- Email: [email protected]
5.4 Gender and Ethno-Racial Differences in Symptom Expression of Posttraumatic Stress Disorder and Depression Among Child Trauma Victims
NEW RESEARCH POSTERS 5.4 — 5.6
tracking documents. Comparing rates of adherence with guidelines of medication number, intraclass polypharmacy, and maximum daily dosage, we found a relative decrease of 0.69, 0.51, and 0.43, respectively, across the study period. Our analysis of the electronic medical records revealed that there was no robust way to track metabolic monitoring, adherence, or medication start dates. Conclusions: Implementation of guideline-based prescribing for foster youth decreased the number of requested medications, the frequency of intraclass polypharmacy, and the frequency of requests for medications above recommended daily dosages. With regard to metabolic monitoring, medication adherence, and medication start dates, scattered systems of care appear to be an impediment to successful monitoring.
FOC, MDM http://dx.doi.org/10.1016/j.jaac.2017.09.286
5.4 GENDER AND ETHNO-RACIAL DIFFERENCES IN SYMPTOM EXPRESSION OF POSTTRAUMATIC STRESS DISORDER AND DEPRESSION AMONG CHILD TRAUMA VICTIMS Christina F. Tolbert, MD, Medical University of South Carolina, [email protected]; Colleen A. HallidayBoykins, PhD, Medical University of South Carolina, hallidca@ musc.edu; Kevin M. Gray, MD, Medical University of South Carolina, [email protected] Objectives: Millions of children in the United States suffer the effects of trauma due to physical abuse, sexual assault, witnessing violence, or other events. The purpose of this study is to determine whether race/ethnicity and gender have an impact on symptom expression of PTSD and depression in trauma-exposed children and adolescents. Methods: Data was drawn from the National Survey of Adolescents-Replication (NSA-R), initiated in 2005 as an epidemiological study of youth aged 12–17 years using computer-assisted telephone interviewing technology. Data for the present study were taken from the first wave of the study, which was completed in 2005, and participants were sampled using random digit dialing. Interviews were conducted in English using computer-assisted telephone interviewing technology. Adolescents (N ¼ 3,497) endorsing at least one “potentially traumatic event” (PTE) at wave 1 were studied, which comprised of 50 percent female (n ¼ 1,750) and 50 percent male (n ¼ 1,747). Mean age was 14.82 (SD ¼ 1.64) and five ethnic groups were examined: Caucasian (n ¼ 2,346, 67.1%), African American (n ¼ 557, 15.9%), Hispanic (n ¼ 409, 11.7%), Native American (n ¼ 86, 2.5%), and Asian American (n ¼ 99, 2.8%). Results: The results of multiple univariate ANOVA tests using SPSS indicated that the effects of gender on symptom expression of PTSD and depression was statistically significant (females > males, p < 0.001) and the effect of race/ ethnicity on symptom expression of PTSD and depression was statistically significant (Native American adolescents > all other ethnicities, p < 0.001). Conclusions: In conclusion, females and Native American adolescents exposed to trauma exhibit more symptoms of PTSD and depression than males and other ethnicities exposed to trauma (Caucasian, African American, Hispanic, and Asian American). Reasons for this include greater exposure to trauma, racial stigmatization, culturally-related gender oppression, cultural differences in reporting symptoms, and sample sizes used.
ETHN, ADOL Supported by the ACAAP Pilot Research Award for General Psychiatry Residents, supported by Pfizer http://dx.doi.org/10.1016/j.jaac.2017.09.287
5.5 EXPLORATION OF A SEMI-STRUCTURED TOOL IN THE ASSESSMENT OF HOMICIDAL IDEATION AND THREATS OF VIOLENCE Sophia A. Walker, BS, University of Connecticut, sowalker@ uchc.edu; Kevin P. Young, PhD, Institute of Living at Hartford Hospital, [email protected]; Mirela Loftus, MD, PhD, Institute of Living at Hartford Hospital,
S254
www.jaacap.org
[email protected]; Salma Malik, MD, DFAACAP, MS, Institute of Living at Hartford Hospital, salma.malik@ hhchealth.org Objectives: This quality improvement study involved pilot testing of a semistructured homicide and violence assessment tool, which was designed to enhance data collection to inform clinical judgment and decision making. In a unique way, it is meant for use in initial evaluation of patients presenting with homicidal ideation or violent threats. Developed based on literature and expert reviews on violence assessment, it encompasses the specific threat, relevant risk factors, and a mental status exam that emphasizes key aspects related to violence. Methods: A needs assessment survey was completed by 39 child and adolescent clinicians [Licensed Clinical Social Worker (LCSWs), PsyD/PhDs, MDs] in various levels of care (outpatient, therapeutic school, partial hospital program, and emergent and inpatient units), examining previous experience and comfort with homicide assessments. After training on the new tool, they completed questionnaires measuring functionality of the tool (i.e., clarity, ease of administration, and usefulness) and changes in their skill appraisal, including clinician knowledge and confidence. Results: Needs assessment strongly favored enhanced approach (82% reported insufficient training, 89% endorsed need for standardization, 94% preferred a tool, and 100% would use one). Baseline discomfort and confidence were moderate, averaging 2.87 (SD ¼ 0.95) and 3.12 (SD ¼ 0.81) on a five-point Likert Scale, respectively. Clinicians agreed that the tool would increase comfort (90%), aid the recollection of essential topics (92%), inform decision making (95%), and improve quality and efficiency (92%); 94 percent would incorporate it into their practice. Nuanced implications, initial experiences/feedback after use in the clinical setting, will be discussed further. Conclusions: There is an undeniable need for structured guides in homicide and violence assessment at the bedside. Evaluation of this novel tool in the clinical setting demonstrated its utility to clinicians and the feasibility of its implementation in clinical practice per the described parameters. It could be of immense help to clinicians across all levels of care, ultimately improving quality and efficiency of care. Future directions include determination of reliability and validity and efforts to widen its dissemination.
