Pediatricians have a responsibility to vote because decisions made by the government have a large effect on both the children we serve and the way we practice medicine. Unfortunately, voter turnout by doctors is less than the general population, although this trend has been improving. To encourage pediatric residents to vote, we assessed barriers to voting and then implemented interventions to overcome these barriers. Using designated voting schedules, informational sessions, and frequent reminders of voting dates, we saw nearly 100% voter participation of respondents in the 2020 and 2022 elections. Residency programs can make voting more feasible for their residents with simple, easy to implement interventions.
There is a need to develop culturally relevant psychological care informed by the experiences of clinicians working with Latinx youth and families. The present qualitative interview-based study explored the challenges Latinx adolescents with suicidal behaviors and their families confront from the perspective of mental health providers. Ten interviews were conducted with mental health clinicians from various clinical settings. An ecological and developmental theoretical framework was used to analyze the data. The five overarching themes identified were: 1) Acculturation and enculturation gap challenges between caregivers and adolescents, 2) Language and cultural gaps with the host society affecting families' ability to navigate the educational and mental health service systems, 3) Contextual and mental health factors affecting the family, 4) Social factors affecting family life, and 5) Adolescent suicidal crisis and well-being. Results aligned with the gap-distress theory in which caregiver and adolescent differences in acculturation and enculturation increase cultural related conflicts between them subsequently augmenting suicide risk when combine with other factors. Authors posit that an assessment of acculturation and enculturation gaps and their possible impact on caregiver and adolescent communication and the wellbeing of adolescents is a critical part of the clinical formulation when working with this population. Other clinical and suicide prevention implications are also discussed, including addressing poverty and structural racism as suicide prevention strategies.
Housing is an essential determinant of health. Neighborhood characteristics, housing conditions and quality, housing stability, and housing affordability are identified pathways linking housing to health outcomes. While historically overlooked by healthcare researchers and organizations, many anchor institutions have recently taken an approach to mitigating the risk associated with poor and/or unstable housing. Using recommendations by Sir Michael Marmot in The Health Gap: Doctors and the Social Determinants of Health as our framework, this paper highlights the importance of housing on health outcomes and the role of clinicians and health systems to address this determinant. These areas of action initially proposed by Marmot, and re-stated in similar terms by the National Academies of Sciences, Engineering and Medicine, call for changes to clinical education around issues like housing, seeing the individual in a broader context, the use of healthcare as employer and anchor in development of affordable housing, investments in community development, and advocacy for policies that increase quality and stability of healthy, affordable housing.
Objectives: To survey pediatric hospitalists about their perceptions on 1) access to interpreter services, 2) how the COVID-19 pandemic affected access to interpreter services, and 3) methods and barriers to providing discharge instructions for families who prefer languages other than English (LOE).
Food insecurity is the leading indicator of well-being for vulnerable children in the United States due to the magnitude of the problem (9.3 million in 2021) and the associated numerous negative health and other consequences. Given the magnitude of food insecurity and its health consequences, food insecurity is a leading contributor to health disparities in the U.S. today. It follows, then, that if we want to reduce health disparities in the U.S. a necessary condition is to reduce food insecurity. The primary tool used to reduce food insecurity is the Supplemental Nutrition Assistance Program (SNAP, formerly known as the Food Stamp Program). In this paper, I provide an overview of food insecurity in the U.S., a description of SNAP and its role in alleviating food insecurity, and conclude with some suggestions for SNAP to become even more successful at alleviating food insecurity.
Despite the alarming rise of suicidal thoughts and behaviors (STBs), in preadolescent children over the last two decades, no scales have been developed and validated to assess these troubling tendencies in this population. We describe how we developed English and Spanish language versions of a new scale to assess STBs in children, the Suicide Risk and Ideation Scale for Kids - Child and Parent versions (S-RISK-C/P), using cognitive interviewing. Method:After creating item pools in English and Spanish, we elicited feedback from three clinician content experts and conducted cognitive interviews with 8 children (4 girls; Mage = 10.37 years; SDage = 1.19 years) and their parents (5 interviews in English, 3 in Spanish). Results:Children and parents readily understood the directions, items, and response options of the S-RISK-C/P and expressed high confidence in their responses. Cognitive interviews indicated only minor issues with wording and sequence of some items, which led to iterative revisions. Conclusion:This is the first study to apply cognitive interviewing in child suicide research to ensure development of a scale that has clear and accessible language. We are currently undertaking measurement development and evaluation of S-RISK-C/P further by gathering data to determine the scale's item properties, reliability, and validity.
