This study tested the feasibility and preliminary efficacy of Coping and Emotional Development for Adolescents to Reduce Stress (CEDARS) a positive psychological intervention (PPI), tailored for adolescents and administered in a classroom setting, in boosting CEDARS skill use and emotional well-being. Adolescents (N = 102, 45

OBJECTIVES:Mindful Awareness and Resilience Skills for Adolescents (MARS-A) is a mindfulness-based intervention adapted for the adolescent population. While previous studies have explored the benefits of MARS-A in various single-diagnosis populations, the aim of this study was to assess MARS-A for a heterogenous clinical adolescent population with mental health and/or chronic diagnoses, focusing on the underlying suffering present in all these conditions rather than its effects on a single diagnosis itself.METHODS:Qualitative data was collected through interviews to understand post-intervention participant perspectives and experiences. Quantitative data was collected through measures to investigate preliminary secondary outcomes.RESULTS:After participating in MARS-A, participants reported qualitative benefits in enhanced well-being, including coping with difficult emotions and managing sleep and/or pain. Quantitative results showed a reduction in functional disability, psychological distress, perceived stress, and depressive symptoms; increase in positive affect; and benefit in coping with pain and chronic conditions.CONCLUSIONS:MARS-A shows great potential in a heterogeneous clinical adolescent population.

Abstract Background Substance use is a recognized Paediatric health care issue. More than 9 in 10 individuals receiving treatment for substance use disorders report that their first use of substances occurred by young adulthood. The Canadian Institute for Health Information reported that 5% of hospital stays among Canadian youth in 2017-2018 were related to harmful substance use. In a study of youth with a first-time emergency department visit for a mental health problem between 2010 and 2014, most visits were due to substance related disorders. Despite this, little is known about practices relating to substance use in children's hospitals. Objectives 1. To describe how adolescents who present to Paediatric hospitals with substance use disorders or substance-related health issues are identified, assessed, and treated. 2. To identify best-practices that can inform national standards of care. Design/Methods An online questionnaire was utilized to obtain information on: 1. Clinical practices in the emergency department, inpatient services and ICU; 2. Hospital policies and practice guidelines; and 3. Hospital and community programs and resources. Recruitment emails were sent to hospital leaders (CEO or equivalent) at all 13 Paediatric hospitals. Leaders were asked to identify one individual to complete the survey on behalf of their hospital with input from relevant stakeholders in the various clinical areas. The survey was developed iteratively by a national group of 9 adolescent medicine clinicians and 2 Paediatric trainees. The survey was piloted at a single Paediatric hospital and refined. The survey was administered via RedCap technology. Results Survey response rate was 70% (9/13 hospitals). The mean number of contributors to each survey was 9 (range of 1-35). Overall, few hospitals utilized best practices consistently. There was inconsistency in the use of validated screening tools, use of clinical practice guidelines for monitoring and ongoing care and prescribing of nicotine replacement therapy and opioid agonist therapy. These inconsistencies were noted within each clinical setting (emergency department, inpatient services, and ICU), across services in each hospital, and between hospitals. With respect to hospital services, 5/9 had some type of consult team related to substance use (e.g., adolescent medicine), 4/9 had specialized substance use outpatient services, and 2/9 offered partial hospitalization/day treatment for patients with substance use issues. Local community-based substance use resources were identified as insufficient to address needs by 8/9 hospitals. Conclusion Inconsistencies in the care of adolescents with substance use disorders or substance-related health issues highlights the need for national guidelines for Paediatric hospital-based assessment and care, and enhanced coordination between services and systems of care for this patient population.

Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is fragmented and scarce. The objective of the study is to establish consensus for the prevention, treatment, and management of high-risk substance use and overdose among youth (10 to 24 years old). Materials and Methods: A modified Delphi technique was used based on the combination of scientific evidence and clinical experience of a group of 31 experts representing 10 countries. A semi-structured questionnaire with five domains (clinical risks, target populations, intervention goals, intervention strategies, and settings/expertise) was shared with the panelists. Based on their responses, statements were developed, which were subsequently revised and finalized through three iterations of feedback. Results: Among the five major domains, 60 statements reached consensus. Importantly, experts agreed that screening in primary care and other clinical settings is recommended for all youth, and that the objectives of treating youth with high-risk substance use are to reduce harm and mortality while promoting resilience and healthy development. For all substance use disorders, evidence-based interventions should be available and should be used according to the needs and preferences of the patient. Involuntary admission was the only topic that did not reach consensus, mainly due to its ethical implications and resulting lack of comparable evidence. Conclusions: High-risk substance use and overdoses among youth have become a major challenge. The system’s response has been insufficient and needs substantial change. Internationally devised consensus statements provide a first step in system improvement and reform.

British Columbia is the epicentre of the opioid crisis in North America. Illicit drug toxicity is now one of the top 3 causes of death for adolescents in British Columbia. Evidence informed treatment is available but adolescents rarely receive it. Non-fatal toxicity can provide an opportunity to intervene. Since 2018, paediatricians in British Columbia have been offering admission, involuntary if necessary, to adolescents presenting to hospital after a life-threatening illicit drug toxicity. This brief stay, termed "stabilization care," offers medical and psychiatric assessments, withdrawal management and initiation of opioid agonist therapy and discharge planning. Hospital policies, procedures and protocols were revised to support the unique needs of this population. Early experience with 17 adolescents shows relatively high attachment to treatment services and opioid agonist treatment, suggesting that paediatric interdisciplinary teams, working strategically, can improve care for adolescents in the face of the opioid epidemic.

