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Kelly J Kelleher - One of the best experts on this subject based on the ideXlab platform.
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Primary Care Clinicians' Use of Standardized Tools to Assess Child Psychosocial Problems
Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association, 2003Co-Authors: William Gardner, Kelly J Kelleher, Kathleen Pajer, John V. CampoAbstract:Background and Objectives.—Children's Psychosocial Problems are prevalent but often inaccurately diagnosed. This study investigated primary care clinicians' (PCCs) use of standardized tools for Psychosocial Problems among children in whom they reported finding a Problem. Methods.—The data consisted of 21 065 unique visits by children ages 4 to 15 years in 204 practices. Parents completed questionnaires before seeing the PCCs, who completed a survey after the visit. This analysis included 3934 children who were recognized by PCCs as having one or more Psychosocial Problems. The primary outcome was the PCCs' usage of a tool to assess child Psychosocial Problems. Results.—PCCs used a tool in 20.2% of visits where a Psychosocial Problem was recognized, whereas 50% of PCCs never used such tools. Tools were less likely to be used by female PCCs and family practitioners and were less likely to be used with girls and African American children. Tools were more frequently used with children with attention Problems, during visits for Psychosocial Problems, and when the PCC knew about the Problem before the visits. Conclusions.—PCCs use standardized tools infrequently to screen for, confirm, or monitor Psychosocial Problems.
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primary care referral of children with Psychosocial Problems
JAMA Pediatrics, 2002Co-Authors: Jerry L Rushton, David Bruckman, Kelly J KelleherAbstract:Objectives To examine primary care provider referral patterns for patients with Psychosocial Problems and to understand the factors that influence whether a mental health referral is made. Design Secondary analysis of the Child Behavior Study data collected during 1994-1997 from background survey of providers, visit survey of providers and parents, and follow-up survey of parents. Setting Two hundred six primary care offices in the United States, Canada, and Puerto Rico. Patients Four thousand twelve of 21 150 patients aged 4 to 15 years in the Child Behavior Study with a clinician-identified Psychosocial Problem. Main Outcome Measures Referral for Psychosocial Problem at index visit and reported follow-up with mental health care provider within 6 months. Results Six hundred fifty (16%) of 4012 patients with Psychosocial Problems were referred at the initial visit. In multivariate analysis, significant factors associated with likelihood of referral included patient factors (severity, type of Problem, academic difficulties, prior mental health service use) and family factors (mental health referral of parent); however, none of the provider factors were significant. Clinicians reported frequent barriers to referral and mental health services in the general background survey; however, these factors were rarely reported as influences on individual management decisions. Only 61% of referred families reported that their child saw a mental health care provider in the 6-month period after the initial primary care referral. Conclusions Most Psychosocial Problems are initially managed in primary care without referral. However, referral is an important component of care for patients with severe Problems, and many families are not effectively engaged in mental health services, even after a referral is made.
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Uninsured Children With Psychosocial Problems: Primary Care Management
Pediatrics, 2000Co-Authors: T K Mcinerny, Richard C. Wasserman, George E. Childs, P G Szilagyi, Kelly J KelleherAbstract:Objective. Nearly 14% of children in the United States are uninsured. We compared the prevalence of Psychosocial Problems and mental health services received by insured and uninsured children in primary care practices. Methods. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician. Results. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of Psychosocial Problems (19%) and severe Psychosocial Problems (2%). For children with a clinician-identified Psychosocial Problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Conclusions. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified Psychosocial and mental health Problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.Psychosocial Problems, uninsured children, pediatrics, family medicine, primary care.
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Uninsured children with Psychosocial Problems: primary care management.
Pediatrics, 2000Co-Authors: T K Mcinerny, G. E. Childs, P G Szilagyi, R C Wasserman, Kelly J KelleherAbstract:Nearly 14% of children in the United States are uninsured. We compared the prevalence of Psychosocial Problems and mental health services received by insured and uninsured children in primary care practices. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4-15 years old) per clinician. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6. 6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of Psychosocial Problems (19%) and severe Psychosocial Problems (2%). For children with a clinician-identified Psychosocial Problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified Psychosocial and mental health Problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children. Psychosocial Problems, uninsured children, pediatrics, family medicine, primary care.
