- Email: [email protected]
2.33 Diagnosing Delirium in a Pediatric Intensive Care Unit
NEW RESEARCH POSTERS 2.32 — 2.33
adolescents ages 12 years or older. The annual admission rate was 37 percent. With regard to overall presentation trends, we found a predictable seasonal pattern to presentation generally correlating to the school year with reduced consultations during summer and extended holidays. Additionally, by use of residential zip code data from the patient presentation, a choropleth map illustrating frequency of presenting regions was generated. Child and adolescent psychiatrists were also plotted according to their listed zip codes. Conclusions: With such data, we hope to illustrate current demands and aid in reassessing the allocation of the limited resources available to optimize acute management, risk assessment, and linkage to appropriate outpatient services for those in need.
EPI, PUP, CON Supported by the University of Alabama at Birmingham and Childrens of Alabama http://dx.doi.org/10.1016/j.jaac.2017.09.111
2.32 MOVING INTO A HIGHER GEAR: THE MOST RECENT DATA ON THE CAP PC PROGRAM, A MULTI-UNIVERSITY EDUCATION AND COLLABORATIVE CARE PROGRAM FOR PRIMARY CARE PROVIDERS IN NEW YORK STATE David L. Kaye, MD, University at Buffalo, [email protected]; Victor Fornari, MD, Northwell Health, [email protected]; Michael A. Scharf, MD, University of Rochester School of Medicine and Dentistry, [email protected]; Wanda Fremont, MD, SUNY Upstate Medical University, [email protected]; Rachel Zuckerbrot, MD, Columbia University, [email protected]; Carmel Foley, MD, Cohen’s Children’s Medical Center, [email protected]; Teresa M. Hargrave, MD, SUNY Upstate Medical University, [email protected]; Beth A. Smith, MD, University at Buffalo, [email protected]; James M. Wallace, MD, University of Rochester, [email protected]; Jennifer N. Petras, MD, Columbia University, [email protected]; Sourav Sengupta, MD, MPH, University at Buffalo, sourav. [email protected]; Jennifer Singarayer, MD, SUNY Upstate Medical University, [email protected]; Eric R. MacMaster, MD, SUNY Upstate Medical University, [email protected]; Scott B. Falkowitz, DO, Northwell Health, [email protected]; Andrew Mietz, MD, University of Rochester, [email protected]. edu; Alex Cogswell, University at Buffalo, alexcogs@buffalo. edu; Matthew Perkins, MD, MBA, MPH, New York State Office of Mental Health, [email protected]; Ira Bhatia, MS, University at Buffalo, [email protected]; Peter S. Jensen, MD, University of Arkansas for Medical Science and The REACH Institute, PeterJensen@ TheReachInstitute.org Objectives: There are currently more than 25 large-scale, statewide child psychiatry access programs across the United States. This study provides updated data on Child and Adolescent Psychiatry for Primary Care (CAP PC), one of the largest and most developed programs nationally. Project TEACH (Treatment Education Activists Combating HIV) is a New York State Office of Mental Health initiative to provide child psychiatric access to primary care. CAP PC is one of two component programs of Project TEACH and has provided service to 90 percent of the state of New York. The program is a collaboration of five university-based child psychiatry divisions that opened in 2010. CAP PC consists of three broad efforts: 1) formal education; 2) linkage/ referral assistance; and 3) consultation support for primary care physicians (PCPs). In 2016, the program’s funding was renewed for five years. A statewide coordinating center (SCC), the Massachusetts General Hospital Psychiatry
S188
www.jaacap.org
Academy, was also designated. The SCC was to coordinate efforts between the two component programs. Methods: Phone consultations and face-to-face evaluations were systematically documented. Two-week satisfaction surveys from PCPs and an annual survey were obtained. These sources formed the basis for the results reported here. Results: PCPs (n ¼ 1,931) have registered for the consultation program. The program has provided 8,013 child psychiatric consultations and 566 face-to-face evaluations for 6,285 children. In 2016, there were 1,975 child psychiatric consultations for 1,600 children and adolescents. PCPs (n ¼ 667) have completed the most robust education program called the REACH Mini-Fellowship. In total, the program has provided more than 17,523 continuing medical education hours to more than 1,000 PCPs. Two-week follow-up surveys confirm that 93.4 percent of consultations were very helpful or extremely helpful and that 99.2 percent would recommend the program to other PCPs. These percentages have been consistent across all of the years of the program. Conclusions: CAP PC has established a robust program of formal education with consultation support for more than six years. The program has been extremely well received by PCPs across the state. CAP PC demonstrates that large-scale, collaborative consultation models for primary care meet the needs of PCPs, are feasible to implement, can be sustained, and provide access to child psychiatric expertise for patients who would otherwise have none.
