Elise M. Fallucco

Teaching Pediatric Residents to Assess Adolescent Suicide Risk With a Standardized Patient Module

OBJECTIVE: We hypothesized that a suicide risk assessment (SRA) training module incorporating standardized patients (SPs) would enhance pediatric resident SRA performance. METHODS: We conducted an educational survey of pediatric residents regarding SRA (N = 80). In addition, we tested the performance of a SRA training module among pediatric interns who received SRA practice with SPs simulating suicidality scenarios, with (n = 6) or without (n = 6) SRA lecture, or SRA lecture only (n = 12) and control interns (n = 10). We examined postintervention confidence in SRA and self-reported and objectively measured knowledge of suicidal risk factors. RESULTS: Resident confidence and knowledge regarding SRA were low, compared with assessment of medical illness. Interns in the SP plus lecture group had significantly greater confidence in screening adolescents for suicide risk factors and assessing suicidal adolescents (screening, 4.2 ± 0.4; assessing, 4.2 ± 0.4), compared with subjects in either the lecture-only (screening, 2.9 ± 0.8; P = .005; assessing, 2.9 ± 1.1; P = .01) or control (screening, 3.1 ± 0.7; P = .025; assessing, 2.6 ± 0.8; P = .003) group. In addition, only the SP plus lecture group demonstrated significantly greater objective knowledge of suicide risk factors (92% vs 25% correct; P = .008) than the control group. Neither the lecture-only group nor the SP-only group was significantly better than the control group in terms of knowledge or confidence relevant to SRA. CONCLUSION: This SRA training module was significantly more effective than lecture alone in enhancing pediatric intern knowledge and confidence in SRA.

Use of a Standardized Patient Paradigm to Enhance Proficiency in Risk Assessment for Adolescent Depression and Suicide

PURPOSE Although routine adolescent depression and suicide risk assessment (ADSRA) is recommended, primary care physician (PCP) ADSRA training is needed for successful ADSRA implementation. This study examined the effect of an intervention using standardized patients (SPs) on PCP ADSRA confidence, knowledge, and practices. METHODS The intervention consisted of a 60-minute seminar followed by a 60-minute SP session to practice ADSRA skills in simulated clinical situations. INTERVENTION PCPs (n = 46) completed pre- and postintervention assessments. Untrained PCPs interested in the intervention (n = 58) also completed assessments. Assessments evaluated ADSRA self-reported confidence and practices and objectively assessed knowledge. The main outcomes were (1) changes in pre-/postintervention PCP ADSRA confidence and knowledge, and (2) ADSRA practices in untrained versus postintervention PCPs. RESULTS Compared with untrained PCPs, PCPs 5-10 months postintervention were more likely to screen most adolescents for depression (40% vs. 22%, p = .05), to use a depression screening tool (50% vs. 19%, p = .001), to have diagnosed at least one adolescent with depression in the past 3 months (96% vs. 78%, p = .013), and to have screened depressed adolescents for suicide risk factors, including access to weapons (51% vs. 25%; p = .007) or an impulsive violence history (27% vs. 11%; p = .037). PCP confidence and knowledge about depression assessment and treatment also significantly improved postintervention. CONCLUSIONS This study supports the use of an SP intervention to improve PCP ADSRA confidence, knowledge, and practices. Widespread implementation of similar educational efforts has the potential to dramatically improve adolescent morbidity and mortality.

The Brief Early Childhood Screening Assessment: Preliminary Validity in Pediatric Primary Care

Objective: Brief, well-validated instruments are needed to facilitate screening for early childhood behavioral and emotional problems (BEPs). The objectives of this study were to empirically reduce the length of the Early Childhood Screening Assessment (ECSA) and to assess the validity and reliability of this shorter tool. Methods: Using caregiver ECSA responses for 2467 children aged 36 to 60 months seen in primary care, individual ECSA items were ranked on a scale ranging from “absolutely retain” to “absolutely delete.” Items were deleted sequentially beginning with “absolutely delete” and going up the item prioritization list, resulting in 35 shorter versions of the ECSA. A separate primary care sample (n = 69) of mothers of children aged 18 to 60 months was used to determine the sensitivity and specificity of each shorter ECSA version using psychiatric diagnosis on the Diagnostic Infant and Preschool Assessment as the gold standard. The version with the optimal balance of sensitivity, specificity, and length was selected as the Brief ECSA. Associations between Brief ECSA scores and other pertinent measures were evaluated to estimate reliability and validity. Results: A 22-item measure reflected the best combination of brevity, sensitivity and specificity. A cutoff score of 9 or higher on the 22-item Brief ECSA demonstrated acceptable sensitivity (89%) and specificity (85%) for predicting a psychiatric diagnosis. Brief ECSA scores correlated significantly and in expected directions with scores on pertinent measures and with demographic variables. Conclusion: The results indicate that the Brief ECSA has sound psychometric properties for identifying young children with BEPs in primary care.

Erratum to: Collaborative Care: a Pilot Study of a Child Psychiatry Outpatient Consultation Model for Primary Care Providers

A Child Psychiatry Consultation Model (CPCM) offering primary care providers (PCPs) expedited access to outpatient child psychiatric consultation regarding management in primary care would allow more children to access mental health services. Yet, little is known about outpatient CPCMs. This pilot study describes an outpatient CPCM for 22 PCPs in a large Northeast Florida county. PCPs referred 81 patients, of which 60 were appropriate for collaborative management and 49 were subsequently seen for outpatient psychiatric consultation. The most common psychiatric diagnoses following consultation were anxiety (57%), ADHD (53%), and depression (39%). Over half (57%) of the patients seen for consultation were discharged to their PCP with appropriate treatment recommendations, and only a small minority (10%) of patients required long-term care by a psychiatrist. This CPCM helped child psychiatrists collaborate with PCPs to deliver mental health services for youth. The CPCM should be considered for adaptation and dissemination.

Feasibility of Screening for Preschool Behavioral and Emotional Problems in Primary Care Using the Early Childhood Screening Assessment

The American Academy of Pediatrics recommends screening young children for behavioral and emotional problems (BEP) during primary care visits. Because of time constraints, few primary care providers (PCPs) use standardized screening tools to detect BEP. The Early Childhood Screening Assessment (ECSA) is a brief screening tool developed specifically to meet the needs of pediatric primary care providers (PCPs). The ECSA has established psychometric properties, but the feasibility and acceptability of the ECSA have not been established. This study examines the degree to which PCPs would incorporate ECSA screening and how PCPs value the ECSA as a tool to detect children with BEP. Twenty-seven pediatric PCPs were trained to implement ECSA screening. Six months after training, 96% of PCPs reported that the ECSA was practical for use at well-visits, 70% were still screening and 89% agreed that it helped detect more cases of BEP than by routine history-taking alone.