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A Closer Look: Examination of Suicide Risk Screening Results and Outcomes for Minoritized Youth in Subspecialty Pediatrics

Lois, Becky H; Mournet, Annabelle M; Menz, Reagan; King, Mya; Malizia, Rebecca; Haines, Elizabeth; Coble-Sadaphal, Chanelle; Liaw, K Ron-Li
OBJECTIVE:To describe a sample of minoritized youth who screened positive for suicide risk within medical subspecialty pediatrics, compared to non-minoritized youth and describe the screening outcomes of these youth. METHODS:This retrospective chart review from October 2018 to April 2021 used electronic medical record data from an academic pediatric medical subspecialty clinic that screens universally for suicide risk for all patients ages 9 and up. Chart reviews were conducted for 237 minoritized youth (operationalized as identifying as non-White or Hispanic/Latinx, identifying as a gender minority, and having a preferred language other than English) who screened positive for suicide risk. Descriptive statistics include need for escalation to an emergency room, connection to mental health care, receival of a mental health referral, and attendance at follow-up visits. RESULTS:Minoritized youth were more likely to screen positive and report a history of suicide attempt when compared to non-minoritized peers. Youth identifying as gender expansive had significant elevation in suicide risk. The majority of youth in this sample were already connected to mental health care, with youth preferring a language other than English being the least likely to be connected. CONCLUSIONS:Findings indicate heightened suicide risk for minoritized youth, with gender expansive youth having particularly elevated suicide risk. A need to support youth with a preferred language other than English in getting connected to mental health care was also revealed.
PMID: 35597439
ISSN: 1876-2867
CID: 5247752

Holding Space for Facilitated Dialogues on Antiracism in Academic Medicine [Letter]

Reliford, Aaron; Berry, Obianuju O; Burgos, Junior Javier; Liaw, K Ron-Li
The year 2020 brought unprecedented challenges and renewed focus on racial disparities and inequities in the United States. For racial and ethnic minority groups, and in particular African Americans, racial disparities have been a constant presence and threat from the time of slavery through the present day. These racial disparities, sanctioned and maintained by institutional racism, manifest in all aspects of life for African Americans-segregated and unequal education and housing systems, health and mental health care disparities, disproportionally elevated incarceration rates, and, as painfully highlighted this past year, continued vulnerability to acts of violence at the hands of law enforcement. In addition, most recently, there has been a renewed focus on the increased suicide rate for Black youth and its relationship to these racial disparities.1 In a large urban environment, our academic Child Psychiatry Department recognized that progress toward addressing racial disparities would be impeded without raising awareness and taking individual and collective action to identify implicit bias, power, and privilege differentials, and systemic racism inherent within academic medicine and our own lived experiences. This letter describes the development of such examination through facilitated dialogues on race and antiracism in our department.
PMID: 35364252
ISSN: 1527-5418
CID: 5206102

Integrating Suicide Risk Screening into Pediatric Ambulatory Subspecialty Care

Lois, Becky H; Urban, Tamaki H; Wong, Christina; Collins, Erin; Brodzinsky, Lara; Harris, Mary Ann; Adkisson, Hayley; Armstrong, Monique; Pontieri, Jeanmarie; Delgado, Diana; Levine, Jeremiah; Liaw, K Ron-Li
Background/UNASSIGNED:Suicide risk screening is recommended in pediatric care. To date, no previous studies illustrate the implementation of suicide risk screening in pediatric subspecialty care, even though chronic medical conditions are associated with a higher risk of suicide. Methods/UNASSIGNED:A large multidivision pediatric ambulatory clinic implemented annual suicide risk screening. Patients ages 9-21 years participated in suicide risk screening using the Ask Suicide-Screening Questions during the project. A multidisciplinary team employed quality improvement methods and survey-research design methods to evaluate the feasibility and acceptability of the screening process for patients, families, and medical providers. Results/UNASSIGNED:During the quality improvement project period, 1,934 patients were offered screening; 1,301 (67.3%) patients completed screening; 82 patients (6.3% of 1,301 patients) screened positive. The monthly compliance rate held steady at 86% following several Plan-Do-Study-Act cycles of improvement. The survey results demonstrate that providers rated the suicide risk screening process positively; however, a subset of providers indicated that the screening process was out of their scope of practice or impeded their workflow. Conclusions/UNASSIGNED:Suicide risk screening is feasible in pediatric specialty care and can identify at-risk patients. Continued efforts are needed to standardize suicide risk screening practices. Future directions include identifying factors associated with suicide risk in patients in pediatric subspecialty care settings.
PMCID:7297392
PMID: 32656472
ISSN: 2472-0054
CID: 5069922

