Search

Previous studies of children with in-utero drug exposure (IUDE) raise concerns that decreased head circumference (HC) at birth increases the child's risk for later compromised cognitive functioning. The purpose of this study was to determine if HC at birth and HC growth change are associated with cognitive functioning (IQ) at 36 months of age in children with IUDE. In-utero drug exposed infants (N = 204) identified following delivery at two urban hospitals were compared with a group of non-exposed children (N = 34) matched for maternal age, gestational age and socioeconomic status. The IUDE infants had significantly smaller HC at birth than the non-exposed infants, however by age 36 months the HC was comparable between the two groups. At age 36 months, there was no difference detected in the IQ between the IUDE and non-exposed groups, yet both groups scored almost one standard deviation below the mean for IQ and both groups were below but approached the US standard HC mean at the same age. Further studies of the more subtle effects of prenatal drug exposure such as attention, impulse control and state regulation on developmental outcomes are recommended as these children mature. [ABSTRACT FROM AUTHOR]

In a study of 66 in-utero drug exposed (IUDE) infants, we evaluated infant cognitive status with the Mental Scale of the Bayley Scales of Infant Development (Second Edition), caregiver-infant interaction using the Nursing Child Assessment Feeding Scale (NCAFS), and caregiver cognitive functioning (IQ) to determine which caregiver variables were associated with infant cognitive status. Mean score on the Bayley Mental Development Index was 87.4 (SD, 10.8). Almost half (44%) of the caregiver-infant dyads were categorized as 'At Risk' for poor caregiver-infant interaction based on scores of the NCAFS. Mean caregiver IQ was 76.9. Logistic regression analysis indicated that caregiver IQ was the only statistically significant coefficient in the model predicting poor infant cognitive status (p = .009); however, caregiver-infant interaction. showed a moderate effect (p = .08). [ABSTRACT FROM AUTHOR]

Children born to substance abusing women face many risks that can impede optimal developmental outcome. These risks include both potential neurologic and organic sequelae of intrauterine substance exposure, as well as additional risk factors in their postnatal environment. Foster care placement is a common occurrence among this population. The current study was conducted to explore the developmental status of a group of drug exposed infants and toddlers in foster care. Twenty-seven children placed through a church-based foster care program were observed. All but one of the children were African-American and nearly half (48%) had been placed shortly after birth. The children ranged in age from I to 29 months. Home environment and caregiver-child interaction was assessed using the HOME Inventory and the NCAS Feeding and Teaching Scales. Children were also given physical, neurological, and developmental assessments (Mean age = 11.7 months). While the majority of the children fell within normal limits on developmental testing, 28% were considered at risk for cognitive delay and over half exhibited suspect or abnormal neurological signs. Many were felt to be at further risk because of poor home environment and/or caregiving. Implications for intervention and policy changes are discussed. [ABSTRACT FROM AUTHOR]