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In-Office Primary Care Management of Child Psychosocial Problems • 58
Pediatric Research, 1998Co-Authors: Kelly J Kelleher, William Gardner, George E. Childs, Richard C. Wasserman, Paul A. Nutting, Kathryn RostAbstract:To examine the primary care management of child Psychosocial Problems and the patient, provider and insurance correlates of management. Questionnaires were completed by 401 clinicians from 44 states, Puerto Rico, and 4 Canadian provinces from two primary care research networks and by families of consecutive children aged 4-15 years presenting for non-emergent care. For children identified with a Psychosocial Problem, clinicians described interventions including drug prescriptions, counseling in the office and visit disposition. Treatment choices were modeled both independently and simultaneously. Complete data on 21,151 visits were analyzed. 19.0% (n=4,012) were identified by clinicians with a Psychosocial Problem. Among these, 24% received no medications, counseling or followup visits (41% of these were already in specialty mental health services). Of children with Psychosocial Problems, 10% were scheduled for an additional visit to address the Problem, but received no other interventions. The remaining children with Psychosocial Problems received counseling only (22%), a psychotropic prescription only(29%), or both (15%). Children with commercial (vs public or no) insurance, younger females and those children seen for parental Psychosocial concerns were more likely to receive counseling. Children were more likely to receive psychotropic medications if older, male, severe, or visited during the school year. Receipt of specialty services and visits for acute or chronic medical Problems were associated with lower rates of drug prescriptions. When modeled simultaneously, clinician identification of attentional and hyperactivity Problems was the best predictor of clinician intervention. Psychosocial Problems are commonly managed in primary care. Counseling and/or psychotropic drugs are provided to 2/3 of all identified patients, but considerable variation exists in management. Development of guidelines or protocols for management for these common and high cost Problems should be a priority.
Yaochung Chuang - One of the best experts on this subject based on the ideXlab platform.
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massively multiplayer online role playing game induced seizures aneglected health Problem in internet addiction
Cyberpsychology Behavior and Social Networking, 2006Co-Authors: Yaochung ChuangAbstract:As the Internet has become rapidly and widely integrated into society, Internet addiction has become a growing Psychosocial Problem. However, epileptic seizure, another out-of-the-ordinary health Problem, is often neglected in this regard. Ten patients who experienced epileptic seizures while playing the newest genre of electronic games—Massively Multiplayer Online Role-Playing Games (MMORPGs)—were investigated. Patients were predominantly male young adults, and most of the events were generalized tonic-clonic seizures, myoclonic seizures, and absences. These patients should be categorized into idiopathic generalized epilepsies. Even though photosensitivity was an important factor, behavioral and higher mental activities also seemed to be significant seizure precipitants. Results demonstrated that MMORPG-induced seizures were not analogous to the ordinary video game–induced seizures. Significantly, an epileptic seizure warning did not always appear on the websites of MMORPGs and instructions for the softw...
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massively multiplayer online role playing game induced seizures a neglected health Problem in internet addiction
Cyberpsychology Behavior and Social Networking, 2006Co-Authors: Yaochung ChuangAbstract:As the Internet has become rapidly and widely integrated into society, Internet addiction has become a growing Psychosocial Problem. However, epileptic seizure, another out-of-the-ordinary health Problem, is often neglected in this regard. Ten patients who experienced epileptic seizures while playing the newest genre of electronic games—Massively Multiplayer Online Role-Playing Games (MMORPGs)—were investigated. Patients were predominantly male young adults, and most of the events were generalized tonic-clonic seizures, myoclonic seizures, and absences. These patients should be categorized into idiopathic generalized epilepsies. Even though photosensitivity was an important factor, behavioral and higher mental activities also seemed to be significant seizure precipitants. Results demonstrated that MMORPG-induced seizures were not analogous to the ordinary video game–induced seizures. Significantly, an epileptic seizure warning did not always appear on the websites of MMORPGs and instructions for the softw...
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massively multiplayer online role playing game induced seizures aneglected health Problem in internet addiction
Cyberpsychology Behavior and Social Networking, 2006Co-Authors: Yaochung ChuangAbstract:As the Internet has become rapidly and widely integrated into society, Internet addiction has become a growing Psychosocial Problem. However, epileptic seizure, another out-of-the-ordinary health Problem, is often neglected in this regard. Ten patients who experienced epileptic seizures while playing the newest genre of electronic games—Massively Multiplayer Online Role-Playing Games (MMORPGs)—were investigated. Patients were predominantly male young adults, and most of the events were generalized tonic-clonic seizures, myoclonic seizures, and absences. These patients should be categorized into idiopathic generalized epilepsies. Even though photosensitivity was an important factor, behavioral and higher mental activities also seemed to be significant seizure precipitants. Results demonstrated that MMORPG-induced seizures were not analogous to the ordinary video game–induced seizures. Significantly, an epileptic seizure warning did not always appear on the websites of MMORPGs and instructions for the softw...
T K Mcinerny - One of the best experts on this subject based on the ideXlab platform.
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Uninsured Children With Psychosocial Problems: Primary Care Management
Pediatrics, 2000Co-Authors: T K Mcinerny, Richard C. Wasserman, George E. Childs, P G Szilagyi, Kelly J KelleherAbstract:Objective. Nearly 14% of children in the United States are uninsured. We compared the prevalence of Psychosocial Problems and mental health services received by insured and uninsured children in primary care practices. Methods. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician. Results. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of Psychosocial Problems (19%) and severe Psychosocial Problems (2%). For children with a clinician-identified Psychosocial Problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Conclusions. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified Psychosocial and mental health Problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.Psychosocial Problems, uninsured children, pediatrics, family medicine, primary care.
