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1.
Pediatrics ; 143(4)2019 04.
Article in English | MEDLINE | ID: mdl-30877145

ABSTRACT

Early engagement in mental health intervention is critical, yet the vast majority of children who are experiencing mental health concerns are not receiving needed services. Pediatric primary care clinics have been recognized as an ideal setting in which to identify and address mental health problems early, although engagement in mental health services within primary care and in community-based settings remains low. Navigators, or individuals with experience in navigating the mental health system, have been highlighted as promising partners in efforts to improve engagement in mental health services. Navigation has a growing body of research support among adults and in targeting medical concerns, but there has been limited research on integrating family navigators into pediatric primary care settings to address mental health concerns. Despite this gap in the evidence base, we believe there is significant promise for the use of this model in addressing children's mental health needs. In this report, we discuss factors contributing to high levels of unmet mental health needs and low levels of engagement in mental health services, the role that navigators can play in increasing engagement in mental health care, and implications and recommendations related to integrating mental health-focused family navigators into pediatric primary care settings.


Subject(s)
Early Medical Intervention/organization & administration , Mental Disorders/therapy , Mental Health Services/organization & administration , Patient Navigation/organization & administration , Primary Health Care/statistics & numerical data , Adolescent , Adult , Child , Female , Humans , Incidence , Male , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Outcome Assessment, Health Care , Pediatrics , Primary Health Care/methods , Professional-Family Relations , Randomized Controlled Trials as Topic , Severity of Illness Index , United States
2.
Res Nurs Health ; 40(6): 512-518, 2017 12.
Article in English | MEDLINE | ID: mdl-29130503

ABSTRACT

Children born to teen mothers may experience less responsive and supportive parenting and are at heightened risk for a range of social, developmental, and health issues. There is literature to support the positive impact of grandmothers on teen parents and their children. However, what if the teen's mother is also limited in her parenting capacities? How do parenting capacities across these two generations of mothers affect the developing child? In this ongoing study we are examining two important aspects of parenting capacities, attachment quality and executive functioning, in teen mothers (TM) and their biological, co- residing mothers or grandmothers (GM or GGM). Both are essential components of effective parenting, but little is known about their impact on young children's development when raised by two generations of parents. In a cross- sectional, descriptive design, a convenience sample of 50 TM/GM dyads with children 1 to 3 years old is being recruited from two urban teen-tot clinics. Participants complete a paper-and-pencil measure of attachment quality and a computerized measure of multiple aspects of executive function (working memory, inhibitory control, cognitive flexibility). A standardized maternal report measure is used to assess child developmental status. The biggest challenges of the study thus far include recruitment and transience of the study population. Progress to date and experiences from recruitment and data collection are discussed, as well as successful strategies to address challenges.


Subject(s)
Child Development , Child Welfare/psychology , Grandparents/psychology , Parenting/psychology , Adolescent , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Mother-Child Relations , Nursing Assessment , Social Support
3.
J Clin Psychol Med Settings ; 24(3-4): 245-258, 2017 Dec.
Article in English | MEDLINE | ID: mdl-28929269

ABSTRACT

Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system's six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists. Additional work remains to be done in improving family engagement, further expanding services, and ensuring sustainability.


Subject(s)
Behavioral Medicine/organization & administration , Delivery of Health Care, Integrated/organization & administration , Hospitals, Pediatric/organization & administration , Primary Health Care/organization & administration , Child , Child Behavior Disorders/diagnosis , Child Behavior Disorders/therapy , Child, Preschool , District of Columbia , Early Diagnosis , Early Medical Intervention , Health Plan Implementation/organization & administration , Humans , Interdisciplinary Communication , Intersectoral Collaboration , Mass Screening , Needs Assessment , United States
4.
Pediatrics ; 139(1)2017 01.
Article in English | MEDLINE | ID: mdl-27965378

