Rebecca Gokiert

Brief emergency department interventions for youth who use alcohol and other drugs: a systematic review

Objective Brief intervention (BI) is recommended for use with youth who use alcohol and other drugs. Emergency departments (EDs) can provide BIs at a time directly linked to harmful and hazardous use. The objective of this systematic review was to determine the effectiveness of ED-based BIs. Methods We searched 14 electronic databases, a clinical trial registry, conference proceedings, and study references. We included randomized controlled trials with youth 21 years or younger. Two reviewers independently selected studies and assessed methodological quality. One reviewer extracted and a second verified data. We summarized findings qualitatively. Results Two trials with low risk of bias, 2 trials with unclear risk of bias, and 5 trials with high risk of bias were included. Trials evaluated targeted BIs for alcohol-positive (n = 3) and alcohol/other drug–positive youth (n = 1) and universal BIs for youth reporting recent alcohol (n = 4) or cannabis use (n = 1). Few differences were found in favor of ED-based BIs, and variation in outcome measurement and poor study quality precluded firm conclusions for many comparisons. Universal and targeted BIs did not significantly reduce alcohol use more than other care. In one targeted BI trial with high risk of bias, motivational interviewing (MI) that involved parents reduced drinking quantity per occasion and high-volume alcohol use compared with MI that was delivered to youth only. Another trial with high risk of bias reported an increase in abstinence and reduction in physical altercations when youth received peer-delivered universal MI for cannabis use. In 2 trials with unclear risk of bias, MI reduced drinking and driving and alcohol-related injuries after the ED visit. Computer-based MI delivered universally in 1 trial with low risk of bias reduced alcohol-related consequences 6 months after the ED visit. Conclusions Clear benefits of using ED-based BI to reduce alcohol and other drug use and associated injuries or high-risk behaviours remain inconclusive because of variation in assessing outcomes and poor study quality.

Should I stay or should I go? Understanding families' decisions regarding initiating, continuing, and terminating health services for managing pediatric obesity: the protocol for a multi-center, qualitative study.

BackgroundAt least two million Canadian children meet established criteria for weight management. Due to the adverse health consequences of obesity, most pediatric weight management research has examined the efficacy and effectiveness of interventions to improve lifestyle behaviors, reduce co-morbidities, and enable weight management. However, little information is available on families’ decisions to initiate, continue, and terminate weight management care. This is an important knowledge gap since a substantial number of families fail to initiate care after being referred for weight management while many families who initiate care discontinue it after a brief period of time. This research aims to understand the interplay between individual, family, environmental, and systemic factors that influence families’ decisions regarding the management of pediatric obesity.Methods/DesignIndividual interviews will be conducted with children and youth with obesity (n = 100) and their parents (n = 100) for a total number of 200 interviews with 100 families. Families will be recruited from four Canadian multi-disciplinary pediatric weight management centers in Vancouver, Edmonton, Hamilton, and Montreal. Participants will be purposefully-sampled into the following groups: (i) Non-Initiators (5 families/site): referred for weight management within the past 6 months and did not follow-up the referral; (ii) Initiators (10 families/site): referred for weight management within the past 6 months and did follow-up the referral with at least one clinic appointment; and (iii) Continuers (10 families/site): participated in a formal weight management intervention within the past 12 months and did continue with follow-up care for at least 6 months. Interviews will be digitally recorded and analyzed using an ecological framework, which will enable a multi-level evaluation of proximal and distal factors that underlie families’ decisions regarding initiation, continuation, and termination of care. Demographic and anthropometric/clinical data will also be collected.DiscussionA better understanding of family involvement in pediatric weight management care will help to improve existing health services in this area. Study data will be used in future research to develop a validated survey that clinicians working in pediatric obesity management can use to understand and enhance their own health services delivery.

Teacher beliefs about the cognitive diagnostic information of classroom‐ versus large‐scale tests: implications for assessment literacy

Classroom teachers are in the front line of introducing students to formal learning, including assessments, which can be assumed to continue for students should they extend their schooling past the expected mandatory 12 years. The purpose of the present investigation was to survey secondary teachers’ beliefs of classroom and large‐scale tests for (a) providing information about students’ learning processes, (b) influencing meaningful student learning, and (c) eliciting learning or test‐taking strategies for successful test performance. Secondary teachers were surveyed because a majority of large‐scale tests are developed for secondary students (e.g., PISA, TIMSS). Results suggested that in comparison to large‐scale tests teachers believe classroom tests provide more information about student learning processes, are more likely to influence meaningful student learning, and are more likely to require learning over test‐taking strategies. The implications of these results for assessment literacy are explored.