CON Supported by New York State Office of Mental Health Contract C007489 http://dx.doi.org/10.1016/j.jaac.2017.09.110
2.33 DIAGNOSING DELIRIUM IN A PEDIATRIC INTENSIVE CARE UNIT Lara P. Nelson, MD, Children’s Hospital Los Angeles, [email protected]; Sage E. Lachman, BA, Children’s Hospital Los Angeles, [email protected]; Jeffrey I. Gold, PhD, Children’s Hospital Los Angeles, jgold@chla. usc.edu Objectives: Delirium, as defined in the DSM-5, is an acute disturbance in attention and awareness and is a well-described adverse outcome following adult critical illness. It is less understood in pediatrics. The primary objective of this study was to evaluate the incidence of delirium in a pediatric intensive care unit (PICU) and diagnostic associations. Methods: Children (ages 5–17 years) with an anticipated PICU stay of >24 hours without significant developmental delay or neurologic injury were recruited. Daily screens for delirium were conducted with the Cornell Assessment of Pediatric Delirium (CAPD) and Pediatric Confusion Assessment Method for the ICU (PCAM). Delirium positive children were referred to psychiatry. All children had cognitive testing done at time of transfer with the Children’s Memory Scale (CMS). Other medical data were collected via chart review. Results: Children (N ¼ 53) were recruited (mean age ¼ 11 years, 51% male), with a variety of ethnic backgrounds. Forty-two percent of children screened positive for delirium. Psychiatry confirmed the diagnosis in 54 percent of them (23% of the total number). Children performed at <50th percentile in all domains of the CMS: 1) attention/concentration (mean ¼ 28.0%ile); 2) visual/ nonverbal memory (mean ¼ 30.9 and 41.7%ile); and 3) auditory/verbal memory (mean ¼ 41.4 and 14.3%ile). There were no group differences based on age or gender in the screen of children’s delirium; however, children who screened positive had higher opiate and benzodiazepine use and longer lengths of stay (t ¼ 4.01, P ¼ 0.00; t ¼ 1.9, P ¼ 0.06; t ¼ 3.7, P ¼ 0.00). Irrespective of delirium status, both groups performed poorly on the CMS without significant group differences. Conclusions: The incidence of delirium in this population was 42 percent by screener and 23 percent after psychiatric evaluation. The new DSM-5 criteria for delirium focus on cognitive dysfunction. The children in this study had significantly impaired cognitive function in the diagnostic domains of delirium, regardless of delirium status. Thus, although delirium
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
NEW RESEARCH POSTERS 2.34 — 2.36
assessments capture some of the children with delirium, both the screeners and psychiatry are still missing a significant proportion of children who have ongoing cognitive dysfunction. Pediatric healthcare needs to improve its evaluation of delirium to minimize ongoing cognitive deficits after admission to the PICU.
