Addressing Adolescent Suicidality in Pediatric Primary Care.

OBJECTIVE: This study examines prevalence rates of reported suicidal ideation (SI) in 2107 adolescents, characterizes recommendations and interventions given by primary care providers (PCPs) and behavioral health clinicians (BHCs) in response to SI on the Patient Health Questionnaire 9-Item Modified for Adolescents (PHQ-9A) for 140 adolescents, and identifies factors associated with a decrease in the frequency of SI at follow-up visits for 85 adolescents. METHODS: A retrospective mixed-method approach was taken. Clinical informatics was used to extract visit data, demographics, and PHQ-9A scores for all visits between January 3, 2017, and August 31, 2018. Conventional content analysis of electronic medical records was used to examine qualitative results, and qualitative codes were then analyzed using point-biserial correlations. The setting includes a fully integrated behavioral health team within the primary care clinic. RESULTS: Of the 2107 adolescents, 140 (7%) endorsed SI within the past 2 weeks. Content analysis yielded 40 actions (17 PCP codes and 23 BHC codes) used in response to SI. Significant correlations were found between decreased SI frequency and the PCP referring to integrated behavioral health ( r = 0.24) and family navigators ( r = 0.26) and BHCs conducting a risk assessment ( r = 0.24), completing a safety plan ( r = 0.21), involving caregivers ( r = 0.29), sending the adolescent to the emergency department ( r = 0.28), and referring to family navigators ( r = 0.21; all p values < 0.05). CONCLUSION: The findings from this study support screening for SI and highlight specific multidisciplinary and family-centered interventions and recommendations to address adolescent endorsement of SI in pediatric primary care settings.

Interconception Care for Adolescent Women During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVE: Interconception care (ICC) is a means of improving health outcomes for women and children by mitigating maternal risks between pregnancies. Within a pediatric medical home ICC is reliant on adherence to well-child visits (WCVs). We hypothesized that a pediatric-based ICC model would remain successful in providing access to services for adolescent women for those seen during the COVID19 pandemic. The objective of this study was to determine if the COVID19 pandemic influenced LARC use and repeat pregnancy for those seen for ICC in a dyadic pediatric medical home. METHODS: The pre-COVID cohort was comprised of adolescent women seen for ICC from September 2018-October 2019. The COVID cohort was comprised of adolescent women seen for ICC from March 2020-March 2021. The two cohorts were compared across multiple characteristics including sociodemographic factors, age, education, number of visits, contraceptive choice and repeat pregnancy during the study interval. RESULTS: The COVID cohort were significantly more likely to be primiparous, seen with a younger infant, and attend fewer visits than the pre-COVID cohort. The COVID cohort were equally likely to initiate long-acting reversible contraception but less likely to experience a repeat pregnancy. CONCLUSIONS: The COVID19 pandemic limited access to routine healthcare and likely impacted access to ICC for many women. ICC provided during WCVs allowed access to care even amid the restrictions of the COVID19 pandemic. Both effective contraception and decreased repeat pregnancy were maintained, highlighting the effectiveness of this approach for ICC within a dyadic pediatric medical home.

All Hands on Deck: Addressing Adolescent Depression in Pediatric Primary Care.

OBJECTIVE: This study examines prevalence rates of elevated depression symptoms utilizing the Patient Health Questionnaire-9 Item Modified for Adolescents (PHQ-9A), characterizes recommendations and interventions by primary care providers (PCPs) and behavioral health clinicians (BHCs) in response to elevated PHQ-9As, and identifies factors associated with improved PHQ-9A scores at follow-up pediatric primary care visits. METHODS: A mixed methods approach was taken. Visit data, demographics, and PHQ-9A scores for 2,107 adolescents aged 11-18 were extracted using clinical informatics between January 3, 2017 and August 31, 2018. Descriptive statistics and chi-square analyses were conducted, followed by conventional content analysis of electronic medical records to examine qualitative results. Qualitative analyses were transformed into quantitative results and analyzed using point biserial correlations. RESULTS: Of the 2,107 adolescents, 277 (13%) had an elevated PHQ-9A. Content analysis resulted in 40 actions (17 PCP codes, 23 BHC codes) in response to an elevated PHQ-9A. Significant correlations were found between an improved PHQ-9A at a follow-up visit and the PCP referring to integrated behavioral health (r = .20, p < .01), and BHCs recommending and checking in at a follow-up visit (r = .20, p < .05), conducting a risk assessment (r = .15, p < .05), and providing psychoeducation about mood symptoms (r = .15, p < .05). CONCLUSIONS: Primary care is an ideal setting to address the public health crisis of untreated adolescent depression. Implications for screening processes, practice implications for PCPs and BHCs, future directions, and limitations are discussed.