Aim First use of opioids often happens in adolescence and an increasing number of opioid overdoses are being reported among youth. The purpose of this narrative review was to present the treatment approaches for youth with high-risk opioid use, determine whether the literature supports the use of opioid agonist treatment among youth and identify evidence for better treatment outcomes in the younger population. Methods A search of the literature on PubMed using MeSH terms specific to youth, opioid use and treatment approaches generated 1436 references. Following a screening process, 137 papers were found to be relevant to the treatment of high-risk opioid use among youth. After full-text review, 19 eligible studies were included: four randomized controlled trials, nine observational studies and six reviews. Results Research for the different treatment options among youth is limited. The available evidence shows better outcomes in terms of retention in care and cost-effectiveness for opioid agonist treatment than abstinence-based comparisons. Integrating psychosocial interventions into the continuum of care for youth can be an effective way of addressing comorbid psychiatric conditions and emotional drivers of substance use, leading to improved treatment trajectories. Conclusions From the limited findings, there is no evidence to deny youth with high-risk opioid use the same treatment options available to adults. A combination of pharmacological and youth-specific psychosocial interventions is required to maximize retention and survival. There is an urgent need for more research to inform clinical strategies toward appropriate treatment goals for such vulnerable individuals.

i can't breathesaid George Floyd,the knee of four hundred years of racismon his necki can't breathesaid the woman with fearin her eyes,her lungs attacked by coronavirus,as she was put onto the ventilatori can't breathesaid the nurse, exhaustedafter a long shift,sweating under a hot surgical maskand foggy gogglesi can't breathesaid the young man,poisoned by a toxic drug supplyand generations of trauma and lossi can't breathesaid the one hundred thousanddead Americans,a nation,and a worldin mourningi can't breathesaid cities choked in smokefrom a planet on firebreathe my dearsaid the Buddha of our time,reminding us of the wayto love and healing and transformationbreathe my dearsaid the beloved community,grievingand waking up togetherbreathe my dearsaid mother earth,and let my oceans, mountains,and forests embrace youright now,when it seems so hard just to breatheright now,just breathe- Dzung X. Vo, MD, FAAP, FSAHMMay 29, 2020

OBJECTIVE:Somatization is a common phenomenon that can severely complicate youths' functioning and health. The burden of somatization on pediatric acute care settings is currently unclear; better understanding it may address challenges clinicians experience in effectively caring for somatizing patients. In this study, we estimate the prevalence of somatization in a pediatric emergency department (ED).METHODS:We conducted a retrospective cross-sectional study of visits for non-critical, non-mental health-related concerns (n = 150) to a quaternary-level pediatric ED between July 2016 and August 2017. Demographic and clinical visit details were collected through chart review and used by two reviewing clinicians to classify whether each visit had a "probable," "unclear" (possible), or "unlikely" somatizing component.RESULTS:Approximately 3.33% (n = 5) of youth displayed probable somatization, and an additional 13.33% (n = 20) possibly experienced a somatizing component but require additional psychosocial and visit documentation to be certain. Longer symptom duration and multiple negative diagnostic tests were associated with a higher likelihood of either probable or possible somatization.CONCLUSIONS:A considerable proportion of non-mental health-related visits may involve a somatizing component, indicating the burden of mental health concerns on the ED may be underestimated. A higher index of suspicion for the possibility of somatization may support clinicians in managing somatizing patients.

Background and ObjectivesBuprenorphine extended‐release (BUP‐XR) is a monthly injectable form of opioid agonist therapy. Before its administration, a minimum 7‐day induction period with a transmucosal buprenorphine‐containing product is recommended.MethodsCase report (n = 1).ResultsA 16‐year‐old female with active, severe opioid use disorder (OUD) and stimulant use disorder, hepatitis C virus, co‐occurring mental health disorders, and complex social stressors had five recent overdoses requiring naloxone. She had previously been treated with methadone and several trials of sublingual buprenorphine/naloxone, but would quickly discontinue the treatment. Using a rapid micro‐induction protocol, buprenorphine/naloxone was administered for 3 days. On day 4, 300 mg BUP‐XR was administered subcutaneously. Minimal withdrawal symptoms occurred, despite recent fentanyl use.Discussion and ConclusionsA rapid sublingual buprenorphine/naloxone micro‐induction was successfully used to initiate BUP‐XR, thereby eliminating the abstinence period prior to buprenorphine/naloxone administration, shortening the induction period, and minimizing withdrawal.Scientific SignificanceThis is the first reported case of using rapid micro‐induction as a bridge to initiate BUP‐XR. By reducing the length of induction to 4 days and minimizing withdrawal, this induction method can make BUP‐XR more accessible to patients who would otherwise refuse the medication due to concerns of enduring withdrawal. (Am J Addict 2020;29:531–535)

