Youth Trauma Histories are Associated with Under-diagnosis and Under-treatment of Co-occurring Youth Psychiatric Symptoms.

OBJECTIVE: We examined whether in the presence of trauma exposure, non-traumatic stress-related symptoms are interpreted by mental health clinicians as less salient than the trauma exposure and are de-emphasized as a treatment target, consistent with a diagnostic overshadowing bias. METHODS: Using an adapted version of a diagnostic overshadowing bias experimental paradigm, mental health clinicians (N = 266, M age = 34.4 years, 82% female) were randomly assigned to receive two of six clinical vignette variations. Vignette 1 described an adolescent with obsessive-compulsive disorder (OCD). Vignette 2 described a pre-adolescent with oppositional defiant disorder (ODD). Vignettes were identical except for whether the youth reported exposure to a potentially traumatic event (PTE; no PTE, sexual PTE, or physical PTE). Clinicians received one vignette with a PTE and one without, counterbalancing order. Clinicians rated the likelihood the youth met criteria for various diagnoses and the appropriateness of various treatments on 7-point scales. RESULTS: Across both vignettes, clinicians rated the target diagnosis (OCD in Vignette 1, ODD in Vignette 2) as less likely for vignettes with a PTE than for the same vignettes without a PTE. Clinicians also rated evidence-based treatment modalities for target diagnoses as less appropriate in the presence of a PTE than when a PTE was present. CONCLUSIONS: Consistent with possible bias, clinicians may under-recognize and under-treat non-traumatic stress-related mental health symptoms in youth with a co-occurring trauma history. Future work to validate this bias in real-world practice is indicated.

Predictors of Clinician-Reported Self-Efficacy in Treating Trauma-Exposed Youth.

Clinicians' self-efficacy with regard to delivering evidence-based interventions (EBIs) to youth is an important target for both improving EBI use in the community and mitigating the risk of clinician burnout and turnover. Examining predictors of clinician self-efficacy to treat trauma-exposed youth is, therefore, an important step for informing the design of implementation strategies to enhance the mental health workforce's capacity to deliver EBIs in this population. We examined predictors of clinician self-efficacy in working with trauma-exposed youth in a sample of practicing mental health clinicians (N = 258, M age = 34.4 years, 85.0% female). Clinicians were recruited and surveyed as part of a larger study examining how clients' exposure to potentially traumatic events influences clinician decision-making. Results of regression models indicated that training in any trauma treatment model, being trained via a variety of formats (e.g., in-person training, online, supervision), and training in a variety of treatment models were all associated with higher perceived self-efficacy regarding effectively treating trauma-exposed youth. Of the treatment models and training formats examined, receiving in-person training, R2 = .10, and training in trauma-focused cognitive behavioral therapy, R2 = .10, were the strongest predictors of higher self-efficacy ratings. Clinician discipline, R2 = .04, and clinical practice factors, R2 = .20, were also related to self-efficacy. Collectively, the R2 indicated a large effect, with the predictors explaining 25.4% of the variance in self-efficacy ratings. Implications for designing implementation strategies targeting clinician self-efficacy and future research are discussed.

Change Across Time in Cancer-Related Traumatic Stress Symptoms of Siblings of Children with Cancer: A Preliminary Investigation.

This pilot study examined changes in cancer-related post-traumatic stress symptoms (PTSS) across time for siblings of children with cancer. Siblings (N = 32; aged 8-18) completed a measure of anxiety, the Child PTSD Symptom Scale (CPSS), and the PTSD section of the Structured Clinical Interview for DSM-IV-TR (SCID) at twelve (SD = .9) and eighteen months (SD = 1.3) post-diagnosis. Moderate-to-severe PTSS was reported by 12 siblings (38%) at T1 and 7 (22%) at T2. Cluster analysis of PTSS data revealed five patterns: Few symptoms, stable across time (31%, n = 10); Mild symptoms, decreasing across time (16%, n = 5); Mild, stable symptoms (28%, n = 9); Moderate/severe symptoms, decreasing across time but remaining moderate (19%, n = 6); and Moderate/severe, stable symptoms (6%, n = 2). SCID data and anxiety scores distinguished siblings in the final two clusters from those with more favorable PTSS levels/trajectories. Additional research with larger samples is needed to validate these trajectories and examine factors that distinguish siblings with consistently elevated cancer-related PTSS from those with mild or significantly improving symptoms.

