Reasons for missed opportunities to screen and test for TB in healthcare facilities.

Missed opportunities for TB screening and/or passive testing in clinics continues to contribute to the number of missed cases. To understand reasons for these missed opportunities, we conducted focus group discussions with clinic-based nurses. Nurses described low indices of suspicion, prioritization of seemingly more urgent ailments and clinic operational challenges as barriers to TB screening and testing. To improve TB screening and testing in clinics, standard patients should be used to identify real-time factors that impact nurses' clinical decision-making and engage in real-time feedback and discussion with nurses to help optimize opportunities for TB screening and testing.

Les occasions manquées de dépistage de la TB et/ou de tests passifs dans les cliniques continuent de contribuer au nombre de cas manqués. Pour comprendre les raisons de ces occasions manquées, nous avons organisé des discussions de groupe avec des infirmières travaillant dans des cliniques. Les infirmières ont décrit les faibles indices de suspicion, la priorité accordée à des affections apparemment plus urgentes et les défis opérationnels des cliniques comme des obstacles au dépistage de la TB. Pour améliorer le dépistage et le test de la TB dans les cliniques, il faudrait utiliser des patients standard pour identifier les facteurs en temps réel qui influent sur la prise de décision clinique des infirmières et engager une rétroaction et une discussion en temps réel avec les infirmières pour aider à optimiser les occasions de dépistage et de test de la TB.

Suicide attempts in the "comprehensive community mental health services for children and their families" program.

OBJECTIVE: To compare clinical characteristics of youths who had attempted suicide recently, previously but not recently, repeatedly, or never. METHOD: The sample comprised 4,677 youths receiving services between 1993 to 1998 in 22 communities and participating in the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program. Data on suicide attempts, demographics, and clinical characteristics were obtained from intake interviews and referring agencies. Chi-square and univariate analyses of variance were used for between-group comparisons. RESULTS: Twenty-one percent of the sample had a history of attempted suicide. Previous and repeat attempters were more likely to have a history of family violence and substance abuse. Repeat attempters were most likely to have depression, while never and previous (but not recent) attempters were more likely to have conduct disorder. Other clinical differences were also found. CONCLUSIONS: Among children receiving mental health services, those who attempt suicide experience more and different types of distress, depending on the recency and frequency of attempts. Clinicians should be aware that depression is not a necessary factor in predicting suicide attempts and that suicide risk is also associated with violent and aggressive behaviors.

Responses of children with different intake profiles to mental health treatment.

OBJECTIVE: The study examined the relative change in functioning of children with serious emotional disturbances served in a system of care who were referred from a variety of sources and who had different intake profiles, including diagnoses, demographic characteristics, and levels of risk. METHODS: A total of 203 children who had received services for at least six months from the East Baltimore mental health partnership were included in the study. The children's functioning was assessed using the Child and Adolescent Functioning Assessment Scale (CAFAS) at both baseline and six months. Univariate analyses were used to compare demographic and functioning characteristics at baseline of children referred from different sources. Repeated-measures general linear analysis was conducted to determine differences in changes in functioning by demographic and clinical characteristics as well as referral source. RESULTS: On average, children demonstrated significant functional improvement from baseline to six months, regardless of referral source, presenting problem, risk factors, age, or gender. The amount or proportion of change did not differ significantly as a function of these factors. CONCLUSIONS: The results indicate that children in this system of care referred from different sources with different diagnoses, demographic profiles, and levels of risk had similar rates of improvement during the first six months of services.