connectedness significantly explained life satisfaction beyond controlled-for variables for both samples. There was a significant increase in social connectedness and life satisfaction for the BC sample. CONCLUSIONS: Social connectedness is an important antecedent of life satisfaction for undergraduates. Brief counseling can increase transition students' social connectedness and life satisfaction.

Psychiatric rehabilitation practitioner perceptions of frequency and importance of performance domain scales.

OBJECTIVE: The primary purpose of this article is to test if reliable performance domain scales can be developed for psychiatric rehabilitation practitioners (PRPs). METHODS: An online survey was filled out by 1,639 PRPs who provided demographic and frequency-based and importance-based performance domain data. There were 70 items each for the frequency and importance performance domains. Complete data for testing the research questions was available for 965 PRPs using frequency and 985 PRPs using importance ratings. Descriptive and correlation analyses tested the research question. RESULTS: The descriptive and correlation results supported the research question. Nine reliable performance domain scales were created for both frequency and importance ratings: interpersonal competencies, professional role, community integration, assessment/planning, facilitating recovery, systems competencies, diversity, supporting health and wellness, and transition-age youth services. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The nine performance domain scales should be useful for future PRP job analyses. In addition, individual performance domain scales can be applied to other PRP research issues. Study limitations are acknowledged. Future research validating this 70-item measure is encouraged using other sources (e.g., supervisor) as well as other data collection methods (e.g., interview), from various psychiatric rehabilitative agency settings.

Comparison of an assumption-free Bayesian approach with Optimal Sampling Schedule to a maximum a posteriori Approach for Personalizing Cyclophosphamide Dosing.

STUDY OBJECTIVE: Variable metabolism, dose-dependent efficacy, and a narrow therapeutic target of cyclophosphamide (CY) suggest that dosing based on individual pharmacokinetics (PK) will improve efficacy and minimize toxicity. Real-time individualized CY dose adjustment was previously explored using a maximum a posteriori (MAP) approach based on a five serum-PK sampling in patients with hematologic malignancy undergoing stem cell transplantation. The MAP approach resulted in an improved toxicity profile without sacrificing efficacy. However, extensive PK sampling is costly and not generally applicable in the clinic. We hypothesize that the assumption-free Bayesian approach (AFBA) can reduce sampling requirements, while improving the accuracy of results. DESIGN: Retrospective analysis of previously published CY PK data from 20 patients undergoing stem cell transplantation. In that study, Bayesian estimation based on the MAP approach of individual PK parameters was accomplished to predict individualized day-2 doses of CY. Based on these data, we used the AFBA to select the optimal sampling schedule and compare the projected probability of achieving the therapeutic end points. MEASUREMENTS AND MAIN RESULTS: By optimizing the sampling schedule with the AFBA, an effective individualized PK characterization can be obtained with only two blood draws at 4 and 16 hours after administration on day 1. The second-day doses selected with the AFBA were significantly different than the MAP approach and averaged 37% higher probability of attaining the therapeutic targets. CONCLUSIONS: The AFBA, based on cutting-edge statistical and mathematical tools, allows an accurate individualized dosing of CY, with simplified PK sampling. This highly accessible approach holds great promise for improving efficacy, reducing toxicities, and lowering treatment costs.

Correlates of Injury-forced Work Reduction for Massage Therapists and Bodywork Practitioners.

