Inpatient Treatment of Children and Adolescents

The report reviews the literature from 1975 to 2001. Conclusions from the report indicate that parental involvement is highly correlated with successful outcomes. Length of stay is not correlated with successful outcomes. Generally, extended hospitalizations provide little added benefit over shorter inpatient programs. Follow-up with community mental health is highly correlated with successful outcomes and is an integral part of maintaining goals. The therapeutic alliance is positively correlated with successful outcomes. Placement may exacerbate the sense of failure and anger, and create a sense of loss of connectedness to the family. Inpatient and residential treatment does not seem any more effective than day treatment, multi-systemic treatment, or community mental health services and is more costly. Inpatient care is generally thought of as a part of a comprehensive treatment program that includes continued treatment as an outpatient following discharge from the inpatient facility. Programs should include a focus on family involvement and establishing good therapeutic alliances. Extended hospitalization should be avoided in favor of intense community-based support and treatment, supported by brief inpatient hospitalizations with coordinated aftercare.c. 2001 State of Kansas Department of Social and Rehabilitation Services May be reproduced in original for

Group Care of Children and Adolescents

This literature review sought the answers to three questions regarding group care for children and adolescents: Question 1: Is there empirical literature that supports the "best practices" idea that family foster care is better than group home care? According to the review, the answer to this question is a "strong yes." The empirical base found family foster care significantly more effective on a number of outcomes with a variety of groups of children. Question 2: Is there empirical literature that says certain types of children do better in group homes than in family foster homes? No well-designed studies were located to answer this question conclusively. However, the author discussed studies conducted with high risk chronic juvenile offenders and reasoned that if chronic juvenile offenders can be better served in family foster care than in group care, it stands to reason that the same is true of other high-risk children with similar problems. Question 3: If group homes might be better for some children, or if we are always going to have group homes due to "nowhere else to go," which types of group homes programs (treatment models) have shown to be effective for which types of children? Few outcome studies were found that used a rigorous research method to show program curriculums that were effective. The author cites 5 models of group home programming; 4 models show promise and include the Teaching Family Model (Kirigan, 2001); Father Flanagan's Boy's Home Model (Thompson, Smith, Oswood Dowd, Friman, & Daly, 1996); The REPARE model (Landsman, Groza, Tyler, & Molone, 2001); and "Schema" (Bass, Dosser, & Powerll, 2000). "Positive Peer Culture" was identified as an ineffective approach by former recipients in the juvenile correctional system (Kapp, 2000). References: 1.Bass, L., Dosser, D., Powerll, J. (2000). Celebrating change: A schema for family-centered practice in residential settings. Residential Treatment for Children & Youth, 17, 123-137. 2. Landsman, M., Groza, V., Tyler, M., and Malone, K. (2001). Outcomes of family centered residential treatment. Child Welfare League of America, 50, 351-378. 3. Kapp, S. (2000). Positive Peer Culture: The viewpoint of former clients. Journal of Adolescent Group Therapy, 10, 175-189. 4.Kirigin, K. (2001). The teaching family model: A replicable system of care. Residential Treatment for Children & Youth, 18, 99-110. 5.Thompson, R., Smith G., Oswood D., Dowd T., Friman P., & Daly D. (1996). Residential care: A study of short and long-term educational effects. Children and Youth Services, 18, 221-241.c. 2002 State of Kansas Department of Social and Rehabilitation Services May be reproduced in original for

A multilevel mHealth intervention boosts adherence to hydroxyurea in individuals with sickle cell disease

Hydroxyurea reduces sickle cell disease (SCD) complications, but medication adherence is low. We tested 2 mobile health (mHealth) interventions targeting determinants of low adherence among patients (InCharge Health) and low prescribing among providers (HU Toolbox) in a multi-center, non-randomized trial of individuals with SCD ages 15-45. We compared the percentage of days covered (PDC), labs, healthcare utilization, and self-reported pain over 24 weeks of intervention and 12 weeks post-study with a 24-week preintervention interval. We enrolled 293 patients (51% male; median age 27.5 years, 86.8% HbSS/HbSβ0-thalassemia). The mean change in PDC among 235 evaluable subjects increased (39.7% to 56.0%; P < 0.001) and sustained (39.7% to 51.4%, P < 0.001). Mean HbF increased (10.95% to 12.78%; P = 0.03). Self-reported pain frequency reduced (3.54 to 3.35 events/year; P = 0.041). InCharge Health was used ≥1 day by 199 of 235 participants (84.7% implementation; median usage: 17% study days; IQR: 4.8-45.8%). For individuals with ≥1 baseline admission for pain, admissions per 24 weeks declined from baseline through 24 weeks (1.97 to 1.48 events/patient, P = 0.0045) and weeks 25-36 (1.25 events/patient, P = 0.0015). PDC increased with app use (P < 0.001), with the greatest effect in those with private insurance (P = 0.0078), older subjects (P = 0.033), and those with lower pain interference (P = 0.0012). Of the 89 providers (49 hematologists, 36 advanced care providers, 4 unreported), only 11.2% used HU Toolbox ≥1/month on average. This use did not affect change in PDC. Tailoring mHealth solutions to address barriers to hydroxyurea adherence can potentially improve adherence and provide clinical benefits. A definitive randomized study is warranted. This trial was registered at www.clinicaltrials.gov as #NCT04080167