Maternal & Child Health Newsletter 4/22/05

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Maternal & Child Health Newsletter 4/22/05

Postby denise » Fri Apr 22, 2005 02:17 pm

MCH Alert
Tomorrow's Policy Today

Maternal and Child Health Library

This and past issues of the MCH Alert are available at

April 22, 2005

1. Report Assesses Current Innovations in Language Service Programs and
2. Tools Released to Help Reduce the Risk of Sudden Infant Death Syndrome
3. Report Presents New Findings From the Foster Care Alumni Studies
4. Randomized Controlled Trial Evaluates Risk of Adolescent Suicide
Screening Programs
5. Article Assesses Child Health Professionals' Use of Medications to Help
Parents Quit Smoking



Providing Language Services in Small Health Care Provider Settings:
Examples from the Field describes a variety of ongoing activities designed
to improve language services in small health care settings. The National
Health Law Program, with support from the Commonwealth Fund, conducted
site visits and phone interviews at small health care settings (defined as
those with 10 or fewer clinicians). The report presents information on
promising, replicable activities including recruiting bilingual staff for
dual roles, providing ongoing cultural and language competency training
for interpreter staff, using community resources (e.g., hospitals, managed
care organizations, students, volunteers), and capitalizing on
underutilized funding sources. The report is intended for use by health
professionals in developing strategies to meet the needs of individuals
with limited English proficiency and the communities in which they reside.
The report is available at ... _id=270667 or ... rvices.pdf.



The American Academy of Pediatrics' Healthy Child Care America Back to
Sleep Campaign has published three brochures about reducing the risk of
sudden infant death syndrome (SIDS). A Child Care Provider's Guide to Safe
Sleep presents data and information about SIDS and safe sleep practices
and is available at ... esleep.pdf.
A Parent's Guide to Safe Sleep includes information about working with
child care providers to ensure that safe sleep practices are used both at
home and in child care settings. It is available at ... esleep.pdf. Tummy Time
contains information about the importance of allowing infants to spend
supervised time lying or playing on their stomachs and is available at



"PTSD [post-traumatic stress disorder] and major depression may be the
most far-reaching mental health conditions for alumni in young adulthood,"
state the authors of Improving Family Foster Care: Findings from the
Northwest Foster Care Alumni Study. The study examined how children and
adolescents who were formerly in foster care (alumni) have fared as
adults, and what changes in foster care services could improve their
lives. The report includes (1) selected findings about the current
functioning of alumni, (2) comparisons of findings with findings from
other studies and general population benchmarks, (3) analyses of foster
care experience areas that lead to positive outcomes, and (4)
recommendations to help improve outcomes for children and adolescents who
are currently in foster care.

The study sample included 659 alumni (ages 20-33) who had been placed in
family foster care between 1988 and 1998 and who were served by one of
three agencies (Casey Family Programs or the Oregon or Washington child
welfare agencies). The study reviewed case records for the total sample
and interviewed 479 alumni between September 2000 and January 2002.
Predictor variables included demographics, pre-placement risk factors,
intervention group (agency or state), and foster care experience. Outcome
variables included mental health, education, and employment and finances.
The authors also conducted statistical simulations to estimate the degree
to which optimizing certain foster care experiences might affect alumni

The authors found that

* More than half of the alumni (54.4%) had current mental health problems,
while less than one-quarter of the general U.S. population (22.1%) had
current mental health problems.

* The prevalence of PTSD within the previous 12 months was significantly
higher among alumni (25.2%) than among the general U.S. population (4.0%).

* The prevalence of major depression within the previous 12 months was
significantly higher among alumni (20.1%) than among the general U.S.
population (10.2%).

* Optimization of two foster care experience areas would be expected to
significantly reduce the number of undesirable mental health outcomes: (1)
placement history and experience (e.g., few placement changes, no
reunification failures, no runaway incidents) and (2) education services
and experience (e.g., access to supplemental education services and
tutoring, few school changes).

Recommendations, based on the descriptive outcomes, the foster care
experience statistical simulations, and conversations with stakeholders,
include the following:

* Increase access to evidence-based medical and mental health treatment.

* Help maintain placement stability.

* Increase education services and experiences.

* Improve foster parent orientation and training with respect to child and
adolescent mental health.

* Normalize the level of mental health symptomatology, and provide
emotional support for children and adolescents in family foster care.

* Address gaps in caseworker skills.

"The statistical simulations revealed the potential power of targeted
program improvements," conclude the authors, adding that "the needed
improvements will be more successful if they are anchored in larger
structural and community-based reforms that involve the public and private

Pecora PJ, Kessler RC, Williams J., et al. 2005. Improving family foster
care: Findings from the Northwest Foster Care Alumni Study. Seattle, WA:
Casey Family Programs. (Revised). Available at ... iStudy.htm;
two-page summary also available at ... pr2005.pdf
(460KB); full report also available at ... pr2005.pdf

Readers: More information on child and adolescent mental health is
available from the Bright Futures Web site at and from the MCH
Library's knowledge path at ... ealth.html, and
annotated bibliographies at ... th&-search
and ... th&-search.