BACKGROUND: Injury-forced work reduction (IFWR) has been acknowledged as an all-too-common occurrence for massage therapists and bodywork practitioners (M & Bs). However, little prior research has specifically investigated demographic, work attitude, and perceptual correlates of IFWR among M & Bs. PURPOSE: To test two hypotheses, H1 and H2. H1 is that the accumulated cost variables set ( e.g., accumulated costs, continuing education costs) will account for a significant amount of IFWR variance beyond control/demographic (e.g., social desirability response bias, gender, years in practice, highest education level) and work attitude/perception variables (e.g., job satisfaction, affective occupation commitment, occupation identification, limited occupation alternatives) sets. H2 is that the two exhaustion variables (i.e., physical exhaustion, work exhaustion) set will account for significant IFWR variance beyond control/demographic, work attitude/perception, and accumulated cost variables sets. RESEARCH DESIGN AND PARTICIPANTS: An online survey sample of 2,079 complete-data M & Bs was collected. Stepwise regression analysis was used to test the study hypotheses. The research design first controlled for control/demographic (Step1) and work attitude/perception variables sets (Step 2), before then testing for the successive incremental impact of two variable sets, accumulated costs (Step 3) and exhaustion variables (Step 4) for explaining IFWR. RESULTS: RESULTS SUPPORTED BOTH STUDY HYPOTHESES: accumulated cost variables set (H1) and exhaustion variables set (H2) each significantly explained IFWR after the control/demographic and work attitude/perception variables sets. The most important correlate for explaining IFWR was higher physical exhaustion, but work exhaustion was also significant. It is not just physical "wear and tear", but also "mental fatigue", that can lead to IFWR for M & Bs. Being female, having more years in practice, and having higher continuing education costs were also significant correlates of IFWR. CONCLUSIONS: Lower overall levels of work exhaustion, physical exhaustion, and IFWR were found in the present sample. However, since both types of exhaustion significantly and positively impact IFWR, taking sufficient time between massages and, if possible, varying one's massage technique to replenish one's physical and mental energy seem important. Failure to take required continuing education units, due to high costs, also increases risk for IFWR. Study limitations and future research issues are discussed.

Exploring correlates of burnout dimensions in a sample of psychiatric rehabilitation practitioners: a cross-sectional study.

OBJECTIVE: The primary purpose of this article is to investigate demographic and work-related correlates of three burnout dimensions, that is, emotional exhaustion, depersonalization, and diminished personal accomplishment, using a national sample of psychiatric rehabilitation practitioners (PRPs). METHOD: An online survey was filled out by 1,639 PRPs who provided demographic, work-related, and burnout data. Complete data for hypotheses testing using stepwise regression analyses was available for 813 PRPs. RESULTS: Lower than expected levels of burnout dimensions were found among PRPs. All 3 study hypotheses were at least partially supported. Looking at individual correlates of burnout dimensions, education level was positively related to emotional exhaustion, age was negatively related to depersonalization, and age and length of service were both negatively related to diminished personal accomplishment. Personal involvement was positively related to emotional exhaustion and depersonalization. Regression results were also supportive of the mental health burnout process model, that is, emotional exhaustion explaining depersonalization, which then combined with emotional exhaustion to help further explain diminished personal accomplishment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Study limitations are acknowledged. This study updates the results of a prior 1996 PRP survey (Blankertz & Robinson, 1996) using a demographically comparable (i.e., gender, race, education level, primary area of study) sample. Reducing one's personal involvement with clients seems important to reducing PRP emotional exhaustion and depersonalization. Emotional exhaustion is generally acknowledged to be the key component to burnout and reducing it via peer support group sessions is recommended.

Validation of a novel approach for dose individualization in pharmacotherapy using gabapentin in a proof of principles study.

STUDY OBJECTIVE: To demonstrate the premise of individualized dosing charts (IDCs) as a clinical-bedside decision-support tool to individualize dosage regimens for drugs in which the interpatient variability is controlled by the pharmacokinetic (PK) behavior of the patient, to calculate the optimal sampling schedule (OSS), which minimizes the number of blood samples per patient. The approach is illustrated with available PK data for gabapentin. DESIGN: Retrospective proof of principles study using gabapentin PK data from a published clinical trial. PATIENTS: Nineteen subjects in a trial designed to uncover the importance of the genetic contributions to variability in gabapentin absorption, renal elimination, and transport; subjects were monitored for 36 hours after administration of a single dose of gabapentin 400 mg, and plasma concentrations were determined at 14 time points. MEASUREMENTS AND MAIN RESULTS: When the PK profiles were different between subjects, the IDCs are dramatically different from each other and from the IDC for an "average" patient representing the patient population. The dose amount and dosing interval must be adjusted to maximize the probability of staying within the target concentration range. An optimal sampling methodology based on the assumption-free Bayesian approach is used to distinguish the PK profile of an individual patient from the patient population. In the case of gabapentin, only two optimally selected test blood samples, at 1.5 and 6 hours after administration of a single doses, were necessary. The average sensitivity and the average specificity of the OSS was 99% and 96%, respectively. CONCLUSION: IDCs display the risk of a patient violating the target concentration range for any dosage regimen. They can be used as a clinical-bedside decision-support tool in a patient-physician partnership to decide on a dose amount and dosing interval that are medically acceptable while practical and convenient to ensure compliance. By using the assumption-free Bayesian approach and the OSS, the number of samples required from a new patient to individualize the dosage regimen can be reduced significantly while preserving high levels of sensitivity and specificity. Prospective studies are being planned to validate the encouraging results. This approach can be extended to any drug if PK data and a target concentration range are available for either therapeutic drug monitoring or target concentration intervention.