Development of a Virtual Consultation-Liaison Psychiatry Service: A Multifaceted Transformation

Caravella, Rachel A.; Deutch, Allison B.; Noulas, Paraskevi; Ying, Patrick; Liaw, K. Ron-Li; Greenblatt, Jeanne; Collins, Kelsey; Eastburn, H. K.; Fries, Emily; Khan, Shabana; Kozikowski, Adam; Sidelnik, S. Alex; Yee, Michael; Ginsberg, David
ISI:000565745900003
ISSN: 0048-5713
CID: 4799202

Co-designed PICU Family Stress Screening and Response System to Improve Experience, Quality, and Safety

Liaw, K Ron-Li; Cho, Jeanne; Devins, Lea; Daly, Jennifer; Sklenar, Dennis; Al-Qaqaa, Yasir
Objective/UNASSIGNED:Evidence for successful and sustainable models that systematically identify and address family stress in the pediatric intensive care unit (PICU) remains scarce. Using an integrated improvement science and family engagement framework, we implemented a standardized family stress screening tool and response protocol to improve family experience and reduce family crises through the timely coordination of parent support interventions. Methods/UNASSIGNED:We conducted this improvement initiative in the 12-bed PICU of a children's hospital within a large, urban academic medical center. Our team, which included 2 family advisors, adapted a validated Distress Thermometer for use in pediatric intensive care. A co-designed family stress screening tool and response protocol were iteratively tested, refined, and implemented in 2015-2017. Process and outcome measures included screening and response reliability, parent satisfaction, and security calls for distressed families. Results/UNASSIGNED:< 0.01; 95% CI). The number of security calls for distressed families decreased by 50%. Conclusions/UNASSIGNED:The successful implementation of a co-designed family stress screening tool and response protocol led to the timely coordination of parent support interventions, the improved family perception of emotional support, and reduced family crises in the PICU.
PMCID:6494229
PMID: 31321362
ISSN: 2472-0054
CID: 3978052

Not by convention: Working with people on the sexual and gender continuum

Chapter by: Wernick, Jeremy; Liaw, K; Janssen, A; Busa, S
in: The Massachusetts General Hospital textbook on diversity and cultural sensitivity in mental health by Parekh, Ranna (Ed)
New York : Humana Press, 2019
pp. 229-252
ISBN:
CID: 4044492

Integrating care across the specialty pediatric continuum: Outcomes-driven engagement of families and teams [Meeting Abstract]