COG, CON, DIAG Supported by a Society of Critical Care Medicine-Weil Research Grant http://dx.doi.org/10.1016/j.jaac.2017.09.113
2.34 IMPAIRMENT OF QUALITY OF LIFE IN CHILDHOOD CANCER SURVIVORS AND PARENTING STRESS Yunhye Oh, National Center Mental Health, nunnerine@ gmail.com; Yoo-Sook Joung, MD, PhD, Samsung Medical Center, Sungkyunkwan Univ Medical School, yschoung@ skku.edu Objectives: This study investigated and compared psychological functioning, quality of life, and parenting stress of caretakers among childhood survivors with brain tumor and neuroblastoma and healthy control subjects. Methods: A total of 304 children were within the age range of 8–15 years, and their parent participated in this study. Psychosocial functioning among survivors of brain tumor (n ¼ 100) and neuroblastoma (n ¼ 51) was assessed using Childhood Behavior Checklist (CBCL). Parenting stress and quality of life among brain tumor group, neuroblastoma group, and healthy control group (n ¼ 151) were assessed using the Parenting Stress Index and the Pediatric Quality of Life Inventory (PedsQLTM). Results: The group with brain tumor had lower intelligence and higher CBCL scores (more problems) on somatic complaints compared with the group with neuroblastoma. The group with brain tumor had lower quality of life compared with the group with neuroblastoma and the healthy control group (all P < 0.05). No differences between cancer groups were found for parenting stress, with the exception of the scale measuring parenting competence. Conclusions: These findings will inform our understanding of childhood cancer survivors and hence suggest that patients with childhood cancer are likely to have higher levels of psychosocial stress and poor quality of life.
IMP, STRESS, PAT http://dx.doi.org/10.1016/j.jaac.2017.09.114
2.35 ADDRESSING MENTAL HEALTH NEEDS OF LATINO IMMIGRANT PARENTS IN PEDIATRIC PRIMARY CARE Rheanna Platt, MD, MPH, Johns Hopkins University, rplatt1@ jhmi.edu; Elisabet Arribas-Ibar, PhD, Barcelona Biomedical Research Park/Hospital Del Mar Research Institute, [email protected] Objectives: Few studies have examined the prevalence of depressive symptoms and comorbid conditions in Latino parents whose children are presenting for well-child care. Methods: Spanish-speaking parents (n ¼ 100) of children (ages 0–5 years) attending well visits at a general pediatric clinic were surveyed between October 2015 and February 2016. The verbally administered survey included the Personal Health Questionnaire Depression Scale-8 (PHQ-8), Generalized Anxiety Disorder 2-item (GAD-2), Primary Care-PTSD screener, and Alcohol Use Disorders Identification Test (AUDIT-C) and psychosocial/demographic measures used in large regional/national surveys. From the sample group of 100 parents, 11 were recruited to participate in in-depth interviews, further exploring sources of parental distress and acceptability of screening and intervention for parental mental health symptoms in the pediatric primary care settings. Results: A total of 96 percent of approached parents agreed to participate. Participants were predominantly female (ages <35 years), lived in the United States a mean of eight years (range 1–17 years), and reported limited English proficiency (75%). Respondents (35%) had a
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
“positive” PHQ-8 score (>5; 95% CI: 25.8–44.6%); 82.8 percent of these fell within the mild range. Of those who screened positive for depression, 50 percent also screened positive for PTSD symptoms (95% CI: 33– 67%), 25 percent for anxiety symptoms (95% CI: 11.7–41.5%), and 29.4 percent for problematic alcohol use (95% CI: 16.1–47.5%). Among parents with a positive PHQ-8, 94 percent did not identify a primary care physician and 73 percent were uninsured in the preceding 12 months. In qualitative interviews, parents were generally supportive of screening for and addressing parental psychosocial stressors within the pediatric primary care setting. Most felt that a group-based intervention would be beneficial and would allow them to share experiences with other parents. Parents cited finances, immigration-related difficulties (including family separation, fear of deportation, and limited English proficiency), and interpersonal and community violence as significant sources of stress. Conclusions: Parents screening positive for depression reported a relatively high prevalence of comorbid anxiety, PTSD, and alcohol use symptoms and limited access to their own source of healthcare. In interviews, parents generally perceived a pediatric clinic-based intervention as acceptable. Resultsfrom this study will be used to inform the development of a groupbased intervention for recently immigrated parents in pediatric primary care.
