Goodbye paper, electronic pediatric screenings are here

MU Pediatrics Physicians, Nurses and Patient Service Representatives"The American Academy of Pediatrics (AAP) recommends universal developmental surveillance and screening of all infants and young children during well-child visits at 9, 18, and 24 or 30 months. Patient Tools, an electronic screening system, automates developmental and social-emotional screenings allowing clinicians to view results in a patient's medical record. The Patient Tools Project supports: Primary care providers in completing recommended screens accurately and efficiently. A 'paperless' health care system (HIMSS EMRAM Stage 7), known to save time and reduce cost."--Overview

Leveraging qualitative approaches to guide sustainable international research collaborations

Qualitative research approaches were used to launch an international research collaboration between the U. S. and Cambodia. Cambodian officials requested assistance in learning qualitative approaches to complement the research skills of Cambodian mental health providers. This article provides a description of how U. S. researchers responded to that request and engaged with Cambodian psychiatrists to explore mental health needs and interventions in both countries and initiate a sustainable relationship. The early focus on qualitative research methodologies may be an avenue that mitigates some of the challenges that can characterize international research. In this study, early communications involved developing a plan to teach qualitative methods while also collecting and analyzing data in both countries that would address the mental health concerns experienced by respective care providers. A case study exemplar was embedded with a scripted focus group guide to collect data from U. S. focus groups, then share with Cambodian psychiatrists. Components of hermeneutic phenomenological interviewing and descriptive content analysis were used to simultaneously teach and enact the research methods, gather data in both countries to analyze, and inspire participants to replicate the methods in their ongoing work. Cambodian psychiatrists were able to demonstrate competence in facilitating focus groups after being participant-observers. Researcher/practitioners from both U. S. and Cambodian teams gained new understandings about the mental health needs of their patients. The mutual engagement of a research focus is an effective way to establish cross-cultural relationships. The challenges of staying with stable teams over times remain, but the content shared and learned in a participatory structure yields understandings that cross cultural boundaries. Anticipated and unexpected challenges may be offset by an intention of reciprocity and mutual engagement. The use of qualitative methodologies, early and repeatedly, can facilitate relational understanding

“No matter what, we just work with the trauma…”: Mental Health Therapists’ Care of Diverse Sexual and Gender Identity Citizens in Cambodia

The convergence of trauma symptomatology, mental health symptoms, family and social difficulties, and intersectionality of diverse sexual and gender minority (SGM) individual issues is complex, multi-faceted, and challenging for the individuals in Cambodia who suffer them and for the therapists in Cambodia who meet individuals in treatment. We documented and analyzed the perspectives of mental health therapists in the context of a randomized control trial (RCT) intervention within the Mekong Project in Cambodia. The research questions explored perceptions of therapists’ care of mental health clients, therapist well-being, and experiences of navigating within a research environment in which SGM citizens with mental health concerns receive treatment. The larger study enrolled 150 Cambodian adults, among which 69 identified as SGM. Three key patterns emerged across our interpretations. Clients seek help when symptoms interfere with daily life, therapists care for clients and themselves, and integrated research and practice is integral yet sometimes paradoxical. Therapists did not identify differences in terms of how they work with SGM clients compared with non-SGM clients. Future studies are warranted to examine a reciprocal academic-research partnership in which we examine therapists’ work alongside rural community members, evaluate the process of embedding and fortifying peer supports within educational systems, and study the wisdom of traditional and Buddhist healers to address the discrimination and violence that citizens who identify as SGM disproportionately suffer. National Library of Medicine (U.S.). (2020). Trauma Informed Treatment Algorithms for Novel Outcomes (TITAN). Identifier NCT04304378

Protocol for a randomized controlled trial in Cambodian individuals with PTSD: Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (project TITAN)

