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Background: Disparities in access to care persist for Latino youth born in the United States (US). The association of maternal characteristics, such as maternal citizenship status and insurance coverage, on youth health insurance coverage is unclear and is important to examine given the recent sociopolitical shifts occurring in the US.Methods: We analyzed pooled cross-sectional data from the 2010-2018 National Health Interview Survey to examine the association of Latina maternal citizenship status on maternal insurance coverage status and youth uninsurance among US-born Latino youth. Our study sample consisted of 15,912 US-born Latino youth (ages < 18) with linked mothers. Our outcome measures were maternal insurance coverage type and youth uninsurance and primary predictor was maternal citizenship status. Generalized structural equation modeling was used to examine the relationships between maternal characteristics (maternal citizenship, maternal insurance coverage status) and youth uninsurance.Results: Overall, 7% of US-born Latino youth were uninsured. Just 6% of youth with US-born mothers were uninsured compared to almost 10% of those with noncitizen mothers. Over 18% of youth with uninsured mothers were uninsured compared to 2.2% among youth with mothers who had private insurance coverage. Compared to both US-born and naturalized citizen Latina mothers, noncitizen Latina mothers had 4.75 times the odds of reporting being uninsured. Once adjusted for predisposing, enabling, and need factors, maternal uninsurance was strongly associated with youth uninsurance and maternal citizenship was weakly associated with youth uninsurance among US-born Latino youth.Conclusion: Maternal citizenship was associated with both maternal uninsurance and youth uninsurance among US-born Latino youth. Federal- and state-level health policymaking should apply a two-generational approach to ensure that mothers of children are offered affordable health insurance coverage, regardless of their citizenship status, thus reducing uninsurance among US-born Latino youth. [ABSTRACT FROM AUTHOR]

Context: Clinicians often rely on the self-report symptoms of patients in making clinical decisions; hence it is important that these scales be reliable. Objective: To determine the test-retest reliability of healthy youth in completing a graded symptom scale (GSS), modified from the Head Injury Scale Self-Report Concussion Symptoms Scale (HIS). Design: Repeated-measures. Setting: Middle school classroom. Patients or Other Participants: 126 middle school students. Intervention: A survey consisting of a demographic and life events questionnaire and a GSS asking about symptom severity and duration. Main Outcomes Measures: Score for each symptom on the severity and duration scale and a total symptom score (TSS) and the total number of symptoms endorsed (TSE) from the severity scale. Responses on a life events questionnaire were also recorded. Results: We found excellent reliability for TSS (ICC = .93) and TSE (ICC = .88) for the severity scale. We found moderate to excellent reliability on the individual symptoms of both the severity (ICC = .65-.89) and duration (ICC =.56-.96) scales. Conclusions: Healthy youth can reliably self-report symptoms using a GSS. This patient-oriented outcome measure should be incorporated into more investigations in this age group. [ABSTRACT FROM AUTHOR]

Objective: To examine health services, social services, education, and justice system outcomes among First Nations children and youth with fetal alcohol spectrum disorder (FASD).Methods: In this retrospective cohort study, health and social services, education, and justice data were linked with clinical records on First Nations (FN) individuals aged 1 to 25 and diagnosed with FASD between 1999 and 2010 (n = 743). We compared the FN FASD group to non-FN individuals with FASD (non-FN FASD; n = 315) and to First Nations individuals (matched on age, sex, and income) not diagnosed with FASD (FN non-FASD; n = 2229). Rates and relative risks (RRs) were calculated using generalized linear models.Results: FN FASD individuals had similar health services use to non-FN FASD individuals but had greater involvement with child welfare (RR, 1.20; 95% confidence interval [CI], 1.02 to 1.41) and the justice system (RR, 1.37; 95% CI, 1.07 to 1.74) and were more likely to be charged with a crime (RR, 1.40; 95% CI, 1.05 to 1.86). There were no suicides/suicide attempts among the non-FN FASD individuals during the study, but the crude rate/100 person-years of suicides among FN FASD individuals (0.22 for females; 1.06 for males) was substantially higher than for FN non-FASD individuals (0.08 for females; 0.32 for males). There were no significant differences between groups in the education outcomes we measured.Conclusions: Young people with FASD are at risk for poor health, education, and social outcomes, but First Nations young people with FASD face comparably higher risks, particularly with child welfare and justice system involvement. The study emphasizes a critical need for appropriate resources for First Nations children with FASD. [ABSTRACT FROM AUTHOR]

Objective: There is a continuing challenge to ensure equitable access to youth healthcare services in small rural communities. Sweden's 'youth clinic' system is an attempt to provide comprehensive youth health services from a single centre, but many small rural communities have not adopted the youth clinic model. This study uses one case study to examine what the issues might be in establishing a youth clinic in a small rural community. The objective of this paper is to examine the issues around youth healthcare access in one municipality without a youth clinic, and to explore whether and how a youth clinic model might contribute to access in this municipality. Results: Three categories emerged from the analysis; (i) rural closeness; both good and bad, (ii) youth are not in the centre of the healthcare organization, and (iii) adapting youth clinics to a rural setting. While limited to one case example, the study provides valuable insights into youth health service planning in particular types of rural communities. This paper identified structural barriers to developing youth-specific services, and some alternative approaches that might be more suitable to smaller communities. [ABSTRACT FROM AUTHOR]

Obesity in the young is increasingly prevalent. Early, effective intervention is paramount. Treatment options are lifestyle modifications, pharmacological therapies, endoscopic treatments and bariatric surgery. However, the relative effectiveness of these treatments in young patients remains unclear. We systematically identify and meta-analyse studies evaluating weight loss treatments in young people (< 21 years) with obesity. From 16,372 identified studies, 83 were eligible for meta-analysis. Bariatric surgery resulted in high short/medium-term weight loss (pooled estimate 14.04 kg/m2). Lifestyle and pharmacological therapies impacted weight more moderately (pooled estimate 0.99 and 0.94 kg/m2 respectively). Due to its high efficacy, bariatric surgery should be considered earlier when treating obesity in young people. However, due to the invasiveness and inherent risks of bariatric surgery, all other weight loss routes should be exhausted first. [ABSTRACT FROM AUTHOR]