Race is a sociopolitical construct based on physical characteristics, not a biological construct. Racism is a system that ascribes value and resources based on the sociopolitical construct called "race." In the United States and other countries around the world, racism is associated with disparate health outcomes and shortened life expectancies. Health equity employs health-related systems (eg, health care providers, insurance companies, hospitals, research, pharmaceutical companies) across multiple sectors (eg, housing, education, business, government) to allocate resources and services to correct and promote political and social determinants associated with health and wellness. Applying health equity practices and policies ensures that each child, youth, and adult receives comprehensive, evidence-informed, culturally relevant, and needs-based services to achieve optimum health. This article provides an overview of the impact of racism embedded in systems and policies that challenge optimal health for children and youth and offers evidence-supported paths forward to advance health and wellness in the United States. Until each child and adolescent enjoys optimal and equal health outcomes, health equity practices and social justice are mandatory., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Autism spectrum disorder (ASD) is a neuropsychiatric condition that may be associated with negative health outcomes. This retrospective cohort study reveals the odds of hospitalization and mortality based on ASD for a population of insured patients with COVID-19. The odds of hospitalization and mortality for people with ASD were found to be greater than individuals without ASD when adjusted for sociodemographic characteristics. Hospitalization and mortality was associated with a dose-response increase to comorbidity counts (1 to 5+). Odds of mortality remained greater for those with ASD when adjusting for comorbid health conditions. ASD is a risk factor for COVID-19 mortality. Comorbid health conditions play a particular role in increasing the odds of COVID-19 related hospitalization and death for ASD patients., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Introduction: In the USA, minoritised communities (racial and ethnic) have suffered disproportionately from COVID-19 compared with non-Hispanic white communities. In a large cohort of patients hospitalised for COVID-19 in a healthcare system spanning five adult hospitals, we analysed outcomes of patients based on race and ethnicity., Methods: This was a retrospective cohort analysis of patients 18 years or older admitted to five hospitals in the mid-Atlantic area between 4 March 2020 and 27 May 2022 with confirmed COVID-19. Participants were divided into four groups based on their race/ethnicity: non-Hispanic black, non-Hispanic white, Latinx and other. Propensity score weighted generalised linear models were used to assess the association between race/ethnicity and the primary outcome of in-hospital mortality., Results: Of the 9651 participants in the cohort, more than half were aged 18-64 years old (56%) and 51% of the cohort were females. Non-Hispanic white patients had higher mortality (p<0.001) and longer hospital length-of-stay (p<0.001) than Latinx and non-Hispanic black patients., Discussion: In this large multihospital cohort of patients admitted with COVID-19, non-Hispanic black and Hispanic patients did not have worse outcomes than white patients. Such findings likely reflect how the complex range of factors that resulted in a life-threatening and disproportionate impact of incidence on certain vulnerable populations by COVID-19 in the community was offset through admission at well-resourced hospitals and healthcare systems. However, there continues to remain a need for efforts to address the significant pre-existing race and ethnicity inequities highlighted by the COVID-19 pandemic to be better prepared for future public health emergencies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

"Toward Equity in Research on Intellectual and Developmental Disabilities" (IDD) is a timely and comprehensive article highlighting gaps in the "dominant culture" approach to current research strategies designed to address IDD. Recentering systems involved in the research enterprise are recommended. This commentary provides additional guidance from a social justice, equity, and inclusion lens, including a clinical anthropology approach to research., (©AAIDD.)

Objective: To examine the experience of interracial anxiety among health professionals and how it may affect the quality of their interactions with patients from racially marginalized populations. We explored the influence of prior interracial exposure-specifically through childhood neighborhoods, college student bodies, and friend groups-on interracial anxiety among medical students and residents. We also examined whether levels of interracial anxiety change from medical school through residency., Data Source: Web-based longitudinal survey data from the Medical Student Cognitive Habits and Growth Evaluation Study., Study Design: We used a retrospective longitudinal design with four observations for each trainee. The study population consisted of non-Black US medical trainees surveyed in their 1st and 4th years of medical school and 2nd and 3rd years of residency. Mixed effects longitudinal models were used to assess predictors of interracial anxiety and assess changes in interracial anxiety scores over time., Principal Findings: In total, 3155 non-Black medical trainees were followed for 7 years. Seventy-eight percent grew up in predominantly White neighborhoods. Living in predominantly White neighborhoods and having less racially diverse friends were associated with higher levels of interracial anxiety among medical trainees. Trainees' interracial anxiety scores did not substantially change over time; interracial anxiety was highest in the 1st year of medical school, lowest in the 4th year, and increased slightly during residency., Conclusions: Neighborhood and friend group composition had independent effects on interracial anxiety, indicating that premedical racial socialization may affect medical trainees' preparedness to interact effectively with diverse patient populations. Additionally, the lack of substantial change in interracial anxiety throughout medical training suggests the importance of providing curricular tools and structure (e.g., instituting interracial cooperative learning activities) to foster the development of healthy interracial relationships., (© 2023 The Authors. Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust.)