AGG, RI, QA Supported by the AACAP Summer Medical Student Fellowship, which is supported by AACAP’s Endowment Fund http://dx.doi.org/10.1016/j.jaac.2017.09.288
5.6 THE IMPLEMENTATION OF THE DEPRESSION AND ANXIETY GUIDELINES BY THE CYSTIC FIBROSIS FOUNDATION Katherine E. Oberhelman, BS, Tulane University, [email protected]; Amie M. Lofton, PsyD, Tulane University, [email protected]; Lisa D. Settles, PsyD, Tulane University, [email protected]; Myo Thwin Myint, MD, Tulane University, [email protected] Objectives: The International Depression Epidemiology Study (TIDES) discovered elevated symptoms of depression and generalized anxiety in adolescents and adults with cystic fibrosis (CF) and their caregivers. This project aims to screen for the depression and generalized anxiety disorder (GAD) in child and adolescent patients with CF using the Patient Health Questionnaire(PHQ-9) and GAD-7 questionnaire and provide the recommended treatment to these patients as part of their integrated care in the Tulane Pediatric CF Clinic. The PHQ-9 and GAD-7 are used to detect both early and late symptoms of depression and GAD so that appropriate treatment or preventative measures can be administered. Methods: The PHQ-9 and GAD-7 screeners are administered to child and adolescent patients in the Tulane Pediatric CF clinic to assess the initial level of depression and anxiety, respectively. The percentage of patients between the ages of 11 and 18 years who score above four qualify for treatment. Patients who receive mild (5–9) or elevated (> 9) scores on the PHQ-9 or GAD-7 are provided with appropriate resources for treatment in their hometown, which includes psychotherapy and medications from providers who are
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017
tracking documents. Comparing rates of adherence with guidelines of medication number, intraclass polypharmacy, and maximum daily dosage, we found a relative decrease of 0.69, 0.51, and 0.43, respectively, across the study period. Our analysis of the electronic medical records revealed that there was no robust way to track metabolic monitoring, adherence, or medication start dates. Conclusions: Implementation of guideline-based prescribing for foster youth decreased the number of requested medications, the frequency of intraclass polypharmacy, and the frequency of requests for medications above recommended daily dosages. With regard to metabolic monitoring, medication adherence, and medication start dates, scattered systems of care appear to be an impediment to successful monitoring.
FOC, MDM http://dx.doi.org/10.1016/j.jaac.2017.09.286
5.4 GENDER AND ETHNO-RACIAL DIFFERENCES IN SYMPTOM EXPRESSION OF POSTTRAUMATIC STRESS DISORDER AND DEPRESSION AMONG CHILD TRAUMA VICTIMS Christina F. Tolbert, MD, Medical University of South Carolina, [email protected]; Colleen A. HallidayBoykins, PhD, Medical University of South Carolina, hallidca@ musc.edu; Kevin M. Gray, MD, Medical University of South Carolina, [email protected] Objectives: Millions of children in the United States suffer the effects of trauma due to physical abuse, sexual assault, witnessing violence, or other events. The purpose of this study is to determine whether race/ethnicity and gender have an impact on symptom expression of PTSD and depression in trauma-exposed children and adolescents. Methods: Data was drawn from the National Survey of Adolescents-Replication (NSA-R), initiated in 2005 as an epidemiological study of youth aged 12–17 years using computer-assisted telephone interviewing technology. Data for the present study were taken from the first wave of the study, which was completed in 2005, and participants were sampled using random digit dialing. Interviews were conducted in English using computer-assisted telephone interviewing technology. Adolescents (N ¼ 3,497) endorsing at least one “potentially traumatic event” (PTE) at wave 1 were studied, which comprised of 50 percent female (n ¼ 1,750) and 50 percent male (n ¼ 1,747). Mean age was 14.82 (SD ¼ 1.64) and five ethnic groups were examined: Caucasian (n ¼ 2,346, 67.1%), African American (n ¼ 557, 15.9%), Hispanic (n ¼ 409, 11.7%), Native American (n ¼ 86, 2.5%), and Asian American (n ¼ 99, 2.8%). Results: The results of multiple univariate ANOVA tests using SPSS indicated that the effects of gender on symptom expression of PTSD and depression was statistically significant (females > males, p < 0.001) and the effect of race/ ethnicity on symptom expression of PTSD and depression was statistically significant (Native American adolescents > all other ethnicities, p < 0.001). Conclusions: In conclusion, females and Native American adolescents exposed to trauma exhibit more symptoms of PTSD and depression than males and other ethnicities exposed to trauma (Caucasian, African American, Hispanic, and Asian American). Reasons for this include greater exposure to trauma, racial stigmatization, culturally-related gender oppression, cultural differences in reporting symptoms, and sample sizes used.