The addictions are characterized by the constant impossibility of controlling substance consumption behavior, despite the knowledge of the negative consequences. In nowadays medicine, it represents a public health problem, because of being widespread throughout the world at all ages and for both genders. The term "addiction" generally refers to problems raised by regular toxic consumption and covers a variety of addictive behaviors with semiological and evolution heterogeneity. The use of both legan and illegal drugs has become a public health problem at international level, and in Romania especially after 1989.Following the usual exposure to the addictive substances and the risk factors, we advocate the Need of a federal concept regarding the common approach to addictions at European and national level, to overcome the consequences of this scourge. [ABSTRACT FROM AUTHOR]

• Although mental health problems represent the largest burden of disease in young people, access to mental health care has been poor for this group. Integrated youth health care services have been proposed as an innovative solution. • Integrated care joins up physical health, mental health and social care services, ideally in one location, so that a young person receives holistic care in a coordinated way. It can be implemented in a range of ways. • A review of the available literature identified a range of studies reporting the results of evaluation research into integrated care services. • The best available data indicate that many young people who may not otherwise have sought help are accessing these mental health services, and there are promising outcomes for most in terms of symptomatic and functional recovery. • Where evaluated, young people report having benefited from and being highly satisfied with these services. • Some young people, such as those with more severe presenting symptoms and those who received fewer treatment sessions, have failed to benefit, indicating a need for further integration with more specialist care. • Efforts are underway to articulate the standards and core features to which integrated care services should adhere, as well as to further evaluate outcomes. This will guide the ongoing development of best practice models of service delivery. [ABSTRACT FROM AUTHOR]

Introduction: The transition from paediatric to adult care poses risks to the health of young adults living with HIV if unsuccessful, including interruptions in care and poor health outcomes. Evolving best practices in HIV healthcare transition should ideally be informed by real-world qualitative and quantitative clinical healthcare transition outcomes. There has been a recent proliferation of HIV healthcare transition outcome research, largely from Europe and North America. Methods: A literature search was undertaken using the online databases PubMed, Web of Science, and Google Scholar. Medical subject and text word searches were combined for terms relating to HIV, paediatric transition outcomes, and internal and external factors were used to identify peer-reviewed articles. Results: In this paper, we review data on HIV healthcare transition outcomes in North America and Europe. Internal and external factors which may impact the success of HIV healthcare transition are examined. We describe ongoing research efforts to capture transition outcomes in the North America and Europe. Clinical, operational, and implementation science research gaps that exist to date are highlighted. Efforts to improve HIV healthcare transition research through country-level surveillance networks and large multicentre cohorts, including data integration and linkage between paediatric and adult cohorts are discussed. Conclusions: We identified the need for a comprehensive approach to implementing empirically supported protocols to support healthcare transition for ALHIV. While there is limited prospective longitudinal cohort data available at this time, cohorts linking the paediatric and adolescent with ongoing surveillance into adulthood are being developed. Through a review of existing qualitative and quantitative healthcare transition outcomes studies, we identify emerging areas of consensus surrounding healthcare transition research implementation. Successful healthcare transition programmes in Europe and North America often share several characteristics, including implementation of a youth friendly multidisciplinary approach, consistent communication and integration between paediatric and adult care teams, and an individualized approach which is attuned the adolescent's transition readiness. Moving forward, the voices of youth and young adults living with HIV should be included in the development and evaluation of healthcare transition protocols to ensure that the definition of successful transition reflects all of the stakeholders in the transition process. [ABSTRACT FROM AUTHOR]

Background: Although health disparities have been documented between Medicare beneficiaries based on age (<65 years vs. older age groups), underuse of recommended medical care in younger beneficiaries has not been thoroughly investigated. In this study, we aim to identify and characterize vulnerabilities of the younger Medicare age group (aged <65 years) in relation to older age groups (aged 65-74 years and ≥75 years) and to explore age group as a determinant of use of recommended care among Medicare beneficiaries.Methods: We conducted a cohort study of community-dwelling Medicare beneficiaries who participated in the Medicare Current Beneficiary Survey between 2001 and 2008 (N = 30,117). Age group characteristics were compared using cross-sectional data at baseline. During follow-up, we assessed the association between age and receipt of recommended care on 38 recommended care indicators, adjusting for sociodemographic and clinical characteristics. Follow-up periods differed by component indicator.Results: At baseline, a higher proportion of younger beneficiaries experienced social disadvantage, disability and certain morbidities than older age groups. During follow-up, younger beneficiaries were significantly less likely to receive overall recommended care compared to those 65-74 years of age (adjusted odds ratio and 95% confidence interval: 0.75, 0.70-0.80). In addition, male gender, non-Hispanic black race, less than high school education, living alone, with children or with others, psychiatric disorders and higher activity limitation stages were all associated with underuse of recommended care.Conclusions: Younger Medicare beneficiary status appears to be an independent risk factor for underuse of appropriate care. Support to ameliorate disparities in different social and health aspects may be warranted. [ABSTRACT FROM AUTHOR]

Juvenile residential facilities house over 100,000 youth annually, and as processes are theoretically tied to outcomes, juvenile facility operations can affect the recidivism of these youth. The researcher sought both to examine the relationship between juvenile facility operations and recidivism and to establish the importance of how these facilities operate. Data were analyzed from rigorous state evaluations of juvenile residential facilities conducted in Florida from 2003 to 2006. These data were analyzed using multilevel regression modeling, in order to account for the nested nature of the data. The analyses indicate that program management, health care services, facility security, and intervention management have significant inverse relationships with recidivism. These results both indicate the importance of the operations of institutional facilities for juveniles and underscore need for quality health care services for institutionalized populations. The policies and procedures of these facilities, when implemented properly, can improve the lives of juveniles and strengthen public safety. [ABSTRACT FROM AUTHOR]

Predictors of successful transition from pediatric to adult services include ability to self-manage and engage with healthcare services. Parents have a key role in healthcare management throughout childhood and adolescence including encouraging development of self-management skills in their children. Transition to adult services can be challenging for parents and young people, yet parents' views regarding transition remain largely unexplored. Nine parents of pediatric liver transplant recipients (15.2-25.1 yr) participated in semistructured interviews. Interviews were analyzed using IPA. Analysis revealed three key themes: 'emotional impact of transplantation,' 'protection vs. independence,' and 'ending relationships and changing roles.' Parents expressed the dichotomous nature of the desire to promote independence in their child while still maintaining control and protection, and discussed how changing roles and relationships were difficult to navigate. Parents are important facilitators of young people's development of self-management skills for successful transfer to adult services. Parents should be supported to move from a 'managerial' to a 'supervisory' role during transition to help young people engage independently with the healthcare team. Findings support the development of interventions for parents to emphasize their role in transition and guide the transfer of self-management skills from parent to young person. [ABSTRACT FROM AUTHOR]