Reservation-based Native American youth are at disproportionate risk for high-risk substance use. The culture-as-treatment hypothesis suggests aspects of tribal culture can support prevention and healing in this context; however, the protective role of communal mastery and tribal identity have yet to be fully explored. The objectives of this study were to investigate (1) the relationship between cultural factors and high-risk substance use, which includes polysubstance use, early initiation of alcohol and illicit drugs, and binge drinking, and (2) substance use frequency and prevalence of various substances via cross-sectional design. Multiple logistic regression modeling was used to analyze data from 288 tribal members (15-24 years of age) residing on/near the Fort Peck Reservation in the Northern Plains. When controlling for childhood trauma and school attendance, having at least a high school education (OR = 0.434, p = 0.028), increased communal mastery (OR = 0.931, p = 0.007), and higher levels of tribal identity (OR = 0.579, p = 0.009) were significantly associated with lower odds of polysubstance use. Overall prevalence of polysubstance use was 50%, and binge drinking had the highest single substance prevalence (66%). Prevalence of early initiation of substances (≤ 14 years) was inhalants (70%), alcohol (61%), marijuana (74%), methamphetamine (23%), and prescription drug misuse (23%). Hydrocodone, an opioid, was the most frequently misused prescription drug. Findings indicate programs focused on promoting education engagement, communal mastery, and tribal identity may mitigate substance use for Native American adolescents living in high-risk, reservation-based settings., (© 2022. The Author(s).)

Introduction: The Maternal and Child Health (MCH) Pipeline Training Program, promotes development of a diverse health workforce by training undergraduate students from underrepresented minorities. We aimed to evaluate the success of this program based on three domains: (1) demographic characteristics, (2) academic and career development, and (3) attitudes towards the field of MCH and the training programs among graduates., Methods: Three domains of success were determined through a collaborative effort between current program directors and the funding agency project officers. The survey with questions related to the three domains was distributed via an online platform to graduates from seven sites (one former site and six current sites). Data were analyzed and presented utilizing descriptive statistics., Results: The survey was distributed to 550 graduates, 162 responded (37% response rate). Demographically, 78% were female, 54% were Black/African American, 22% were Latinx and 83% did not report any disability. Eighty percent of respondents applied to graduate/professional schools, 67% received admission. Graduates often continued to work in MCH fields (70%). Majority felt confident and knowledgeable in the field (89%) and agreed the faculty were supportive at their training sites (90%)., Conclusion: The study highlights successes in recruiting from underrepresented minorities, particularly Black/African Americans and first-time college goers in the family into the MCH Pipeline Training Programs. Programs were successful in furthering academic and career development for most trainees. Attitudes towards MCH and the training programs were overwhelmingly positive. Continued support of these programs is critical in addressing health disparities and achieving health equity., (© 2022. The Author(s).)

Purpose: Presently, there are six undergraduate HRSA-funded MCH pipeline training programs (MCHPTP) in the nation and they have gained significant momentum since inception by recruiting, training and mentoring undergraduate students in a comprehensive MCH-focused approach. This article describes the outcomes from the 6 training programs; and primarily Baylor College of Medicine-Texas Southern University (BCM-TSU's) collaborative strategy focusing on the MCH research training and outcomes, which align with HRSA's MCH bureau's missions., Description: Each MCHPTP offers trainees interdisciplinary MCH research experiences through intra/inter-institutional collaborations and partnerships, but BCM-TSU's MCHPTP was the only one with the primary focus to be research. As a case study, the BCM-TSU Program developed an innovative research curriculum integrated with MCH Foundations Course that comprised 2 hour weekly meetings. Students were split into collaborative research groups of 4-5 students, with multidisciplinary peer-mentors, clinical fellows and MCH research faculty from institutions at the world-renowned Texas Medical Center., Assessment: Since the inception of the MCH mentorship programs, all six MCHPTPs have enrolled up to 1890 trainees and/or interns. BCM-TSU Program trainees are defined as undergraduate students in their 1st or 2nd year of college while research interns are upper classmen in their 3rd or 4th year of college. The case study showed that BCM-TSU Program trainees demonstrated outstanding accomplishments in the area of research through primary and co-authorships of 13 peer-reviewed journal publications by 78 trainees, over a period of 3 years, in addition to dozens of presentations at local, regional and national conferences., Conclusions: The research productivity of students in the six MCHPTPs is strongly indicative of the success of integrating MCH research mentoring into MCH didactic training. The development of a diverse and robust MCH mentorship program promotes and strengthens research activities in areas of high priority such as addressing health disparities in MCH morbidity and mortality in the U.S., (© 2022. The Author(s).)

