Caregiver and Clinician Experience With Virtual Services for Children and Youth With Complex Needs During COVID-19.

INTRODUCTION: During the COVID-19 pandemic, support services for children and youth quickly shifted to virtual means. To continue delivering essential, trauma-informed, specialized services, the center transitioned to providing most services by phone/video conference. METHOD: A quality improvement project using survey methods was conducted to determine if virtual delivery was timely and satisfactory for inpatient and outpatient care. RESULTS: Findings indicated services were timely. Caregivers appreciated the support, felt a personal connection with staff, and confirmed services met their goals and expectations. However, challenges faced by staff included engaging the child/youth by phone/video, loss of collaboration with colleagues, and concerns about fulfilling their role through virtual means. DISCUSSION: Understanding stakeholder experiences illuminated the path of quality improvement during this major shift in service delivery. Benefits were shown for a blended model of in-person and virtual services on the basis of clinical judgment and the unique needs of clients and families in considering future service model options.

Interrupting the Cycle: Association of Parental Stress and Child/Youth Psychotropic Medication Nonadherence.

Efficacy of psychotropic medication depends in large part on successful adherence to prescribed regimens. This study investigated child/youth nonadherence in relation to family dynamics and informal support. The participants were 10,225 children and youth prescribed psychotropic medication and receiving services from 50 Ontario mental health agencies, assessed with the interRAI™ Child and Youth Mental Health (ChYMH) and ChYMH-Developmental Disability (ChYMH-DD) tools. Findings suggest a cycle of parental stress and child/youth medication nonadherence possibly leading to or even perpetuated by worsening psychiatric symptoms. Informal supports do not appear to moderate this cycle. While the present data cannot speak to causes of medication nonadherence in children/youth or where the cycle begins, the results are consistent with the extant literature calling for attention to parental wellbeing to support children/youth for optimal therapeutic benefits. Understanding home dynamics related to nonadherence can assist care planning that engages the family to achieve best possible child/youth outcomes.

An Examination of Correlates of Quality of Life in Children and Youth With Mental Health Issues.

Quality of life (QoL) is significantly lower in children with mental health issues compared to those who are typically developing or have physical health problems. However, little research has examined factors associated with QoL in this particularly vulnerable population. To address this limitation, 347 clinically referred children and adolescents were assessed using the interRAI Child and Youth Mental Health (ChYMH) Assessment and Self-reported Quality of Life- Child and Youth Mental Health (QoL-ChYMH). Hierarchical multiple linear regression analyses were conducted to examine QoL at the domain-specific level. Children and adolescents who experienced heightened anhedonia and depressive symptoms reported lower social QoL (e.g., family, friends and activities; p = 0.024, 0.046, respectively). Additionally, children and youth who experienced heightened depressive symptoms reported lower QoL at the individual level (e.g., autonomy, health; p = 0.000), and level of basic needs (e.g., food, safety; p = 0.013). In contrast, no mental state indicators were associated with QoL related to services (e.g., school, treatment). Due to the paucity of research examining predictors of QoL in children and youth with mental health challenges, this study contributes to the field in assisting service providers with care planning and further providing implications for practice.

Adverse effects of psychotropic medications in children: predictive factors.

OBJECTIVE: Despite limited information related to efficacy in children, psychotropic medications are commonly prescribed as a first-line treatment for a range of psychiatric diagnoses in children in a variety of clinical settings. Usage has increased over the past three decades. Although psychotropic medications are often effective at treating psychiatric symptoms, the risk of adverse effects (AE) in children is unclear. The current research seeks to identify the mental health characteristics of those children at highest risk of experiencing potential AE from psychotropic medications. METHODS: Psychotropic medication monitoring checklists were used to record possible AE for 99 pediatric clients in a tertiary mental health residential treatment centre for the duration of one to eight weeks. Client characteristics, including the number of diagnoses and behavioural variables, were explored for predictive value of potential AE observed. RESULTS: Results showed that the total number of potential AE was positively predicted by the number of DSM-IV categories diagnosed, as well as behavioural symptoms of impulsiveness and uncooperativeness. CONCLUSIONS: The findings of this study indicate that the number of potential AE from psychotropic medications may be predictable based on client characteristics. Predicting this likelihood during initial assessment can be useful in directing and monitoring treatment, as well as preventing serious events related to medication use.