Background: Youth friendly services are designed to make health services accommodate the unique needs of youth. Nevertheless, in developing countries like Ethiopia, the level of knowledge about the use of these services is limited. The main aim of this study was to assess the extent of youth friendly service utilization and the associated factors among the youth.Methods: A community based- cross sectional quantitative study design supplemented with qualitative inquiry was used from January to February 2011. Data were collected from a random sample of 845 youth using a pretested structured questionnaire. Qualitative data were collected through interview guides. Odds ratios, along with 95 % confidence level, were estimated to measure the strength of association between the study variables using multivariable logistic regression. Level of statistical significance was declared at p-value less than 0.05. Thematic analysis was used to analyze the qualitative data.Results: Nearly 64 % of the youth had already utilized youth friendly services at least once at the time of the survey. In multivariable logistic regression analysis, using friends [AOR = 3.65, 95 % CI (1.81,7.32)], health care providers [AOR = 3.27, 95 % CI (1.18,9.00)], and schools [AOR = 1.79, 95 % CI (1.00,3.19) as source of information, and having knowledge about the youth friendly services [AOR = 2.77,95 % CI (1.93,3.96)] were significantly associated with the utilization of youth friendly services. In contrast, being daily laborer and private worker by occupation [AOR = 0.12, 95 % CI (0.05, 0.92)], having negative perception about counseling [AOR = 0.50, 95 % CI (0.31-0.80)], about reproductive health services [AOR = 0 .13, 95 % CI (0.04-0.46)], and about youth friendly service providers [AOR-0.02, 95 % CI (0.08-0.50)] negatively influenced the outcome variable.Conclusions: The utilization of youth friendly services is moderate in this study. Getting youth related services information from different sources and being knowledgeable about the services have increased the utilization of the services. Efforts should be made by all relevant stakes to create conducive environment for the youth through training of the youth service providers, particularly for those who work in the government institutions, and strengthening of the awareness creation strategies among the youth to increase the utilization of the services. [ABSTRACT FROM AUTHOR]

This is the 13th in a series of papers by the Association of Children’s Residential Centers (ACRC) addressing critical issues facing the field of residential treatment. ACRC is the longest standing association focused exclusively on the needs of children and youth who need residential intervention and their families. The purpose of the papers is to stimulate dialogue and self-examination among organizations, stakeholders, and the field. This paper focuses on the overarching goal for all children in out-of-home care to achieve safety, permanence, and well-being, and the role of those providing quality residential interventions in accomplishing this mission. While it particularly focuses on children and youth in the child welfare system, it is applicable to all young people and families. With residential interventions a necessary therapeutic option in community systems of care (Blau, Caldwell, & Lieberman, 2014), it is important that residential providers embrace their critical role in helping children and families move toward permanency and achieve successful outcomes. [ABSTRACT FROM AUTHOR]

Nationally, well over half of juvenile justice-involved youth report behavioral health impairment. Although the juvenile justice system may be the first place a youth is screened for behavioral health problems, the system is often ill-prepared to properly treat these youth. In response to the growing number of youth entering the juvenile justice system with behavioral health issues and the lack of proper care in these facilities, many communities have developed diversion programs as an alternative to detention. The current study investigated Ohio’s Behavioral Health Juvenile Justice (BHJJ) program, a diversion program for juvenile justice-involved youth with behavioral health issues that provides evidence-and community-based behavioral health treatment. Results indicated BHJJ was effective at improving behavioral health outcomes, including general functioning and trauma symptomatology, and reducing future delinquency. Analyses also examined the variables that predicted successful treatment completion and future adjudications. Implications for juvenile justice programming and policy are discussed. [ABSTRACT FROM AUTHOR]

Violence continues to take its toll on post-apartheid South Africa and the youth remain the most affected group in many communities. Research has either dealt with violence in isolation, or the youth affected by violence. Very little is known about the nurse leaders delivering healthcare to youth victims of violence. This study sought to explore and describe the experiences of nurse leaders in delivering care to youth victims of violence at a community health centre in Khayelitsha. A qualitative, descriptive, and contextual design was used. The accessible population was professional nurses (N = 40) taking the lead in influencing victims of violence in the community to wellness. Nine individual unstructured interviews were conducted until data saturation was reached. The findings of this study showed that nurse leaders experienced challenges in terms of under-preparedness, staff shortages, work load, verbal abuse, as well as victim-related factors. Participants also expressed some rewarding experiences, such as increased personal awareness, personal empowerment, victim empowerment, and job satisfaction. The study recommended that in-service training should be conducted for newly-appointed staff members with the purpose of preparing them for the challenges and expectations in the field of violence amongst youth in the community. [ABSTRACT FROM AUTHOR]

This paper presents the outcomes of a Dialectical Behavior Treatment (DBT) program, implemented in intensive outpatient care with two groups of adolescents ( n = 55 and n = 45), ages 12-18, who engaged in deliberate self-harm (DSH) but had different insurance/funding sources and risk backgrounds. This pre-post study examined variability in clinical functioning and treatment utilization between the two groups and investigated moderating risk factors. Findings support DBT's effectiveness in improving clinical functioning for youth with DSH regardless of insurance type. However, lower rates of treatment completion among youth without private insurance call for extra engagement efforts to retain high-risk youth in DBT. [ABSTRACT FROM AUTHOR]

Efforts to identify empirically supported treatments ( ESTs) for youth's mental health problems are valuable, but the descriptor empirically supported does not guarantee that a treatment will work well in everyday clinical use. The voltage drop often seen when ESTs move from efficacy studies to clinical practice contexts may reflect limited exposure to real-world conditions during development and testing. One result may be interventions that are focused more narrowly and are more linear than the clinical practice they are designed to enhance. In this article, we suggest three strategies for building and refining ESTs that are robust for real-world application: (a) designing interventions to fit the contexts of youth treatment, (b) structuring interventions that can be tailored to fit individual youth characteristics, and (c) building programs for nontraditional intervention contexts. In addition, we describe how to develop interventions that are ready for practical implementation: the deployment-focused model. [ABSTRACT FROM AUTHOR]