Introduction: Efforts to recruit and retain diverse Maternal and Child Health (MCH) professionals are of paramount public health significance. Culturally congruent mentorship strategies are key to supporting a successful transition from undergraduate to graduate studies., Methods: This mixed-method study evaluated a culturally congruent mentorship training used by one of the MCH Pipeline Training programs and described mentorship practices and lessons learned from the six MCH Pipeline programs. A retrospective pre-test post-test survey assessed mentorship competency skills following a mentoring workshop. All MCH Pipeline program leaders completed a questionnaire to elicit responses about mentoring training practices, mentor evaluation strategies, and lessons learned., Results: Maternal and Child Health Pipeline Training Programs supported 1890 undergraduate scholars at universities and institutions nationally. Scholars at six MCH Pipeline Programs participated in MCH education and mentored experiential leadership opportunities in clinical practice, research, and public health education. Qualitative program-level mentor survey themes indicated the importance of creating a reflective space and building mentorship teams. Mean mentor self-assessed improvement in mentor competencies was 14.4 points, 95% CI [10.5, 18.3], p < .001 following completion of a mentoring training workshop implemented by one of the MCH Pipeline programs., Discussion: The Health Resources and Services Administration's Maternal and Child Health Bureau recognized the need to support the development of the next generation of diverse MCH leaders. Pipeline programs that included mentoring workshops and building culturally congruent mentorship teams are two strategies to increase and retain diverse scholars in graduate school and leaders in the public health workforce., (© 2022. The Author(s).)

The coronavirus disease 2019 pandemic may require rationing of various medical resources if demand exceeds supply. Theoretical frameworks for resource allocation have provided much needed ethical guidance, but hospitals still need to address objective practicalities and legal vetting to operationalize scarce resource allocation schemata. To develop operational scarce resource allocation processes for public health catastrophes, including the coronavirus disease 2019 pandemic, five health systems in Maryland formed a consortium-with diverse expertise and representation-representing more than half of all hospitals in the state. Our efforts built on a prior statewide community engagement process that determined the values and moral reference points of citizens and health-care professionals regarding the allocation of ventilators during a public health catastrophe. Through a partnership of health systems, we developed a scarce resource allocation framework informed by citizens' values and by general expert consensus. Allocation schema for mechanical ventilators, ICU resources, blood components, novel therapeutics, extracorporeal membrane oxygenation, and renal replacement therapies were developed. Creating operational algorithms for each resource posed unique challenges; each resource's varying nature and underlying data on benefit prevented any single algorithm from being universally applicable. The development of scarce resource allocation processes must be iterative, legally vetted, and tested. We offer our processes to assist other regions that may be faced with the challenge of rationing health-care resources during public health catastrophes., (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Research suggests that youth in urban communities often remain in the same sexual relationships after a pelvic inflammatory disease (PID) diagnosis. Utilizing data from the Technology Enhanced Community Health Nursing (TECH-N) study, we explored partner notification, treatment, and condom use after PID diagnosis. Outreach interviews assessed adherence to self-care behaviors, followed by interviews 3 months after diagnosis. Descriptive statistics and multivariable logistic regressions evaluated baseline condom use versus 3 months after diagnosis as it relates to group and relationship status. Ninety-one percent reported partner notification, and of those notified, 90% reported partner treatment. Reports of condom use increased in both groups compared with baseline use. TECH-N participants were more likely to report condom use at last sex at 3 months compared with baseline. Given the open communication with partners about PID and partner-associated effects on condom use, exploring dyadic intervention to promote consistent, condom use after PID for youth in high STI (sexually transmitted infection) prevalence communities is required.