The Journal of Alternative and Complementary MedicineVol. 26, No. 3 CommentaryFree AccessMindfulness-Based Interventions for Adolescents: Time to Consider TelehealthNicholas Chadi, Elli Weisbaum, Dzung X. Vo, and Sara Ahola KohutNicholas ChadiAddress correspondence to: Nicholas Chadi, MD, MPH, Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Sainte-Justine Hospital Pediatric Research Centre, University of Montreal, 3175 Ch de la Cote Sainte-Catherine, Montreal H3T 1C5, Quebec, Canada E-mail Address: nicholas.chadi@umontral.caDivision of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Sainte-Justine Hospital Pediatric Research Centre, University of Montreal, Montreal, Canada.Search for more papers by this author, Elli WeisbaumInstitute of Medical Sciences, University of Toronto, Toronto, Canada.Search for more papers by this author, Dzung X. VoDivision of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, Canada.Search for more papers by this author, and Sara Ahola KohutDivision of Gastro-Enterology, Department of Pediatrics, Hospital for Sick Children, Toronto, Canada.Department of Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, Canada.Search for more papers by this authorPublished Online:11 Mar 2020https://doi.org/10.1089/acm.2019.0302AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail IntroductionInterest in Mindfulness-based interventions (MBIs) has been growing exponentially within the sectors of health care, business, and education. Taking roots from ancient Eastern spiritual traditions, MBIs are now well established as an approach to enhance well-being and quality of life among adolescents and adults.1 Yet, the rapid increase in popularity of MBIs has led to challenges to meet the growing need for adequately trained providers to deliver these interventions, especially outside large urban centers. Children and adolescents are particularly receptive to MBIs.2 As rates of anxiety and depression steadily increase among children and adolescents, MBIs offer a promising therapeutic avenue to prevent and treat several of the most common mental health concerns in this age group.3 MBIs can also improve adolescents' ability to cope with chronic illness and chronic pain.4 The delivery of structured MBIs facilitated in real time through telehealth can broaden access for youth who live outside of urban centers and who otherwise may not have access to MBIs.Online delivery also comes with several unique challenges and a pressing question: is it possible to reach some or all of the benefits associated with in-person MBIs (often considered the “gold standard”) using available technology? In this commentary, this question is addressed, through a discussion of the authors' own experience as pediatric mindfulness providers delivering mindfulness interventions through telehealth using evidence-informed programs tailored specifically for groups of adolescents, such as the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) program. MARS-A is an adaptation of 8-week Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy interventions for adults and has been described elsewhere.5Delivering MBIs OnlineAlthough research about the applications and health benefits of MBIs in youth is rapidly emerging,4,6 evidence on the feasibility and effectiveness of delivering facilitated MBIs online, in real-time, remains limited (note that this differs from MBIs that adolescents can watch or download online, which do not have the benefits of live facilitation and group interactions). In a study conducted in a small sample of adolescents with a wide range of chronic medical illnesses, similar levels of feasibility, acceptability, and reports of benefit between youth who had received an 8-week MBI facilitated in-person, versus online through telehealth were found. In this study, participants were randomly allocated to the in-person or online group and completion rates were seven of nine participants, or 78%, in both groups.7 In a separate study comparing a moderated in-person MBI versus an online MBI for adolescents with inflammatory bowel disease, retention was far superior in the online (67% enrolled) than in the in-person version (41% enrolled) with similar benefits reported in both groups.8,9 In both studies, participants received the intervention from their own home and could see the facilitator as well as all the other participants on their screen. Self-guided and facilitator-guided individual or group-based online MBIs have been the object of a small number of adult studies, yielding promising results, with larger effect sizes noted for guided interventions.10,11This experience facilitating online MBIs has revealed that relatively minimal changes are needed to adapt in-person programs so they can be delivered online. These adaptations tend to be focused on the logistics of setting up the learning space, which is something a facilitator also needs to consider and manage for in-person groups, with slight differences in what needs to be explicitly discussed in terms of privacy and confidentiality (see Table 1 for complete list). In this experience, slightly smaller groups (optimal range: 8–10 participants, compared with 10–15 participants for in-person groups) are preferable for online facilitation, contingent on what is known about group dynamics.Table 1. Suggestions for Online Adaptations of In-Person Mindfulness-Based Interventions In-personOnline adaptations and rationaleOptimal group size range10–158–10: smaller groups allow more frequent interactions between participants and facilitatorsLocationQuiet space in a hospital, school, or community space offering minimal distractions and interruptionsQuiet space that is either in the home or outside and is conducive to quiet meditation. Comes with the additional challenges and responsibility of insuring that the space is private and quiet. Potential benefit of increasing generalizability to everyday lifeSession duration and format90 min, includes a 5-min snack/health break90 min, may include an optional 5-min break during which youth can leave camera viewInstructorsTwo instructors present in personTwo instructors present through webcam, may be in same or separate location(s):Presence of two instructors in the same space allows more flexibility and addressing any technical issues that may emerge without disturbing the flow of the sessionPresence of two instructions in different rooms allows facilitators to be closer to their webcam and be more visible to participants who may be using a smaller screenEquipment or supplies neededSnacksDesktop computer, laptop, tablet, or smartphone with a webcam and a reliable wired (preferred when available), wireless, or roaming function for Internet access: a larger screen is preferred to allow better visibility of other participantsExpenses (beyond facilitation)Parking and transportation costsUsually none: most youth would have access to the electronic equipment/technology requiredPrivacy and distractionsAsk that participants refrain from using mobile devices and taking pictures or recordings during sessionsNeed to ensure that youth stay in view of camera and that there are no other people in the room (including parents or siblings), or if other people must be in the room, the use of headphones (ideally noise cancelling) should be encouragedEncourage turning off any other mobile devices, chat, or messaging programs that may take away from the experienceOther logistical aspects specific to online facilitationN/AMake sure participants cannot join without the host/facilitatorMake sure participants cannot message each other on the program (chat) unless monitored or instructed by a facilitatorAsk participants to use “gallery view” (or equivalent) settings to allow all participants to view facilitators and other group members simultaneouslyAsk participant not to include last names in loginHave participants mute their microphone when not speaking, to reduce background noiseN/A, not applicable.Facilitator ExperienceOur backgrounds in medicine, psychology, education, public health, and mindfulness have allowed us to reflect in different ways on the experience of delivering MBIs online. Although there was some initial skepticism (including from one of the coauthors) about the possibility of embodying mindfulness through an online platform, the authors have been surprised by how positive the experience has been. In fact, it was noticed very quickly that it was not only possible, but also quite natural, to develop the sense of support and community that is integral to the experience of an in-person MBI. An important reflection has been that participants in the online groups reported a different, yet valuable, experience of social connectedness with their