Given the unique characteristics of people who meet criteria for attenuated psychosis syndrome (APS) and the growing literature on the clinical benefits of providing services to individuals who meet these criteria, the APS diagnosis serves an important, and previously missing, role in psychiatry. The promotion of the APS diagnosis should help reduce the over-diagnosis and over-treatment of individuals with prodromal psychotic conditions and it should also encourage expanded training about attenuated psychosis among clinicians who primarily provide services to youth (a primary group who are diagnosed with APS). Only some of the individuals with APS subsequently develop psychosis, but all have existing clinical needs - regardless of subsequent conversion. The formal recognition of APS in DSM-5 will facilitate the research needed to identify and meet those needs. [ABSTRACT FROM AUTHOR]

The article focuses on the need for improvement in the medical care of children and youth in Great Britain. It discusses the invisibility of children in the British National Health Service, the importance of children as the nation's resource, and the forward thinking in policy for children in various administrations in the country.

Background Psychosocial problems are highly prevalent among Dutch adolescents. We have conducted a trial to test whether offering chat-based consultations could be of added value within the context of Dutch Youth Health Care. This trial was ended prematurely because of recruitment issues. The aim of this study is to learn from this failed trial and to provide more insight into non-participation. Sources of data were non-participation forms, oral clarification, patient records, telephone interviews with adolescents that declined to participate, and a questionnaire-based process evaluation among nurses. Results Non-participation appears to be a multi-factorial problem. Of those 290 adolescents eligible to participate, the majority (n =165, 57%) declined to do so. Two-third of those (n =109) also refused usual care, which might be indicative of not wanting help and/or experiencing problems and the validity of the assessment instrument. The other one-third (n =56) did enrol in usual care and indicated other reasons for non-participation, such as a preference for face-to-face consultations, the extensive information that was provided, and not liking the idea of being randomized. Conclusions This study shows that even if a trial fails, we can learn about the challenges of recruiting adolescents in intervention trials. Trial registration NL37668.068.11 / METC11-3-077. [ABSTRACT FROM AUTHOR]

This Viewpoint describes legislation aiming to criminalize medical care for transgender youth and explains why these bills are harmful and potentially unlawful. [ABSTRACT FROM AUTHOR]

Background Research shows us that auditory hallucinations or 'hearing voices' may be more common than previously thought, particularly in childhood and adolescents. Importantly, not all individuals are affected negatively by their voice hearing experiences, yet child and adolescent mental health services (CAMHS) have traditionally understood voice hearing as a symptom of psychosis and severe mental illness, with implications for the way interventions are offered. The purpose of the present study was to gain an understanding of how young people who hear voices and their families find engaging with mental health service, and to better understand their experience of mental health professionals. Methods A two-stage, mixed methods study was used. In the first stage, semi-structured interviews were carried out with two young people and their parents who had engaged with mental health services, and the collected data were analysed using Interpretative Phenomenological Analysis (IPA). In the second stage, a questionnaire was designed to test the generalizability of the themes arising from the first stage, and was completed online by 32 young voice hearers and 27 parents. Results IPA analysis produced 4 themes: (1) The struggle to understand the hearing voices phenomenon; (2) Battle with the Mental Health Services; (3) 'Stuck in a limbo'; and (4) The wish for a more holistic approach from mental health services and professionals. The survey partially confirmed the findings of study one, with young people and parents finding useful information difficult to come by, and many reported feeling lost in CAMHS. Additionally, young voice hearers and parents often felt not listened to, and many parents expressed the need for a holistic care, whilst young people wanted a more normalizing and less stigmatizing experience. Conclusions Young people and their families had varying experiences of mental health services. Whilst the survey showed that some young people and their families had more positive experiences, many expressed dissatisfaction. To fulfil the needs of young people and their families, mental health services would benefit from developing alternative approaches to voice hearing and running support groups that could form part of a 'normalising' and 'holistic care' package. [ABSTRACT FROM AUTHOR]

The provision of aftercare services for youth and families is an important topic in residential care. Focus groups were conducted with seven service professionals working with youth in residential care in the United States. Providers responded to two questions: Based on your involvement in residential care 1) what barriers do providers experience when trying to access aftercare services for youth who are departing residential care; and 2) what solutions have providers attempted or recommended to overcome barriers so that aftercare services are made available to youth? Common themes for barriers included: 1) Youth/Family barriers to engagement; 2) Aftercare programming issues and concerns; 3) State, local, and agency policy; 4) Lack of funding; and 5) Lack of interagency collaboration. Common themes for solutions included: 1) Continuity of care; 2) State, local, and agency policy recommendations; 3) Family engagement; 4) Funding solutions; 5) Discharge planning; 6) Agency collaboration; and 7) Technology. Study limitations, future research, and implications are discussed. [ABSTRACT FROM PUBLISHER]

There are many young people from troubled backgrounds today in residential treatment care facilities. However, the majority of the residential care facilities do not offer the type of services required to have the desired impact on young people. In an attempt to contribute to this gap this study used a qualitative methodology to explore the retrospective experiences of youths who attended a faith-based residential treatment facility in the southern region of the United States. Findings suggest that program atmosphere, staff, punishment practices, counseling, spiritual development, and re-entry issues are important elements of the efficacy of residential care facilities. [ABSTRACT FROM AUTHOR]

Children served in residential treatment often present with behaviors and issues emanating from complex developmentally traumatic experiences. Implementing trauma informed practices is critical for successful treatment outcomes. This paper from the American Association of Children’s Residential Centers conceptualizes traumatic stress in the context and identifies strategies and practices at the organizational, environmental, programmatic and individual treatment levels that are responsive to the needs of these children and youth. [ABSTRACT FROM AUTHOR]

Youth-guided care is an important aspect of improving residential treatment in all settings. This paper, authored in collaboration with youth, identifies key aspects of implementing youth-guided care in residential settings. It address practices that can be used at entry, during the course of treatment, and at discharge, and also identifies systemic approaches that will enhance organizational climate and performance. [ABSTRACT FROM AUTHOR]

