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OBJECTIVES: Geographic barriers limit access to clinical care in the United States for transgender and gender-diverse (TGD) youth. Some factors differentiating access to care are variability in state laws/policies, the number of available clinical care programs and mental health providers for TGD youth. METHODS: We aggregated data from the Human Rights Campaign for pediatric clinical care programs for TGD youth, the Movement Advancement Project for state-by-state assessment of gender identity laws and policies, and Psychology Today for mental health providers for TGD youth by state. Current prevalence rates for TGD youth were applied by state with 2020 Census data. Findings were summarized as a whole and per capita by state, region, and country overall. RESULTS: The South has the highest number of TGD youth per clinic (36 465-186 377), and the lowest average equality score in gender identity laws and policies (1.96). The Midwest has the highest number of TGD youth per mental health provider (278-1422). The Northeast has the lowest number of TGD youth per clinic (11 094-56 703), the highest average equality score in laws and policies per state (17.75), and the highest average number of TGD youth per mental health providers (87-444). CONCLUSIONS: Findings support there are barriers to TGD youth care throughout the United States, especially the South and Midwest. Increasing medical and mental health care for TGD youth is likely to improve their health and well-being. Enacting gender identity protective laws/policies would allow for equal treatment and access to care among TGD youth. [ABSTRACT FROM AUTHOR]

Behavioral parent training is an efficacious treatment for children with externalizing behavior problems, but many parents refuse to attend treatment and/or terminate prematurely. The Obstacles to Engagement Scale (OES) assesses the impact of personal and intervention-based obstacles on attending parent training. The published factor structure of the OES has an unstable, two-item subscale and has not been confirmed. We ran exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) and, consistent with literature, hypothesized that factors would differ across different demographic groups. An EFA was conducted on 192 parents of 2-8 year old children presenting to primary care pediatric clinics, with a CFA on a similar sample. CFA failed to support a stable factor structure for the full sample. An EFA on 129 parents with at least a college degree revealed a 3-factor solution: Health and legal barriers, Belief in utility and effectiveness, and Personal barriers. This structure was confirmed with a CFA on 53 parents. Consistent with our hypothesis, this model did not fit for parents with less than a college education. Findings of differences based on amount of education of parents supports the need for additional research on the factor structure and predictive validity of the OES for parents with more or less education. Research should continue to examine educational differences in willingness to attend and belief in efficacy of psychological treatments. Interventions to improve attendance at empirically supported treatments need to be customized based on education of parents. Larger samples will be needed to assess the factor structure for other relevant groups. [ABSTRACT FROM AUTHOR]

The present study examined the relationship between stigma and parental help-seeking after controlling for demographics, child behavior, and barriers to treatment. One hundred fifteen parents of children ages 4 to 8 years were surveyed during well-child visits in a rural pediatric primary care practice. Parental perceptions of stigma toward parents and children were both assessed. Parents believe that children are more likely to be stigmatized by the public and personally impacted by stigma. In linear regression analyses, parents rated themselves as more likely to attend parenting classes with lower levels of self-stigma and greater levels of personal impact of stigma. Stigma toward the child was not associated with help-seeking. Child behavior moderated the relationship between stigma and parental help-seeking. When referring parents to treatment, providers should address potential stigma concerns. Future research should assess both the impact of the stigma of attending treatment and the stigma of having a child with behavior problems. [ABSTRACT FROM AUTHOR]

Literature suggests advantages for co-locating behavioral health care in primary care. We compared the impact of location of services on attendance at behavioral health appointments when access to care was assured for externalizing behavior problems with referral as usual. Two primary care pediatric practices had an evidence-based parenting program co-located in the practice for parents of children aged 2-12 years and two practices had the program available using an enhanced-referral procedure for locations external to the practices. The program was available at the regional children's hospital (referral as usual). During an 8-month period, the rate of attendance at first appointments was significantly higher in the co-located than the enhanced referral condition (.38 and .12 % of patient visits, respectively; χ = 13.32; p < .0003; OR = 3.10; 95 % CI: 1.63, 5.89). These outcomes, while low, were better than the near 0 rate of attendance to referral as usual. Availability of behavioral health services in both conditions increased rates of attended appointments. However, the low rates of attendance indicate increasing availability of services, alone, is not sufficient to decrease the unmet need of children with behavioral problems. Factors other than availability must be addressed in order to improve outcomes for children. [ABSTRACT FROM AUTHOR]