peers. The observation as facilitators, which was mirrored by the qualitative analyses of participants' accounts from in-person and online groups,12 revealed that online delivery of MBIs shifts the focus of social connectedness toward feeling a sense of community and support from their peers, rather than an emphasis on trying to make new friends. In fact, participants in the online group mentioned that they had felt connected with the group as a whole, whereas participants in the in-person group reported that they had enjoyed the social aspect of the program and meeting other adolescents who were facing similar challenges (a more detailed discussion can be found elsewhere).12 It was also noted that since participants attend sessions in the comfort of their own home, and make a conscious effort to identify a quiet, private, and restful space to practice mindfulness, they directly use and naturally generalize the practices learned to their everyday lives outside of the group sessions.Online facilitation also comes with a unique set of challenges. While digital interfaces allow the possibility of visualizing all participants at once, nonverbal communication and picking up social cues can feel more limited (this may be felt by participants and facilitators). Poor audio quality can also be an issue if more than one person speaks at once. It was found that these challenges can be managed effectively by eliciting participation through different means, such as using “thumbs up” signs, which all participants can do at once without causing audio issues. This and other active gestures allow to maintain ongoing engagement and contact with all participants. Potential technology issues are another challenge that can distract the facilitator (especially if facilitating alone) and make it more difficult to entertain an atmosphere of calm, introspection, and open sharing conducive to the practice and learning of mindfulness skills. It was found that even more so than in the context of in-person facilitation, having two facilitators to help with potential distractions and technological issues offers facilitators peace of mind and an opportunity to ensure a higher level of depth in practice and inquiry. Specifically, the capacity to maintain eye contact through a digital interface can be enhanced by the presence of two facilitators.In speaking with adolescents who have experienced online MBIs moderated in real time, it was found that participants quickly became comfortable with, or were already familiar to, the online platform the authors used. Participants also reported that participating in MBIs from the comfort of their home is convenient, pleasant, and more personable, as being surrounded by familiar objects can be helpful in encouraging self-expression. Considering that the majority of adolescents now create and maintain friendships through social media and that more than half of 14–17-year-olds in North America report playing online video games, often in social forums, it may be that the level of comfort with online MBIs is a reflection of how current day adolescents interact with their peers.13Future DirectionsThe online delivery of MBIs facilitated in real time is bound to become easier in the years to come. The authors recognize that certain obstacles still exist, and that experiencing sound or connectivity issues during sessions can have an impact on the experience. However, newer technologies such as virtual reality may soon help make online MBIs even more engaging and accessible than they are now.There is a clear need for more research, including larger scale studies to determine the role that online MBIs can play as a first- or second-line treatment modality for youth with different mental and physical health conditions.14 Another question that remains unanswered is whether online MBIs moderated in real time can be optimized with the use of other adjunct modalities such as mobile mindfulness apps. It is also unknown whether new or modified practices such as mindful social media browsing or mindful online communication could take a more central role in future online MBI programs.Although mindfulness training is experienced in a different way through an electronic platform, fundamental principles key to the delivery of in-person MBIs can be honored. Mindfulness remains a highly experiential approach, and for participants, just like providers, quality and benefits of MBIs, whether delivered in-person or online, will be optimized with the cultivation of a committed personal mindfulness practice.Increasing the offer of online MBIs requires training and developing new skill sets and sensitivities for facilitators who are only familiar with in-person settings. However, this training can easily be delivered through telehealth, offering a first-person experience for facilitators in training that can be translated and later shared with participants. Our experience suggests that online delivery of MBIs has a high potential to expand the accessibility of MBIs, moving the field of mindfulness forward: the time has come to consider it as a promising alternative for delivery of MBIs.Author Disclosure StatementNo competing financial interests exist.Funding InformationThere was no funding associated with this publication.References1. Long J, Briggs M, Astin F. Overview of systematic reviews of mindfulness meditation-based interventions for people with long-term conditions. Adv Mind Body Med 31:26–36. Medline, Google Scholar2. Vo DX, Doyle J, Christie D. Mindfulness and adolescence: A clinical review of recent mindfulness-based studies in clinical and nonclinical adolescent populations. Adolesc Med State Art Rev 2014;25:455–472. Medline, Google Scholar3. Lin J, Chadi N, Shrier L. Mindfulness-based interventions for adolescent health. Curr Opin Pediatr 2019;31:469–475. Crossref, Medline, Google Scholar4. Ahola Kohut S, Stinson J, Davies-Chalmers C, et al. Mindfulness-based interventions in clinical samples of adolescents with chronic illness: A systematic review. J Altern Complement Med 2017;23:581–589. Link, Google Scholar5. Chadi N, Kaufman M, Weisbaum E, et al. In-person versus ehealth mindfulness-based intervention for adolescents with chronic illness: Protocol for a randomized controlled trial. JMIR Res Protoc 2017;6:e241. Crossref, Medline, Google Scholar6. Tan LB. A critical review of adolescent mindfulness-based programmes. Clin Child Psychol Psychiatry 2015;21:193–207. Crossref, Medline, Google Scholar7. Chadi N, Kaufman M, Weisbaum E, et al. Comparison of an in-person vs. ehealth mindfulness meditation-based intervention for adolescents with chronic medical conditions: A mixed methods study. J Adolesc Heal 2018;62:S12. Crossref, Google Scholar8. Ahola Kohut S, Stinson J, Jelen A, Ruskin D. Feasibility and acceptability of a mindfulness-based group intervention for adolescents with inflammatory bowel disease. J Clin Psychol Med Settings 2019 [Epub ahead of print]; DOI: 10.1007/s10880-019-09622-6. Crossref, Medline, Google Scholar9. Ahola Kohut S. The nuts and bolts of online mindfulness and ACT based treatment for youth with inflammatory bowel disease. Association for Contextual Behavioral Science World Conference, Montreal, QC, 2018. Google Scholar10. Spijkerman MPJ, Pots WTM, Bohlmeijer ET. Effectiveness of online mindfulness-based interventions in improving mental health: A review and meta-analysis of randomised controlled trials. Clin Psychol Rev 2016;45:102–114. Crossref, Medline, Google Scholar11. Ma Y, She Z, Siu AF-Y, et al. Effectiveness of online mindfulness-based interventions on psychological distress and the mediating role of emotion regulation. Front Psychol 2018;9:2090. Crossref, Medline, Google Scholar12. Chadi N, Weisbaum E, Malboeuf-Hurtubise C, et al. Can the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) program be provided online? Voices from the youth. Child (Basel, Switzerland) 2018;5:115. Google Scholar13. Nesi J, Choukas-Bradley S, Prinstein MJ. Transformation of adolescent peer relations in the social media context: Part 1—A theoretical framework and application to dyadic peer relationships. Clin Child Fam Psychol Rev 2018;21:267–294. Crossref, Medline, Google Scholar14. Kelson J, Rollin A, Ridout B, Campbell A. Internet-delivered acceptance and commitment therapy for anxiety treatment: Systematic review. J Med Internet Res 2019;21:e12530. 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Vo, and Sara Ahola Kohut.Mindfulness-Based Interventions for Adolescents: Time to Consider Telehealth.The Journal of Alternative and Complementary Medicine.Mar 2020.172-175.http://doi.org/10.1089/acm.2019.0302Published in Volume: 26 Issue 3: March 11, 2020Online Ahead of Print:November 25, 2019PDF download