ETHN, CC, PAT Supported by the Johns Hopkins Institute for Clinical and Translational Research and National Center for Advancing Translational Sciences Grant KL2TR001077 http://dx.doi.org/10.1016/j.jaac.2017.09.115
2.36 THE TWO-YEAR NATIONWIDE SURVEY OF COMMUNITY MENTAL HEALTH OUTREACH SERVICE COMBINED OUTPATIENT PSYCHIATRIC TREATMENT FOR CHILDREN AND ADOLESCENTS WITH MENTAL DISABILITY IN TAIWAN Chao-Wei Hsu, MD, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, [email protected] Objectives: Since June 2015, Ministry of Health and Welfare in Taiwan started a project of providing community mental health outreach services and outpatient psychiatric treatment for children and adolescents with mental disability from schools and institutions within the community. The primary goal of this project was promotion of medical service quality by early detection and management for children and adolescents with mental disability and psychiatric disorder. Methods: Service team members from seven hospitals in Taiwan, including psychiatrists, psychologists, and case managers, provided both outreach services and outpatient psychiatric treatment and collected all of the outpatient’s basic data and assessment scales from June 2015 to December 2016 (N ¼ 772). In this retrospective study, the study team of this project analyzed outpatient’s basic data and assessment scales, including Clinical Global Impression (CGI)—Schizophrenia (S), CGI-Global Improvement (CGI-I), Global Assessment of Functioning (GAF), Personal and Social Performance (PSP), rehospitalization rate, length of hospital stay, and satisfaction survey from their family members and caregivers. Results: The study findings revealed significant improvement in CGI-S, CGI-I, GAF, and PSP (P < 0.01); lower rehospitalization rate; and shorter length of hospital stay. Majority of these outpatients presented less mood or behavioral symptoms, better adaptation and academic performance at schools and institutions, and higher scores of satisfaction survey provided from their family members and caregivers. Conclusions: From the study’s findings, community mental health outreach service combined with outpatient psychiatric treatment allowed for early detection and intervention of children and adolescents with mental disability and psychiatric disorder. This service model can help children and adolescents alleviate their symptoms at early stages of psychiatric disorder, reduce hospitalization and medical cost, and avoid
www.jaacap.org
S189
adolescents ages 12 years or older. The annual admission rate was 37 percent. With regard to overall presentation trends, we found a predictable seasonal pattern to presentation generally correlating to the school year with reduced consultations during summer and extended holidays. Additionally, by use of residential zip code data from the patient presentation, a choropleth map illustrating frequency of presenting regions was generated. Child and adolescent psychiatrists were also plotted according to their listed zip codes. Conclusions: With such data, we hope to illustrate current demands and aid in reassessing the allocation of the limited resources available to optimize acute management, risk assessment, and linkage to appropriate outpatient services for those in need.
EPI, PUP, CON Supported by the University of Alabama at Birmingham and Childrens of Alabama http://dx.doi.org/10.1016/j.jaac.2017.09.111
2.32 MOVING INTO A HIGHER GEAR: THE MOST RECENT DATA ON THE CAP PC PROGRAM, A MULTI-UNIVERSITY EDUCATION AND COLLABORATIVE CARE PROGRAM FOR PRIMARY CARE PROVIDERS IN NEW YORK STATE David L. Kaye, MD, University at Buffalo, [email protected]; Victor Fornari, MD, Northwell Health, [email protected]; Michael A. Scharf, MD, University of Rochester School of Medicine and Dentistry, [email protected]; Wanda Fremont, MD, SUNY Upstate Medical University, [email protected]; Rachel Zuckerbrot, MD, Columbia University, [email protected]; Carmel Foley, MD, Cohen’s Children’s Medical Center, [email protected]; Teresa