IMPORTANCE: Suicidal behavior has increased since the onset of the global recession, a trend that may have long-term health and social implications. OBJECTIVE: To test whether suicide attempts among young people signal increased risk for later poor health and social functioning above and beyond a preexisting psychiatric disorder. DESIGN: We followed upa cohort of young people and assessed multiple aspects of their health and social functioning as they approached midlife. Outcomes among individuals who had self-reported a suicide attempt up through age 24 years (young suicide attempters) were compared with those who reported no attempt through age 24 years (nonattempters). Psychiatric history and social class were controlled for. SETTING AND PARTICIPANTS: The population-representative Dunedin Multidisciplinary Health and Development Study, which involved 1037 birth cohort members comprising 91 young suicide attempters and 946 nonattempters, 95% of whom were followed up to age 38 years MAIN OUTCOMES AND MEASURES: Outcomes were selected to represent significant individual and societal costs; mental health, physical health, harm toward others, and need for support. RESULTS: As adults approaching midlife, young suicide attempters were significantly more likely to have persistent mental health problems (eg, depression, substance dependence, and additional suicide attempts) compared with nonattempters. They were also more likely to have physical health problems (eg, metabolic syndrome and elevated inflammation). They engaged in more violence (eg, violent crime and intimate partner abuse) and needed more social support (eg, long-term welfare receipt and unemployment). Furthermore, they reported being lonelier and less satisfied with their lives. These associations remained after adjustment for youth psychiatric diagnoses and social class. CONCLUSIONS AND RELEVANCE: Many young suicide attempters remain vulnerable to costly health and social problems into midlife. As rates of suicidal behavior rise with the continuing global recession, additional suicide prevention efforts and long-term monitoring and after-care services are needed. [ABSTRACT FROM AUTHOR]

Tested and effective approaches are available to prevent mental, emotional, and behavioral problems in youth, but such approaches are underused. Communities That Care (CTC) is a coalition-based strategy that aims to increase the use of tested and effective programs by combining the use of scientific evidence and stakeholder consensus to support the community adoption of a scientific approach to preventing mental, emotional, and behavioral problems in youth. A community-randomized trial of CTC was conducted with a sample of 24 communities, with the communities matched in pairs and assigned randomly to a control or an intervention condition. The findings demonstrate that CTC significantly increases the community-wide adoption of a science-based approach to prevention. Using a meta-analysis technique, this study shows that despite uniformly high fidelity implementation of CTC in intervention communities, the effect of CTC on the adoption of a scientific approach to prevention varies significantly across the 12 community pairs. Understanding the extent of variation in the effect of CTC on adopting a science-based approach to prevention lays a foundation for identifying aspects of coalition structure, functioning, or capacity that not only may help explain variation in adoption, but may in turn be targeted to strengthen the effect of CTC on the adoption of a science-based approach to prevention within communities. [ABSTRACT FROM AUTHOR]

Background: Young people with complex health needs have impairments that can limit their ability to carry out day-to-day activities. As well as coping with other developmental transitions, these young people must negotiate the transfer of their clinical care from child to adult services. The process of transition may not be smooth and both health and social outcomes may suffer. Increasingly, policy-makers have recognised the need to ensure a smoother transition between children's and adult services, with processes that are holistic, individualised, and person-centred; however, there is little outcome data to support proposed models of care. This study aims to identify the features of transitional care that are potentially effective and efficient for young people with complex health needs making their transition. Methods/Design: Longitudinal cohort study. 450 young people aged 14 years to 18 years 11 months (with autism spectrum disorder and an additional mental health problem, cerebral palsy or diabetes) will be followed through their transition from child to adult services and will contribute data at baseline, 12, 24 and 36 months. We will collect data on: health and wellbeing outcomes (participation, quality of life, satisfaction with services, generic health status (EQ-5D-Y) and condition specific measure of disease control or management); exposure to proposed beneficial features of services (such as having a key worker, appropriate involvement of parents); socio-economic characteristics of the sample; use of condition-related health and personal social services; preferences for the characteristics of transitional care. We will us regression techniques to explore how outcomes vary by exposure to service features and by characteristics of the young people. These data will populate a decision-analytic model comparing the costs and benefits of potential alternative ways of organising transition services. In order to better understand mechanisms and aid interpretation, we will undertake qualitative work with 15 young people, including interviews, non-participant observation and diary collection. Discussion: This study will evaluate the effect of service components of transitional care, rather than evaluation of specific models that may be unsustainable or not generalisable. It has been developed in response to numerous national and international calls for such evaluation. [ABSTRACT FROM AUTHOR]

Study analyzes key determinants of Youth Friendly Health Services that influence the client's satisfaction level. Data from 120 clients were collected from selected four districts of Uttar Pradesh and Bihar States of India. Multivariate logistic regression model was applied to understand the independent effect of important predictors. Overall only 32.0% clients were satisfied with the services. Positive association is observed with the educational status of the clients. If the parents/guardians are supportive, clients are 4.4 times more likely to get overall satisfaction from the services. 92% clients are less likely to get satisfied, if there is a fear of privacy disclosure to parents. Hence, privacy and confidentiality in services and support of parents/guardians play a significant role in affecting client satisfaction as compared to other determinants of the services. Study will enable decision-makers to improve the quality of health care effectively, keeping a balance between providers' and clients' perspectives. [ABSTRACT FROM AUTHOR]

Objective: This research study aimed to assess national trends in pediatric use of anticonvulsants for seizures and psychiatric disorders. Methods: In a cross-sectional design, data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were analyzed. Outpatient visit information for youths (ages 0-17 years) was grouped by year for 1996-1997, 2000-2001, 2004-2005, and 2008-2009. Six of the most common anticonvulsant drugs used for psychiatric conditions were examined. Psychiatric diagnoses and seizure or convulsion diagnoses were identified with ICD-9-CM codes. The primary outcome measure was percentage prevalence of visits for anticonvulsants that included a psychiatric diagnosis as a proportion of total youth visits for an anticonvulsant. Total, diagnosis-stratified, and drug specific visits, as well as visits for concomitant anticonvulsants and psychotropics, were analyzed. Results: As a proportion of total youth visits for anticonvulsants, visits with a psychiatric diagnosis increased 1.7 fold (p<.001), whereas the proportion of seizure-related visits did not change significantly. Regardless of diagnosis, anticonvulsant use significantly increased, from .33% to .68% of total youth visits in the 14-year period. There were significant increases in anticonvulsant use to treat pediatric bipolar disorder and disruptive behavior disorders. Visits noting divalproex decreased while visits noting lamotrigine increased among visits involving a psychiatric diagnosis. The concomitant use of stimulants and anticonvulsants significantly increased in visits noting a psychiatric diagnosis. Conclusions: Whereas anticonvulsant use for seizure disorders across the 14-year period was stable, the use of these drugs for psychiatric conditions rose to a dominant position. The growth of concomitant and off-label use to treat behavioral disorders raises questions about effectiveness and safety in community populations of youths. [ABSTRACT FROM AUTHOR]