Eight-week mindfulness-based interventions (MBIs) have a beneficial impact on mental health and well-being in adolescents with chronic health conditions. Usually delivered in person in a group setting, these programs are difficult to access for teens with disabilities or who do not have in-person MBIs available in their communities. This paper outlines the rationale, development, and design of a randomized controlled trial comparing the effects of an MBI delivered in person or via eHealth in adolescents with a chronic illness. Quantitative outcomes will include mindfulness skills acquisition (primary outcome), effects of the MBI on self-reported mood, anxiety, self-esteem, illness perception, and physiological stress (via salivary cortisol), and qualitative outcomes will include individual practice, participant appreciation, and adaptation of the MBI for eHealth. This is a randomized noninferiority mixed methods study comparing 2 MBI arms: in-person and eHealth. Participants are eligible to participate if they are aged 13 to 18 years, have a diagnosis of chronic medical condition, live close enough to the recruitment hospital to participate in the in-person arm of the study, and are currently followed by a health care provider. Each participant will receive an adapted 8-week MBI delivered either in person at a tertiary pediatric hospital or via a secure audio-visual platform allowing group interactions in real time. Groups will be facilitated by 2 experienced mindfulness providers. Quantitative and qualitative data will be collected through standardized research questionnaires administered via a secure, youth-friendly online platform and through semistructured interviews, participant log books, facilitator log books, and salivary cortisol analysis. Qualitative data will be analyzed using a grounded theory model. Data collection is currently underway. Data analysis, manuscript writing, and additional publications are expected to be completed in the winter and spring of 2018. Based on previous results from in-person trials conducted in adolescents and eHealth trials conducted in adults, we anticipate that both modes of delivery will significantly improve mindfulness skills acquisition, mood, anxiety, self-esteem, illness perception, and stress and that the magnitude of the effects will be correlated to the level of home practice. We predict that participants in both arms will show similar levels of home practice and that both modes of delivery will have high levels of feasibility and acceptability. If successful, this study could provide evidence for the use of eHealth in the delivery of 8-week MBIs in clinical adolescent populations, potentially increasing availability to MBIs for a large group of youth with mobility issues or living away from large urban centers. ClinicalTrials.org NCT03067207; https://clinicaltrials.gov/ct2/show/NCT03067207 (archived by WebCite at http://www.webcitation.org/6v4ZK8RBH)