ABSTRACT

Poverty is a common experience for many children and families in the United States. Children <18 years old are disproportionately affected by poverty, making up 33% of all people in poverty. Living in a poor or low-income household has been linked to poor health and increased risk for mental health problems in both children and adults that can persist across the life span. Despite their high need for mental health services, children and families living in poverty are least likely to be connected with high-quality mental health care. Pediatric primary care providers are in a unique position to take a leading role in addressing disparities in access to mental health care, because many low-income families come to them first to address mental health concerns. In this report, we discuss the impact of poverty on mental health, barriers to care, and integrated behavioral health care models that show promise in improving access and outcomes for children and families residing in the contexts of poverty. We also offer practice recommendations, relevant to providers in the primary care setting, that can help improve access to mental health care in this population.


Subject(s)
Health Services Accessibility/organization & administration , Mental Disorders/epidemiology , Mental Disorders/therapy , Mental Health Services/organization & administration , Poverty/psychology , Poverty/statistics & numerical data , Primary Health Care/organization & administration , Adult , Child , Cross-Sectional Studies , Follow-Up Studies , Health Services Needs and Demand/statistics & numerical data , Humans , Mental Health Services/supply & distribution , Risk Factors
5.
J Prim Prev ; 36(3): 139-54, 2015 Jun.
Article in English | MEDLINE | ID: mdl-25771911

ABSTRACT

Teen childbearing is associated with a range of adverse outcomes for both mothers and children, and perpetuates an intergenerational cycle of socioeconomic disadvantage. Fathers may be an underappreciated source of support to teen mothers and their children. The strongest and most consistent predictor of positive father involvement is a positive coparenting relationship between the mother and father. Thus, strengthening the coparenting relationship of teen parents may be protective for both parents and children. This paper describes the rationale, the intervention model, and the cultural adaptation of Strong Foundations, an intervention designed to facilitate and enhance positive coparenting in teen parents. Adapted from an evidence-based coparenting program for adult, cohabiting parents, this intervention was modified to be developmentally and culturally appropriate, acceptable, and feasible for use with urban, low-income, minority expectant teen mothers and their male partners. The authors present lessons learned from the cultural adaptation of this innovative intervention. Pilot testing has shown that this model is both acceptable and feasible in this traditionally hard to reach population. Although recruitment and engagement in this population present specific challenges, young, urban minority parents are deeply interested in being effective coparents, and were open to learning skills to support this goal.


Subject(s)
Black or African American , Interpersonal Relations , Minority Groups , Parenting/ethnology , Parents/education , Parents/psychology , Adolescent , Age Factors , Female , Humans , Male , Program Evaluation , Vulnerable Populations , Young Adult
6.
Matern Child Health J ; 19(5): 1016-23, 2015 May.
Article in English | MEDLINE | ID: mdl-25102809

ABSTRACT

The purpose of this study is to examine the role of father involvement on infant distress among children born to teen mothers, particularly those who are depressed. 119 teen mothers (<20 years) and their infants (<6 months) enrolled in a quasi-experimental trial of a comprehensive pediatric primary care program. Data were drawn from mother-reported questionnaires administered at baseline, before participation in the intervention or comparison conditions. 29 % of teen mothers screened positive for depression. Mothers reported that 78 % of fathers were engaged with their children, typically seeing them a few times per month, and 71 % took financial responsibility for their children. In a multiple linear regression, father responsibility predicted lower infant distress, maternal depression predicted higher infant distress, and there was a significant interaction in which father engagement buffered the effect of maternal depression on infant distress. Fathers may be a protective resource for children born to teen mothers, even as early as the first 6 months of life, potentially mitigating the heightened risk associated with maternal depression in the postpartum period.