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Uninsured children with Psychosocial Problems: primary care management.
Pediatrics, 2000Co-Authors: T K Mcinerny, G. E. Childs, P G Szilagyi, R C Wasserman, Kelly J KelleherAbstract:Nearly 14% of children in the United States are uninsured. We compared the prevalence of Psychosocial Problems and mental health services received by insured and uninsured children in primary care practices. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4-15 years old) per clinician. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6. 6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of Psychosocial Problems (19%) and severe Psychosocial Problems (2%). For children with a clinician-identified Psychosocial Problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified Psychosocial and mental health Problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children. Psychosocial Problems, uninsured children, pediatrics, family medicine, primary care.
P G Szilagyi - One of the best experts on this subject based on the ideXlab platform.
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Uninsured Children With Psychosocial Problems: Primary Care Management
Pediatrics, 2000Co-Authors: T K Mcinerny, Richard C. Wasserman, George E. Childs, P G Szilagyi, Kelly J KelleherAbstract:Objective. Nearly 14% of children in the United States are uninsured. We compared the prevalence of Psychosocial Problems and mental health services received by insured and uninsured children in primary care practices. Methods. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician. Results. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of Psychosocial Problems (19%) and severe Psychosocial Problems (2%). For children with a clinician-identified Psychosocial Problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Conclusions. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified Psychosocial and mental health Problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.Psychosocial Problems, uninsured children, pediatrics, family medicine, primary care.
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Uninsured children with Psychosocial Problems: primary care management.
Pediatrics, 2000Co-Authors: T K Mcinerny, G. E. Childs, P G Szilagyi, R C Wasserman, Kelly J KelleherAbstract:Nearly 14% of children in the United States are uninsured. We compared the prevalence of Psychosocial Problems and mental health services received by insured and uninsured children in primary care practices. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4-15 years old) per clinician. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6. 6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of Psychosocial Problems (19%) and severe Psychosocial Problems (2%). For children with a clinician-identified Psychosocial Problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified Psychosocial and mental health Problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children. Psychosocial Problems, uninsured children, pediatrics, family medicine, primary care.
Richard C. Wasserman - One of the best experts on this subject based on the ideXlab platform.
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Uninsured Children With Psychosocial Problems: Primary Care Management
Pediatrics, 2000Co-Authors: T K Mcinerny, Richard C. Wasserman, George E. Childs, P G Szilagyi, Kelly J KelleherAbstract:Objective. Nearly 14% of children in the United States are uninsured. We compared the prevalence of Psychosocial Problems and mental health services received by insured and uninsured children in primary care practices. Methods. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician. Results. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of Psychosocial Problems (19%) and severe Psychosocial Problems (2%). For children with a clinician-identified Psychosocial Problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Conclusions. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified Psychosocial and mental health Problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.Psychosocial Problems, uninsured children, pediatrics, family medicine, primary care.
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In-Office Primary Care Management of Child Psychosocial Problems • 58
Pediatric Research, 1998Co-Authors: Kelly J Kelleher, William Gardner, George E. Childs, Richard C. Wasserman, Paul A. Nutting, Kathryn RostAbstract:To examine the primary care management of child Psychosocial Problems and the patient, provider and insurance correlates of management. Questionnaires were completed by 401 clinicians from 44 states, Puerto Rico, and 4 Canadian provinces from two primary care research networks and by families of consecutive children aged 4-15 years presenting for non-emergent care. For children identified with a Psychosocial Problem, clinicians described interventions including drug prescriptions, counseling in the office and visit disposition. Treatment choices were modeled both independently and simultaneously. Complete data on 21,151 visits were analyzed. 19.0% (n=4,012) were identified by clinicians with a Psychosocial Problem. Among these, 24% received no medications, counseling or followup visits (41% of these were already in specialty mental health services). Of children with Psychosocial Problems, 10% were scheduled for an additional visit to address the Problem, but received no other interventions. The remaining children with Psychosocial Problems received counseling only (22%), a psychotropic prescription only(29%), or both (15%). Children with commercial (vs public or no) insurance, younger females and those children seen for parental Psychosocial concerns were more likely to receive counseling. Children were more likely to receive psychotropic medications if older, male, severe, or visited during the school year. Receipt of specialty services and visits for acute or chronic medical Problems were associated with lower rates of drug prescriptions. When modeled simultaneously, clinician identification of attentional and hyperactivity Problems was the best predictor of clinician intervention. Psychosocial Problems are commonly managed in primary care. Counseling and/or psychotropic drugs are provided to 2/3 of all identified patients, but considerable variation exists in management. Development of guidelines or protocols for management for these common and high cost Problems should be a priority.