Youth with serious mental illness come into contact with juvenile justice more than 3 times as often as other youth, obliging communities to expend substantial resources on adjudicating and incarcerating many who, with proper treatment, could remain in the community for a fraction of the cost. Incarceration is relatively ineffective at remediating behaviors associated with untreated serious mental illness and may worsen some youths' symptoms and long-term prognoses. Systems of care represent a useful model for creating systems change to reduce incarceration of these youth. This paper identifies the systemic factors that contribute to the inappropriate incarceration of youth with serious mental illness, including those who have committed non-violent offenses or were detained due to lack of available treatment. It describes the progress of on-going efforts to address this problem including wraparound and diversion programs and others utilizing elements of systems of care. The utility of systems of care principles for increasing access to community-based mental health care for youth with serious mental illness is illustrated and a number of recommendations for developing collaborations with juvenile justice to further reduce the inappropriate incarceration of these youth are offered. [ABSTRACT FROM AUTHOR]

Addressing the unique needs of youth transitioning to adulthood has long been viewed as a priority in implementation of systems of care (SOCs) and wraparound. Developmental research and 'practice-based evidence' suggest that there are differences between transitioning youth and their younger peers in family environment and wraparound team processes. Although these differences are thought to have significant implications for wraparound practice, few studies have examined them empirically. The present research involves two studies examining differences across several age cohorts (i.e., 10-12, 13, 14, 15, 16-17 year-olds) ranging from early adolescent to transitioning youth in: (1) caregiver perceptions of role-related strain and family environment quality, and (2) facilitator, caregiver, and youth perceptions of wraparound processes. In Study #1, older age was associated with higher levels of caregiver strain. In Study #2, age was associated with differences between youth and other team members' perceptions of wraparound processes, such that older youth perceived teams as less cohesive than others on their teams. These findings suggest that transitioning youth and their families merit special consideration in wraparound implementation and underscore the importance of considering the perceptions of transitioning youth in system change and practice improvement efforts (192 words). [ABSTRACT FROM AUTHOR]

To discuss critical considerations in the formation and maintenance of agency partnerships designed to provide integrated care for young people. Two years after its establishment, an evaluation of the headspace Barwon collaboration and a review of the health-care and management literature on agency collaboration were conducted. The principal findings together with the authors' experience working at establishing and maintaining the partnership are used to discuss critical issues in forming and maintaining inter-agency partnerships. Structural and process considerations are necessary but not sufficient for the successful formation and maintenance of inter-agency partnerships and integrated care provision. Specifically, organizational culture change and staff engagement is a significant challenge and planning for this is essential and often neglected. Although agreeing on common goals and objectives is an essential first step in forming partnerships designed to provide integrated care, goodwill is not enough, and the literature consistently shows that most collaborations fail to meet their objectives. Principles and lessons of organizational behaviour and management practices in the business sector can contribute a great deal to partnership planning. [ABSTRACT FROM AUTHOR]

System-wide research on the use of out-of-home care among children and youth is needed to inform the development of policies and services. We used Medicaid claims from North Carolina to examine patterns of out-of-home care, identify demographic and diagnostic differences between those who received care in residential treatment, psychiatric hospitals, or general hospitals, and determine whether demographic or diagnostic characteristics were associated with having more than one out-of-home stay during the year. Among those who received out-of-home care during a 1 year period, 36% received care in residential treatment only, 32.4% in general hospitals only, and 17.6% in psychiatric hospitals only, while 14.0% used more than one sector of out-of-home care. Boys, teenagers, and youth in foster care or diagnosed with emotional disturbance or hyperkinetic syndrome had higher odds of receiving care in residential treatment only whereas girls, youth age 19-21, and those with depressive and stress and adjustment disorders had higher odds of receiving care from hospitals only. Teenagers and youth in foster care had higher odds of having more than one stay. Among those with more than one stay, there were 300 patterns of care and nearly half received care from more than one service sector. The implications for services and policy are discussed. Further research is needed to understand patterns of out-of-home care and the factors that influence placement decisions. [ABSTRACT FROM AUTHOR]

The Health Care Consent Act, 1996, states that every person in Ontario, regardless of age, is presumed to be capable of consenting to or refusing medical treatment unless he or she is found incapable with respect to a specific treatment or plan of treatment. Health care practitioners may find it especially challenging to apply the legal test of capacity to young people. As an aid to assessment, a guide incorporating both legal and medical perspectives has been developed. This article describes the background and context of the development of the guide and explains how it helps practitioners to conduct a simpler , more focused evaluation of capacity in youth. The guide, along with an introduction and comments for parents, is included in an appendix. [ABSTRACT FROM AUTHOR]