Caught off guard by covid-19: Now what?

Human beings are social in nature and maintaining social interactions, relationships and intimacy are fundamental needs of older adults (OAs) living in assisted living (AL) communities. Yet, these very basic human needs have been impeded by quarantine mandates imposed by the COVID-19 pandemic. The socialization aspect offered in AL, allows for an integration of the whole person: body, mind, and spirit and is beneficial in mitigating the development of co-morbidities and negative patient outcomes. Additionally, the authenticity of home comes from the caring interactions provided by an interprofessional health care staff. Utilizing the 4 M Framework, created by The John A. Hartford Foundation and Institute of Healthcare Improvement, the authors describe simple direct bedside interventions of low cost, and high patient-centered value which front-line nursing and caregiver staff can employ to maintain social connections, interactions, mentation, function and mobility among residents they care for, and care about, in AL communities.

Psychosocial Assessment as a Standard of Care in Pediatric Cancer.

This paper presents the evidence for a standard of care for psychosocial assessment in pediatric cancer. An interdisciplinary group of investigators utilized EBSCO, PubMed, PsycINFO, Ovid, and Google Scholar search databases, focusing on five areas: youth/family psychosocial adjustment, family resources, family/social support, previous history/premorbid functioning, and family structure/function. Descriptive quantitative studies, systematic reviews, and meta-analyses (n = 149) were reviewed and evaluated using grading of recommendations, assessment development, and evaluation (GRADE) criteria. There is high quality evidence to support a strong recommendation for multifaceted, systematic assessments of psychosocial health care needs of youth with cancer and their families as a standard of care in pediatric oncology.

Family psychosocial risk screening guided by the Pediatric Psychosocial Preventative Health Model (PPPHM) using the Psychosocial Assessment Tool (PAT).

BACKGROUND: Although families of children with cancer and other serious medical conditions have documented psychosocial needs, the systematic identification of needs and delivery of evidence-based care remain challenges. Screening for multifaceted family psychosocial risk is a means by which psychosocial treatment needs for pediatric patients and their families can be identified in an effective and inclusive manner. MATERIAL AND METHODS: The Pediatric Psychosocial Preventative Health Model (PPPHM) is a model that can guide systematic assessment of family psychosocial risk. The Psychosocial Assessment Tool (PAT) is a brief parent report screener of psychosocial risk based on the PPPHM that can be used for families of infants through adolescents. The PPPHM and the PAT are described in this paper, along with a summary of data supporting systematic risk assessment. RESULTS: The PPPHM outlines three tiers of family psychosocial risk - Universal (low), Targeted (medium), and Clinical (high). The PAT is a validated measure of psychosocial risk. Scores on the PAT, derived from multiple sites and disease conditions, map on to the PPPHM with indications that one-half to two-thirds of families score at the Universal level of risk based on the PAT. CONCLUSION: The PAT is a unique screener of psychosocial risk, both in terms of its breadth and underlying model (PPPHM), and its length and format. As an example of a means by which families can be screened early in the treatment process, PAT scores and corresponding PPPHM levels can provide direction for the delivery of evidence-based psychosocial care.

Maternal Perspective of Inpatient Methadone Initiation: Opportunities to Increase Retention in Treatment.

OBJECTIVES: Recent trends demonstrate increases in the rates of opioid use among pregnant and parenting women. Treatment for pregnant people with opioid use disorder (OUD) includes medications for OUD, like methadone, as well as comprehensive support services. Still, inpatient treatment engagement is suboptimal and treatment drop out is common. There is little research examining the maternal perspective of the inpatient methadone initiation experience. The primary aim of this qualitative methods study was to explore patient experience and perspective of the inpatient methadone initiation period. METHODS: All participants were recruited from a single urban university affiliated hospital and OUD treatment program. Data were collected from 30 maternal participants in OUD treatment about their inpatient methadone initiation experience while pregnant using semistructured interviews. Thematic analyses were conducted using an inductive approach after an iterative process of code development and application among a multidisciplinary team of 3 coders. Validity was accounted for through 2 participant feedback interviews and study team review and discussion of findings. RESULTS: Four themes emerged from the maternal interview data: (1) Barriers to Inpatient Methadone Initiation, (2) Facilitators to Inpatient Methadone Initiation, (3) Transition From Hospital Inpatient to Outpatient or Residential OUD Treatment Services, and (4) Opportunities for Enhanced Clinical Support. CONCLUSION: Maternal participants reported multiple barriers and facilitators to inpatient care during methadone initiation, highlighting opportunities for improvement to effectively engage pregnant individuals in treatment.