Poverty and financial insecurity are major drivers of poor health outcomes, but health systems have traditionally lacked the tools to address these economic drivers of health. In recent years, an innovative clinical care model is starting to change that: Medical-Financial Partnerships (MFPs). Medical-Financial Partnerships are collaborations between health care systems and financial services providers. They connect patients to a variety of financial services including financial coaching, free tax preparation, and public benefits navigation. These services have been shown to significantly improve health and financial well-being. In addition, MFPs provide effective and welcome access points for under-utilized social service and anti-poverty public benefits programs. Most MFPs are grant-funded, but given their benefits to patient health and social service access, they may be able to grow by attracting investments from social service providers, healthcare systems, and payors as well. Finally, MFPs transcend the limitations of the traditional medical model and can even transform it in important ways. First, they use strengths-based approaches like financial coaching and motivational interviewing in a medical model that relies heavily on problem-based diagnoses to organize, prioritize, and incentivize care. Second, they bring community-level resources and interventions to a medical system that operates primarily at the individual-level. Third, they bring upstream health interventions like financial supports and policy advocacy to a medical model that focuses on more downstream causes of illness. Overall, MFPs represent an important and effective set of tools and a novel approach to health promotion within a broader health care strategy to address the economic and structural drivers of health.
Virginia Brown and Christine Thomas report in this issue that misinformation between healthcare providers and caregivers of patients with mental illness may impact the plan of care for that patient. This commentary explores why the need for trust in these relationships is critical to accurate information sharing.
The increased publicity of mass shootings and the COVID-19 pandemic have fueled American demand for firearm purchases. Firearm violence has largely been blamed on people with mental illnesses instead of firearm accessibility, despite the lack of population-level evidence associating mental illness with firearm violence perpetration. We support interventions and policies to limit firearm access in homes, schools, and by all intimate partners who have been convicted of domestic abuse. We advocate for restrictions on the civilian purchases of semi-automatic rifles and large capacity magazines. Finally, we call for research addressing firearm violence as an environmental and structural issue, not an intrapersonal one.
Background: Dissociative Trance Disorder (DTD), is a complex psychological condition characterized by abrupt trance-like states and altered consciousness, commonly seen in young women throughout various regions of India. Currently, there is a lack of research on the experiences of Indian adolescent girls with DTD and how inaccurate medical information affects their quest for suitable care. This study aims to develop a thorough comprehension of the help-seeking patterns and experiences of adolescent girls with DTD, specifically concerning encountering medical misinformation. By identifying the obstacles, they face and the cultural beliefs that shape their decision-making, this research seeks to guide interventions and initiatives aimed at enhancing care and support for this group.
Developing transition planning for youth living with severe and persistent mental illness requires the creation, memorialization, and retrieval of appropriate and responsive treatment preferences to meet their needs, especially during a mental health crisis. Regrettably, transition-aged youth at the age of 18 can no longer rely on their support persons (typically family caregivers) to consent to care during a mental health crisis. Due to this, caregivers expressed challenges conveying information about their loved one's preferences for care (Lavoie, 2018) during a crisis. This lack of access to patient information exchange during a mental health crisis can effect treatment decisions. Caregivers report a range of negative outcomes including traumatic events resulting in distrust of the health care system (Lester et al., 2005). While misinformation is typically thought of as the deliberate falsification of information, we explore misinformation as both omission and lack of access to patient information, in this case health information. But what happens when a caregiver is distrustful of the health care system? What influence does distrust have on disclosure of health information? The purpose of this paper is to understand how caregivers trust of the healthcare system effects their decision regarding the sharing of health information on behalf of a person experiencing a mental health crisis. Using a mixed methods approach, this paper provides the results of Texas wide online survey regarding disclosure of healthcare information during a mental health crisis. This study expands the understanding of misinformation and the consequence of when information is withheld from individuals and healthcare systems, that can result in clinical decisions based on misinformation. The data provides preliminary evidence to suggest that the role of distrust of the medical system plays a part of the decision to not disclose health information. Open ended responses also suggest a relationship of how lack of information can lead to misinformed decisions. Practical recommendations call for applications in which capacitated persons living with serious mental illness and their caregivers collaborate on the sharing and memorialization using a psychiatric advance directive (PAD). A psychiatric advance directive (PAD) is not only a communication tool it is a medical-legal document that promotes patients' autonomy giving capacitated adults living with serious mental illnesses the ability to record their preferences for care during a mental health crisis (Table et al., 2020).