British Columbia (BC) is the epicentre of the illicit drug overdose crisis in Canada. There were 1422 deaths from overdose in 2017; 23 of these deaths occurred in children (aged 10–18 yr).[1][1] Rates of death from illicit drug use in this age group doubled between 2015 and 2016, and doubled again

Mindfulness-based interventions (MBIs) have been shown to improve health and well-being in adolescents with chronic illnesses. Because they are most often delivered in person in a group setting, there are several barriers that limit access to MBIs for youth with limited mobility or who cannot access in-person MBIs in their communities. The objective of this study was to determine if eHealth is a viable platform to increase accessibility to MBIs for teens with chronic illnesses. This study reports the qualitative results of a mixed method randomized trial describing the experience of the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) program, an eight-week MBI, delivered either in person or via eHealth. Participants were adolescents between the ages of 13 and 18 with a chronic illness recruited at a tertiary pediatric hospital in Toronto, Canada. Individual semi-structured post-participation audio-video interviews were conducted by a research assistant. A multiple-pass inductive process was used to review interview transcripts and interpret emergent themes from the participants' lived experiences. Fifteen participants (8 online and 7 in person) completed post-participation interviews. Four distinct themes emerged from participants in both groups: Creation of a safe space, fostering peer support and connection, integration of mindfulness skills into daily life, and improved well-being through the application of mindfulness. Direct quotations representative of those four themes are reported. Results from this study suggest that eHealth delivery of an adapted MBI for adolescents with chronic illnesses may be an acceptable and feasible mode of delivery for MBIs in this population. EHealth should be considered in future studies of MBIs for adolescents with chronic illnesses as a promising avenue to increase access to MBIs for youth who might not be able to access in-person programs.

Purpose: Mindfulness-based interventions (MBIs) have been shown to have positive impacts on mental health and well-being for adolescents living with chronic health conditions. However, many teens with chronic illnesses experience barriers such as pain, reduced mobility and distance making it difficult to attend mindfulness programs in person and compromising accessibility. The aim of this study was to compare the acceptability and effectiveness of a MBI for adolescents with chronic illnesses delivered in person vs. electronically.

Objective: Chronic pain is common in paediatric populations and many patients do not respond to the currently available evidence-based treatments. Mindfulness-based interventions (MBIs) have a growing evidence-base in adults, but evidence is limited in youth with chronic pain. Methods: We conducted an open-label pilot study to test the feasibility of an 8-week MBI for this population. Results: Seven adolescents (age range 14-17; median age 15; six female) completed the intervention. There were no dropouts. Median class attendance was seven of eight total sessions (SD = 0.76). Only one (14.3%) participant reported not finding it useful; five (71.4%) reported that they would recommend it to a friend; and the remaining two (28.6%) reported "maybe". There was no worsening of internalizing symptoms. Secondary outcomes included significant reduction of pain intensity, which was maintained at three-month follow-up. Somatic symptoms and functional disability were both non-significantly lower immediately following the intervention; but were significantly improved at three-month follow-up. Conclusion: An eight-week group MBI is a feasible intervention for adolescents with chronic pain, and warrants further investigation as a potential alternative to cognitive behavioural therapy in this population.

Adolescents frequently present to the emergency department or to primary care physicians for acute health concerns that range from minor to life-threatening. This issue of AM:STARs focuses on many of the more urgent and emergent health problems and concerns that bring adolescents to clinics, private offices, and emergency department settings.