M. Hargrave, MD, SUNY Upstate Medical University, [email protected]; Beth A. Smith, MD, University at Buffalo, [email protected]; James M. Wallace, MD, University of Rochester, [email protected]; Jennifer N. Petras, MD, Columbia University, [email protected]; Sourav Sengupta, MD, MPH, University at Buffalo, sourav. [email protected]; Jennifer Singarayer, MD, SUNY Upstate Medical University, [email protected]; Eric R. MacMaster, MD, SUNY Upstate Medical University, [email protected]; Scott B. Falkowitz, DO, Northwell Health, [email protected]; Andrew Mietz, MD, University of Rochester, [email protected]. edu; Alex Cogswell, University at Buffalo, alexcogs@buffalo. edu; Matthew Perkins, MD, MBA, MPH, New York State Office of Mental Health, [email protected]; Ira Bhatia, MS, University at Buffalo, [email protected]; Peter S. Jensen, MD, University of Arkansas for Medical Science and The REACH Institute, PeterJensen@ TheReachInstitute.org Objectives: There are currently more than 25 large-scale, statewide child psychiatry access programs across the United States. This study provides updated data on Child and Adolescent Psychiatry for Primary Care (CAP PC), one of the largest and most developed programs nationally. Project TEACH (Treatment Education Activists Combating HIV) is a New York State Office of Mental Health initiative to provide child psychiatric access to primary care. CAP PC is one of two component programs of Project TEACH and has provided service to 90 percent of the state of New York. The program is a collaboration of five university-based child psychiatry divisions that opened in 2010. CAP PC consists of three broad efforts: 1) formal education; 2) linkage/ referral assistance; and 3) consultation support for primary care physicians (PCPs). In 2016, the program’s funding was renewed for five years. A statewide coordinating center (SCC), the Massachusetts General Hospital Psychiatry
S188
www.jaacap.org
Academy, was also designated. The SCC was to coordinate efforts between the two component programs. Methods: Phone consultations and face-to-face evaluations were systematically documented. Two-week satisfaction surveys from PCPs and an annual survey were obtained. These sources formed the basis for the results reported here. Results: PCPs (n ¼ 1,931) have registered for the consultation program. The program has provided 8,013 child psychiatric consultations and 566 face-to-face evaluations for 6,285 children. In 2016, there were 1,975 child psychiatric consultations for 1,600 children and adolescents. PCPs (n ¼ 667) have completed the most robust education program called the REACH Mini-Fellowship. In total, the program has provided more than 17,523 continuing medical education hours to more than 1,000 PCPs. Two-week follow-up surveys confirm that 93.4 percent of consultations were very helpful or extremely helpful and that 99.2 percent would recommend the program to other PCPs. These percentages have been consistent across all of the years of the program. Conclusions: CAP PC has established a robust program of formal education with consultation support for more than six years. The program has been extremely well received by PCPs across the state. CAP PC demonstrates that large-scale, collaborative consultation models for primary care meet the needs of PCPs, are feasible to implement, can be sustained, and provide access to child psychiatric expertise for patients who would otherwise have none.
CON Supported by New York State Office of Mental Health Contract C007489 http://dx.doi.org/10.1016/j.jaac.2017.09.110