Psychotropic medication use and clinical outcomes among children and adolescents receiving system of care services.

OBJECTIVE: Few studies of psychotropic medication use among children and adolescents address the effectiveness of this medication, as it is typically used in naturalistic treatment settings. The objective of this study was to investigate psychotropic medication use among children and adolescents treated in system of care communities, to identify subject characteristics associated with psychotropic medication use, and determine whether psychotropic medication use is associated with reduced symptom severity. METHODS: Data were collected through the National Evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. For this evaluation, 27 system of care communities reported data on medication use and clinical ratings at intake and 6-month follow-up on children and adolescents 6-18 years of age receiving mental health services between 2006 and 2009. We used mixed-effects logistic regression to determine associations between patient characteristics and medication use, and mixed-effects linear regression to determine whether subjects taking medication and those not taking medication experienced different changes in symptom severity between intake and 6 months. RESULTS: Subject characteristics associated with psychotropic medication use, when controlling for other characteristics, included having more severe emotional and behavioral symptoms at intake, having more co-occurring diagnoses, and receiving more than one type of service. Those both taking and not taking medication showed symptom reduction at 6 months, although symptom severity among subjects taking medication remained in the clinical range. When controlling for covariates, symptom reduction was associated with medication use. CONCLUSION: Taking psychotropic medication was more strongly associated with measures of illness severity-greater symptom severity at intake, more co-occurring diagnoses, and more service intensity-than with other demographic characteristics. Subjects who took medication showed more symptom reduction at 6 months than those not taking medication, although this reduction was not sufficient to normalize symptoms among those taking medication.

Improving community-based mental health care for children: a commentary.

In their article, "Improving Community-Based Mental Health Care for Children," Garland and colleagues explore and confront quality issues that are endemic to outpatient specialty mental health care for children in the United States. Their article presents evidence supporting the lack of effectiveness of usual care and draws on implementation science to explore areas for improving the quality of outpatient mental health care for young people. This commentary accepts these basic arguments and strategies, explores policy options that support the suggested reforms, and examines evidence-based programs in a broader context that draws on the systems of care approach. Specific issues addressed in this commentary include workforce capacity, policy options for improving care quality, provider incentives, systematic implementation supports, strategies to incorporate evidence-based approaches into practice, youth-guided and family-driven care, and the need to expand the definition of evidence-based practice to include the concepts of community-defined evidence and practice-based evidence.

Correlates of safety outcomes during patient ambulance transport: a partial test of the Haddon matrix.

The Haddon Matrix has been cited in a recent review of patient safety as a useful framework for understanding Emergency Medical Services (EMS) provider and patient injury prevention and safety during ambulance response and transport. The research goal of this study was to test part of the Haddon matrix, specifically variables within the pre-event host and event host cells, for explaining three multi-item ambulance-related safety outcomes: i.e., anticipated use of safety equipment, securing the patient, and securing the equipment. Complete study data were available for 648 EMS professionals who responded to the 2004 Longitudinal Emergency Medical Technician Attributes and Demographic Study (LEADS) survey. Overall very modest results were found. Specific findings indicated that EMS professionals with: lower perceived health, greater intrinsic satisfaction, more time in the patient compartment of an ambulance, and greater seatbelt use had higher anticipated use of ambulance safety equipment. For the patient being secured in an ambulance, the extremely high mean/low score variance resulted in only extrinsic satisfaction having a significant positive association. Finally, female EMS professionals, those more extrinsically satisfied, not being involved in a prior ambulance accident, and greater seatbelt use were related to higher frequency of securing ambulance equipment during patient transport.