ETHN, ADOL Supported by the ACAAP Pilot Research Award for General Psychiatry Residents, supported by Pfizer http://dx.doi.org/10.1016/j.jaac.2017.09.287
5.5 EXPLORATION OF A SEMI-STRUCTURED TOOL IN THE ASSESSMENT OF HOMICIDAL IDEATION AND THREATS OF VIOLENCE Sophia A. Walker, BS, University of Connecticut, sowalker@ uchc.edu; Kevin P. Young, PhD, Institute of Living at Hartford Hospital, [email protected]; Mirela Loftus, MD, PhD, Institute of Living at Hartford Hospital,
S254
www.jaacap.org
[email protected]; Salma Malik, MD, DFAACAP, MS, Institute of Living at Hartford Hospital, salma.malik@ hhchealth.org Objectives: This quality improvement study involved pilot testing of a semistructured homicide and violence assessment tool, which was designed to enhance data collection to inform clinical judgment and decision making. In a unique way, it is meant for use in initial evaluation of patients presenting with homicidal ideation or violent threats. Developed based on literature and expert reviews on violence assessment, it encompasses the specific threat, relevant risk factors, and a mental status exam that emphasizes key aspects related to violence. Methods: A needs assessment survey was completed by 39 child and adolescent clinicians [Licensed Clinical Social Worker (LCSWs), PsyD/PhDs, MDs] in various levels of care (outpatient, therapeutic school, partial hospital program, and emergent and inpatient units), examining previous experience and comfort with homicide assessments. After training on the new tool, they completed questionnaires measuring functionality of the tool (i.e., clarity, ease of administration, and usefulness) and changes in their skill appraisal, including clinician knowledge and confidence. Results: Needs assessment strongly favored enhanced approach (82% reported insufficient training, 89% endorsed need for standardization, 94% preferred a tool, and 100% would use one). Baseline discomfort and confidence were moderate, averaging 2.87 (SD ¼ 0.95) and 3.12 (SD ¼ 0.81) on a five-point Likert Scale, respectively. Clinicians agreed that the tool would increase comfort (90%), aid the recollection of essential topics (92%), inform decision making (95%), and improve quality and efficiency (92%); 94 percent would incorporate it into their practice. Nuanced implications, initial experiences/feedback after use in the clinical setting, will be discussed further. Conclusions: There is an undeniable need for structured guides in homicide and violence assessment at the bedside. Evaluation of this novel tool in the clinical setting demonstrated its utility to clinicians and the feasibility of its implementation in clinical practice per the described parameters. It could be of immense help to clinicians across all levels of care, ultimately improving quality and efficiency of care. Future directions include determination of reliability and validity and efforts to widen its dissemination.
AGG, RI, QA Supported by the AACAP Summer Medical Student Fellowship, which is supported by AACAP’s Endowment Fund http://dx.doi.org/10.1016/j.jaac.2017.09.288
5.6 THE IMPLEMENTATION OF THE DEPRESSION AND ANXIETY GUIDELINES BY THE CYSTIC FIBROSIS FOUNDATION Katherine E. Oberhelman, BS, Tulane University, [email protected]; Amie M. Lofton, PsyD, Tulane University, [email protected]; Lisa D. Settles, PsyD, Tulane University, [email protected]; Myo Thwin Myint, MD, Tulane University, [email protected] Objectives: The International Depression Epidemiology Study (TIDES) discovered elevated symptoms of depression and generalized anxiety in adolescents and adults with cystic fibrosis (CF) and their caregivers. This project aims to screen for the depression and generalized anxiety disorder (GAD) in child and adolescent patients with CF using the Patient Health Questionnaire(PHQ-9) and GAD-7 questionnaire and provide the recommended treatment to these patients as part of their integrated care in the Tulane Pediatric CF Clinic. The PHQ-9 and GAD-7 are used to detect both early and late symptoms of depression and GAD so that appropriate treatment or preventative measures can be administered. Methods: The PHQ-9 and GAD-7 screeners are administered to child and adolescent patients in the Tulane Pediatric CF clinic to assess the initial level of depression and anxiety, respectively. The percentage of patients between the ages of 11 and 18 years who score above four qualify for treatment. Patients who receive mild (5–9) or elevated (> 9) scores on the PHQ-9 or GAD-7 are provided with appropriate resources for treatment in their hometown, which includes psychotherapy and medications from providers who are
J OURNAL
OF THE
AMERICAN A CADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 56 NUMBER 10S OCTOBER 2017