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Browsing by Author "Hall, James A."
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Item Characteristics Associated with Confidential Consultation for Adolescents in Primary Care(Elsevier, 2018-08) Gilbert, Amy Lewis; McCord, Allison L.; Ouyang, Fangqian; Etter, Dillon J.; Williams, Rebekah L.; Hall, James A.; Tu, Wanzhu; Downs, Stephen M.; Aalsma, Matthew C.; Pediatrics, School of MedicineOBJECTIVE: To examine how provider report of confidential consultation in the electronic health record is associated with adolescent characteristics, health risk factors, and provider training. STUDY DESIGN: This prospective cohort study was conducted as part of a larger study implementing computerized clinical decision support in 2 urban primary care clinics. Adolescents used tablets to complete screening questions for specified risk factors in the waiting room. Adolescent-reported risk factors included sexual activity, substance use, and depressive symptoms. Providers were prompted on encounter forms to address identified risk factors and indicate whether confidential consultation was provided. Provider types included adolescent medicine board certified pediatrics and general pediatrics. Differences in proportions of adolescents reporting risk factors by provider type were assessed using χ2 tests. Associations between adolescent characteristics, risk factors, and provider-reported confidential consultation were examined using logistic regression analyses. RESULTS: The sample included 1233 English and Spanish-speaking adolescents 12-20 years of age (52% female; 60% black; 50% early adolescent). Patients seen by adolescent medicine board certified providers reported sexual activity, depressive symptoms, and substance use significantly more often than those seen by general pediatric providers. Among patients seen by board certified adolescent medicine providers, confidential consultation was provided to 90%. For those seen by general pediatric providers, confidential consultation was provided to 53%. Results of multiple logistic regression demonstrated that female sex, later adolescence, and clinic location were significantly associated with confidential consultation. CONCLUSIONS: Provider training is needed to reinforce the importance of confidential consultation for all adolescents.Item New approaches to research with vulnerable populations - interdisciplinary application of a framework for vulnerability and adolescent capacity to consent(2015-10-16) McGregor, Kyle A.; Hall, James A.; Bennett, Larry W.; Wilkerson, David A.; Ott, Mary A.Children's and adolescents' capacity to provide valid informed consent is one of the key ethical concerns in pediatric research, and the focus of this project. The original contribution to knowledge is the advancement of both conceptual and empirical bioethical approaches to research with vulnerable populations. First, a review of adolescent vulnerability is presented to highlight the complex interplay between capacity and other forms of vulnerability. This review is offered as an interdisciplinary analysis to better understand why the study of vulnerable populations is critical to the ethical advancement of clinical research. Results from this analysis suggest the need for enhanced screening techniques as well as the utilization of specialized staff to identify and reduce the impact of different forms of vulnerability. The primary tasks of the empirical portion of the dissertation were to: (1) Adapt a validated adult competency assessment tool for clinical research, the MacArthur Competency Assessment Tool for Clinical Research, to assess the capacity of children and adolescents to consent to clinical research; (2) Identify predictors that impact children and adolescents’ capacity to provide consent to clinical research; and (3) assess differences and similarities in capacity between healthy and chronically ill children and adolescents. Overall results suggest adolescent capacity to consent to research was similar to adults, and most strongly associated with their family's socioeconomic status as well as their level of health literacy. These findings contrast starkly with the age-based criterion for providing consent currently utilized in assent and consent determinations. These findings also provide insights into ways to ethically involve youth in complex biomedical research.Item Physician Intervention to Positive Depression Screens Among Adolescents in Primary Care(Elsevier, 2018-02) Aalsma, Matthew C.; Zerr, Ashley M.; Etter, Dillon J.; Ouyang, Fangqian; Gilbert, Amy Lewis; Williams, Rebekah L.; Hall, James A.; Downs, Stephen M.; Pediatrics, School of MedicinePurpose The objective of this study was to determine the effectiveness of computer-based screening and physician feedback to guide adolescent depression management within primary care. Methods We conducted a prospective cohort study within two clinics of the computer-based depression screening and physician feedback algorithm among youth aged 12–20 years between October 2014 and October 2015 in Marion County (Indianapolis), Indiana. Results Our sample included 2,038 youth (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Over 20% of youth screened positive for depression on the Patient Health Questionnaire-2 and 303 youth (14.8%) screened positive on the Patient Health Questionnaire-9 (PHQ-9). The most common follow-up action by physicians was a referral to mental health services (34.2% mild, 46.8% moderate, and 72.2% severe range). Almost 11% of youth in the moderate range and 22.7% of youth in the severe range were already prescribed a selective serotonin reuptake inhibitor. When predicting mental health service referral, significant predictors in the multivariate analysis included clinic site (40.2% vs. 73.9%; p < .0001) and PHQ-9 score (severe range 77.8% vs. mild range 47.5%; p < .01). Similarly, when predicting initiation of selective serotonin reuptake inhibitors, only clinic site (28.6% vs. 6.9%; p < .01) and PHQ-9 score (severe range 46.7% vs. moderate range 10.6%; p < .001) were significant. Conclusions When a computer-based decision support system algorithm focused on adolescent depression was implemented in two primary care clinics, a majority of physicians utilized screening results to guide clinical care.Item Placement Decisions Impact On Youth Well-Being In The Foster Care Setting(Journal of Adolescent Health, 2019-02-01) Imburgia, Teresa M.; Armstrong-Richardson, Eprise; Hensel, Devon J.; Hall, James A.Item SCAFFOLDING IN INTERPROFESSIONAL EDUCATION: IMPLICATIONS FOR SOCIAL WORK EDUCATION(2015-09-30) Anderson, Jennifer June; Adamek, Margaret E.; Chonody, Jill M.; Hall, James A.; Rouse, Susan