Psychiatrists as Partners in Suicide Prevention for Pediatric Medical Settings

The article discusses the role of psychiatrists and other mental health clinicians in preventing suicide, which remains a global public health crisis and the third leading cause of death among U.S. youth. Topics include effect of the COVID-19 pandemic on the pediatric mental health crisis, available tools to conduct a brief suicide safety assessment, and initiatives that can empower primary care providers to better address mental health concerns when specialty care is unavailable.

Left on Read: Reply Latency for Anxiety & Depression Screening

Mental health is a critical societal issue and early screening is vital to enabling timely treatment. The rise of text-based communications provides new modalities that can be used to passively screen for mental illnesses. In this paper we present an approach to screen for anxiety and depression through reply latency of text messages. We demonstrate that by constructing machine learning models with reply latency features. Our models screen for anxiety with a balanced accuracy of 0.62 and F1 of 0.73, a notable improvement over prior approaches. With the same participants, our models likewise screen for depression with a balanced accuracy of 0.70 and F1 of 0.80. We additionally compare these results to those of models trained on data collected prior to the COVID-19 pandemic. Finally, we demonstrate generalizability for screening by combining datasets which results in comparable accuracy. Latency features could thus be useful in multimodal mobile mental illness screening. © 2022 ACM.

2021 U.S. Virgin Islands Zika health brigade: Providing recommended pediatric health screenings for children born to mothers with laboratory evidence of possible Zika virus infection during pregnancy.

BACKGROUND: The United States Virgin Islands (USVI) Department of Health (DOH) conducted a second Zika health brigade (ZHB) in 2021 to provide recommended Zika-related pediatric health screenings, including vision, hearing, neurologic, and developmental screenings, for children in the USVI. This was replicated after the success of the first ZHB in 2018, which provided recommended Zika-related pediatric health screenings to 88 infants and children exposed to Zika virus (ZIKV) during pregnancy. METHODS: Ten specialty pediatric care providers were recruited and traveled to the USVI to conduct the screenings. USVI DOH scheduled appointments for children included in CDC's U.S. Zika Pregnancy and Infant Registry (USZPIR). During the ZHB, participants were examined by pediatric ophthalmologists, pediatric audiologists, and pediatric neurologists. We report the percentage of participants who were referred for additional follow-up care or given follow-up recommendations in the 2021 ZHB and compare these referrals and recommendations to those given in the 2018 ZHB. RESULTS: Thirty-three children born to mothers with laboratory evidence of ZIKV infection during pregnancy completed screenings at the 2021 ZHB, of which 15 (45%) children were referred for additional follow-up care. Ophthalmological screenings resulted in the highest number of new referrals for a specialty provider among ZHB participants, with 6 (18%) children receiving referrals for that specialty. Speech therapy was the most common therapy referral, with 10 (30%) children referred, of which 9 (90%) were among those who attended the 2018 ZHB. CONCLUSIONS: Thirty-three children in a jurisdiction with reduced access to healthcare specialists received recommended Zika-related pediatric health screenings at the ZHB. New and continuing medical and developmental concerns were identified and appropriate referrals for follow-up care and services were provided. The ZHB model was successful in creating connections to health services not previously received by the participants.

Meeting the Behavioral Health Needs of Health Care Workers During COVID-19 by Leveraging Chatbot Technology: Development and Usability Study.

BACKGROUND: During the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources. OBJECTIVE: This study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles. METHODS: In a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group. RESULTS: The UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80% of attendees reporting the experience as helpful. CONCLUSIONS: UCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings.