Objective: This pragmatic, randomized, non-inferiority trial compared the effectiveness and cost of group-based parent management training with mastery-based individual coaching parent management training in a low-income, predominantly African American sample., Method: Parents seeking treatment for their 2- to 5-year-old children's behavior problems in an urban fee-for-service child mental health clinic were randomized to the Chicago Parent Program (CPP; n = 81) or Parent-Child Interaction Therapy (PCIT; n = 80). Consent followed clinic intake and diagnostic assessment and parent management training was delivered by clinicians employed at the clinic. Primary outcome measures were externalizing child behavior problems, assessed at baseline and postintervention follow-up, using the Child Behavior Checklist (CBCL) and average per-participant treatment cost., Results: Data from 158 parents were analyzed. Most were mothers (75.9%), African American (70.3%), and economically disadvantaged (98.7% Medicaid insured). Of children, 58.2% were boys, and mean age was 3.6 years (SD 1.03). Based on CBCL scores, behavior problems improved in the 2 conditions (Cohen d = 0.57 for CPP and 0.50 for PCIT). CPP was not inferior to PCIT (90% CI -1.58 to 4.22) at follow-up, even after controlling for differences in treatment length (90% CI -1.63 to 4.87). Average per-participant treatment cost was higher for PCIT (mean $2,151) than for CPP (mean $1,413, 95% CI -1,304 to -170)., Conclusion: For parents of young children living in urban poverty, CPP is not inferior to PCIT for decreasing child behavior problems. CPP requires less time to complete and costs a third less than PCIT., Clinical Trial Registration Information: Early Parenting Intervention Comparison (EPIC); https://clinicaltrials.gov/; NCT01517867., (Copyright © 2018 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Trauma-exposed youth with impaired caregivers (i.e., due to substance use and/or mental health problems) may be at particular risk for negative outcomes. This study utilized data from the National Child Traumatic Stress Network Core Data Set to examine the impact of caregiver impairment on youth outcomes. Trauma-exposed youth with an impaired caregiver due to either: substance use ( n  = 498), mental health problems ( n  = 231), or both substance use and mental health problems ( n  = 305) were compared to youth without a reported impaired caregiver ( n  = 2282) to determine if impaired caregiver status is independently associated with increased likelihood of negative behavioral and mental health outcomes and service utilization after accounting for demographics and exposure to traumatic events. Youth with impaired caregivers compared to those without were more likely to display PTSD, emotional and behavioral problems, suicidality, self-injury, and substance abuse and had higher rates of service utilization ( p  < 0.05). Differential patterns were observed based on the type of caregiver impairment. Findings support the importance of family-centered assessment and intervention approaches for youth affected by trauma., Competing Interests: Conflict of InterestOn behalf of all authors, the corresponding author states that there is no conflict of interest., (© Springer Nature Switzerland AG 2019.)

