Experiences of Child and Adolescent Psychiatric Patients Boarding in the Emergency Department from Staff Perspectives: Patient Journey Mapping.

Over the past decade, healthcare providers nationwide have contended with a growing boarding crisis as pediatric patients await psychiatric treatment in emergency departments (EDs). COVID-19 has exacerbated this urgent youth mental health crisis, driving EDs to act as crisis units. Journey mapping is a robust methodology with which to examine strengths and challenges in patient care workflows such as boarding and emergency psychiatric care. Psychiatric, emergency medicine, and hospitalist providers serving patients boarding at a northeastern children's hospital participated in semi-structured qualitative interviews. Investigators conducted directed content analysis with an inductive approach to identify facilitators, barriers, and persistent needs of boarding patients, which were summarized in a patient journey map. Findings were presented to participants for feedback and further refinement. Quantitative data showed a three-fold increase in the number of patients who boarded over the past three years and a 60% increase in the average time spent boarding in the ED. Emergent qualitative data indicated three stages in the boarding process: Initial Evaluation, Admitted to Board, and Discharge. Data highlighted positive and negative factors affecting patient safety, availability of beds in pediatric hospital and psychiatric inpatient settings, high patient-provider ratios that limited staffing support, and roadblocks in care coordination and disposition planning. Patient journey mapping provided insight into providers' experiences serving patients boarding for psychiatric reasons. Findings described bright points and pain points at each stage of the boarding process with implications for psychiatric care and systemic changes to reduce boarding volume and length of stay.

Project STRONG: an Online, Parent-Son Intervention for the Prevention of Dating Violence among Early Adolescent Boys.

Despite broad calls for prevention programs to reduce adolescent dating violence (DV), there is a dearth of programs designed specifically for males. In fact, there are no programs that capitalize on the importance of parents in modeling and influencing the choices their sons make in future romantic relationships. To address these gaps, this study assessed the initial feasibility, acceptability, and efficacy of an online, parent-son intervention (STRONG) aimed at reducing DV among early adolescent males. One-hundred nineteen 7th- and 8th-grade boys were recruited, with a parent (90% mothers), from six urban middle schools in the Providence, RI area. Dyads were randomized to either STRONG or a waitlist comparison group. STRONG targets three primary constructs: relationship health knowledge, emotion regulation, and communication. Families randomized to the waitlist were nearly twice as likely at 3 months (OR = 1.92 [0.43-8.60]) and nearly 7 times as likely at 9 months (OR = 6.76 [0.66-69.59]) to endorse any form of DV perpetration (physical, sexual, verbal/emotional) when compared with STRONG families. STRONG also had positive effects on teens' attitudes toward dealing with DV, their emotional awareness, and their short-term regulation skills and was associated with increased discussion of critical relationship topics. Pilot outcomes indicate that an online DV prevention program designed to engage early adolescent boys and parents is both acceptable and engaging. Findings show promise for reducing DV behaviors and theory-driven mediators. ClinicalTrials.gov Identifier: NCT03109184.

Suicide Risk, Self-Injury, and Sleep: An Exploration of the Associations in a Sample of Juvenile Justice Involved Adolescents.

Court-involved youth living in the community represent a vulnerable, yet understudied, group that is at risk for a variety of concerning outcomes including increased suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). Additionally, sleep disruption, which has been associated with an increase in impulsive decision making, appears to be disproportionately high in this population. However, little is known about any connection between poor sleep and increased suicide risk and NSSI in a group of youth. This study explores the associations between sleep disruption, suicidal ideation, suicide attempts, and NSSI in a sample of court-involved youth in the community referred for mental health evaluation at a court based mental health clinic. Findings suggest that sleep disruption is related to NSSI in this population but not suicidal ideation and suicide attempts. Additional relationships were found between NSSI and being female, as well as having a lifetime history of trauma and marijuana use. Findings suggest that court clinics may wish to screen for sleep disruption as a risk factor for NSSI, and future studies may wish to explore improved sleep as a protective factor for CINI youth.

Perpetration of Electronic Intrusiveness Among Adolescent Females: Associations With In-Person Dating Violence.

Electronic intrusiveness is a form of cyber dating abuse that includes monitoring a partners' location, whom a partner is talking to, and other private information via technology and social networking sites. The aim of this study was to further explore the prevalence of electronic intrusiveness, as well as to assess how electronic intrusiveness relates to in-person dating violence while controlling for known risk factors for in-person dating violence, namely, depression, emotion regulation, and acceptance of couple violence. Data for this study were drawn from the baseline assessment of a larger clinical trial. A sample of high-risk adolescent females between the ages of 14 and 17 with a lifetime history of prior dating violence victimization or perpetration was used. Participants completed self-report measures for all study variables. Findings demonstrate that perpetration of electronic intrusiveness within the past 3 months is common among a sample of high-risk adolescent females, with rates across various modes of technology ranging from 30% to 57%. Results also revealed electronic intrusiveness is associated with in-person dating violence perpetration after accounting for known risk factors. This study highlights the need to increase awareness of electronic intrusiveness and to better incorporate electronic intrusiveness into theoretical and empirical models of dating violence.

Depressive Symptoms Moderate Dating Violence Prevention Outcomes Among Adolescent Girls.

Purpose: Few dating violence prevention programs assess how variations in initial violence risk affects responsiveness. This study examines the efficacy of Date SMART, a dating violence and sexual risk prevention program designed to target high-risk adolescent girls, in preventing dating violence in the context of varying initial levels of depressive symptoms. Method: A diverse sample of N = 109 female adolescents with a history of physical dating violence participated in a randomized controlled trial of the Date SMART program and a knowledge only (KO) comparison. Results: Using baseline depression level as a primary risk factor, a series of multilevel models revealed significant main effects of baseline depression such that higher baseline depression was associated with greater physical dating violence perpetration and victimization. Results also showed a three-way interaction for assessment point, depressive symptoms, and condition for physical dating violence perpetration. Specifically, those with higher baseline depression in Date SMART showed significantly less physical dating violence perpetration at follow-ups compared with those with higher baseline depression in the KO group. This difference in violence reduction between conditions was not observed for those with lower baseline depression. Discussion: Date SMART appears to effectively reduce physical dating violence perpetration in those with higher levels of initial risk. Current findings support that adolescents with different risk profiles respond differently to violence prevention programs.

Application of the actor-partner interdependence model in parent-adolescent emotion regulation and depression.

BACKGROUND: The family environment is an important context for the development and maintenance of depressive symptoms within families. In this study, we evaluated whether parent and adolescent self-reports of emotion regulation constructs are linked with their own (actor effects) and each other's (partner effects) depressive symptoms. METHODS: Participants were 123 adolescent-parent dyads, recruited from adolescent inpatient and partial hospitalization programs, who completed self-report assessments of emotion dysregulation and depression. RESULTS: Using the Actor-Partner Interdependence Model (APIM), results revealed expected actor effects for emotion regulation strategies, but not impulsiveness. A significant partner effect for parents' impulsiveness and adolescents' depressive symptoms was observed, demonstrating the interdependent nature of these characteristics in the sample. Interpretation of APIM model coefficients indicated that greater parent impulsiveness was associated with less adolescent depression symptom severity. LIMITATIONS: Limitations include a small sample of primarily Caucasian adolescents who were receiving intensive psychiatric services making generalizability more challenging. The sample also consisted of largely mothers which is important to consider given there are known gender differences in rates of depression and sensitivity to interpersonal processes. CONCLUSIONS: Overall, findings shed light on the nature of these characteristics within the families of depressed adolescents and the role of emotion regulation in the parent-child relationship. Implications of this work and future studies are discussed.