A Comparative Case Study of the Implementation of a Digital App-Based Platform Aimed at Reducing Sexual Risk in Adolescents and Young Adults

Risky sexual behaviors in adolescents and young adults often result in negative outcomes, such as sexually transmitted infections (STIs) and unwanted pregnancies. This case study compares the experience of implementing a digital app-based platform aimed at reducing adolescent sexual risk behavior in a rural medical clinic and a university-based mental health clinic in an effort to better understand how the cliexa-OPTIONS mobile app can inform care and enhance the overall quality of treatment in very different clinical health settings. Clinicians in charge of the implementation of the digital app report that it opens up more transparent discussions with patients/clients, allowing them to provide better care in both medical and mental health settings. The differences in context provide different demographic-related challenges at the two sites. Challenges in online recruitment and workflow were evident only at the university-based mental health clinic as a result of the COVID-19 pandemic. Implementers at both sites indicated a highly positive overall experience with cliexa-OPTIONS and a desire to use the digital app in the future. Patient/client satisfaction surveys indicate that patients/clients enjoy using the digital app and find it easy to use. © 2023 Taylor & Francis Group, LLC.

Piloting a clinical mental health process in the intermediate school setting

The COVID-19 pandemic has highlighted the need for increased adolescent mental health support in the school setting. This evidence-based quality improvement project aimed to determine if implementing a clinical mental health pathway increases the number of mental health screenings completed and increases school nurse practitioners' comfort and confidence in completing mental health screenings. A Mental Health Toolkit was developed to include program-specific management recommendations, a school collaboration flowsheet, and educational and community resources for the nurse practitioner, students, and school community. The 15-week pilot intervention was evaluated using quantitative pre-and post-survey and qualitative interviews. The intervention increased the number of depression screenings performed compared to the previous school year. In addition, the post-intervention interview provided clarity to the persistent system-level and clinic-level barriers and provided personal insights into performing mental health screenings within the school setting. This pilot project allowed the nurse practitioner to model the normalization of mental health discussions. It also provided an opportunity for increased collaboration between the nurse practitioner and school partners, which can substantially impact adolescent mental health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

A cross-sectional study of unlocking childhood cancer services during COVID-19 pandemic: a pediatric oncology tertiary care center's experience from a developing country

Introduction: The global coronavirus disease 2019 (COVID-19) pandemic has made the provision of cancer care services a challenging task all over the world, even in developed countries. Multiple studies have already reported increased rate of diagnostic delays, interruptions in radiotherapy and chemotherapy administration, and shortage of health care personnel to deliver these services. Background: The aim of this study was to analyze the impact of strategies used to deliver uninterrupted childhood cancer services at our center during the COVID-19 pandemic. Materials and Methods: This is a cross-sectional study of the children less than 18 years of age admitted at our center between March 2020 and September 2021 to assess the effect of strategies adopted to provide uninterrupted cancer services during the COVID-19 pandemic. All the children with cancer who were managed during the study period were included in the study. The children who had treatment interruptions/lost to follow-up prior to onset of COVID-19 were excluded from the study. The primary outcome was to measure the effect of COVID-19 on delivery of cancer care services. The secondary outcome was to assess whether the strategies followed at our center helped to reduce diagnostic delays or loss to follow-up during the COVID-19 pandemic. Results: Out of total 1,490 admissions, 199 children were managed during the study period. Among the 199 children managed, 124 of them were newly diagnosed, 75 had ongoing treatment, 16 children relapsed, 13 children received palliative care, and 6 families were lost to follow-up. Out of 1,471 tests done, only 16 children and 6 caregivers tested COVID-19 positive during routine screening. Thirty-five underwent surgery and 23 received radiotherapy during this period. Among 199 children, 143 (71.8%) received financial support for hospital expenses, 23 (11.5%) received travel support, 20 (10%) were provided free accommodation, and 15 (7.5%) received home delivery of oral chemotherapy and pain medications. A total of $86,989.05 was supported for diagnostic investigations, COVID-19 testing, chemotherapy, and supportive care;$1,144.90 for travel support;and $17,010.94 was waived off by hospital administration to support the poor families. Conclusion: The shared care model, support from nongovernmental organizations and hospital administration, and utilization of local resources productively and effectively helped to avoid diagnostic delays and treatment interruptions, and provide uninterrupted pediatric cancer care services at our center.