OBJECTIF: Malgré l'information limitée sur leur efficacité chez les enfants, les médicaments psychotropes sont communément prescrits comme traitement de première ligne pour une variété de diagnostics psychiatriques chez les enfants, dans divers milieux cliniques. L'usage a augmenté dans les 30 dernières années. Bien que les médicaments psychotropes soient souvent efficaces pour traiter les symptômes psychiatriques, le risque d'effets indésirables (EI) chez les enfants n'est pas déterminé. La recherche actuelle vise à identifier les caractéristiques de la santé mentale des enfants les plus à risque d'éprouver des EI potentiels des médicaments psychotropes. MÉTHODES: Les listes de surveillance des médicaments psychotropes ont été utilisées pour repérer des EI possibles chez 99 clients pédiatriques dans un centre tertiaire de traitement résidentiel de santé mentale pour une durée d'une à huit semaines. Les caractéristiques des clients, notamment le nombre de diagnostics et de variables comportementales, ont été explorées pour la valeur prédictive des EI potentiels observés. RÉSULTATS: Les résultats ont indiqué que le nombre total d'EI potentiels était positivement prédit par le nombre de catégories du DSM-IV diagnostiquées, et par les symptômes comportementaux d'impulsivité et de non-coopération. CONCLUSIONS: Les résultats de cette étude indiquent que le nombre d'EI potentiels des médicaments psychotropes peut être prédictible d'après les caractéristiques des clients. Prédire cette probabilité durant l'évaluation initiale peut être utile pour orienter et surveiller le traitement, et prévenir des incidents sérieux liés à l'utilisation de médicaments.

Psychotropic medication monitoring checklists: use and utility for children in residential care.

OBJECTIVE: To develop side effect (SE) monitoring checklists for four categories of psychotropic medications (antipsychotics, mood stabilizers, stimulants, and selective serotonin-reuptake inhibitors), to improve residential direct care staff's confidence and competence in SE monitoring, and to facilitate communication of potential observed SE to medical personnel (e.g., nurse, physician). METHODS: Seventy-two staff members (three nurses, 69 child/youth workers) from five residential units at a tertiary mental health centre utilized the Psychotropic Medication Monitoring Checklists (PMMC) for eight weeks and completed pre- and post-test measures of staff characteristics and PMMC satisfaction. RESULTS: The use of PMMC led to significant changes in direct care staff's awareness and beliefs associated with medication monitoring. An increase in staff-physician communication with direct care staff was marginally significant. Further investigation into the educational qualities of the PMMC revealed that staff with very little prior formal medication education showed greater change compared to those staff reporting greater formal medication instruction. Staff ratings of the PMMC exceeded mild levels of satisfaction, indicating that the checklists were a well-received and useful tool for monitoring SE in a residential care setting. CONCLUSIONS: The PMMC are useful as an educational SE monitoring tool for direct care staff in child residential care settings, with potential utility for multiple types of healthcare settings.

OBJECTIF: Dresser des listes de surveillance des effets secondaires (ES) pour quatre catégories de médicaments psychotropes (antipsychotiques, psychorégulateurs, stimulants, et inhibiteurs spécifiques du recaptage de la sérotonine), améliorer la confiance et la compétence du personnel de soins directs résidentiels en matière de surveillance des ES, et faciliter la communication des ES éventuellement observés au personnel médical (p. ex., infirmières, médecins). MÉTHODES: Soixante-douze membres du personnel (trois infirmières, 69 travailleurs auprès des enfants/adolescents) de cinq unités résidentielles d'un centre tertiaire de santé mentale ont utilisé les Listes de surveillance des médicaments psychotropes (LSMP) durant huit semaines et ont répondu à des mesures pré-test et post-test des caractéristiques du personnel et de la satisfaction relativement aux LSMP. RÉSULTATS: L'utilisation des LSMP a entraîné des changements significatifs de la connaissance et des croyances liées à la surveillance des médicaments chez le personnel de soins directs. L'accroissement de la communication entre les médecins en poste et le personnel des soins directs était marginalement significatif. Une autre recherche sur les qualités didactiques des LSMP a révélé que le personnel ayant très peu de formation pharmacologique antérieure démontrait un plus grand changement comparé au personnel déclarant une formation pharmacologique plus poussée. Les notations du personnel sur les LSMP excédaient les faibles niveaux de satisfaction, indiquant que les listes de surveillance étaient un outil bien reçu et utile pour surveiller les ES dans un contexte de soins résidentiels. CONCLUSIONS: Les LSMP sont utiles en tant qu'outil éducatif de surveillance des ES pour le personnel des soins directs d'établissents de soins résidentiels pour enfants, et peuvent éventuellement être utiles dans de multiples types d'établissements de soins de santé.

An 8-year longitudinal study of mirror self-recognition in chimpanzees (Pan troglodytes).

In a previous cross-sectional study of mirror self-recognition involving 92 chimpanzees, Povinelli et al. [Journal of Comparative Psychology 107 (1993) 347] reported a peak in the proportion of animals exhibiting self-recognition in the adolescent/young adult sample (8-15 years), with 75% being classified as positive. In contrast, only 26% of the older animals (16-39 years) were classified as positive, suggesting a marked decline in self-recognition in middle to late adulthood. In the present study, all of the chimpanzees from the 8-15-year-old group in the Povinelli et al. study (n=12) were again tested for self-recognition, 8 years later. Using the same criteria, 67% of the animals were classified the same. Although a higher proportion of the adult animals in this study (50%) exhibited self-recognition than would be inferred on the basis of the previous study (25%), all changes in self-recognition status were in the negative direction. These results show that mirror self-recognition is a highly stable trait in many chimpanzees, but may be subject to decline with age. Connections with human research are briefly discussed.