Correlates of perceived care comfort with an EMS professional having a legal conviction.

OBJECTIVES: The first objective was to examine the outcome of how comfortable a potential EMS-caller would be receiving care from an out-of-hospital-care EMS professional who might have a legal conviction. A second objective was to test for correlates that would explain this outcome. METHODS: In the autumn of 2010, a structured phone survey was conducted. To maximize geographical representation across the contiguous United States, a clustered, stratified sampling strategy was used based upon US Postal Service zip codes. RESULTS: Of the 2,443 phone calls made, 1,051 (43%) full survey responses were obtained. Data cleaning efforts reduced the total to 929 in the final model regression analysis. Results revealed significant public discomfort in receiving care from EMS professionals who may have such a conviction. In addition, respondents who are less educated and older more strongly (1) agree that EMS professionals should have their licenses revoked for wrong doing; (2) agree EMS professionals should be screened before being hired; (3) perceive EMS credentials to be important; (4) support a lawsuit for improper care; and (5) are collectively less comfortable with being cared for by an EMS professional who may have a legal conviction. Reliable scales were found for future research use. CONCLUSION: There is significant public discomfort in receiving care from EMS professionals who may have a legal conviction. The results of this study provide increased impetus for the careful screening of EMS professionals before they are hired or allowed to be volunteers. Beyond this due diligence, the results serve as a reminder for increased EMS provider awareness of the importance of exhibiting professionalism when dealing with the public.

What influences a decision to call 9-1-1?: exploring differential correlates for retired versus employed samples.

In fall 2010, a phone survey of 318 retired and 362 employed respondents examined the decision to call 9-1-1 in a simulated emergency situation. Our study purpose was to investigate if there were different correlates between these two samples which would affect their decision to call 9-1-1. Different variables were measured to help explain this 9-1-1 call decision. Reliable scales for measuring the following variables were found: decision to call 9-1-1; emergency medical service (EMS) credentials importance; EMS wrongdoing license revocation; and EMS training consistency. Separate stepwise regression analyses, first controlling for a set of five demographic variables, then adding a set of five perceptual scales, were carried out for the retired and employed samples. After controlling for five demographic variables (race, marital status, age, overall health, and total 2009 income), three perceptual scales--EMS credentials importance, EMS wrongdoing license revocation, and EMS service comparison scales--each had a significant positive relationship to the retired sample's decision to call 9-1-1. For the employed sample, the perceived EMS training consistency scale had a positive relationship with the decision to call 9-1-1 beyond the controlled-for demographics. Study limitations included excluding cell phone users and the simulated emergency situation, while contributions included finding a number of reliable scales for future research.

What variables affect public perceptions for EMS meeting general community needs?

In the fall, 2010, a phone survey of 928 respondents examined two research questions: does the general public perceive Emergency Medical Services (EMS) as meeting their community needs? And what factors or correlates help to explain EMS meeting community needs? To maximize geographical representation across the contiguous United States, a clustered stratified sampling strategy was used based upon zip codes across the 48 states. Results showed strong support by the sample for perceiving that EMS was meeting their general community needs. 17 percent of the variance in EMS meeting community needs was collectively explained by the demographic and perceptual variables in the regression model. Of the correlates tested, the strongest relationship was found between greater admiration for EMS professionals and higher perception of EMS meeting community needs. Study limitations included sampling households with only landline (no cell) phones, using a simulated emergency situation, and not collecting gender data.

Sustaining and expanding systems of care to provide mental health services for children, youth and families across America.

The Substance Abuse and Mental Health Services Administration has been instrumental in supporting the development and implementation of systems of care to provide services to children and youth with serious mental health conditions and their families. Since 1993, 173 grants have been awarded to communities in all 50 states, Puerto Rico, Guam, the District of Columbia, and 21 American Indian/Alaska Native communities. The system of care principles of creating comprehensive, individualized services, family-driven and youth-guided care and cultural and linguistic competence, supported by a well-trained and competent workforce, have been successful in transforming the field of children's mental health and facilitating the integration of child-serving systems. This approach has achieved positive outcomes at the child and family, practice and system levels, and numerous articles have been published using data collected from system of care communities, demonstrating the effectiveness of this framework. This article will describe lessons learned from implementing the system of care approach, and will discuss the importance of expanding and sustaining systems of care across the country.