A systematic review of crisis interventions used in the emergency department: recommendations for pediatric care and research

Objective: In this systematic review, we evaluated the effectiveness of emergency department (ED)-based management interventions for mental health presentations with an aim to provide recommendations for pediatric care. Methods: A search of electronic databases, references, key journals, and conference proceedings was conducted, and primary authors were contacted. Experimental and observational studies that evaluated ED crisis care with pediatric and adult patients were included. Adult-based studies were evaluated for potential translation to pediatric investigation. Pharmacological-based studies were excluded. Inclusion screening, study selection, and methodological quality were assessed by 2 independent reviewers. One reviewer extracted the data, and a second checked for completeness and accuracy. Presentation of study outcomes included odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CI). Meta-analysis was deferred due to clinical heterogeneity in intervention, patient population, and outcome. Results: Twelve observational studies were included in the review with pediatric (n = 3), and adult or unknown (n = 9) aged participants. Pediatric studies supported the use of specialized care models to reduce hospitalization (OR, 0.45; 95% CI, 0.33-0.60), return ED visits (OR, 0.60; 95% CI, 0.28-1.25), and length of ED stay (MD, −43.1 minutes; 95% CI, −63.088 to −23.11 minutes). In an adult study, reduced hospitalization was reported in a comparison of a crisis intervention team to standard care (OR, 0.59; 95% CI, 0.43-0.82). Five adult-based studies assessed triage scales; however, little overlap in the scales investigated, and the outcomes measured limited comparability and generalizability for pediatrics. In a comparison of a mental health scale to a national standard, a study demonstrated reduced ED wait (MD, −7.7 minutes; 95% CI, −12.82 to −2.58 minutes) and transit (MD, −17.5 minutes; 95% CI, −33.00 to −1.20 minutes) times. Several studies reported a shift in triage scores of psychiatric patients dependent on the scale or nurse training (psychiatric vs emergency), but linkage to system- or patient-based outcomes was not made, limiting clinical interpretation. Conclusions: Pediatric studies have demonstrated that the use of specialized care models for mental health care can reduce hospitalization, return ED visits, and length of ED stay. Evaluation of these models using more rigorous study designs and the inclusion of patient-based outcomes will improve this evidence base. Adult-based studies provided recommendations for pediatric research including a focus on triage and restraint use.

Using Exploratory and Confirmatory Methods to Identify the Cognitive Dimensions In a Large-Scale Science Assessment

Studies of test dimensionality indicate that many large-scale science assessments measure multiple dimensions. These findings have reinforced the perspective that science achievement is an inherently dynamic process and that there is benefit in reporting subscores in science. A limitation with some of these studies is that they fail to indicate how the dimensions found to underlie science assessments relate to psychological theories of scientific reasoning. A convincing argument for the dynamic character of scientific reasoning and the need to report subscores should include how the dimensions relate to psychological theories of scientific reasoning. Otherwise, the broader, psychological character of student science performance will not be informed. The first objective of this article was to identify the dimensional structure of a new large-scale science assessment using nonparametric and parametric techniques, thus attempting to replicate findings from previous studies. The second objective was to determine whether a content-based or psychologically-based framework could be used to identify, define, and explain the dimensions found to underlie this new large-scale science assessment. The results of the current study indicate that a psychological theory of scientific reasoning could be used to describe the multiple dimensions underlying at least one large-scale science assessment.

Instruments to Detect Alcohol and Other Drug Misuse in the Emergency Department: A Systematic Review

CONTEXT: Alcohol and other drug (AOD) misuse by youth is a significant public health concern. Unanticipated treatment for AOD-related morbidities is often sought in hospital emergency departments (EDs). Screening instruments that rapidly identify patients who require further diagnostic evaluation and/or brief intervention are critically important. OBJECTIVE: To summarize evidence on screening instruments that can assist emergency care clinicians in identifying AOD misuse in pediatric patients. METHODS: Fourteen electronic databases (including Medline, Embase, and PsycINFO) and reference screening were used. Psychometric and prospective diagnostic studies were selected if the instrument focused on detecting AOD misuse in patients aged 21 years or younger in the ED. Two reviewers independently assessed quality and extracted data. Validity and reliability data were collected for psychometric studies. Instrument performance was assessed by using sensitivity, specificity, and positive (LR+) and negative (LR−) likelihood ratios. Meta-analysis was not possible because of clinical and measurement heterogeneity. RESULTS: Of the 1545 references initially identified, 6 studies met inclusion criteria; these studies evaluated 11 instruments for universal or targeted screening of alcohol misuse. Instruments based on diagnostic criteria for AOD disorders were effective in detecting alcohol abuse and dependence (sensitivity: 0.88; specificity: 0.90; LR+: 8.80) and cannabis use disorder (sensitivity: 0.96; specificity: 0.86; LR+: 6.83). CONCLUSIONS: On the basis of the current evidence, we recommend that emergency care clinicians use a 2-question instrument for detecting youth alcohol misuse and a 1-question instrument for detecting cannabis misuse. Additional research is required to definitively answer whether these tools should be used as targeted or universal screening approaches in the ED.

