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Surveys of directors of Schools of the 21st Century, an educational model that provides integrated services to children and families, examined the availability of school health services. Results found that the services varied greatly in availability and comprehensiveness. Most schools provided basic preventive screenings, health education, and referrals, but one-third lacked on-site nurses. (SM)

OBJECTIVE. We sought to identify characteristics of pediatricians that were associated with identification or management (referral and/or treatment) of mothers with depression. METHODS. A cross-sectional survey was mailed to a random sample of 1600 of the 50 818 US nonretired members of the American Academy of Pediatrics. Overall, 832 responded, with 745 responses from nontrainee members. The 662 fellow nontrainee members who engaged in direct patient care and completed information on identifying, referring, and treating maternal depression were included in the analyses. RESULTS. A total of 511 of 662 respondents reported identifying maternal depression; of those who reported identifying maternal depression, 421 indicated they referred and 29 that they treated maternal depression in their practices. Pediatricians who are older, work in practices that provide child mental health services, see primarily ([greater than or equal to] 75 %) white patients, use [greater than or equal to] 1 method to address maternal depression, agree that pediatricians should be responsible for identifying maternal depression, think that maternal depression has an extreme effect on children's mental health, and are attitudinally more inclined to identify or manage maternal depression had significantly higher odds of reporting identification of maternal depression. Positive correlates of identification and management of maternal depression included practicing in the Midwest, using [greater than or equal to] 1 method to address maternal depression, working in a practice that provides child mental health services, thinking that caregiving problems attributable to maternal health have an extreme effect on children's physical health, having attitudes that are more inclined to identify and to manage maternal depression, and usually inquiring about symptoms routinely to identify maternal depression. CONCLUSIONS. Pediatricians' practice characteristics and attitudes are associated with their identification and management of mothers with depression., MATERNAL DEPRESSION, A global term encompassing a range of depressive symptoms and syndromes, may affect women immediately after childbirth or later in the child-rearing years. (1,2) For women 15 to [...]

Background. Parenting stress and maternal depressive symptoms are ubiquitous and have negative consequences for children. Pediatricians may be an underused resource to mothers regarding these issues. Objective. To explore maternal beliefs and perceptions about discussing the stress of parenting and depressive symptoms with their child's pediatrician. Design/Methods. Mothers were recruited from 5 community-based pediatric practices and 1 hospital-based practice to ensure a diverse sample. An experienced, trained facilitator conducted focus groups by using open-ended questions and administered a standard questionnaire. Audiotapes and transcripts of the groups were reviewed for major themes by 3 independent researchers using grounded theory and immersion/crystallization technique. Results. Seven focus groups (N = 44) were convened. Participants were 70% black and 30% white with a mean age of 27 years; 61% were single; 50% were educated beyond high school; and 43% received public assistance as their main source of income. The mean score on the Psychiatric Symptom Index was 26.3 (high [greater than or equal to] 20). Within 2 overarching domains (maternal and interaction between mother and pediatrician), several themes emerged. Within the maternal domain, dominant themes included 1) emotional health: all respondents indicated that a mother's emotional health greatly affects her child's well being; 2) self-efficacy: mothers believed in the importance of accepting responsibility for monitoring their own well being and that of their child; and 3) support systems: all mothers expressed the need to share parenting experiences, stressors, and depressive symptoms with someone (most preferred to speak with family or friends rather than with their child's pediatrician). Within the interaction domain, 2 themes emerged: 1) communication: open communication with a pediatrician who listens well was perceived by mothers in all groups as very important, and 2) trust: mothers trust pediatricians with their child's health, but many were hesitant to discuss their own stress or depressive symptoms. Mothers in all socioeconomic groups expressed fear of judgment and possible referral to child protection if they talked about such issues. Both of these were mediated by the presence of an ongoing relationship between the pediatrician and mother. Mothers were more likely to discuss their own emotional health if they felt their child's pediatrician "knew them well." Conclusions. Mothers are aware that their own emotional health has consequences for their children. Although many mothers experienced lacks in their social support systems, many are reluctant to discuss parenting stress and depressive symptoms with their child's pediatrician because of mistrust and fear of judgment. Mothers are, however, generally receptive to the idea of open communication with their pediatricians and are interested in receiving supportive written communication about parenting stress and depressive symptoms from pediatricians. These qualitative data are valuable in developing an intervention to help pediatricians assist mothers at risk. Pediatrics 2004;113:460-467; depressive symptoms, maternal, focus groups, pediatric providers, parenting stress, primary care. ABBREVIATION. PSI, Psychiatric Symptom Index., Depressive symptoms in mothers are common (1-6) and have serious negative consequences for children, (7-12) yet mothers with depressive symptoms may not be recognized and treated by their own primary [...]