PurposeAdolescents with psychological distress, chronic illness, and/or chronic pain experience critical challenges in their mental health and development, coping, and transition to adulthood. A large body of evidence supports the benefits of mindfulness-based interventions for adults in coping with a wide range of stressors, including chronic pain and illness, depression, and anxiety. The empirical literature on clinical mindfulness-based interventions for adolescents is still in its infancy. The purpose of this pilot study is to develop and examine the effectiveness of a novel mindfulness-based intervention on adolescent mental health.MethodsA novel mindfulness-based intervention, MARS-A, was developed by two experienced clinicians (Adolescent Medicine specialist and Child and Adolescent Psychiatrist), who also have significant personal mindfulness practice experience. MARS-A is an 8-week referral-based outpatient program for adolescents age 14 to 19 with psychological distress (depression or anxiety symptoms), with or without co-occurring chronic illness and/or chronic pain. The developers adapted elements from existing evidence-based mindfulness-based interventions for adults, and also integrated elements of their personal mindfulness practices and clinical practice with adolescents. Data were collected pre and post intervention from participants in the MARS-A intervention (n=31, 71% female, ages 14 to 17 years). A survey at baseline and immediately after the intervention assessed psychological distress (Kessler-10), stress (Perceived Stress Scale), depressive symptoms (Center for Epidemiological Studies-Depression), and functioning in daily and physical activities (Functional Disability Index). Thirteen cases had some incomplete data. Tests of missingness revealed data were missing at random and therefore could be handled by imputing information using an Expectation-Maximization (EM) algorithm. Analyses involved paired t-tests with bootstrapping to compare mean scores pre and post intervention. Effect size was calculated using Morris and DeShon's (2002) equation 8 to correct for dependence among means.ResultsPerceived Stress scores declined (t[30]=3.07, p=.01, d=.55) from pre to post-test (3.63 to 3.22) as did Kessler-10 scores (t[30]=2.08, p=.05, d=.37) (T1=2.92, T2=2.64) and depressive symptoms (t[30]=2.08, p=.05, d=.37) (T1=2.43, T2=2.21). Daily and physical activities, as measured by the Functional Disability Index, changed in the predicted directions but results were not statistically significant. The effect sizes for Perceived Stress, Kessler-10, and CES-D scores (d ranging from 0.37 to 0.56) are noteworthy.ConclusionsThis study is one of the first trials of a mindfulness-based clinical intervention for adolescents. Results of this study suggest that MARS-A is a promising intervention for a heterogeneous clinical population of adolescents with anxiety and depressive symptoms. Participants reported lower perceived stress, psychological distress, and depression symptoms. The magnitude of changes suggests clinically significant benefit. Adolescents' life functioning showed a non-significant trend towards improvement, and the study may have been limited by power to detect statistically significant improvements. This was an uncontrolled pilot study, so definitive conclusions cannot yet be drawn. Further research (including randomized controlled trials, and qualitative research to examine adolescents' perception of the intervention) is warranted.Sources of SupportChildren's and Women's Mental Health Programs, British Columbia Mental Health & Addictions Services. PurposeAdolescents with psychological distress, chronic illness, and/or chronic pain experience critical challenges in their mental health and development, coping, and transition to adulthood. A large body of evidence supports the benefits of mindfulness-based interventions for adults in coping with a wide range of stressors, including chronic pain and illness, depression, and anxiety. The empirical literature on clinical mindfulness-based interventions for adolescents is still in its infancy. The purpose of this pilot study is to develop and examine the effectiveness of a novel mindfulness-based intervention on adolescent mental health. Adolescents with psychological distress, chronic illness, and/or chronic pain experience critical challenges in their mental health and development, coping, and transition to adulthood. A large body of evidence supports the benefits of mindfulness-based interventions for adults in coping with a wide range of stressors, including chronic pain and illness, depression, and anxiety. The empirical literature on clinical mindfulness-based interventions for adolescents is still in its infancy. The purpose of this pilot study is to develop and examine the effectiveness of a novel mindfulness-based intervention on adolescent mental health. MethodsA novel mindfulness-based intervention, MARS-A, was developed by two experienced clinicians (Adolescent Medicine specialist and Child and Adolescent Psychiatrist), who also have significant personal mindfulness practice experience. MARS-A is an 8-week referral-based outpatient program for adolescents age 14 to 19 with psychological distress (depression or anxiety symptoms), with or without co-occurring chronic illness and/or chronic pain. The developers adapted elements from existing evidence-based mindfulness-based interventions for adults, and also integrated elements of their personal mindfulness practices and clinical practice with adolescents. Data were collected pre and post intervention from participants in the MARS-A intervention (n=31, 71% female, ages 14 to 17 years). A survey at baseline and immediately after the intervention assessed psychological distress (Kessler-10), stress (Perceived Stress Scale), depressive symptoms (Center for Epidemiological Studies-Depression), and functioning in daily and physical activities (Functional Disability Index). Thirteen cases had some incomplete data. Tests of missingness revealed data were missing at random and therefore could be handled by imputing information using an Expectation-Maximization (EM) algorithm. Analyses involved paired t-tests with bootstrapping to compare mean scores pre and post intervention. Effect size was calculated using Morris and DeShon's (2002) equation 8 to correct for dependence among means. A novel mindfulness-based intervention, MARS-A, was developed by two experienced clinicians (Adolescent Medicine specialist and Child and Adolescent Psychiatrist), who also have significant personal mindfulness practice experience. MARS-A is an 8-week referral-based outpatient program for adolescents age 14 to 19 with psychological distress (depression or anxiety symptoms), with or without co-occurring chronic illness and/or chronic pain. The developers adapted elements from existing evidence-based mindfulness-based interventions for adults, and also integrated elements of their personal mindfulness practices and clinical practice with adolescents. Data were collected pre and post intervention from participants in the MARS-A intervention (n=31, 71% female, ages 14 to 17 years). A survey at baseline and immediately after the intervention assessed psychological distress (Kessler-10), stress (Perceived Stress Scale), depressive symptoms (Center for Epidemiological Studies-Depression), and functioning in daily and physical activities (Functional Disability Index). Thirteen cases had some incomplete data. Tests of missingness revealed data were missing at random and therefore could be handled by imputing information using an Expectation-Maximization (EM) algorithm. Analyses involved paired t-tests with bootstrapping to compare mean scores pre and post intervention. Effect size was calculated using Morris and DeShon's (2002) equation 8 to correct for dependence among means. ResultsPerceived Stress scores declined (t[30]=3.07, p=.01, d=.55) from pre to post-test (3.63 to 3.22) as did Kessler-10 scores (t[30]=2.08, p=.05, d=.37) (T1=2.92, T2=2.64) and depressive symptoms (t[30]=2.08, p=.05, d=.37) (T1=2.43, T2=2.21). Daily and physical activities, as measured by the Functional Disability Index, changed in the predicted directions but results were not statistically significant. The effect sizes for Perceived Stress, Kessler-10, and CES-D scores (d ranging from 0.37 to 0.56) are noteworthy. Perceived Stress scores declined (t[30]=3.07, p=.01, d=.55) from pre to post-test (3.63 to 3.22) as did Kessler-10 scores (t[30]=2.08, p=.05, d=.37) (T1=2.92, T2=2.64) and depressive symptoms (t[30]=2.08, p=.05, d=.37) (T1=2.43, T2=2.21). Daily and physical activities, as measured by the Functional Disability Index, changed in the predicted directions but results were not statistically significant. The effect sizes for Perceived Stress, Kessler-10, and CES-D scores (d ranging from 0.37 to 0.56) are noteworthy. ConclusionsThis study is one of the first trials of a mindfulness-based clinical intervention for adolescents. Results of this study suggest that MARS-A is a promising intervention for a heterogeneous clinical population of adolescents with anxiety and depressive symptoms. Participants reported lower perceived stress, psychological distress, and depression symptoms. The magnitude of changes suggests clinically significant benefit. Adolescents' life functioning showed a non-significant trend towards improvement, and the study may have been limited by power to detect statistically significant improvements. This was an uncontrolled pilot study, so definitive conclusions cannot yet be drawn. Further research (including randomized controlled trials, and qualitative research to examine adolescents' perception of the intervention) is warranted. This study is one of the first trials of a mindfulness-based clinical intervention for adolescents. Results of this study suggest that MARS-A is a promising intervention for a heterogeneous clinical population of adolescents with anxiety and depressive symptoms. Participants reported lower perceived stress, psychological distress, and depression symptoms. The magnitude of changes suggests clinically significant benefit. Adolescents' life functioning showed a non-significant trend towards improvement, and the study may have been limited by power to detect statistically significant improvements. This was an uncontrolled pilot study, so definitive conclusions cannot yet be drawn. Further research (including randomized controlled trials, and qualitative research to examine adolescents' perception of the intervention) is warranted.

