Gwyne W. White

Preliminary evidence for the effects of morphine on posttraumatic stress disorder symptoms in one- to four-year-olds with burns.

This study tested the hypothesis that very young children who received more morphine for acute burns would have larger decreases in posttraumatic symptoms 3 to 6 months later. This has never before been studied in very young children, despite the high frequency of burns and trauma in this age group. Seventy 12- to 48-month-old nonvented children with acute burns admitted to a major pediatric burn center and their parents participated. Parents were interviewed at three time points: during their child’s hospitalization, 1 month, and 3 to 6 months after discharge. Measures included the Child Stress Disorders Checklist – Burn Version (CSDC-B). Chart reviews were conducted to obtain children’s morphine dosages during hospitalization. Mean equivalency dosages of morphine (mg/kg/d) were calculated to combine oral and intravenous administrations. Eleven participants had complete 3 to 6-month data on the CSDC. The correlation between average morphine dose and amount of decrease in posttraumatic stress disorder symptoms on the CSDC (r = −0.32) was similar to that found in studies with older children. The correlation between morphine dose and amount of decrease in symptoms on the arousal cluster of the CSDC was significant (r = −0.63, P < .05). Findings from the current study suggest that, for young children, management of pain with higher doses of morphine may be associated with a decreasing number of posttraumatic stress disorder symptoms, especially those of arousal, in the months after major trauma. This extends, with very young children, the previous findings with 6- to 16-year olds.

Increases in Behavioral Health Screening in Pediatric Care for Massachusetts Medicaid Patients

OBJECTIVE To explore rates of screening and identification and treatment for behavioral problems using billing data from Massachusetts Medicaid immediately following the start of the states new court-ordered screening and intervention program. DESIGN Retrospective review of the number of pediatric well-child visits, number of screens, and number of screens that identify risk for psychosocial problems from January 2008 (the month pediatric screening started) to March 2009. During the surrounding 1-year period, we also examined the number of claims with a behavioral health evaluation code. SETTING Massachusetts. PARTICIPANTS Massachusetts Medicaid-enrolled children. INTERVENTION Funded court-ordered mandate to screen for mental health during Medicaid well-child visits. OUTCOME MEASURES Percentage of visits with a screen, percentage of screens identified at risk, and number of children seen for behavioral health evaluations. RESULTS Major increase from 16.6% of all Medicaid well-child visits coded for behavioral screens in the first quarter of 2008 to 53.6% in the first quarter of 2009. Additionally, the children identified as at risk increased substantially from about 1600 in the first quarter of 2008 to nearly 5000 in quarter 1 of 2009. The children with mental health evaluations increased from an average of 4543 to 5715 per month over a 1-year period. CONCLUSIONS The data suggest payment and a supported mandate for use of a formal screening tool can substantially increase the identification of children at behavioral health risk. Findings suggest that increased screening may have the desired effect of increasing referrals for mental health services.

Patterns of medication administration from 2001 to 2009 in the treatment of children with acute burn injuries: A multicenter study

Children with burn injuries receive a broad range of medications, from analgesics to antipsychotics, but how utilization of these drugs differs from one pediatric burn center to another is unclear. This study examined utilization patterns of six categories of medication administered acutely to burned children as a first step in creating evidence-based practice guidelines. Six medications administered to pediatric patients enrolled in a multicenter study were recorded from patient charts using a standardized chart review template. The medication categories included opiates, benzodiazepines, antidepressants, beta-blockers, two different anesthetics, and antipsychotics. Data were analyzed by &khgr;2 and logistical regression analysis. Analysis of data from three sites and 470 patients revealed significant differences in prescription patterns across hospitals for all medication groups except opiates. Differences were significant for benzodiazepines and antidepressants (&khgr;2 = 7.3; P < .01 for both) controlling for age, gender, race, language, burn size, and length of stay. Differences in prescribing patterns for beta-blockers and the anesthetics ketamine and propofol failed to reach statistical significance; however, the results did trend in that direction (&khgr;2 = 3.8 and 3.4, respectively; P < .10 for both). The pharmacotherapeutic agents described in this study are an integral part of acute pediatric burn care, and yet there is variation in use of these medications among the centers. The differences in prescribing indicate that, for certain drugs, a range of approaches to pharmacotherapeutics is being used and suggest that evidence-based guidelines for administration of these agents need to be developed.

The increasing impact of socioeconomics and race on standardized academic test scores across elementary, middle, and high school.

For students and schools, the current policy is to measure success via standardized testing. Yet the immutable factors of socioeconomic status (SES) and race have, consistently, been implicated in fostering an achievement gap. The current study explores, at the school-level, the impact of these factors on test scores. Percentage of students proficient for Language and Math was analyzed from 452 schools across the state of New Jersey. By high school, 52% of the variance in Language and 59% in Math test scores can be accounted for by SES and racial factors. At this level, a 1% increase in school minority population corresponds to a 0.19 decrease in percent Language proficient and 0.33 decrease for Math. These results have significant implications as they suggest that school-level interventions to improve academic achievement scores will be stymied by socioeconomic and racial factors and efforts to improve the achievement gap via testing have largely measured it.

Evaluation of the Meaning of Life Program in Israel.