ABSTRACT. Objective. To identify factors associated with depressive symptoms in inner-city mothers of young children. Design. A cross-sectional survey was administered to a convenience sample of English-speaking mothers attending a [...]

Family preservation services (FPS) intended to prevent out-of-home placement of children do not appear to have sufficient data to indicate that they are working, and evaluations of such programs do not appear to use a rigorous experimental methodology. Researchers searched databases, bibliographies and a national directory of family services to yield 802 references about such services. Among these references, 46 evaluations were identified and reviewed for content that concerned intensive FPS, showed outcome data, and made use of a comparison group. Ten evaluations had such content, and 5 of these were based on randomized trials. Two independent reviewers rated the methodological quality of the 10 evaluations, and found that 2 of the evaluations were acceptable, 4 were adequate, and 4 were unacceptable. In only two evaluations was FPS shown to reduce the risk of out-of-home placement of children., Objectives. To determine the adequacy of evaluations of family Preservation services (FPS), which are designed to support families and prevent out-of-home placements of children at risk of abuse or neglect, and to assess the effectiveness of FPS at reducing out-of-home placements of children. Data Sources. References published from 1977 to 1993 were identified from a computerized search of databases for English-language publications using the key phrases "family preservation," "child abuse," and "family-based services." Unpublished references were identified by mail or phone from a listing of more than 200 programs in a national directory. Selection of Studies. Of 802 references initially identified, 46 program evaluations were reviewed. Ten studies met the following inclusion criteria: (1) evaluated an intensive family preservation program, (2) included outcome data in the report, and (3) used a comparison group. Five were randomized trials, and 5 were quasi-experimental studies (nonrandomized). Data Extraction. Descriptive information about the programs and evaluations was collected. To determine methodological quality, two independent raters used a 15-item questionnaire to examine the assignment of families to treatment groups, the interventions provided, and the outcomes assessed. A composite score of 11 or greater represented an acceptable study, 6 to 10 represented an adequate study, and 5 or less represented an unacceptable study. Results. Only two studies were rated acceptable, four were adequate, and four were unacceptable. Methodological shortcomings included poorly defined assessment of risk, inadequate descriptions of the interventions provided, and nonblinded determination of the outcomes. Rates of out-of-home placements were 21% to 59% among families who received FPS and 20% to 59% among comparison families. The relative risk of placement was significantly reduced by FPS in only two studies (one randomized trial and one quasi-experimental study). Conclusions. Despite current widespread use of FPS to prevent out-of-home placements of children, evaluations of FPS are methodologically difficult and show no benefit in reducing rates of out-of-home, placements of children at risk of abuse or neglect in 8 of 10 studies. Consistent, methodologically rigorous evaluations are needed to determine the effectiveness of FPS and to guide social policy for high-risk children and their families. Pediatrics 1996;97:535-542; family preservation, child abuse, family-based services, methodological review., During the past two decades, programs to maintain and improve family functioning have become an important approach to treatment when children are referred to protective service agencies for abuse or [...]