Low- and middle-income countries shoulder a disproportionate burden of mental health disorders with limited resources to support the provision of care using culturally relevant, evidence-based interventions. This is particularly true in Cambodia where the population continues to confront traumatic consequences of the Khmer Rouge genocide that targeted educated people, including treatment providers. Trauma-Informed Treatment Algorithms for Advancing Novel Outcomes (Project TITAN) will examine proof of concept and preliminary efficacy of culturally tailored interventions for symptoms of post-traumatic stress (PTS) among Cambodian adults. A stepped care randomized controlled trial enrolling people seeking mental health treatment and priority populations with high rates of trauma exposure, including female entertainment and sex workers and sexual and gender minorities. In total, 160 participants with symptoms of PTS are randomized to Stabilization Techniques or Behavioral Activation plus Stabilization Techniques, implemented within a culturally relevant framework. Individuals who do not demonstrate a reduction in symptoms of PTS after six treatment sessions receive Eye Movement Desensitization and Reprocessing therapy. PTS, depression, anxiety, and substance use are assessed at baseline and two and four months post-randomization. The percentage of individuals achieving reductions in symptoms of PTS after four months is the primary outcome. Secondary outcomes are depression, anxiety, and substance use over four months. Finally, machine learning analyses will be conducted to identify features at baseline and during treatment that predict outcomes. Findings will guide future development and implementation of interventions to improve mental health conditions among individuals in Cambodia and other resource-limited settings

Multnomah County Project Launch Evaluation

Early childhood is a critical time in human development. Any experience, positive or negative, can influence long-term outcomes for physical, emotional, social, and cognitive health (Center on the Developing Child at Harvard University, 2010). To ensure a strong foundation for success in school and in life, efforts designed to promote wellness and identify early learning or mental health challenges must begin well before kindergarten. Strong evidence shows that investing in early childhood can yield large dividends for children. Additionally, the ability of our systems to provide positive outcomes for children can be enhanced through strategic planning, well-developed partnerships, and coordinated family services. Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health), a federally funded United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) initiative, aims to enhance and improve the way systems function by bringing together all participants in each child’s life including caregivers, primary care providers, early childhood educators, and mental health providers. Project LAUNCH strives to incorporate all participants, at all levels of service provision, to strengthen our ability to achieve the best possible outcomes in social and emotional health and wellness for all children. Project LAUNCH has funded states, local jurisdictions, and tribes interested in achieving these goals since 2008. Under Project LAUNCH, grantees are charged with (1) promoting the healthy development of children from birth to age 8 and their families by harnessing and coordinating existing resources and (2) increasing access to high-quality, evidence-based programs in five childcentric domains: developmental screening and assessment, home visiting, mental health consultation, family strengthening and training, and integration of behavioral health into primary care. By developing an understanding of the landscape of services and supports unique to each state and community and by evaluating strengths and opportunities for change, grantees begin to implement promotion and prevention strategies that best serve the needs of their communities at the child, family, and systems levels. Thus, while there are distinct cultural, geographic, and economic differences across LAUNCH sites in all cohorts, the fundamental components of the LAUNCH model remain the same for all grantees. To date, Project LAUNCH has funded 55 projects across six cohorts. All LAUNCH grantees are expected to demonstrate local policy and practice improvements that can be sustained statewide. Unlike other LAUNCH cohorts, Cohort 3 grantees are distinguished by the fact that they were funded solely at the community level with no state or tribal oversight. This presented the six sites with a unique set of opportunities and challenges as they sought to bring policy and practice improvements to scale, enhance infrastructure, and implement direct services in the five domains or strategies. The uniqueness of the community-based aspect of Cohort 3 grantees provided both challenges and opportunities. Grantees identified the flexibility and ability to control program activities within a community setting as key advantages to the local grants, whereas the ability to replicate successful activities and implement policy change on a statewide basis were limited. Additionally, the uniqueness of Cohort 3 made it challenging to evaluate the success of Cohort 3 grantees by measuring their progress against that of other cohorts. This e-book was developed to highlight and share the experience of the local communities in Cohort 3. This publication is designed to serve as a resource for future early childhood systems development activities implemented by LAUNCH grantees or by other early childhood programs with similar goals and interests. This publication shares the contributions of this unique cohort to the field of young children’s mental health and family wellness by spotlighting accomplishments, evidence, and lessons learned within the context of the LAUNCH strategic framework. Narratives from the six grantees detail the successes and challenges of systems building from the ground up and emphasize the value-added benefits of funding directly at the community level. Recommendations for present and future LAUNCH projects and similar initiatives address strategies to build local, state, and national partnerships to support replication and sustainability. We hope you will find this resource of value for supporting local initiatives that promote young child and family wellnes