Developing a pediatric palliative care service in a large urban hospital: challenges, lessons, and successes.

BACKGROUND AND AIM: We report the process of creating a new palliative care service at a large, urban children's hospital. Our aim was to provide a detailed guide to developing an inpatient consultation service, along with reporting on the challenges, lessons, and evaluation. METHODS: We examined the hiring process of personnel and marketing strategies, a clinical database facilitated ongoing quality review and identified trends, and a survey project assessed provider satisfaction and how referring physicians used the palliative care service. RESULTS AND CONCLUSION: The pilot phase of service delivery laid the groundwork for a more effective service by creating documentation templates and identifying relevant data to track growth and outcomes. It also allowed time to establish a clear delineation of team members and distinction of roles. The survey of referring physicians proved a useful evaluation starting point, but conclusions could not be generalized because of the low response rate. It may be necessary to reconsider the survey technique and to expand the sample to include patients and families. Future research is needed to measure the financial benefits of a well-staffed inpatient pediatric palliative care service.

African American inner-city youth exposed to violence: coping skills as a moderator for anxiety.

The current study examined types of coping as either protective or vulnerability factors for youth exposed to community violence in a sample of 240 inner-city, African American pre- and early adolescents across sixth and seventh grade. Coping was conceptualized within a contextually relevant framework. It was predicted that avoidant coping would interact with exposure to violence to predict reductions in anxiety, cross-sectionally and longitudinally, whereas approach coping was expected to interact with violence exposure to predict increases in anxiety. Youth and parents both reported on youth exposure to community violence and anxiety symptoms; youth provided self-reports of their coping strategies. Data were analyzed by using hierarchical multiple regression analyses. As predicted, avoidant coping showed a protective function on anxiety symptoms; contrary to predictions, approach coping was unrelated to anxiety. Implications for future research on contextually and culturally relevant coping are discussed.

Social support factors as moderators of community violence exposure among inner-city African American young adolescents.

Using both surveys and the experience sampling method (ESM), community violence exposure, social support factors, and depressive and anxiety symptoms were assessed longitudinally among inner-city African American adolescents. Moderator models were tested to determine protective factors for youth exposed to community violence. Several social support factors emerged as protective-stabilizing forces for witnesses of violence both cross-sectionally and longitudinally, including maternal closeness, time spent with family, social support, and daily support (ESM). Contrary to hypotheses, several social support factors demonstrated a promotive-reactive effect such that, in conditions of high victimization, they failed to protect youth from developing symptoms. Effects did not differ by outcome or sex, though sex differences in findings emerged. Protective-stabilizing effects occurred more for witnessing violence, whereas promotive-reactive patterns occurred more for victimization. Results affirm social support factors as protective from the adverse effects of violence exposure, but they also suggest that some factors typically conceived as contributing to resilience might at times fail to protect youth in conditions of extreme risk.