Stephanie K. Doupnik

Suburban Families’ Experience With Food Insecurity Screening in Primary Care Practices

To effectively address food insecurity and provide family-centered care, we determined parents’ perceptions of screening for food insecurity in suburban pediatrics practices. BACKGROUND: Food insecurity (FI) remains a major public health problem. With the rise in suburban poverty, a greater understanding of parents’ experiences of FI in suburban settings is needed to effectively screen and address FI in suburban practices. METHODS: We conducted 23 semistructured interviews with parents of children <4 years of age who presented for well-child care in 6 suburban pediatric practices and screened positive for FI. In the interviews, we elicited parents’ perceptions of screening for FI, how FI impacted the family, and recommendations for how practices could more effectively address FI. All interviews were audio recorded and transcribed. We used a modified grounded theory approach to code the interviews inductively and identified emerging themes through an iterative process. Interviews continued until thematic saturation was achieved. RESULTS: Of the 23 parents interviewed, all were women, with 39% white and 39% African American. Three primary themes emerged: Parents expressed initial surprise at screening followed by comfort discussing their unmet food needs; parents experience shame, frustration, and helplessness regarding FI, but discussing FI with their clinician helped alleviate these feelings; parents suggested practices could help them more directly access food resources, which, depending on income, may not be available to them through government programs. CONCLUSIONS: Although most parents were comfortable discussing FI, they felt it was important for clinicians to acknowledge their frustrations with FI and facilitate access to a range of food resources.

Mental Health Conditions and Medical and Surgical Hospital Utilization

OBJECTIVE: Mental health conditions are prevalent among children hospitalized for medical conditions and surgical procedures, but little is known about their influence on hospital resource use. The objectives of this study were to examine how hospitalization characteristics vary by presence of a comorbid mental health condition and estimate the association of a comorbid mental health condition with hospital length of stay (LOS) and costs. METHODS: Using the 2012 Kids’ Inpatient Database, we conducted a retrospective, nationally representative, cross-sectional study of 670 161 hospitalizations for 10 common medical and 10 common surgical conditions among 3- to 20-year-old patients. Associations between mental health conditions and hospital LOS were examined using adjusted generalized linear models. Costs of additional hospital days associated with mental health conditions were estimated using hospital cost-to-charge ratios. RESULTS: A comorbid mental health condition was present in 13.2% of hospitalizations. A comorbid mental health condition was associated with a LOS increase of 8.8% (from 2.5 to 2.7 days, P < .001) for medical hospitalizations and a 16.9% increase (from 3.6 to 4.2 days, P < .001) for surgical hospitalizations. For hospitalizations in this sample, comorbid mental health conditions were associated with an additional 31 729 (95% confidence interval: 29 085 to 33 492) hospital days and

Parent Coping Support Interventions During Acute Pediatric Hospitalizations: A Meta-Analysis.

90 million (95% confidence interval:

Closing the Gap: Improving Access to Mental Health Care Through Enhanced Training in Residency

81 to

Mental Health Conditions and Symptoms in Pediatric Hospitalizations: A Single-Center Point Prevalence Study

101 million) in hospital costs. CONCLUSIONS: Medical and surgical hospitalizations with comorbid mental health conditions were associated with longer hospital stay and higher hospital costs. Knowledge about the influence of mental health conditions on pediatric hospital utilization can inform clinical innovation and case-mix adjustment.

Hospitalization for Suicide Ideation or Attempt: 2008–2015

In this systematic literature review, we found evidence that parents of hospitalized children who received coping support interventions had better emotional well-being. CONTEXT: Parents may experience psychological distress when a child is acutely hospitalized, which can negatively affect child outcomes. Interventions designed to support parents’ coping have the potential to mitigate this distress. OBJECTIVE: To describe interventions designed to provide coping support to parents of hospitalized children and conduct a meta-analysis of coping support intervention outcomes (parent anxiety, depression, and stress). DATA SOURCES: We searched Pubmed, Embase, PsycINFO, Psychiatry Online, and Cumulative Index to Nursing and Allied Health Literature from 1985 to 2016 for English-language articles including the concepts “pediatric,” “hospitalization,” “parents,” and “coping support intervention.” STUDY SELECTION: Two authors reviewed titles and abstracts to identify studies meeting inclusion criteria and reviewed full text if a determination was not possible using the title and abstract. References of studies meeting inclusion criteria were reviewed to identify additional articles for inclusion. DATA EXTRACTION: Two authors abstracted data and assessed risk of bias by using a structured instrument. RESULTS: Initial searches yielded 3450 abstracts for possible inclusion. Thirty-two studies met criteria for inclusion in the systematic review and 12 studies met criteria for inclusion in the meta-analysis. The most commonly measured outcomes were parent depression, anxiety, and stress symptoms. In meta-analysis, combined intervention effects significantly reduced parent anxiety and stress but not depression. Heterogeneity among included studies was high. LIMITATIONS: Most included studies were conducted at single centers with small sample sizes. CONCLUSIONS: Coping support interventions can alleviate parents’ psychological distress during children’s hospitalization. More evidence is needed to determine if such interventions benefit children.

