Background:A substantial number of youth experience suicidal thoughts and behaviors, and those living in rural areas are at even greater risk. Pediatric health care providers tend to be the first point of contact for youth at risk for suicide. Thus, there is a need to understand rural and non-rural providers' beliefs, training, and practices in youth suicide prevention. Objective:We examined providers' beliefs, previous training, and current practices in youth suicide prevention, with attention to potential differences across providers working in rural and non-rural areas. Method:Participants were 171 pediatric health care providers in Texas, working in primary care or pediatric settings, who completed an online survey. Results:Overall, 70% of participants reported having never participated in suicide risk assessment/intervention training for youth patients, with no significant difference between rural and non-rural providers. Nearly all providers expressed an interest in additional training, with many reporting a willingness to engage in a virtual training. Rural and non-rural providers were not significantly different in their self-reported knowledge and skills related to suicide risk assessment/intervention. However, providers' responses differed in confidence ratings; that is, non-rural providers' ratings of their confidence in conducting youth suicide risk assessment/intervention were higher compared to rural providers. Conclusions:Our findings highlight a clear gap between pediatric health care providers' previous training and current responsibilities in treating child and adolescent patients experiencing suicidal ideation and behavior. Implications and future directions are discussed.
Background:An estimated 1 in 4 children seeking mental health care have an undiagnosed fetal alcohol spectrum disorder (FASD). Few mental health providers receive training or feel competent to serve this population. Evidence-based interventions (EBIs) for FASD have low uptake across mental health settings. Objective:This study aimed to systematically adapt an EBI to increase access to care for youth with FASD in mental healthcare settings, resulting in the innovative Families Moving Forward (FMF) Connect Pro program. Method:A multidisciplinary planning group employed the theoretically-driven implementation science framework, Intervention Mapping-Adapt (IM-Adapt). This 6-step process incorporated multiple information sources, including literature review, theory, clinical wisdom, and focus groups. 18 community mental health providers participated in focus groups to assess the fit of the adapted program. Data were analyzed with rapid qualitative methods using the COM-B model (Capability, Opportunity, Motivation) of behavior change and Theoretical Domains Framework (TDF) for coding and interpretation. Results:Step 1: Planning group developed a logic model of change. Step 2: Review of EBIs, selecting the Families Moving Forward (FMF) intervention and two training methods: Extension of Community Healthcare Outcomes (ECHO) and Self-Directed modular approaches. Steps 3&4: Planning group identified needed adaptations for providers with low utilization of FASD-informed care and flexible use in diverse settings. Focus group participants reviewed prototypes of the resulting FMF Connect Pro program, endorsing high acceptability. TDF determinants across domains of capability, opportunity, and motivation were highlighted as contributing factors to provider behavior change. Step 5: Implementation/evaluation plans were developed. Conclusions:Results reveal the FMF Connect Pro program was deemed acceptable and appears a promising method to expand FASD-informed care. A clinical trial is now underway (Step 6). Additionally, this study models an IM-Adapt approach that could be applied to increase broader adoption and implementation of EBIs.
Background:An increasing number of hospital systems have implemented universal depression screening protocols in response to the growing prevalence of pediatric depression. However, to date no studies have qualitatively explored how the sustainment of depression screening workflow functions in practice. Objective:To characterize the workflow for an existing universal depression screening pathway within a large pediatric healthcare system and explore barriers and solutions to barriers in implementing the workflow effectively. Method:Eight focus groups with 37 staff members in a large pediatric hospital system were conducted. Participants were considered eligible if they were involved in depression screening within their unit. Focus groups were recorded, transcribed, and analyzed for themes using rapid qualitative analysis. Results:Six barriers and five proposed solutions were identified as common themes across units, organized along three stages of the depression care cascade: screening, assessment and resources, and disposition planning. Key barriers included the language appropriateness of the Patient Health Questionnaire-9 (PHQ-9) for younger and neurodivergent patients, siloing of medical and behavioral health roles, and lack of infrastructure for follow-up after referral. Proposed solutions included adapting screening language, cross-training staff in mental health assessment, and designating dedicated roles for follow-up. Conclusions:Our findings suggest that strategies aimed at improving how teams work together could assist hospitals in delivering depression screening at all stages through better team coordination and role clarification.
Background:Gradual exposure (GE) is a key component of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Initial evidence suggests that negative beliefs about GE may partially explain suboptimal exposure implementation. Objective:The current study sought to evaluate GE negative beliefs and determine what professional factors might contribute to them. Methods:Participants (N = 742; 85.71% cisgender women; 67.25% White; M age(SD)=36.06[10.47]) who recently engaged in TFCBTWeb2.0 filled-out questionnaires assessing their views of GE within TF-CBT, evidence-based practice (EBP), TF-CBT implementation, and training experiences. Beliefs about GE and difficulty implementing TF-CBT were compared across various professional characteristics (e.g. TF-CBT experience, student status). Structural equation modeling (SEM) was utilized to evaluate which professional characteristics may relate to negative beliefs about TF-CBT GE. Results:The most negatively rated TF-CBT GE beliefs included concerns about youth experiencing negative effects from exposure, endangering confidentiality, and provider vicarious trauma. Participants who used TF-CBT with a patient generally had less negative GE beliefs compared to those who had never used TF-CBT. In the SEM analysis, general TF-CBT negative beliefs and beliefs about EBP were significant predictors, such that participants who reported more general negative beliefs about TF-CBT and EBP were more likely to report stronger negative GE beliefs. Conclusions:These results suggest that negative beliefs about GE can be a target during training to improve TF-CBT implementation, and that novel training approaches (e.g. experiential training) that specifically address negative GE beliefs are needed given the lack of currently available trainings in this domain.