Approximately 49.5% of the adolescents report a mental health disorder; only about half of the children and adolescents with mental health disorders seek treatment from a mental health professional. Stigma and poor access to behavioral health providers are leading barriers to care. A large ambulatory health system implemented a BH navigation program to facilitate referrals from primary care physicians (PCPs), including pediatricians and family physicians, to BH providers. We studied PCP adoption of BH navigation services over a 4-year period, from July 2014 to June 2018. We retrieved operational data regarding service utilization, patient information from electronic health records and PCP information from administrative data, and surveyed PCPs for their appraisals of navigation services. Four thousand five hundred and fifty-five referrals were made for 3,912 patients from 290 PCPs (71% of PCPs in the health system). Depression (39%), anxiety (25%), and attention-deficit hyperactivity disorder (7%) were the most frequent reasons for referral. Referrals increased dramatically in the first half of the study period and decreased afterwards. Ninety-one percent of the PCPs agreed or strongly agreed that navigation enhanced their clinical care at 12-month survey. More than 90% of the PCPs rated the referral process, communication with navigation staff, and the overall experience as above average or excellent at 12 months. There was a decrease in these evaluation indicators after 2.5 years. The initial high referral volume reflects a need for BH navigation services. However, challenges remain to maintain positive PCP assessment in the face of such demand. [ABSTRACT FROM AUTHOR]

CONTEXT. Child psychosocial issues and maternal depression are underidentified and undertreated, but we know surprisingly little about the barriers to identification and treatment of these problems by primary care pediatricians. [...]

Objective: To examine the rates and predictors of mental health services use for a nationally representative cohort of youths who had been investigated for alleged maltreatment., Methods: Data came from caregiver and caseworker baseline and 18-month interviews in the second National Survey of Child and Adolescent Well-being. These interviews took place from March 2008 to September 2008 and September 2010 to March 2011. Data on family and child characteristics and service use were gathered and examined by using weighted univariate and multivariate analyses., Results: Children had numerous challenges: 61.8% had a previous report of maltreatment, 46.3% had poor socialization skills, and 23.9% had a mental health problem measured by the Child Behavior Checklist (CBCL). At baseline, 33.3% received some mental health service and this varied by age, with younger children receiving fewer services. This percentage decreased to 30.9% at the 18-month follow-up, although the youngest children had increases in services use. For younger children, race/ethnicity, out-of-home placement, chronic physical health problems, low adaptive behaviors, and CBCL scores in the clinical range were related to use. For children ≥ 11, out-of-home placement, high CBCL scores, and family risk factors predicted services use at 18 months., Conclusions: Mental health services utilization increases as young children come into contact with schools and medical providers or have more intensive involvement with child welfare. Minority children receive fewer services adjusting for need. Over the 18-month follow-up, there was a decrease in service use that may be a result of the tremendous financial challenges taking place in the United States.

Objectives: Food insecurity is associated with a wide variety of adverse health conditions in adults and children, but its relationship to asthma outcomes in children has not been described. The objectives of this study were to assess and characterize the food security status of an inner-city asthmatic population and to determine whether and to what extent household food insecurity is independently associated with negative clinical outcomes in children presenting to a pediatric emergency department (ED) with asthma exacerbations., Methods: This study is a cross-sectional survey of a convenience sample of families of children presenting to an urban children's hospital ED for asthma exacerbations. Data were gathered through structured chart review and interview, including a published food insecurity questionnaire., Results: A total of 127 families were enrolled, with a median patient age of 6.6 years. Of all families, 81% were black and 10% were white. Of these families, 35% met criteria for household food insecurity. 78% of food-insecure and 46% of food-secure households received food stamps. Of all food-insecure households, 67% reported never using food pantries or free community meals. 36% of food-insecure and 31% of food-secure patients lacked an adequate home supply of asthma medications. The overall admission rate was 37%; no significant difference was found in admission rate or length of stay., Conclusions: The rate of household food insecurity in families of asthmatic children presenting to an urban ED is high, with relatively low participation in a number of safety net programs. This study failed to demonstrate an association between household food insecurity and negative asthma outcomes.