Background: The ability of specific behaviour-change interventions to reduce HIV infection in young people remains questionable. Since January 1999, an adolescent sexual and reproductive health (SRH) intervention has been implemented in ten randomly chosen intervention communities in rural Tanzania, within a community randomised trial (see below; NCT00248469). The intervention consisted of teacher-led, peer-assisted in-school education, youth-friendly health services, community activities, and youth condom promotion and distribution. Process evaluation in 1999-2002 showed high intervention quality and coverage. A 2001/2 intervention impact evaluation showed no impact on the primary outcomes of HIV seroincidence and herpes simplex virus type 2 (HSV-2) seroprevalence but found substantial improvements in SRH knowledge, reported attitudes, and some reported sexual behaviours. It was postulated that the impact on ''upstream'' knowledge, attitude, and reported behaviour outcomes seen at the 3-year follow-up would, in the longer term, lead to a reduction in HIV and HSV-2 infection rates and other biological outcomes. A further impact evaluation survey in 2007/8 (,9 years post-intervention) tested this hypothesis. Methods and Findings: This is a cross-sectional survey (June 2007 through July 2008) of 13,814 young people aged 15-30 y who had attended trial schools during the first phase of the MEMA kwa Vijana intervention trial (1999-2002). Prevalences of the primary outcomes HIV and HSV-2 were 1.8% and 25.9% in males and 4.0% and 41.4% in females, respectively. The intervention did not significantly reduce risk of HIV (males adjusted prevalence ratio [aPR] 0.91, 95%CI 0.50-1.65; females aPR 1.07, 95%CI 0.68-1.67) or HSV-2 (males aPR 0.94, 95%CI 0.77-1.15; females aPR 0.96, 95%CI 0.87-1.06). The intervention was associated with a reduction in the proportion of males reporting more than four sexual partners in their lifetime (aPR 0.87, 95%CI 0.78-0.97) and an increase in reported condom use at last sex with a non-regular partner among females (aPR 1.34, 95%CI 1.07-1.69). There was a clear and consistent beneficial impact on knowledge, but no significant impact on reported attitudes to sexual risk, reported pregnancies, or other reported sexual behaviours. The study population was likely to have been, on average, at lower risk of HIV and other sexually transmitted infections compared to other rural populations, as only youth who had reached year five of primary school were eligible. Conclusions: SRH knowledge can be improved and retained long-term, but this intervention had only a limited effect on reported behaviour and no significant effect on HIV/STI prevalence. Youth interventions integrated within intensive, community-wide risk reduction programmes may be more successful and should be evaluated. [ABSTRACT FROM AUTHOR]

In order to examine the association between HIV/AIDS knowledge and perceptions, and risk intentions and behaviours among adolescents in Goa, India, cross-sectional data from 942 youth were collected and assessed. The prevalence rates in the past six months for fighting, smoking, drinking and drug use were 16.5%, 3.8%, 17.8% and 1.1%, respectively; 5.2% acknowledged ever having engaged in sex. Prior risk involvement was significantly correlated with future risk intention (odds ratio [OR]: 9.7-19.7), and those involved in one risk behaviour were more likely to engage in other risk behaviours (OR: 1.3-23.5). The findings suggest the importance of targeted interventions for youth engaging or intending to engage in risk behaviours and universal interventions regarding basic facts and skills for all youth in Goa. [ABSTRACT FROM AUTHOR]

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We examined the relative efficiency of non-clinical sites to screen for chlamydia in youth and young adults. Chlamydia screening targeting youth (under 30 years of age) was performed at non-clinical sites in high-morbidity neighbourhoods of two California counties. Venues were subdivided into community outreach, schools, parenting centres and drug treatment/correctional facilities. Relative efficiency was estimated with multivariate Poisson regression using incidence of chlamydia per person-hours labour adjusting for strategy and county. Among the 1514 youths screened, the overall prevalence of chlamydia was 5.5%. By venue, the highest prevalence was in drug treatment/correction facilities at 11.1% followed by parenting centres at 6.3%, community outreach at 4.9% and schools at 4.6%. Drug treatment/correctional facilities were the most labour time efficient at 9.9 person-hours per chlamydia case. Schools and parenting centres had the lowest cost per screen at 0.9 person-hours per screen. Adjusted relative labour time efficiency (chlamydia cases per paid person-hour) was significantly higher in schools, 2.0 (95% confidence interval [CI] 1.0-4.2), parenting centres, 3.2 (95% CI 1.6-6.6) and drug treatment/correctional facilities, 2.9 (95% CI 1.0-7.8), compared with community outreach. In conclusion, parenting centres and drug treatment centres and correctional facilities are the most efficient venues for chlamydia screening. [ABSTRACT FROM AUTHOR]

Introduction: The transition to adulthood is extremely difficult for individuals with disabilities. We sought to explore the specific issue of transition to adult-oriented health care in a Canadian context. Methods: We conducted semi-structured individual interviews with 15 youth and 15 adults with cerebral palsy, spina bifida, and acquired brain injuries of childhood, and their parents ( n = 30). Respondents discussed their health care services, their experience with clinical transition, and contributing factors. We analyzed the transcripts using qualitative methods. Results: All participants identified challenges in transition, including: lack of access to health care; lack of professionals' knowledge; lack of information and uncertainty regarding the transition process. Two solutions were identified: early provision of detailed information and more extensive support throughout the clinical transition process. Discussion: The challenges of clinical transition were universal. More extensive information and support is needed during transition to ensure an efficient move to appropriate adult-oriented health care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to describe a 20-week integrated cognitive behavioural therapy (CBT) program addressing co-occurring substance misuse and major depression in young people. Method: Participants were aged between 15 and 25 years, met DSM-IV criteria for major depressive disorder and had at least weekly illicit drug use and/or weekly alcohol use exceeding the Australian national guidelines on alcohol. Results: Between December 2004 and January 2007, an integrated CBT program was offered to 60 young people with co-occurring depression and substance misuse who presented to a youth-specific mental health service. Young people attended for a median of 10.5 sessions. Conclusions: We describe the components of a 20-week integrated CBT program for young people with co-occurring depression and comorbid substance misuse, as well as the challenges associated with providing such treatment. While integrated treatment approaches are recommended as best practice for this population, further evaluation is necessary to determine their effectiveness within routine clinical settings. [ABSTRACT FROM AUTHOR]

Background Care coordination has been shown to improve the quality of care for children and youth with special health care needs (CYSHCN). However, there are different models for structuring care coordination in relation to the medical home and most Title V agencies use an agency-based model of care coordination. No studies have prospectively compared a practice-based care coordination model to a Title V agency-based care coordination model. Objective Report the results of a prospective cohort study comparing a practice-based nurse care coordinator model with Title V agency-based care coordination model. Design/Methods Three pediatric practices received the intervention, placement of a nurse care coordinator onsite within the practice, along with training and quality improvement on the principles of the medical home. Three practices continued to rely on agency-based care coordination services. CYSHCN in the practices were identified, interviewed at baseline, and re-interviewed after 18 months. We interviewed 262 families/children at baseline and 144 families/children (76 in the intervention and 68 in the comparison group) at 18 months. Families rated the quality of services they received from the care coordinator and the pediatric practice, and their experience of barriers to services for their CYSHCN. Results Families in the practice-based care coordination group were more likely to report improvement in their experience with the care coordinator ( P = 0.02), fewer barriers to needed services ( P = 0.003), higher overall satisfaction with care coordination ( P = 0.03), and better treatment by office staff ( P = 0.04). Conclusions We found that for families of CYSHCN, practice-based care coordination in the medical home led to increased satisfaction with the quality of care they received and a reduction of barriers to care. The practice-based care coordination model is utilized by a minority of State Title V agencies and should be considered as a potentially more effective model than the agency-based approach. [ABSTRACT FROM AUTHOR]