Subject(s)
Depression, Postpartum/psychology , Father-Child Relations , Fathers/psychology , Parenting/psychology , Adolescent , Adult , Black or African American , Child Abuse/prevention & control , Female , Humans , Infant , Infant, Newborn , Linear Models , Male , Mother-Child Relations , Pediatrics , Poverty , Pregnancy , Pregnancy in Adolescence , Primary Health Care , Surveys and Questionnaires , Young Adult
8.
J Pediatr Adolesc Gynecol ; 27(3): 172-6, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24629716

ABSTRACT

STUDY OBJECTIVE: To examine the self-reported pregnancy intentions of the male partners of expectant adolescent mothers, the accuracy of adolescent mothers' perceptions of their partner's pregnancy intentions, and the concordance between young mothers' and fathers' pregnancy intentions. DESIGN: This cross-sectional pilot study collected interview data from expectant adolescent mothers and their male partners. SETTING: Data were collected in participants' homes. PARTICIPANTS: 35 expectant couples were interviewed separately. Most participants were African American (89% of mothers, 74% of fathers). 69% of mothers were 17-18 years old, and half of the fathers were ≥19. MAIN OUTCOME MEASURES: Parents responded to survey questions adapted from the Center for Disease Control and Prevention's Pregnancy Risk Assessment Monitoring System Questionnaire. RESULTS: 44% of fathers reported wanting their partner to get pregnant. Another 15% were ambivalent. A kappa statistic of 0.12 (P = .33) indicated very little "accuracy" of mothers' perceptions of their partners' pregnancy intentions. Further, there was low concordance between the pregnancy intentions of mothers and fathers. Young fathers who wanted or were ambivalent about pregnancy were significantly more likely to use no contraception or withdrawal. CONCLUSION: For a notable number of minority couples, adolescent mothers do not have an accurate perception of their partners' pregnancy intentions and use contraceptive methods that are not within their control. These findings indicate that teen pregnancy prevention interventions must target young males in addition to females and sexually active adolescents should be encouraged to discuss pregnancy intentions with each other.


Subject(s)
Intention , Pregnancy in Adolescence/psychology , Sexual Partners/psychology , Adolescent , Contraception/statistics & numerical data , Contraception Behavior , Cross-Sectional Studies , Female , Humans , Male , Pilot Projects , Pregnancy , Pregnancy, Unwanted , Self Report , Surveys and Questionnaires , Young Adult
9.
Pediatrics ; 133(1): 114-22, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24298010

ABSTRACT

Adolescent parenthood is associated with a range of adverse outcomes for young mothers, including mental health problems such as depression, substance abuse, and posttraumatic stress disorder. Teen mothers are also more likely to be impoverished and reside in communities and families that are socially and economically disadvantaged. These circumstances can adversely affect maternal mental health, parenting, and behavior outcomes for their children. In this report, we provide an overview of the mental health challenges associated with teen parenthood, barriers that often prevent teen mothers from seeking mental health services, and interventions for this vulnerable population that can be integrated into primary care services. Pediatricians in the primary care setting are in a unique position to address the mental health needs of adolescent parents because teens often turn to them first for assistance with emotional and behavioral concerns. Consequently, pediatricians can play a pivotal role in facilitating and encouraging teen parents' engagement in mental health treatment.


Subject(s)
Mental Disorders , Mental Health Services , Mothers/psychology , Pregnancy in Adolescence/psychology , Vulnerable Populations/psychology , Adolescent , Female , Health Services Accessibility , House Calls , Humans , Mental Disorders/diagnosis , Mental Disorders/epidemiology , Mental Disorders/etiology , Mental Disorders/therapy , Mental Health Services/organization & administration , Mental Health Services/statistics & numerical data , Mother-Child Relations/psychology , Parenting/psychology , Pediatrics , Physician's Role , Pregnancy , Prevalence , Primary Health Care , United States/epidemiology
10.
J Behav Med ; 36(5): 454-65, 2013 Oct.
Article in English | MEDLINE | ID: mdl-22772584

ABSTRACT

Somatic symptoms are a common physical response to stress and illness in childhood. This study assessed 409, primarily African American (85.6 %), urban elementary school children to examine the association between: (1) somatic symptoms and potential external stressors (school and peer stress, family conflict, and community violence) and (2) parent and child agreement on children's self-report of somatic symptoms. The odds of self-report of somatic complaints were significantly associated with family conflict, school and peer stress, and community violence exposure (OR = 1.26, 95 % CI: 1.05-1.50; OR = 1.18, 95 % CI 1.08-1.28; and OR = 1.02, 95 % CI: 1.00-1.05, respectively). Identifying the associations between social, family, and community based stress and somatic symptoms may improve the quality of life for children living in urban environments through early identification and treatment.