Beyond Mental Health Crisis Stabilization in Emergency Departments and Acute Care Hospitals

“Daniel,” a previously healthy teenager, complained of chest pain at his annual well child visit. His doctor, a second-year pediatric resident, quickly and confidently evaluated Daniel for cardiac or pulmonary causes of chest pain. She recognized that his pain was associated with anxiety and provided Daniel with a referral to a clinical psychologist. After several counseling sessions, his symptoms improved and the two agreed he no longer required therapy. But when Daniel returned to primary care several months later, his depression screen was positive. He had been having frequent panic attacks on the subway, difficulty concentrating at school, and feelings of hopelessness. The pediatric resident caring for him realized he needed additional mental health treatment, but she was unable to persuade him to seek care with a psychologist or psychiatrist. He was firm in his refusal to see a specialist, leaving his resident provider unsure what to do next. Her skills and expertise were not sufficient to deliver initial therapies for depression and anxiety, nor was she able to coordinate follow-up with a mental health specialist. Daniel’s situation is not uncommon; although 1 in 5 children in the United States experiences a severe mental health disorder, nearly 80% of children with mental health disorders do not receive mental health care.1,2 Daniel’s reluctance to see a psychologist or psychiatrist may have stemmed from denial that his symptoms signaled a mental health condition, lack of comfort with a specialist provider, or the stigma associated with mental … Address correspondence to Gauri Raval, MD, MPH, Department of Pediatrics, University of Virginia School of Medicine, P.O. Box 800386, Charlottesville, VA 22908. E-mail: raval{at}virginia.edu

Mental Health Conditions and Unplanned Hospital Readmissions in Children

BACKGROUND Children and adolescents necessitating hospitalization for physical health conditions are at high risk for mental health conditions; however, the prevalence of mental health conditions and symptoms among hospitalized children and adolescents is uncertain. The objective of this study was to determine the proportion of hospitalized children and adolescents who have diagnosed mental health disorders or undiagnosed mental health problems. METHODS In this single-center point prevalence study of hospitalized children between the ages of 4 and 21 years, patients or their parents reported known mental health diagnoses and use of services using the Services Assessment for Children and Adolescent, and they reported patient mental health symptoms using the Pediatric Symptom Checklist, 17-item form (PSC-17). RESULTS Of 229 eligible patients, 119 agreed to participate. Demographic characteristics of patients who enrolled were not statistically significantly different from those of patients who declined to participate. Among participants, 26% (95% confidence interval [CI], 18%-35%) reported a known mental health diagnosis. On the PSC-17, 29% (95% CI, 21%-38%) of participants had a positive screen for mental health symptoms. Of those with a positive screen, 38% (95% CI, 21%-55%) had no known mental health diagnosis, and 26% (95% CI, 12%-43%) had not received ambulatory mental health services in the 12 months before hospitalization. CONCLUSIONS Mental health conditions and symptoms are common among patients hospitalized in a tertiary childrens hospital, and many affected patients are not receiving ambulatory mental health services.

The Influence of Comorbid Mood and Anxiety Disorders on Outcomes of Pediatric Patients Hospitalized for Pneumonia

With this study, we examined trends in encounters for SI and SA in children and adolescents ages 5 to 17 years at US children’s hospitals from 2008 to 2015. OBJECTIVES: Suicide ideation (SI) and suicide attempts (SAs) have been reported as increasing among US children over the last decade. We examined trends in emergency and inpatient encounters for SI and SA at US children’s hospitals from 2008 to 2015. METHODS: We used retrospective analysis of administrative billing data from the Pediatric Health Information System database. RESULTS: There were 115 856 SI and SA encounters during the study period. Annual percentage of all visits for SI and SA almost doubled, increasing from 0.66% in 2008 to 1.82% in 2015 (average annual increase 0.16 percentage points [95% confidence intervals (CIs) 0.15 to 0.17]). Significant increases were noted in all age groups but were higher in adolescents 15 to 17 years old (average annual increase 0.27 percentage points [95% CI 0.23 to 0.30]) and adolescents 12 to 14 years old (average annual increase 0.25 percentage points [95% CI 0.21 to 0.27]). Increases were noted in girls (average annual increase 0.14 percentage points [95% CI 0.13 to 0.15]) and boys (average annual increase 0.10 percentage points [95% CI 0.09 to 0.11]), but were higher for girls. Seasonal variation was also observed, with the lowest percentage of cases occurring during the summer and the highest during spring and fall. CONCLUSIONS: Encounters for SI and SA at US children’s hospitals increased steadily from 2008 to 2015 and accounted for an increasing percentage of all hospital encounters. Increases were noted across all age groups, with consistent seasonal patterns that persisted over the study period. The growing impact of pediatric mental health disorders has important implications for children’s hospitals and health care delivery systems.

Collaboration Is Key to Improving Hospital Care for Patients With Medical and Psychiatric Comorbidity

* Abbreviation: ED — : emergency department A 15-year-old boy with a previous traumatic brain injury arrives in the emergency department (ED) with aggressive behavior. During his ED visit and admission to the inpatient unit, the boy initially requires physical restraints and medications to treat his aggression. A thorough medical evaluation reveals that his behavior is a symptom of constipation. After medical treatment, along with mental health counseling and adjustment of his psychiatric medications, he is discharged from the hospital with outpatient rehabilitation, regular pediatrician visits, and community mental health services. The health care team was able to identify effective physical and mental health treatments using a collaborative multidisciplinary approach. At least 1 in 5 children experiences a mental health condition during childhood or adolescence,1 and more children with mental health concerns than ever before require ED and acute hospital care.2 Improvements in preventing and treating children’s mental health conditions have not kept pace with the remarkable progress in preventing and treating other pediatric illnesses. To illustrate, over the past 2 decades, childhood cancer deaths have declined by 20%,3 and infant mortality rates have reached historic lows.3 During the same time period, adolescent suicide deaths have increased by 1% to 2% each year, and deaths from opioid overdose in young adults have quadrupled.3 Improving these and other outcomes requires integrating mental health care into all levels of the continuum … Address correspondence to Stephanie K. Doupnik, MD, MSHP, #10194 Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, 2716 South St, Philadelphia, PA 19146. Email: doupniks{at}chop.edu