This groundbreaking multimedia resource embodies the core belief that identifying, reinforcing, and building on inherent strengths can facilitate positive youth development.Text and video combine to show how expert-tested, strength-based communication approaches work in today's teens. Contributions from leading practitioners - plus first-hand perspectives from teens - help you refine your communication strategies and skills.Professionals and teens offer hard-won insight on addressing behavioral and emotional issues; crisis management; stress management; sexuality; grief; depression; peer pressure; substance abuse; sexual abuse; bullying; youth violence - virtually all the issues you're most likely to encounter.Successful solutions targeting today's foremost youth-development issuesCreated to benefit all professionals who serve adolescents, Reaching Teens explores and demonstrates communications strategies for diverse healthcare, counseling, youth programs, and educational settings.Bolster your communication skills with this multi-facted 'how to' resourceTurn here for actionable advice and counsel spanning your toughest youth communication challenges:- How to help teens recognize existing strengths- How to empower wiser decisions and healthier choices- How to foster resilience-building- How to ally with parents and support effective parenting- How to develop and prioritize your interventions- How to help with special psychosocial and environmental challenges- How to de-escalate crisis situations- How to establish appropriate boundaries- How to discourage unhealthy relationships- How to serve populations with special healthcare needs- How to practice effective self-care that enhances your ability to serve youth- And much more!

This issue of AM:STARs, Hot Topics in Adolescent Health, presents a wide array of articles exploring some of the most exciting advances and controversies in adolescent health. These topics and other evolving areas are presented to guide the reader toward providing state of the art clinical care to adolescents, as well as reviewing new research that will shape the future of adolescent health.Topics include:Nutritional and metabolic controversies including the diagnosis of gluten intolerance, vitamin D deficiency and metabolic syndrome in adolescents, and the use of bariatric surgery to treat the comorbidities of adolescent obesity.New diagnostic considerations, including updated DSM-5 diagnostic criteria for mental health disorders such as mood dysregulation, eating disorders, and ADHD.Reproductive health advances including new diagnostic techniques and treatment regimens for HIV and other sexually transmitted infections, as well as the expanding use of long-acting reversible contraceptives.New frontiers in adolescent medicine including office-based management of opiate addiction, support of gender nonconforming youth, and the use of mindfulness practices in the care of a variety of conditions.AM:STARs: Adolescent Medicine: State of the Art Reviews is the official publication of the American Academy of Pediatrics Section on Adolescent Health. Published 3 times per year, the journal offers adolescent medicine specialists and other primary care physicians who treat adolescent patients with state of the art information on all matters relating to adolescent health and wellness.