This article defines and discusses 6 beliefs, attitudes, and practices that can erode or undermine self-esteem and self confidence in student-scholars from underrepresented and marginalized groups in academic settings. Specifically, the beliefs and practices are reactions to implicit bias, color blindness, imposter syndrome, internalized racism, stereotype threat, and code-switching. Mentors need to know how to discuss these reactions because they can also influence the mentoring process and academic performance. To minimize incidents or interactions that might result in scholars not being able to find their place in these settings, recommendations for basic mentoring strategies and individual- and systemic-level approaches to address institutional racism are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Efforts to recruit and retain public health researchers should include scholars that reflect the demographics of the United States. Innovative research mentoring programs that integrate one-to-one and small group learning experiences may result in improved engagement and research productivity among graduate school scholars from underrepresented populations in public health research fields. This study analyzed leadership characteristics and research productivity of 54 graduate scholars who participated in the Dr. James A. Ferguson Emerging Infectious Diseases Fellowship Program (Ferguson Fellowship). Ferguson Fellows participated in 9-week research experience before and after implementation of a multimodal mentorship (M3) designed to support submission of research abstracts to national scientific conferences. M3 strategies included: (a) weekly research content mentoring, (b) myIDP, (c) professional development (process) mentoring, and (d) Research Accountability Groups. Overall, transformational leadership characteristics improved following completion of the Ferguson Fellowship (M = 3.71, SD = 6.37), t(33) = 3.39, p < .01. Transformational leadership characteristics of Ferguson Fellows who received M3 improved significantly (M = 3.88, SD = 6.63), t(24) = 2.93, p < .01 during the program. Fellows who received M3 had almost 4 times (OR = 3.88; 95% CI [1.21, 12.47], p < .05) higher odds of submitting research to scientific meetings compared to their peers who did not participate in M3. Providing process mentoring and research accountability groups were associated with increased research self-efficacy. Graduate scholars from underrepresented populations may benefit from multimodal mentoring strategies that provide scholars with individualized research and professional development support based on the scholar's needs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

This issue is a call for more culturally congruent mentorship training, support, and research on the effectiveness of mentoring strategies. The role of mentoring is fundamental to professional growth and success. Importantly, one size does not fit all. A repertoire of mentoring strategies and formats is necessary to include the talent, skills, and contributions of the next generation of diverse researchers in public health and biomedical sciences. It is incumbent on us now to grow a comprehensive knowledge base so we may best promote health and well-being for all citizens through innovative and effective strategies to support mentoring and research that eliminates health disparities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

We examined whether parent engagement in parent training (PT) differed based on PT format (parent group-based with video versus mastery-based individual coaching with child) in an economically disadvantaged sample of families seeking behavioral treatment for their preschool children in an urban mental health clinic. Parents (N=159; 76.1% mothers, 69.8% African American, 73% low-income) were randomized to one of two interventions, Chicago Parent Program (parent group + video; CPP) or Parent Child Interaction Therapy (individualized mastery-based coaching; PCIT). Parent engagement indicators compared were PT attendance and completion rates, participation quality, and parent satisfaction. Risk factors predictive of PT attrition (parent depression, psychosocial adversity, child behavior problem severity, length of wait time to start PT) were also compared to determine whether they were more likely to affect engagement in one PT format versus the other. No significant differences were found in PT attendance or completion rates by format. Clinicians rated parents' engagement higher in PCIT than in CPP while satisfaction with PT was rated higher by parents in CPP compared to PCIT. Never attending PT was associated with more psychosocial adversity and externalizing behavior problems for CPP and with higher baseline depression for PCIT. Parents with more psychosocial adversities and higher baseline depression were less likely to complete PCIT. None of the risk factors differentiated CPP completers from non-completers. Delay to treatment start was longer for PCIT than CPP. Strengths and limitations of each PT format are discussed as they relate to the needs and realities of families living in urban poverty., Competing Interests: Conflict of Interest: Under an agreement between Rush University Medical Center and Dr. Deborah Gross, Dr. Gross is entitled to revenue from the program described in this paper. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. This manuscript has been reviewed for bias by an independent committee prior to submission to this journal. Dr. Belcher declares that she has no conflict of interest. Dr. Budhathoki declares that he has no conflict of interest. Dr. Ofonedu declares that she has no conflict of interest. Ms. Uveges declares that she has no conflict of interest.