Brahmbhatt, K; Liaw, K R -L; Maslow, G
Objectives: We aim to present four integrated care models across the continuum of care in subspecialty pediatrics. We will share case examples and pilot data of clinical programs that incorporate unique and shared elements. Methods: A brief review of the need for integrated care within subspecialty pediatrics will be conducted followed by an overview of a multidisciplinary program for enhancing resilience in children dealing with the stress of medical illness in inpatient settings. We will discuss a quality improvement initiative that systematically assesses family stress and coordinates matched interventions within pediatric intensive care. Systematic screening in outpatient settings will be discussed by the next two presenters who will describe assessment of family stress, quality of life, and mental health in patients with medical illnesses, such as cystic fibrosis and epilepsy, amongst others. Finally, our discussant will review the opportunities and challenges in program implementation and evaluation. Results: Mounting evidence suggests that chronic illness management and hospitalizations can have significant psychological and health repercussions for both children and their family caregivers. Evidence-based models of pediatric specialty care for the systematic identification of stress and risk, as well as the deployment of coordinated, matched supports, remain scant. Integrated family-engaged care refers broadly to models of care in which multidisciplinary teams work in partnership with youth and families to plan, deliver, manage, and continuously improve the integration of health and behavioral health services, systems, and outcomes. New York University and the University of California, San Francisco have implemented four models for increasing integration and family engagement across the pediatric specialty care continuum. Key drivers of success and challenges in implementation have been analyzed through in-depth case studies. Teams evaluated both process and outcomes measures, such as treatment engagement, family stress/coping, and healthcare utilization. Conclusions: Outcome-driven engagement of families and teams toward greater levels of integration has the potential to both improve the lives of youth and families we serve and help transform our health care system toward the quadruple aim of better culture, better health, and better care at lower costs
EMBASE:620080365
ISSN: 1527-5418
CID: 2924332

Integrated family stress screening and response in pediatric intensive care [Meeting Abstract]

Liaw, K R -L
Objectives: The hospitalization of a child can precipitate significant stress among caregivers and impact the long term health of both the child and family caregivers. Given a lack of evidence-based inpatient models for systematically identifying and addressing family stress, a Hassenfeld Children's Hospital interdisciplinary quality improvement team aimed to co-design, test, and implement the use of a co-designed family stress screening and response system. Methods: The improvement initiative was conducted in the pediatric intensive care unit (PICU) of an embedded children's hospital within a large, urban academic medical center. The interdisciplinary improvement team was led by a child psychiatrist with improvement science and family engagement expertise and included PICU nursing leaders and champions, critical care physicians, psychosocial team representatives, and two family advisors who are parents with PICU experience. The improvement team co-designed the following: 1) a family stress screening tool adapted from a research-validated distress thermometer and 2) a standardized yet individualized family-centered response protocol. Results: The percentage of PICU families screened for stress increased from 0 to 96 percent over a 12-month period. Stress scores ranged from 0 to 10 ("no stress" to "high stress"). Of the 361 families screened, 53 percent rated their stress as five or greater, which was categorized as a positive screen and activated a matched response protocol. Top stressors included their child's medical condition (69% of families) and their child's level of comfort and well-being (55%). Other top stressors included caring for other children in the home (55%), issues with a partner/spouse (35%), and work problems (36%). Forty-nine percent of families reported problems with fatigue, and 84 percent of families reported feeling worried and anxious. The stress thermometer identified several "near misses," including parents with postpartum depression and safety concerns in the home, allowing for improved discharge planning and facilitation of ongoing community-based support. Conclusions: The successful implementation of a co-designed family stress screening tool and matched response protocol has improved the timely deployment and coordination of support services and demonstrated reductions in family stress with potential for generalizability across the pediatric care continuum
EMBASE:620079395
ISSN: 1527-5418
CID: 2924272

Paving their own paths : what kids & teens can teach us about sexual and gender identity

Chapter by: Janssen, Aron; Glaeser, Elizabeth; Liaw, K
in: Cultural Sensitivity in Child and Adolescent Mental Health by Parekh, Ranna; Gorrindo, Tristan; Rubin, David
[Boston MA] : Massachusetts General Hospital Psychiatry Academy, 2016
pp. ?-?
ISBN: 0985531878
CID: 2914652

Not by Convention: Working with People on the Sexual & Gender Continuum

Chapter by: Liaw, Karen Ron-Li; Janssen, Aron
in: The Massachusetts General Hospital textbook on diversity and cultural sensitivity in mental health by Parekh, Ranna [Eds]
New York, NY : Springer New York, 2014
pp. 89-117
ISBN: 9781461489177
CID: 846252