2.33 DIAGNOSING DELIRIUM IN A PEDIATRIC INTENSIVE CARE UNIT Lara P. Nelson, MD, Children’s Hospital Los Angeles, [email protected]; Sage E. Lachman, BA, Children’s Hospital Los Angeles, [email protected]; Jeffrey I. Gold, PhD, Children’s Hospital Los Angeles, jgold@chla. usc.edu Objectives: Delirium, as defined in the DSM-5, is an acute disturbance in attention and awareness and is a well-described adverse outcome following adult critical illness. It is less understood in pediatrics. The primary objective of this study was to evaluate the incidence of delirium in a pediatric intensive care unit (PICU) and diagnostic associations. Methods: Children (ages 5–17 years) with an anticipated PICU stay of >24 hours without significant developmental delay or neurologic injury were recruited. Daily screens for delirium were conducted with the Cornell Assessment of Pediatric Delirium (CAPD) and Pediatric Confusion Assessment Method for the ICU (PCAM). Delirium positive children were referred to psychiatry. All children had cognitive testing done at time of transfer with the Children’s Memory Scale (CMS). Other medical data were collected via chart review. Results: Children (N ¼ 53) were recruited (mean age ¼ 11 years, 51% male), with a variety of ethnic backgrounds. Forty-two percent of children screened positive for delirium. Psychiatry confirmed the diagnosis in 54 percent of them (23% of the total number). Children performed at <50th percentile in all domains of the CMS: 1) attention/concentration (mean ¼ 28.0%ile); 2) visual/ nonverbal memory (mean ¼ 30.9 and 41.7%ile); and 3) auditory/verbal memory (mean ¼ 41.4 and 14.3%ile). There were no group differences based on age or gender in the screen of children’s delirium; however, children who screened positive had higher opiate and benzodiazepine use and longer lengths of stay (t ¼ 4.01, P ¼ 0.00; t ¼ 1.9, P ¼ 0.06; t ¼ 3.7, P ¼ 0.00). Irrespective of delirium status, both groups performed poorly on the CMS without significant group differences. Conclusions: The incidence of delirium in this population was 42 percent by screener and 23 percent after psychiatric evaluation. The new DSM-5 criteria for delirium focus on cognitive dysfunction. The children in this study had significantly impaired cognitive function in the diagnostic domains of delirium, regardless of delirium status. Thus, although delirium
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
NEW RESEARCH POSTERS 2.34 — 2.36
assessments capture some of the children with delirium, both the screeners and psychiatry are still missing a significant proportion of children who have ongoing cognitive dysfunction. Pediatric healthcare needs to improve its evaluation of delirium to minimize ongoing cognitive deficits after admission to the PICU.
COG, CON, DIAG Supported by a Society of Critical Care Medicine-Weil Research Grant http://dx.doi.org/10.1016/j.jaac.2017.09.113
2.34 IMPAIRMENT OF QUALITY OF LIFE IN CHILDHOOD CANCER SURVIVORS AND PARENTING STRESS Yunhye Oh, National Center Mental Health, nunnerine@ gmail.com; Yoo-Sook Joung, MD, PhD, Samsung Medical Center, Sungkyunkwan Univ Medical School, yschoung@ skku.edu Objectives: This study investigated and compared psychological functioning, quality of life, and parenting stress of caretakers among childhood survivors with brain tumor and neuroblastoma and healthy control subjects. Methods: A total of 304 children were within the age range of 8–15 years, and their parent participated in this study. Psychosocial functioning among survivors of brain tumor (n ¼ 100) and neuroblastoma (n ¼ 51) was assessed using Childhood Behavior Checklist (CBCL). Parenting stress and quality of life among brain tumor group, neuroblastoma group, and healthy control group (n ¼ 151) were assessed using the Parenting Stress Index and the Pediatric Quality of Life Inventory (PedsQLTM). Results: The group with brain tumor had lower intelligence and higher CBCL scores (more problems) on somatic complaints compared with the group with neuroblastoma. The group with brain tumor had lower quality of life compared with the group with neuroblastoma and the healthy control group (all P < 0.05). No differences between cancer groups were found for parenting stress, with the exception of the scale measuring parenting competence. Conclusions: These findings will inform our understanding of childhood cancer survivors and hence suggest that patients with childhood cancer are likely to have higher levels of psychosocial stress and poor quality of life.