Subject(s)
Family/psychology , Peer Group , Stress, Psychological/psychology , Students/statistics & numerical data , Violence/psychology , Anxiety/epidemiology , Anxiety/psychology , Child , Female , Headache/epidemiology , Headache/psychology , Humans , Male , Odds Ratio , Residence Characteristics , Schools , Self Report , Students/psychology , Urban Population/statistics & numerical data
11.
J Trauma Stress ; 23(6): 802-6, 2010 Dec.
Article in English | MEDLINE | ID: mdl-21105068

ABSTRACT

Families exposed to urban poverty face a disproportionate risk of exposure to repeated trauma. Repeated exposures can lead to severe and chronic reactions in multiple family members with effects that ripple throughout the family system. Interventions for distressed families residing in traumatic contexts, such as low-income, urban settings are desperately needed. This report presents preliminary data in support of Strengthening Family Coping Resources, a trauma-focused, multifamily, skill-building intervention. Strengthening Family Coping Resources is designed for families living in traumatic contexts with the goal of reducing symptoms of posttraumatic stress disorder and other trauma-related disorders in children and caregivers. Results from open trials suggest Strengthening Family Coping Resources is a feasible intervention with positive effects on children's symptoms of trauma-related distress.


Subject(s)
Adaptation, Psychological , Family/psychology , Psychotherapy, Group , Wounds and Injuries/therapy , Adolescent , Child , Child, Preschool , Feasibility Studies , Humans , Infant , Poverty Areas , Wounds and Injuries/psychology
12.
J Pediatr Adolesc Gynecol ; 23(1): 16-22, 2010 Feb.
Article in English | MEDLINE | ID: mdl-19679498

ABSTRACT

STUDY OBJECTIVE: Few studies have examined the effects of maternal depressive symptoms among adolescent women. The purpose of this study was to investigate the impact of depressive symptoms on birth outcomes of infants born to adolescent mothers. DESIGN: The medical records of pregnant adolescent patients were examined. Information about maternal depressive symptoms and birth outcomes was collected. SETTING: Data were collected at Washington Hospital Center, a nonprofit, community-based hospital that serves residents throughout the Washington, DC area. PARTICIPANTS: Participants were 294 African-American and Latina adolescent mothers. Mean age was 16.2 years (standard deviation [SD] 1.4). Based on self-reports of depressive symptoms, adolescents were categorized by the following: no reported symptoms, depressive symptoms without SI/SA (suicidal ideation or attempt), and depressive symptoms with SI/SA. MAIN OUTCOME MEASURES: Infant birth weight and gestational age at delivery. RESULTS: Over one-quarter of pregnant adolescents in this study reported symptoms of depression. Adolescents reporting depressive symptoms with SI/SA delivered babies that weighed 239.5 grams (98.3% confidence interval [CI] 3.9 to 475.1) less than babies born to mothers reporting depressive symptoms without SI/SA. There was no association between reported symptoms and gestational age. CONCLUSIONS: Results suggest that compared to nonpregnant teens and adults, pregnant teens may have an increased risk for depression. Additionally, pregnant adolescents with suicidal ideation are at greater risk for delivering infants of lower birth weight compared with teens reporting depressive symptoms without SI/SA and teens reporting no symptoms. This study supports the need for early screening and treatment of depression for young pregnant women.


Subject(s)
Depression/etiology , Infant, Very Low Birth Weight , Pregnancy Complications/psychology , Suicide, Attempted/statistics & numerical data , Adolescent , Birth Weight , Depression/epidemiology , District of Columbia/epidemiology , Female , Gestational Age , Humans , Incidence , Infant, Newborn , Pregnancy , Retrospective Studies
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