During the 2009–2010 academic year, 10 schools participated in the Meaning of Life educational program, an adaption of the popular U.S. Laws of Life program. The program sought to encourage each participant to develop a personal approach to finding meaning in life. To evaluate the success of the program, we conducted a study to compare measures of psychological health among participants in the program. We administered questionnaires to participants pre- and postintervention that dealt with the following topics: Meaning in Life, Perceived Hope, Self-Efficacy, Virtues and Values Enacted, and School Climate. We conducted an analysis on a sample of 256 Jewish children (91 boys, 165 girls) and 396 Arab children (155 boys, 241 girls) in 8 schools. Results yielded convergent and construct validity among the 5 measures. Differential results were found among the different schools in both Jewish and Arab samples. From this data we discuss implications for future research.

Test performance characteristics of a case-finding psychosocial questionnaire for children with burn injuries and their families

BACKGROUND The Long-Form Psychosocial Questionnaire (LFPQ) includes full versions of the Child Stress Reaction Checklist, the Family Environment Scale, and the Parenting Stress Index. Condensed versions of these measures were used to create a Short-Form Psychosocial Questionnaire (SFPQ) that could be used as an indicator of child well-being and specific areas of child, parent, and family functioning in children aged 0 years to 18 years with burn injury. METHODS Parents of 830 children aged 0 years to 18 years with acute burn injury from the Shriners Hospitals for Children Multi-Center Benchmarking Study completed the LFPQ at baseline and follow-up visits up to 48 months at four major burn centers. The internal consistency reliability and variability of the LFPQ explained by the SFPQ for each of the measures were calculated. The construct validity of the SFPQ measures was determined by factor analysis. The magnitude of the change for the SFPQ measures during 48 months of follow-up was examined. RESULTS The internal consistency reliability of the short-form measures ranged from 0.62 to 0.90. The variability of the long-form measures explained by the short-form measures was 61% for the Child Stress Reaction Checklist (average of six long-form scales), 60% for the Family Environment Scale (conflict), and 90% for the Parenting Stress Index (average of 13 scales). Factor analysis supported the construct validity of the model for the short-form measures. The magnitude of change for the short-form measures showed clinical improvement for 48 months. CONCLUSION The SFPQ is both a reliable and valid assessment for evaluating the psychosocial functioning of children following burn injuries.

Girls Leading Outward (GLO): A School-Based Leadership Intervention to Promote Resilience for At-Risk Middle School Girls

Girls Leading Outward (GLO) is a positive youth development program for at-risk middle school girls that not only seeks to prevent future problems but also aims to foster resilience. GLO focuses predominately on urban, African-American, and Latina students from low-income communities, with a goal of reaching them prior to their transition to high school. It provides a safe space for girls to express their opinions, voice their concerns, and develop positive relationships with their peers. Through the program, girls are equipped with the skills necessary to effectively problem-solve, overcome obstacles, and manage conflicts with others. Key skills learned include emotion regulation, effective communication and assertiveness, active listening, goal setting, and problem solving. These skills are developed through weekly lunch and after-school groups beginning in the seventh grade and continuing in the eighth grade. These skills are then applied in the context of a community service project that further serves to promote engagement in community action and leadership. Building students’ skills in a context that provides them with a new perspective on themselves and their future, while fostering a sense of community with a group of like-minded peers, may be sufficiently powerful to create a positive trajectory for middle school girls. This intervention draws on ecological systems theory (The ecology of human development, Cambridge, MA, 1979; Community psychology: Linking individuals and communities, Belmont, CA, 2007), a model in which an individual is embedded within multiple systems (e.g., school, family, neighborhood contexts) that each impacts the individual’s mental health and behaviors. GLO differs from typical after-school programs in that involves a weekly in-school component and asks participants to conduct a school-based community service project. Through positive in-school visibility, the role that these students play in the school setting can shift from “at-risk girls” to “student leaders,” which will also positively impact the overall school environment. In order to evaluate program impact, the GLO participants are assessed at baseline and at the end of the school year using self- and teacher report. The assessment includes measures of self-efficacy, perseverance, and overall social–emotional competence. Qualitative data are also collected from the participants and the group facilitators in order to better understand how the intervention influences social–emotional and leadership development.

Social-Normative Expectations Mediates School Climate’s Association With Academic Achievement in Latino Middle School Students:

Many Latino students miss opportunities to develop their full potential in U.S. schools. Increasing attention is being paid to the malleable, nonacademic, factors that can affect student learning. The current study sought to evaluate the impact of school climate on Language Arts grade for Latino students in a large, low-income, urban middle school. In addition, the novel construct of Social-Normative Expectations, student perceptions of school-wide norms about achievement expectations for their peers, was explored in relation to school climate and academic achievement. The study sample reflected 513 Latino students, Grades 7 and 8. A mediation model found that approximately 30% of the variance in final Language Arts grades was accounted for by the predictors, including control variables (R2 = .299). A distinctive mediation effect was also found, whereby the impact of school climate was associated with an approximately .6 points lower final grade mediated through the indirect pathway of Social-Normative Expectations (b = −0.064, SE = 0.019, 95% confidence interval [CI] = [−0.104, −0.028]). Implications of these findings are discussed.

The Use of Rating Scales to Measure Outcomes in Child Psychiatry and Mental Health

Objective. To help clinicians and administrators select among rating scales in common use in child and adolescent psychiatry.