Evaluating the Adequacy of Social-Emotional Measures in Early Childhood

Technical adequacy and usability are important considerations in selecting early childhood social-emotional (SE) screening and assessment measures. As identification of difficulties can be tied to programming, intervention, accountability, and funding, it is imperative that practitioners and decision makers select appropriate and quality measures from the plethora of measures available. This study systematically reviewed and evaluated the technical adequacy and usability of 10 commonly used SE assessment and screening measures, using a framework for evaluating selected properties of measures (e.g., reliability, validity). Through this review, it was found that there are inadequacies in many commonly used SE measures, deserving the attention of both users and developers.

An Experimental Test of Student Verbal Reports and Teacher Evaluations as a Source of Validity Evidence for Test Development

The Standards for Educational and Psychological Testing indicate that test instructions, and by extension item objectives, presented to examinees should be sufficiently clear and detailed to help ensure that they respond as developers intend them to respond (Standard 3.20; AERA, APA, & NCME, 1999). The present study investigates the use of verbal reports, one of many sources of evidence for validity arguments, as a way to evaluate the content clarity of 30 items from a large-scale science assessment. Student reports were used to edit items and create a student-modified test form. Evaluations from expert preservice teachers were used to edit the items and create an expert-modified test form. Both experimental forms, along with the original set of 30 items, were then randomly assigned to a sample of 264 examinees. Hierarchical regression analyses indicated that examinee performance on the student-modified and expert-modified forms was similar relative to performance on the original test items. Item statistics indicated that student-modified test items were equally difficult and discriminating as expert-modified test items. The implications of using student and teacher evaluations are discussed for informing test development.

Screening for post-traumatic stress disorder after injury in the pediatric emergency department--a systematic review protocol.

BackgroundPediatric injury is highly prevalent and has significant impact both physically and emotionally. The majority of pediatric injuries are treated in emergency departments (EDs), where treatment of physical injuries is the main focus. In addition to physical trauma, children often experience significant psychological trauma, and the development of acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) is common. The consequences of failing to recognize and treat children with ASD and PTSD are significant and extend into adulthood. Currently, screening guidelines to identify children at risk for developing these stress disorders are not evident in the pediatric emergency setting. The goal of this systematic review is to summarize evidence on the psychometric properties, diagnostic accuracy, and clinical utility of screening tools that identify or predict PTSD secondary to physical injury in children. Specific research objectives are to: (1) identify, describe, and critically evaluate instruments available to screen for PTSD in children; (2) review and synthesize the test-performance characteristics of these tools; and (3) describe the clinical utility of these tools with focus on ED suitability.MethodsComputerized databases including MEDLINE, EMBASE, CINAHL, ISI Web of Science and PsycINFO will be searched in addition to conference proceedings, textbooks, and contact with experts. Search terms will include MeSH headings (post-traumatic stress or acute stress), (pediatric or children) and diagnosis. All articles will be screened by title/abstract and articles identified as potentially relevant will be retrieved in full text and assessed by two independent reviewers. Quality assessment will be determined using the QUADAS-2 tool. Screening tool characteristics, including type of instrument, number of items, administration time and training administrators level, will be extracted as well as gold standard diagnostic reference properties and any quantitative diagnostic data (specificity, positive and negative likelihood/odds ratios) where appropriate.DiscussionIdentifying screening tools to recognize children at risk of developing stress disorders following trauma is essential in guiding early treatment and minimizing long-term sequelae of childhood stress disorders. This review aims to identify such screening tools in efforts to improve routine stress disorder screening in the pediatric ED setting.Trials registrationPROSPERO registration: CRD42013004893

Parent Recommendations to Enhance Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management.

Objective To explore parents’ recommendations to enhance enrollment in multidisciplinary clinical care for managing pediatric obesity. Study design Data for this interpretative description study were collected through individual, semistructured interviews that were audiorecorded, transcribed verbatim, and analyzed thematically. Parents (n = 79) were recruited from 4 multidisciplinary weight management clinics in Canada located in Edmonton, Hamilton, Montreal, and Vancouver. Results Most interviewed parents had children with obesity (body mass index ≥95th percentile; 84.2%), were female (87.3%), had postsecondary education (69.6%), and were white (75.9%). Parents’ recommendations referred to enrollment opportunities, information about obesity services, motivation for treatment, and accessibility to obesity services. Specifically, parents recommended to increase referral options and follow‐up contacts with families during the enrollment process, inform referring physicians and families about the availability and characteristics of obesity services, enhance families’ motivation for treatment, prevent families from getting discouraged, make services more appealing to families, and address accessibility issues (eg, offering multiple options for appointment times, providing support for transportation). Conclusions Parents’ recommendations support the need for family‐centered approaches to enhance enrollment; however, their feasibility, acceptability, and effectiveness remain to be tested empirically.