Seclusion and restraint practices in residential treatment facilities for children and youth.

Policymakers, advocates, and families remain concerned about the use of seclusion and restraint in residential treatment facilities for children and youth. This study used data from 2 national surveys to examine the extent to which residential treatment facilities consistently implement certain practices following incidents of seclusion or restraint. The study found that 76% of facilities reported having secluded or restrained youth in the previous year; 34% of these facilities reported that, following such incidents, they always debrief the youth, family, and staff; notify the attending physician; and record the incident in the treatment plan. Accredited facilities and those that conduct a trauma assessment upon admission were more than twice as likely as others to consistently implement these practices. States and providers should continue to monitor seclusion and restraint practices and identify opportunities for quality improvement.

Exploring the importance of different items as reasons for leaving emergency medical services between fully compensated, partially compensated, and non-compensated/volunteer samples.

The purpose of our study was to investigate the importance of different items as reasons for leaving the Emergency Medical Service (EMS) profession. An exit survey was returned by three distinct EMS samples: 127 full compensated, 45 partially compensated and 72 non-compensated/volunteer respondents, who rated the importance of 17 different items for affecting their decision to leave EMS. Unfortunately, there were a high percentage of "not applicable" responses for 10 items. We focused on those seven items that had a majority of useable responses across the three samples. Results showed that the desire for better pay and benefits was a more important reason for leaving EMS for the partially compensated versus fully compensated respondents. Perceived lack of advancement opportunity was a more important reason for leaving for the partially compensated and volunteer groups versus the fully compensated group. Study limitations are discussed and suggestions for future research offered.

Retrospectively exploring the importance of items in the decision to leave the emergency medical services (EMS) profession and their relationships to life satisfaction after leaving EMS and likelihood of returning to EMS.

An exit survey was returned by a sample of 127 respondents in fully compensated positions who left the EMS profession, most within 12 months prior to filling out the exit survey. A very high percentage continued to work after leaving EMS. Respondents were asked to rate the importance of each of 17 items in affecting their decision to leave EMS. A higher than anticipated response to a "not applicable" response choice affected the usability of 8 of these items. Nine of the 17 items had at least 65 useable responses and were used for further analysis. Within these 9, stress/burnout and lack of job challenges had the highest importance in affecting the decision to leave EMS, while desire for better pay and benefits had the lowest importance. Desire for career change was positively related to life satisfaction after leaving EMS and negatively related to likelihood of returning to EMS. Stress/burnout was positively related to life satisfaction after leaving EMS. Study limitations and future research issues are briefly discussed.

Family-driven care in america: more than a good idea.

OBJECTIVES: This paper will provide a history of how family-driven care has evolved in the United States. METHODS: Several examples of family-driven care including the National Policy Academy led by the Federation of Families for Children's Mental Health, the Jefferson County Kentucky's Parent Advocacy Program, and the Family Ties Resource Centers in Westchester, New York, and the 2009 American Academy of Child and Adolescent Psychiatry's Policy Statement are used to illustrate the development of family-driven care. RESULTS: In the past twenty-five years the mental health field has shifted from viewing parents as the cause of their child's issues to active participants in treatment and active participants in policy development and system reform efforts. Research shows that better outcomes are achieved when family members and youth have meaningful roles in their treatment. CONCLUSIONS: Family-driven care has advanced in the child and youth mental health system in America and next steps are needed to further develop the ability of families to become true partners in treatment planning, service and system development, enhance research as to the effectiveness of these activities and reform policies and practices to reflect needs of families.

The Building Bridges Initiative: residential and community-based providers, families, and youth coming together to improve outcomes.

The Building Bridges Initiative (BBI) provides a framework for achieving positive outcomes for youth and families served in residential and community programs. Founded on core principles, an emerging evidence base, and acknowledged best practices, the BBI emphasizes collaboration and coordination between providers, families, youth, advocates, and policymakers to achieve its aims. Examples are presented of successful state, community, and provider practice changes, and available tools and resources to support all constituencies in achieving positive outcomes.