Szűrőbuszok statikus pontként való alkalmazása a Covid-19-járvány idején

Purpose: The aim of our study is to present the results of the mobile sampling of the National Public Health Center during the Covid-19 pandemic, the implementation process of the screening buses of the program "We bring the screening tests in place” as static points, as well as the spatial and temporal frequency of use. Methods: Our retrospective analysis was performed in Pest County between 12th of November, 2020 and 18th of April 2022 by evaluating the Covid-19 sampling results from screening buses (N=164,576). Descriptive statistical methods were used to process the data. Results: In most cases, the screening was carried out in the patient's car, which reduced the risk of infection and ensured the safety and smoothness of the work by moving quickly through the screening point. Sampling was performed using AbottTM, Clintest® and VivaDiagTM rapid tests, and in case of a negative result, another nasopharyngeal sampling was performed for RT-PCR. An average of 504 samples were taken per day, of which on average almost 1⁄3(31.41%) were positive. Conclusion: The advantage of the screening buses was the ability to perform a significant number of tests, their mobility, the fact that they can be placed in easily accessible locations and the reduced risk of infection. Mass testing at static points has proven to be an efficient process that can be used in the future if the need arises. Célkitűzés: Tanulmányunk célja a Covid-19-járvány során a Nemzeti Népegészségügyi Központ mobil mintavételezésének, a „Helybe visszük a szűrővizsgálatokat” program szűrőbuszainak statikus pontként történő megvalósítási folyamatának, illetve területi és időbeni igénybevételi gyakoriságának, eredményeinek bemutatása. Vizsgálat módszere: Retrospektív elemzésünk Budapesten és Pest megyében 2020. november 12. és 2022. április 18. között a szűrőbuszokon végzett Covid-19-mintavételi leleteinek értékelésével valósult meg (N=164 576). A kapott adatok feldolgozásához leíró statisztikai módszereket alkalmaztunk. Eredmények: A teszteléseket legtöbb esetben a páciens személygépjárműjében végeztük el, ami csökkentette az infektálódás kockázatát, illetve a szűrőponton való gyors áthaladás szavatolta a munka biztonságát és gördülékenységét is. A mintavételezések során az AbottTM, a Clintest®, valamint a VivaDiagTM rapid tesztjeit használtuk, negatív eredmény esetén újabb nasopharingealis mintavétel történt RT-PCR elvégzése céljából. Naponta átlagosan 504 mintavétel valósult meg, amelynek átlagosan közel egyharmada (31,41%) mutatott pozitivitást. Következtetések: A szűrőbuszok előnye a nagyszámú tesztek elvégzésének lehetőségében, a mozgathatóságban, a mindenki számára könnyen megközelíthető pontokra való kihelyezésben, valamint a fertőződés kockázatának csökkentésében mutatkozott meg. A tömeges tesztelések statikus pontokon való lebonyolítása hatékonynak bizonyult, amely folyamatot a jövőben is alkalmazhatunk, ha arra szükség lesz.

Designing Digital COVID-19 Screening: Insights and Deliberations.

Due to the global COVID-19 pandemic, public health control and screening measures have been introduced at healthcare facilities, including those housing our most vulnerable populations. These warning measures situated at hospital entrances are presently labour-intensive, requiring additional staff to conduct manual temperature checks and risk-assessment questionnaires of every individual entering the premises. To make this process more efficient, we present eGate, a digital COVID-19 health-screening smart Internet of Things system deployed at multiple entry points around a children's hospital. This paper reports on design insights based on the experiences of concierge screening staff stationed alongside the eGate system. Our work contributes towards social-technical deliberations on how to improve design and deploy of digital health-screening systems in hospitals. It specifically outlines a series of design recommendations for future health screening interventions, key considerations relevant to digital screening control systems and their implementation, and the plausible effects on the staff who work alongside them.

Regional differences in health screening participation between before and during COVID-19 pandemic.