While most primary care pediatricians acknowledge the importance of identifying child behavior problems, fewer than 2% of children with a diagnosable psychological disorder are referred for mental health care in any given year. The present study examined the potential role of parental characteristics (parental affect, parenting style, and parenting self-efficacy) in pediatrician identification of child behavior problems, and determined whether these relationships differed across practices. Parents of 831 children between 2 and 16 years completed questionnaires regarding demographic information, their child's behavior, their affect, their parenting style, and their parenting self-efficacy. Pediatricians completed a brief questionnaire following visits in four community-based primary care practices in the Midwest. Logistic regressions controlling for child behavior and demographic predictors of pediatrician identification found that an authoritarian parenting style, in which parents yell or strongly negatively react to problem behavior, was negatively associated with likelihood of identification in the overall sample. However, the variables that were predictive of pediatrician identification differed depending on the specific practice. Parental characteristics can aid in understanding which children are likely to be identified by their pediatrician as having behavioral problems. The finding that practices differed on which variables were associated with pediatrician identification suggests the need to potentially individualize interventions to certain physicians and practices to improve identification of child behavior problems in primary care. [ABSTRACT FROM AUTHOR]

Parenting behaviors have received ample support as a mediator of the relationship between maternal affect and child behavior problems. The majority of these research efforts were based on a uni-dimensional conceptualization of maternal mood, even though decades of theory and research suggest that mood is multidimensional. We examined the mediating role of parenting behaviors on positive affect (PA) and negative affect (NA) and reports of child behavior problems. Evidence for mediation was demonstrated for both PA and NA for children in early to middle childhood. Consistent with the positive psychology movement, our results suggest that maternal PA plays an important role in parents’ utilization of effective parenting behaviors. Implications for clinical intervention and future research are discussed. [ABSTRACT FROM AUTHOR]

Pediatricians have been criticized for failing to identify psychosocial problems in their pediatric patients. Maternal disclosure is important for identification; however, many mothers fail to discuss their concerns with the pediatrician. The present study explored the hypothesis that mothers are seeking and receiving help from sources other than the pediatrician. Participants were 50 mothers who brought their 4-13-year-old child for a routine health supervision visit at a county-funded hospital serving primarily low-income families. Results indicated that mothers actively seek help from multiple sources and find the help they receive useful. Clinical implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND. Physician identification and management of psychosocial problems in children is related to parental disclosure. The purpose of this research was to evaluate a method of prompting parental disclosure of such problems and to determine the impact of parental disclosure on family physicians' identification of and intervention for childhood psychosocial problems. METHODS. Participants were parents and physicians of 60 children between the ages of 3 and 10 years attending an ambulatory care clinic of a community-based, university-affiliated family medicine training program. Parents completed the Child Behavior Checklist and also indicated whether psychosocial problems were discussed or managed. Physicians completed a checklist about the psychosocial status of the child and potential interventions for identified problems. One half of the participating parents formed the experimental group and were also asked to note their concerns on a Psychosocial Checklist for Children and to discuss these concerns with their child's physician; the other half of parents received no such checklist and acted as the control group. All interactions between parents and physicians were videotaped. RESULTS. The number of parental psychosocial disclosures, but not the number of parents who disclosed them, was significantly higher for the experimental group. Physicians were three times as likely to identify a psychosocial problem and 10 times as likely to intervene when parents discussed psychosocial concerns. CONCLUSIONS. Parents' disclosure of psychosocial concerns to their child's physician increases the likelihood of physicians identifying and intervening for these problems. The finding that physicians intervened for psychosocial problems even when they failed to record these problems suggests that research needs to focus on measuring both intervention and identification. [ABSTRACT FROM AUTHOR]

BACKGROUND. Between 15% and 25% of children who visit primary care physicians have emotional, behavioral, or psychiatric problems that affect their functioning. The majority of these children are treated by primary care physicians. The purpose of this study was to examine the presentation and treatment of children's psychosocial problems in primary care and to investigate ways in which physician management of a problem is related to parent-physician agreement that the problem exists. METHODS. Twenty-six physicians at an ambulatory care center of a community-based, university-affiliated family medicine training program collected data during outpatient visits of 898 children aged 2 to 16 years. The physicians used a checklist to collect data on children's developmental problems, parents' concerns about the psychosocial functioning of their children, whether physicians and parents were in agreement about these concerns, and the parents' influence on physicians' management of the problems. RESULTS. Family physicians and parents agreed that 10% of the children were experiencing psychosocial problems. For 5% of children, physicians recorded emotional or behavioral concerns when parents did not disclose any such concerns. For only 1.8% of children, parents raised psychosocial concerns while physicians did not. Physicians diagnosed and managed psychosocial concerns during both acute-care and well-child visits. When parents and physicians agreed on the presence of pediatric psychosocial problems, referral to a mental health professional was more likely than when they disagreed (60% vs 16%). CONCLUSIONS. Pediatric psychosocial concerns are raised by parents during acute-care and well-child visits. Family physicians identified and managed these problems at rates consistent with past research. Management strategies appeared to differ as a function of agreement between physicians and parents on whether a problem existed. [ABSTRACT FROM AUTHOR]