M.; Szarleta, Ellen J.Medical errors due to failure to communicate and collaborate are one of the top causes of death in the United States. Interprofessional education (IPE) is an integrated instructional approach where various health care disciplines create opportunities for students to learn together in order to function as cohesive, effective, and collaborative interprofessional teams. Successful IPE program design is a multi-faceted challenge, especially for social work educators in light of the changes in EPAS 2015. Academic institutions are being encouraged to offer IPE programs; faculty members are then charged with developing IPE programs for their institutions. IPE program design could generate a multitude of advantages for students, faculty, academic programs, professions, university partners, and communities—provided the approach is systematic and inclusive. This prospectus will explore IPE program design in field settings for social work faculty as a scaffold design, which targets proactive understanding of resources and applications. The prospectus will explore three interrelated special considerations: 1) the connections between IPE and social work education; 2) the learning needs (learning styles and fear of negative evaluation) of students most likely to be invited to participate in an IPE program; and 3) the needs of field instructors and needs of social work students in relation to their field experience. Social work faculty as program developers new to IPE will gain insights from this work and be better able to concurrently layer educational outcomes with professional gains, while initiating opportunities for interprofessional collaborative practice skill-building in field settings—ultimately enhancing health outcomes.Item A Social Work Perspective on Paediatric and Adolescent Research Vulnerability(Whiting and Birch, 2016) McGregor, Kyle A.; Hall, James A.; Wilkerson, David A.; Bennett, Larry W.; Ott, Mary A.; Pediatrics, School of MedicineChildren’s and adolescents’ capacity to provide valid informed consent is one of the key ethical concerns in pediatric research. This review of adolescent vulnerability is presented to highlight the complex interplay between capacity and other forms of vulnerability. This review is offered as an interdisciplinary analysis to better understand why the study of vulnerable populations is critical to the ethical advancement of clinical research. Results from this analysis suggest the need for enhanced screening techniques as well as the utilization of specialized staff to identify and reduce the impact of different forms of vulnerability. These findings also provide insights into ways to ethically involve youth in complex biomedical research.Item Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents(Elsevier, 2018-02) Etter, Dillon J.; McCord, Allison; Ouyang, Fangqian; Gilbert, Amy Lewis; Williams, Rebekah L.; Hall, James A.; Tu, Wanzhu; Downs, Stephen M.; Aalsma, Matthew C.; Pediatrics, School of MedicinePurpose The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. Predictors of patient endorsement of suicidality and provider documentation of follow-up were examined. Methods A prospective cohort study was conducted to examine the implementation of a CDSS that screened adolescent patients for suicidality and provided follow-up recommendations to providers. The intervention was implemented for patients aged 12–20 years in two primary care clinics in Indianapolis, Indiana. Results The sample included 2,134 adolescent patients (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Just over 6% of patients screened positive for suicidality. A positive endorsement of suicidality was more common among patients who were female, depressed, and seen by an adolescent−medicine board-certified provider as opposed to general pediatric provider. Providers documented follow-up action for 83% of patients who screened positive for suicidality. Documentation of follow-up action was correlated with clinic site and Hispanic race. The majority of patients who endorsed suicidality (71%) were deemed not actively suicidal after assessment by their provider. Conclusions Incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care is feasible and well utilized by providers. Female gender and depressive symptoms are consistently associated with suicidality among adolescents, although not all suicidal adolescents are depressed. Universal use of a multi-item suicide screener that assesses recency might more effectively identify suicidal adolescents.Item Using Marion County, Indiana coroner records and deputy field officer reports to understand heroin and prescription painkiller overdoses(2017-08-08) Willis, Aaron Carl; Lay, Kathy; Zimet, Gregory Z.; Adamek, Margaret E.; Hall, James A.; Hensel, Devon J.Deaths due to prescription painkillers and heroin have quickly become national, state, and local public health concerns. Studies using data from Medical Examiners or Coroner Offices throughout the United States have been conducted and are contributing to the understanding of this epidemic. However, the analysis of these fatalities are specific to the communities where the study was conducted and cannot be assumed that the decedents in one community are similar to decedents in another community. Many local governments and agencies throughout the U.S. are aware that this problem exists in their communities, but are not prepared to adequately respond to and intervene in these fatalities as an analysis of those who have died has rarely been conducted. This dissertation is a replication study of longitudinal epidemiological analyses of opiate related fatalities that was implemented in a location where an analysis of opiate-related fatalities had not been conducted, Marion County, Indiana. The purpose of the dissertation was twofold: (1) to describe the demographic characteristics of the decedents using publicly available data from the Marion County Coroner’s Office to be used in informing future preventative efforts to decrease opiate-related fatalities in Marion County and (2) to inform other communities on how to conduct a similar analysis in their own community. This dissertation describes the methods of the replication study, provides descriptive results of the people who died from opiate-related overdoses, and: (a) Report the types of opiates identified in blood toxicology reports and (b) Present the histories of opiate-related decedents as reported in the Deputy Coroner Field Officer’s Reports (DCFOR). Additionally, analysis was conducted to determine if decedent characteristics deferred depending on the type of opiate fatality based on the toxicology in 1) heroin alone, 2) painkillers alone, and 3) heroin and painkillers combined.