BACKGROUND: Health screening is a preventive and cost-effective public health strategy for early detection of diseases. However, the COVID-19 pandemic has decreased health screening participation. The aim of this study was to examine regional differences in health screening participation between before and during COVID-19 pandemic and vulnerabilities of health screening participation in the regional context. METHODS: Administrative data from 229 districts consisting of 16 provinces in South Korea and health screening participation rate of each district collected in 2019 and 2020 were included in the study. Data were then analyzed via descriptive statistics and geographically weighted regression (GWR). RESULTS: This study revealed that health screening participation rates decreased in all districts during COVID-19. Regional vulnerabilities contributing to a further reduction in health screening participation rate included COVID-19 concerns, the population of those aged 65+ years and the disabled, lower education level, lower access to healthcare, and the prevalence of chronic disease. GWR analysis showed that different vulnerable factors had different degrees of influence on differences in health screening participation rate. CONCLUSIONS: These findings could enhance our understanding of decreased health screening participation due to COVID-19 and suggest that regional vulnerabilities should be considered stringent public health strategies after COVID-19.

Piloting a clinical mental health process in the intermediate school setting

The COVID-19 pandemic has highlighted the need for increased adolescent mental health support in the school setting. This evidence-based quality improvement project aimed to determine if implementing a clinical mental health pathway increases the number of mental health screenings completed and increases school nurse practitioners' comfort and confidence in completing mental health screenings. A Mental Health Toolkit was developed to include program-specific management recommendations, a school collaboration flowsheet, and educational and community resources for the nurse practitioner, students, and school community. The 15-week pilot intervention was evaluated using quantitative pre-and post-survey and qualitative interviews. The intervention increased the number of depression screenings performed compared to the previous school year. In addition, the post-intervention interview provided clarity to the persistent system-level and clinic-level barriers and provided personal insights into performing mental health screenings within the school setting. This pilot project allowed the nurse practitioner to model the normalization of mental health discussions. It also provided an opportunity for increased collaboration between the nurse practitioner and school partners, which can substantially impact adolescent mental health outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Nurse, Give Me the News! Understanding Support for and Opposition to a COVID-19 Health Screening System.

Helping the sick and protecting the vulnerable has long been the credo of the health profession. In response to the coronavirus-disease-2019 (COVID-19 pandemic), hospitals and healthcare institutions have rapidly employed public health measures to mitigate patient and staff infection. This paper investigates staff and visitor responses to the COVID-19 eGate health screening system; a self-service technology (SST) which aims to protect health care workers and facilities from COVID-19. Our study evaluates the in situ deployment of the eGate, and employs a System Usability Scale (SUS) and questionnaire (n = 220) to understand staff and visitor's acceptance of the eGate. In detailing the themes relevant to those who advocate for the system and those who oppose it, we contribute towards a more detailed understanding of the use and non-use of health-screening SSTs. We conclude with a series of considerations for the design of future interactive screening systems within hospitals.

Medical Experts' Agreement on Risk Assessment Based on All Possible Combinations of the COVID-19 Predictors-A Novel Approach for Public Health Screening and Surveillance.

During the initial phase of the coronavirus disease 2019 (COVID-19) pandemic, there was a critical need to create a valid and reliable screening and surveillance for university staff and students. Consequently, 11 medical experts participated in this cross-sectional study to judge three risk categories of either low, medium, or high, for all 1536 possible combinations of 11 key COVID-19 predictors. The independent experts' judgement on each combination was recorded via a novel dashboard-based rating method which presented combinations of these predictors in a dynamic display within Microsoft Excel. The validated instrument also incorporated an innovative algorithm-derived deduction for efficient rating tasks. The results of the study revealed an ordinal-weighted agreement coefficient of 0.81 (0.79 to 0.82, p-value < 0.001) that reached a substantial class of inferential benchmarking. Meanwhile, on average, the novel algorithm eliminated 76.0% of rating tasks by deducing risk categories based on experts' ratings for prior combinations. As a result, this study reported a valid, complete, practical, and efficient method for COVID-19 health screening via a reliable combinatorial-based experts' judgement. The new method to risk assessment may also prove applicable for wider fields of practice whenever a high-stakes decision-making relies on experts' agreement on combinations of important criteria.