"Our findings can allay concerns about the potential harm of high
school-based suicide screening," state the authors of an article published
in the April 6, 2005, issue of JAMA, The Journal of the American Medical
Association. The authors note that while evidence for the clinical
validity and reliability of school-based screening procedures has recently
emerged, the potential harm of screening for suicide remains unstudied.
The article examines whether asking an adolescent about suicidal ideation
and behavior during a screening program creates immediate or persistent
distress or increases suicidal ideation among high school students
generally or among high-risk students with depression symptoms, substance
use problems, or previous suicide attempts, specifically.

Students from six high schools in the state of New York participating in a
school-based suicide-screening program were assessed between fall 2002 and
spring 2004. Classes within each of the six high schools were randomized
to either an experimental group (N=1,172 students) or a control group
(N=1,170 students). The experimental group received a first screening
survey with a set of questions assessing suicidal ideation and behavior;
the control group received the same first survey but without suicide
questions. Students' transient distress was measured at the beginning and
end of the first survey and again at the beginning of a second survey
administered 2 days after the first. Both groups received the same second
survey, which included suicide questions.

The authors found that

* Experimental and control groups did not differ significantly in their
distress levels immediately after the first survey or 2 days later.

* The experimental group reported no more suicidal ideation after the
survey than the control group.

* Students with depression symptoms reported more distress and suicidal
ideation than other students; however, being exposed to suicide questions
in the first survey did not exacerbate distress or suicidal ideation among
students with depression. On the contrary, among students with depression,
the experimental group had slightly lower distress scores than the control

* Among previous suicide attempters, the experimental group had less
suicidal ideation than the control group.

The authors conclude that "universal screening for mental health problems
and suicide risk should continue to be at the forefront of the national
agenda for youth suicide prevention."

Gould MS, Marrocco FA, Kleinman M, et al. 2005. Evaluating iatrogenic risk
of youth suicide screening programs: A randomized controlled trial. JAMA,
The Journal of the American Medical Association 293(13):1635-1643.
Abstract available at ... /1635?etoc.



"Provision of medication by child health care providers to treat parental
tobacco dependence is low, despite clear evidence assembled in numerous
clinical settings to support this type of assistance for adults who
smoke," state the authors of an article published in the April 2005 issue
of Pediatrics. Child health professionals are in a unique and important
position to address parental smoking, and helping parents quit smoking is
now a recognized priority of child health professionals. However, parental
attitudes about receipt of medication from child health professionals and
national rates of recommending and prescribing smoking cessation
medication have never been established. The goals of the study described
in this article were to determine parental attitudes about child health
professional provision of smoking cessation medications and to assess the
reported delivery of evidence-based tobacco treatments to parents,
including recommending and prescribing smoking cessation medications.

Researchers surveyed households using a random-digit dial telephone survey
between July and September 2003. Of the eligible respondents contacted,
211 were parents and self-identified smokers.

The authors found that

* Of the parental smokers, one half (N=106) would consider using a
medication to help them quit, and 126 (59.7%) thought it would be
acceptable for the child's doctor to prescribe or recommend this

* Of the 106 smokers who would consider using medication to quit smoking,
the vast majority (85%; N=90) thought it would be acceptable for the
child's doctor to prescribe or recommend this medication.

* Among the 703 parents (smokers and nonsmokers) who accompanied their
child to the health care setting in the past year, there were low rates of
screening for tobacco use (48.5%) and for the presence of rules
prohibiting smoking in the home (34.8%) and car (25.5%).

* Among the 143 smokers who accompanied their child to the health care
setting in the past year, there were similarly low rates of screening,
only 38% were advised to quit, and 15% had a medication recommended to
help them quit.

* Among the 143 smokers who accompanied their child to the health care
setting in the past year, 7% were actually prescribed a medication to help
them quit, and very few were referred for or enrolled in any additional
services to help them quit.

The authors conclude that "low rates of medication assistance for parental
[smoking] cessation contradict the expressed attitudes of the majority of
parents who would consider using medication to help them quit smoking."
The authors continue, "Efforts should focus on how the child health care
system can facilitate the delivery of effective treatments to parents who

Winickoff JP, Tanski SE, McMillen RC, et al. 2005. Child health care
clinicians' use of medications to help parents quit smoking: A national
parent survey. Pediatrics 115(4):1013-1017. Abstract available at ... 115/4/1013.


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Child Health and Georgetown University. MCH Alert is produced by Maternal
and Child Health Library at the National Center for Education in Maternal
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MCH Alert
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Denise (29) Co-coordinator for WI
Jason (32)
Ariana (22 months)5/3/03-just shy of 35 weeks: Class 1 HELLP

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