The medical needs of individuals with sickle cell disease (SCD) are complex. Patients with SCD experience complications such as recurrent pain episodes and increased hospitalizations. Over 70% of AYA and their parents seek medical information from the Internet; 83% inquire on sites that have interactive/social features, such as Facebook or Twitter, yet accuracy remains unclear. Our objective was to assess the accuracy of the SCD-information posted on social media. We hypothesized that most of the posted information is inaccurate. We coded one month of threads from two common SCD Facebook groups (Sickle Cell Warriors Unity and Sickle Cell Anemia) to identify the purpose of each post and the accuracy of medical information posted. Amongst both social media sites, there were 487 posts. Most of the posts were directed toward socializations (n = 311, 63.8%), while other posts mainly focused mainly on SCD and its management (n = 173, 35.5%). When looking at the medical posts, 44.9% were accurate, whereas 55.1% of the posts included inaccurate information. We found that less than half of the medical information posted on interactive social media is inaccurate. Our findings raise potentially serious implications for individuals with SCD and/or their caregivers who may rely on social media to gather more information about their or their child's disease. Our data highlight the importance of health care providers encouraging patients and parents to ask any questions they may have about SCD, given they may consult social media and Internet site that provide inaccurate information. [ABSTRACT FROM AUTHOR]

We used confirmatory factor analysis (CFA) to investigate the factor structure of several models of Arnold et al.’s Parenting Scale [Arnold et al. (1993). Psychological Assessment, 5, 137–144] across children from various age groups and races. Participants were parents of children (ages 2–16 years) presenting to four community-based pediatric practices for routine care. Parents completed questionnaires pertaining to various aspects of parenting and child behavior problems. Results indicated that a two-factor revision proposed by Reitman et al. [(2001). Journal of Clinical Child Psychology, 30, 514–524] represented the data well and better than the original three-factor structure and other two-factor models. Results from multigroup CFA analyses indicated that this factor structure did not vary across child sex, child age, and parental race. Results of validity analyses indicated that scores on both factors were related to reports of children’s behavior and parental affect and cognitions. This study was the first to use multigroup CFA procedures to demonstrate that relationships between individual items and factors of the Parenting Scale are similar for parents of children across various age groups. [ABSTRACT FROM AUTHOR]

Objective: Given the associations between externalizing behaviors and childhood unintentional injuries (CUI), this pilot study evaluated whether an empirically supported behavioral parent training program, Group Triple P, decreased risk for CUI. Methods: Parents of 19 children ages 2-8 referred by their child’s primary care physician for child externalizing behavior problems completed measures of child injury risk pre- and post-Triple P. Results: Child injury risk and disruptive behavior problems decreased significantly. Conclusions: Overall, our findings indicate that teaching behavior management and parenting skills to parents has the potential to decrease injury risk in their children, despite this not being an explicit target of intervention. [ABSTRACT FROM AUTHOR]

Significant numbers of children have diagnosable mental health problems, but only a small proportion of them receive appropriate services. Stigma has been associated with help-seeking for adult mental health problems and for Caucasian parents. The current study aims to understand factors, including stigma, associated with African American parents' help-seeking behavior related to perceived child behavior problems. Participants were a community sample of African American parents and/or legal guardians of children ages 3-8 years recruited from an urban primary care setting ( N = 101). Variables included child behavior, stigma (self, friends/family, and public), object of stigma (parent or child), obstacles for engagement, intention to attend parenting classes, and demographics. Self-stigma was the strongest predictor of help-seeking among African American parents. The impact of self-stigma on parents' ratings of the likelihood of attending parenting classes increased when parents considered a situation in which their child's behavior was concerning to them. Findings support the need to consider parent stigma in the design of care models to ensure that children receive needed preventative and treatment services for behavioral/mental health problems in African American families. [ABSTRACT FROM AUTHOR]