Integrated care is associated with increased behavioral health access and utilization for youth in crisis.

INTRODUCTION: Pediatric integrated care is well-positioned to play a substantial role in crisis intervention; however, few studies have investigated the impact of these services. METHOD: We investigated differences in service utilization for youth experiencing a crisis in a large, predominantly rural health system by comparing outcomes for 171 youth who received a crisis evaluation in a primary care behavioral health (PCBH) setting to 171 youth presenting to the emergency department at the main hospital campus using a retrospective cohort study design. RESULTS: PCBH patients were less likely to be male, more likely to be diagnosed with an Adjustment Disorder and less likely to be diagnosed with Autism Spectrum Disorder. Youth evaluated in PCBH were more likely to receive a psychiatric admission, had a shorter latency to the next BH appointment, and had higher rates of completing at least 1 visit in the year following the evaluation. A statistically nonsignificant reduction in frequency of psychiatric admission was observed in the year after the index date, with 3 integrated care patients (vs. 18 on index date) and 5 ED patients (vs. 6 on index date) admitted. DISCUSSION: Opportunities for future research on cost-effectiveness of care and continuous improvement aligned with quadruple aim outcomes are discussed. Overall, this study is among few others investigating the potential for pediatric integrated care models to contribute to youth suicide prevention and the study demonstrated promising increases in access and engagement with timely behavioral health care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Examining Parental Factors as Moderators Between Maltreatment and Adolescent Delinquency.

There is a well-established relationship between child maltreatment and delinquency, indicating that maltreated youth are at a heightened risk for later delinquency. However, the literature is unclear as to why some maltreated youth proceed to engage in delinquent behaviors, whereas others do not. The present study examined whether parental or family factors moderated the relation between a history of maltreatment and engagement in delinquent behavior during adolescence. Parental and family moderators included parental monitoring, parental emotional distress (depression and everyday stressors), parent-child relationship quality, family community and religious disengagement, poverty, and negative life events. This study utilized data on 1,149 children from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a collaborative effort across research sites that collected data regarding the risk factors and consequences of child maltreatment. For the purposes of this study, we utilized adolescent self-reports of delinquency, caregiver reports of parental and family variables, and administrative data on child maltreatment. Community and religious disengagement was the only variable that moderated the relation between maltreatment and delinquency. The effects of community and religious disengagement varied by maltreatment group such that greater community and religious disengagement was related to increased delinquent involvement for those in the no maltreatment, childhood-only maltreatment, and persistent maltreatment groups. Child maltreatment was not a significant predictor of delinquency over and above the effect of parenting and family variables that were measured during adolescence. Findings point to the importance of considering proximal parenting and family factors in understanding the maltreatment-delinquency relationship.

Sibling Child Protective Services Involvement Following a Child Maltreatment Fatality.

OBJECTIVE: This study examined CPS involvement of children surviving the CMF of a sibling as well as predictors of subsequent CPS reports. METHOD: Department of Human Services and Child Death Review Board data about children who died from a CMF during 1993-2003 (n = 416) and their siblings in the state of Oklahoma were used to examine CPS involvement and predictors of subsequent CPS reports for surviving siblings. RESULTS: Surviving siblings of a victim of a CMF experienced substantial CPS involvement; 81% of the original victims had siblings who were subsequently reported to CPS (n = 1,840). Original victim and family characteristics that predicted a greater rate of siblings' subsequent reports to CPS included younger original victim age, greater number of children in the original victim's home, and more previous reports of the original victim to CPS. DISCUSSION: A large portion of families with a CMF struggle to adequately care for their surviving children. Such families may need additional support after a CMF.

The Role of Proximal Maternal Supervision in Children's Risk for Injury in a Low-Income Sample.

Objective: This study examined the role of proximal maternal supervision in children's injury occurrence and severity among low-income families. Methods: We used a case crossover design and collected data about injury and control conditions for children aged 1-5 in 50 low-income families. Results: Higher levels of mothers' proximity to children predicted lower likelihood of injury occurrence. When controlling for child activity level, there was a trend for visual supervision to predict injury occurrence. The number of children in the home was also associated with lower supervision and higher prior injury frequency. Discussion: These findings provide evidence for the important role of maternal supervision in preventing unintentional injuries among low-income, at-risk children. Interventions that help at-risk caregivers provide closer supervision for their children are needed.