Implementation and Outcomes of the Trauma Ambassadors Program: A Case Study of Trauma-Informed Youth Leadership Development.

Community-based programs serve a critical need for vulnerable youth and families. In recent years, researchers and practitioners have urged programs to adopt a trauma-informed care (TIC) approach to address adversity in young people's lives. The purpose of this article is to describe the implementation and outcomes of the Trauma Ambassador (TA) Program, a pilot youth leadership program guided by a community-university partnership that utilized a TIC approach in an underserved East North Philadelphia neighborhood. Fourteen youth engaged in interactive trainings to build their understanding of trauma and develop practical tools to support encounters with individuals with trauma histories. Focus groups and individual interviews were conducted to better understand program implementation and outcomes. Rich data emerged that identifies a myriad of ways that youth and their community might benefit from a program like the one described. The program successfully impacted participants, as TAs recognized their own trauma and were motivated to help others who may have trauma histories. This program provided quality youth development experiences, particularly with respect to trauma-informed care, and results support taking a holistic, healing-centered approach to foster well-being for youth and adult mentors.

Racial/Ethnic Disparities in Mental Healthcare in Youth With Incarcerated Parents.

INTRODUCTION: Youth with incarcerated parents experience more adverse childhood experiences than other youth, placing them at higher risk for mental health and substance use disorders. Despite their increased risk, these youth may be less likely to access mental health services, particularly given their racial and ethnic makeup. Therefore, this study aimed to assess racial and ethnic disparities in access to mental health services for youth with incarcerated parents. METHODS: This secondary data analysis used longitudinal data from 2016 to 2019 from the Adolescent Brain Cognitive Development Study. Logistic regression models assessed the relationships among incarceration, cumulative childhood experiences, DSM-5 diagnoses, and mental health services. Additional analyses stratified these models by race and ethnicity. All analyses were performed in 2022. RESULTS: Youth with incarcerated parents were more likely to report 4 or more childhood experiences (51% vs 14%; AOR=3.92; 95% CI=3.3, 4.65; p<0.001) and to have received mental health services (25% vs 15%; AOR=1.89; 95% CI=1.6, 2.21; p<0.001) than unexposed youth. However, Black youth with incarcerated parents (19% vs 34%; AOR=0.38; 95% CI=0.27, 0.52; p<0.001) and Latinx youth with incarcerated parents (10% vs 17%; AOR=0.5; 95% CI=0.33, 0.76; p<0.001) were significantly less likely to report receiving mental health services than White youth with incarcerated parents and non-Latinx youth with incarcerated parents, respectively. CONCLUSIONS: Youth with incarcerated parents were more likely to report utilization of mental health services, but significant racial and ethnic disparities exist between Black and Latinx youth with incarcerated parents compared with that among White and non-Latinx youth with incarcerated parents. There is a continued need to expand mental health services to youth with incarcerated parents and to address racial and ethnic disparities in access to care.

A Qualitative Exploration of the Use of Service Dogs in Veterans with Post Traumatic Stress Disorder and Traumatic Brain Injury.

Objective: This qualitative research was conducted to add to the body of knowledge that supports the benefits of service dogs (SDs), as a tertiary treatment modality, to veterans with post-traumatic stress disorder (PTSD) and/or traumatic brain injury (TBI). Methods: This grounded theory research design utilized open-ended, semi-structured interviews with veterans (n = 10) who were using SDs as a treatment modality for PTSD and/or TBI. Transcripts were analyzed using NVivo qualitative software until data saturation was achieved. Results: Results from the data analysis identified 4 major themes with concurrent subthemes. The most prominent themes were functional status, impact of a SD, recognition of symptoms of PTSD and/or TBI by the SD, and barriers and challenges to the acquisition of a SD. Participants reported that the SD increased socialization and was a positive adjunct to treatment modalities for PTSD and/or TBI. Conclusions: Our study highlights the benefits of using a SD as a tertiary treatment for PTSD and/or TBI in veterans. Veterans in our study articulated the benefits of using a SD as a tertiary treatment option, and the need to make this a standard treatment option for all veterans who suffer from PTSD and/or TBI.