IMP, STRESS, PAT http://dx.doi.org/10.1016/j.jaac.2017.09.114
2.35 ADDRESSING MENTAL HEALTH NEEDS OF LATINO IMMIGRANT PARENTS IN PEDIATRIC PRIMARY CARE Rheanna Platt, MD, MPH, Johns Hopkins University, rplatt1@ jhmi.edu; Elisabet Arribas-Ibar, PhD, Barcelona Biomedical Research Park/Hospital Del Mar Research Institute, [email protected] Objectives: Few studies have examined the prevalence of depressive symptoms and comorbid conditions in Latino parents whose children are presenting for well-child care. Methods: Spanish-speaking parents (n ¼ 100) of children (ages 0–5 years) attending well visits at a general pediatric clinic were surveyed between October 2015 and February 2016. The verbally administered survey included the Personal Health Questionnaire Depression Scale-8 (PHQ-8), Generalized Anxiety Disorder 2-item (GAD-2), Primary Care-PTSD screener, and Alcohol Use Disorders Identification Test (AUDIT-C) and psychosocial/demographic measures used in large regional/national surveys. From the sample group of 100 parents, 11 were recruited to participate in in-depth interviews, further exploring sources of parental distress and acceptability of screening and intervention for parental mental health symptoms in the pediatric primary care settings. Results: A total of 96 percent of approached parents agreed to participate. Participants were predominantly female (ages <35 years), lived in the United States a mean of eight years (range 1–17 years), and reported limited English proficiency (75%). Respondents (35%) had a
JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
“positive” PHQ-8 score (>5; 95% CI: 25.8–44.6%); 82.8 percent of these fell within the mild range. Of those who screened positive for depression, 50 percent also screened positive for PTSD symptoms (95% CI: 33– 67%), 25 percent for anxiety symptoms (95% CI: 11.7–41.5%), and 29.4 percent for problematic alcohol use (95% CI: 16.1–47.5%). Among parents with a positive PHQ-8, 94 percent did not identify a primary care physician and 73 percent were uninsured in the preceding 12 months. In qualitative interviews, parents were generally supportive of screening for and addressing parental psychosocial stressors within the pediatric primary care setting. Most felt that a group-based intervention would be beneficial and would allow them to share experiences with other parents. Parents cited finances, immigration-related difficulties (including family separation, fear of deportation, and limited English proficiency), and interpersonal and community violence as significant sources of stress. Conclusions: Parents screening positive for depression reported a relatively high prevalence of comorbid anxiety, PTSD, and alcohol use symptoms and limited access to their own source of healthcare. In interviews, parents generally perceived a pediatric clinic-based intervention as acceptable. Resultsfrom this study will be used to inform the development of a groupbased intervention for recently immigrated parents in pediatric primary care.
ETHN, CC, PAT Supported by the Johns Hopkins Institute for Clinical and Translational Research and National Center for Advancing Translational Sciences Grant KL2TR001077 http://dx.doi.org/10.1016/j.jaac.2017.09.115
2.36 THE TWO-YEAR NATIONWIDE SURVEY OF COMMUNITY MENTAL HEALTH OUTREACH SERVICE COMBINED OUTPATIENT PSYCHIATRIC TREATMENT FOR CHILDREN AND ADOLESCENTS WITH MENTAL DISABILITY IN TAIWAN Chao-Wei Hsu, MD, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, [email protected] Objectives: Since June 2015, Ministry of Health and Welfare in Taiwan started a project of providing community mental health outreach services and outpatient psychiatric treatment for children and adolescents with mental disability from schools and institutions within the community. The primary goal of this project was promotion of medical service quality by early detection and management for children and adolescents with mental disability and psychiatric disorder. Methods: Service team members from seven hospitals in Taiwan, including psychiatrists, psychologists, and case managers, provided both outreach services and outpatient psychiatric treatment and collected all of the outpatient’s basic data and assessment scales from June 2015 to December 2016 (N ¼ 772). In this retrospective study, the study team of this project analyzed outpatient’s basic data and assessment scales, including Clinical Global Impression (CGI)—Schizophrenia (S), CGI-Global Improvement (CGI-I), Global Assessment of Functioning (GAF), Personal and Social Performance (PSP), rehospitalization rate, length of hospital stay, and satisfaction survey from their family members and caregivers. Results: The study findings revealed significant improvement in CGI-S, CGI-I, GAF, and PSP (P < 0.01); lower rehospitalization rate; and shorter length of hospital stay. Majority of these outpatients presented less mood or behavioral symptoms, better adaptation and academic performance at schools and institutions, and higher scores of satisfaction survey provided from their family members and caregivers. Conclusions: From the study’s findings, community mental health outreach service combined with outpatient psychiatric treatment allowed for early detection and intervention of children and adolescents with mental disability and psychiatric disorder. This service model can help children and adolescents alleviate their symptoms at early stages of psychiatric disorder, reduce hospitalization and medical cost, and avoid
www.jaacap.org
S189