Improving standards of care using the resources available requires leadership, team working and communication. A clinical governance framework is used in this article to demonstrate how arrangements for transitional care for young people with diabetes have been enhanced using the limited evidence available, as well as the experience of paediatric and adult team members. Changes to the way clinics were conducted and the introduction of additional joint nursing clinic appointments for the young people prior to formal medical transfer appointments aimed to reduce the risk of non attendance and contribute to the improvement of metabolic control in the young adult. [ABSTRACT FROM AUTHOR]

A recent review of health care for young people who offend recommended that youth offending teams should include healthcare provision. The type of provision that is common may not be meeting the general health needs of this vulnerable group who are known to have multiple health needs that can influence their offending behaviour. An advanced nurse practitioner/general health nurse piloted onsite general health provision, working alongside a multidisciplinary learn supporting the young people attending a youth offending team in London. An audit of the first 70 clients confirmed the complex family, social, health and other factors affecting the lives of these young people. There was a significant amount of general hearth care needed among this group that was not being addressed and more than three quarters of the young people whose records were audited required follow-up by the general health nurse. A nurse who is trained to work with young people and able to deliver holistic health care complements the roles of the youth offending team's extended support team and enables young people to receive general health care and follow up onsite. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this evaluation project were to describe a group of homeless adolescents and street-involved youth who utilized a mobile unit that provided medical and mental healthcare services and to assess the efficacy of the services provided in reducing their health risk behaviors. Data sources: The records of 95 youth aged 15-25 years who used the medical mobile unit for an average of 14 months were examined and evaluated according to the national health indicators related to risk reduction. Current literature related to health risk behavior among homeless youth was reviewed, synthesized, and provided the background for this article. Conclusions: Data were obtained from the records of mostly heterosexual youth with a mean age of 20.5 years. Approximately one third of the participants were high school graduates and most were without health insurance. Living situations were transient including friends, shelters, crash pads, or the streets. Abuse accounted for the majority leaving home. Psychiatric conditions and substance abuse were common. Medical conditions were related to transient living situations, substance abuse, and sexual activity. Success of the program was associated with sustained counseling, stabilizing youth on psychotropic medications, decreasing substance use, providing birth control and immunizations, and treating medical conditions. Implications for practice: Homeless youth are one of the most underserved vulnerable populations in the United States with limited access and utilization of appropriate healthcare services. Nurse practitioners often serve as care providers but are also in a position to effectively lobby to improve health care for homeless youth through professional organizations and community activism. Furthermore, when designing and evaluating healthcare services, multidisciplinary teams need to consider risk reduction for homeless youth in the context of their environment. [ABSTRACT FROM AUTHOR]

Background and objective: Access to medicines by young people with chronic conditions during the school day and suitable environments and support in the administration of a range of dosage forms may be required for optimal clinical management. Whilst Government policy emphasizes that children and young people with chronic illness should be able to lead as normal lives as possible, there is only limited evidence on the experiences and concerns of young people and their parents regarding the use of medicines at school and the impact on school life. The objective of this study was to examine the experiences and concerns of young people with chronic conditions, and their parents/carers, in managing medication at school. Methods: Data were gathered in audio-recorded face-to-face semi-structured interviews with 27 young people (5–18 years) and their parents attending out-patient clinics at a major London teaching hospital. Open-ended questions provided an opportunity for participants to describe experiences and views in the context of their activities, priorities and concerns and enabled a qualitative analysis. Results and discussion: The findings indicated that storage and access of medicines did not present major problems for young people receiving regular medication. However, those receiving medication on a ‘when required’ basis reported barriers to access. The most common concern regarding taking medication was lack of privacy, which sometimes led to non-adherence. Adverse effects of medication were highlighted as a cause of both non-adherence and poorer school performance. Extracurricular activities such as school trips were not viewed as presenting a problem by those who were interviewed. However, this was often because young people and their families devised their own strategies regarding the use of medicines that did not depend on the input of staff. There was wide variation in responses about the support young people received from school staff, with evidence of helpful and unhelpful practice. The potential benefits of liaison between schools and health professionals to assist schools in their support of students with their medicines were highlighted. Conclusion: This study has identified medication-related issues from the perspective of young people and their parents, indicating ways in which their needs might be served more sensitively and effectively. [ABSTRACT FROM AUTHOR]

Objective: The present meta-analysis illustrates relevant information about hip replacement in young patients that has been published during the past 3 decades. Material and methods: Based on a MedLine literature review a total of 95 studies were evaluated. Parameters for evaluation of study quality and outcome were implant survival rates (ISR), number of patients, indications, follow-up, surgical approaches and number of surgeons. Results: Most studies consider patient numbers <50. In 33 studies one implant system was applied compared to 65 studies in which more than one system was used. Most studies include different surgical approaches. 20% of all studies contained neither the number of surgeons, nor the type of surgical approach. The overall ISR could be evaluated in 67 studies. Sufficient data about the ISR of stem and/or sockets were available in 50 papers. Conclusions: Most published studies analyzed inhomogeneous study populations; study variables vary as do the implants used for treatment. [ABSTRACT FROM AUTHOR]

This article addresses ethical issues in conducting randomized clinical trials (RCTs) with youth. Ethical considerations that occur prior to treatment (matters of research design, the risk-benefit ratio, issues concerning assent/consent, the influence of payment for participation), during treatment (issues of privacy, protocol adherence, premature termination), and following treatment (needs for posttreatment referrals and/or follow-up contacts, archiving of treatment data) are reviewed. Recommendations, based on empirical evidence and clinical experience, are offered for conducting ethical treatment research with youth and future directions for carrying out research on the ethics of conducting RCTs with youth are offered. [ABSTRACT FROM AUTHOR]