Background: Leadership is a process by which an individual influences a group or individual to achieve a common goal, in this case health promotion for individuals with disabilities., Objectives: (1) To examine the association between the transformational leadership behaviors of the Association of University Centers on Disabilities (AUCD) network professionals and their practice beliefs about health promotion activities, specifically cardiovascular fitness and healthy weight, for people with disabilities. (2) To determine if discipline and/or years of practice moderate the association between transformational leadership behaviors and practice beliefs regarding health promotion., Hypothesis: There is a positive association between transformational leadership behaviors and health professionals practice beliefs regarding health promotion activities for persons with disabilities., Methods: A quantitative cross-sectional web-based survey design was used to determine the association between leadership behaviors and practices beliefs regarding health promotion for people with disabilities. The Multifactor Leadership Questionnaire and an adapted version of the Role of Health Promotion in Physical Therapy Survey were used to measure leadership and practice beliefs, respectively. Multiple regression analysis was applied to determine the association of leadership behaviors with health promotion practice beliefs variables., Results: Transformational leadership behaviors of the AUCD network professionals were positively associated with health promotion practice beliefs about cardiovascular fitness for people with disabilities. Years post licensure and discipline did not moderate the association between transformational leadership and practice beliefs regarding health promotion., Conclusion: Transformational leadership may facilitate health professionals' health promotion practices for people with disabilities. Further research and training in leadership is needed., (Copyright © 2017 Elsevier Inc. All rights reserved.)

This mixed method study examined factors associated with parents not attending their child's mental health treatment after initially seeking help for their 2-5 year old child. It was part of a larger study comparing two evidence-based treatments among low-income racial/ethnic minority families seeking child mental health services. Of 123 parents who initiated mental health treatment (71% African American or multi-racial; 97.6% low-income), 36 (29.3%) never attended their child's first treatment session. Socio-demographic characteristics, parenting stress, depression, severity of child behavior problems, and length of treatment delay from intake to first scheduled treatment session were compared for families who did and did not attend their first treatment session. Parents who never attended their child's first treatment session were more likely to live with more than 4 adults and children (p=.007) and have more depressive symptoms (p=.003). Median length of treatment delay was 80 days (IQR =55) for those who attended and 85 days (IQR =67.5) for those who did not attend their child's first treatment session (p=.142). Three themes emerged from caregiver interviews: (a) expectations about the treatment, (b) delays in getting help, and (c) ambivalence about research participation. Findings suggest the need to develop better strategies for addressing risk factors early in the treatment process and reducing the length of time families with adverse psychosocial circumstances must wait for child mental health treatment.

Objective: Adverse childhood experiences are prevalent and have been associated with sleep disturbance. However, there are limited data examining factors that influence this relationship. The purpose of this study was to extend the current literature by characterizing the relationship between adverse childhood experiences and sleep disturbance in a sample of trauma-exposed youth and to identify factors that may influence this relationship., Study Design: Data were collected from 56 mental health centers across the National Child Traumatic Stress Network. For the current study, secondary data analysis was conducted using de-identified data from the National Child Traumatic Stress Network Core Data Set. The present study included 4043 children and adolescents who met eligibility criteria., Results: Sixteen percent of the sample (n=634) met criteria for a sleep disturbance as determined through clinician assessment and collateral report. Posttraumatic stress disorder (PTSD) symptom severity influenced the risk of disturbed sleep (ages 7-12: t=-4.33, ages 13-18: t=-7.12, P≤.001 for both analyses), with those meeting full criteria for PTSD at greatest risk (age 7-12: odds ratio [OR]=1.95; 95% confidence interval [CI], 1.17-3.24; age 13-18: OR=3.18; 95% CI, 1.87-5.43). Exposure to sexual assault and community violence also contributed independently to the risk of disturbed sleep (age 7-12, sexual assault: OR=1.76; 95% CI, 1.21-2.57; age 13-18, community violence: OR=1.61; 95% CI, 1.19-2.18)., Conclusions: Comprehensive treatment strategies should include assessment of disturbed sleep in youth exposed to trauma, particularly those with elevated PTSD symptoms and exposure to sexual trauma or community violence., (Copyright © 2016 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)