HOW DO WE PROVIDE WOMEN-CENTRED CARE FOR THE ONE-IN-FIVE WOMEN WHO HAVE A MENTAL HEALTH CONDITION? 2. CHALLENGES AND NEXT STEPS

The Scottish Government released the Mental Health Strategy to improve mental health services. With one-in-five pregnant women being identified as having a mental health condition, it is a prevalent issue for midwives. There are obstacles in midwifery to being able to meet the expectations of the aims of the Mental Health Strategy. These include accessing services, mental health stigma, organisational challenges, training and the impact of COVID-19. Solutions such as The Best Start and continuity of care within midwifery, appropriate referral process, training and education, and increased awareness can help midwives achieve the Scottish Government's aims. This is the final article in the series.

THE POWER OF TOUCH: A MIDWIFE'S HANDS

As well as being a basic diagnostic tool, our hands as midwives give us the opportunity to provide a tender touch, which research tells us can boost the immune system, reduce pain and trigger the release of endorphins and oxytocin.1 Touch is a powerful yet sometimes underestimated sense;as babies it is our first sensation and as we grow, a universal language. Touch fosters compassion and empathy2 by activating the vagus nerve3 and can help with reconciliation.4 In addition, touch indicates trust, and calms the cardiovascular system.

Factorial Validity and Invariance of an Adolescent Depression Symptom Screening Tool.

CONTEXT: Depression is among the most common mental health disorders in youth, results in significant impairment, and is associated with a higher risk of suicide. Screening is essential, but assessment tools may not account for the complex interrelatedness of various demographic factors, such as sex, socioeconomic status, and race. OBJECTIVES: To determine the (1) the factor structure of the Patient Health Questionnaire-Adolescent (PHQ-A) for measuring depression in a group of adolescent athletes and (2) measurement invariance between Black and White patients on the PHQ-A. DESIGN: Retrospective cohort design. SETTING: Data were obtained from a secure database collected at a free, comprehensive, mass preparticipation physical examination event hosted by a large health care system. PATIENTS OR OTHER PARTICIPANTS: Participants were 683 high school athletes (Black = 416, White = 267). The independent variables were somatic and affective factors contributing to the construct of depression measured by the PHQ-A and participant race (Black or White). MAIN OUTCOME MEASURE(S): (1) Factors upon which the construct of depression is measured and (2) measurement invariance between Black and White participants. RESULTS: A 2-factor model, involving affective and somatic components, was specified and exhibited adequate fit to the data (comparative fit index >0.90). All items exhibited moderate to high squared multiple correlation values (R2 = 0.10-0.65), suggesting that these items resonated relatively well with participants. The 2-factor model demonstrated noninvariance between Black and White participants (root mean square error of approximation = 0.06-0.08). CONCLUSIONS: Overall, the structure of the PHQ-A was supported by a 2-factor model in adolescent athletes, measuring both affective and somatic symptoms of depression. However, a 2-factor PHQ-A structure was not fully invariant for the adolescents sampled across participant groups, indicating that the model functioned differently between the Black and White participants sampled.

Coronavirus Pandemic Anxiety Scale (CPAS-11): development and initial validation.

The mental health impact of the COVID-19 pandemic will increase as the outbreak continues and persist even after the pandemic passes. We developed an 11-item Coronavirus Pandemic Anxiety Scale (CPAS-11) to measure symptoms of anxiety related to the COVID-19 pandemic to help identify individuals who might need mental health services. In developing the scale items, we considered previous research and theory on anxiety symptoms and symptoms reported by clinically referred cases in the Philippines. The scale was validated in a Filipino sample (N = 925). Exploratory factor analysis indicated two factors corresponding to somatic and non-somatic symptoms; confirmatory factor analysis showed good fit for the two-factor model. CPAS-11 showed good internal consistency, convergent and divergent validity, and screening accuracy. A cutoff score of 15 showed adequate sensitivity and specificity to distinguish GAD-7 screened participants. The results support the viability of CPAS-11 as a screening tool to identify individuals experiencing COVID-19-related anxiety.