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Introduction
Current institution
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August 2008 - June 2011
Education
August 2006 - August 2011
Publications
Publications (100)
Health care transition from pediatric to adult medical care for individuals with diabetes is a challenging endeavor during a developmental period of emerging adulthood. In this study, the psychometric properties of a diabetes-specific transition readiness assessment tool, READDY 1.1, were evaluated through confirmatory factor analysis of two datase...
There is a lack of evidence-based programs to support the prevention of child behavior problems designed specifically for foster and kinship caregivers from historically minoritized groups. Drawing on existing best-practice recommendations for tailoring interventions to new cultural and social contexts, this study evaluates initial evidence of the...
INTRODUCTION
Many pediatricians use question-based substance use screening to detect substance use and prevent substance use disorder (SUD).1,2 Despite availability,3 implementing standardized, universal question-based substance use screening with adolescents is low,4 hindering prevention in healthcare2,3 and increasing risk for inequity and bias d...
Background
Children in foster care who are newly placed with licensed or kinship caregivers are often vulnerable to increased behavior problems associated with trauma and social disruptions. When those issues are not addressed, children are susceptible to placement disruptions that exacerbate behavior problems. Few preventive interventions are avai...
OBJECTIVES/GOALS: The goal of theIntegrating Special Populations (ISP) Studiosis tointegrate communityvoice into research design and en hance diversity, equity, and inclusion in research, and disseminate findings in ways that improve health literacy and equity. METHODS/STUDY POPULATION: Based on the Vanderbilt Community Engagement Studio model, the...
In 2023, the incoming Editors of the Journal of Pediatric Psychology (JPP) and Clinical Practice in Pediatric Psychology (CPPP), Drs. Avani Modi and Christina Duncan, respectively, both identified enhancing reporting practices for diversity, equity, and inclusion (DEI) in pediatric psychology as a top priority (Duncan, 2023; Modi, 2023). These effo...
Children exposed to maltreatment and foster care (i.e., out-of-home care) experience disproportionately high healthcare utilization; however, the etiology of these differences is unclear. Health status, healthcare access, maltreatment histories, risk behaviors, and out-of-home placement likely all contribute. This chapter reviews empirical studies...
Children of color—especially Black and Indigenous children—are disproportionately overrepresented in foster care and experience barriers in accessing services and receiving physical and behavioral healthcare compared to their White counterparts. Although racial disparities in mental health outcomes of children in foster care have been examined syst...
Between 2012 and 2017, N = 2814 youth between the ages of 4 and 20 were in child protective services (CPS) custody in Hamilton County, Ohio, and placed in out-of-home care. Child welfare administrative records were extracted and linked to electronic health records for all encounters at Cincinnati Children's Hospital Medical Center, with n = 2787 (9...
Objective
This study sought to examine how mental health diagnoses, health care utilization and foster care placement instability affect antipsychotic prescribing and how these factors may contribute to disproportionate antipsychotic prescribing among youth in foster care.
Methods
This retrospective cohort study utilized EHR data that were linked...
Children in foster care in the United States face unique challenges related to access to health and education services. With the COVID-19 pandemic, many of those services were temporarily disrupted, adding burden to an already strained system. This observational study describes the experiences of licensed and kinship caregivers (N = 186) during the...
Women previously in out‐of‐home care (i.e., foster care) experience poorer health and psychosocial outcomes compared to peers, including higher pregnancy rates and child protective services involvement. Home visiting programs could mitigate risks. Studies examining home visiting enrollment for women with a history of out‐of‐home care are needed. Wo...
Background
Children in foster care experience poor health and high healthcare use. Child welfare agencies frequently require healthcare visits when children enter foster care; subsequent placement changes also disrupt healthcare. Studies of healthcare use have not accounted for placement changes.
Objective
To understand patterns of healthcare use...
Children in foster care have higher healthcare costs and poor care coordination, often due to inconsistent information exchanged between healthcare and child welfare systems. This study implemented secure automated information sharing and detected improvements in time spent gathering information, healthcare services delivered, and billing practices...
Childhood maltreatment has been linked with chronic pain in adulthood, primarily through retrospective studies. Our ongoing longitudinal study in women with and without a history of documented childhood maltreatment (CM), the Female Adolescent Development Study (FADS), was leveraged to comprehensively and prospectively examine pain characteristics...
Objective:
The purpose of this study was to determine whether children with developmental disorders (DDs) in protective custody are more likely to experience specific placement types and stay in care longer than their typically developing peers. Furthermore, in the DD-only group, we examined whether the likelihood of each placement type differed b...
Objective:
Regular psychosocial assessment is a best-practice guideline for young adult oncology care, but multipurpose, multidimensional, developmentally appropriate patient-reported outcome measurement strategies for young adults with cancer are lacking. This study reported on the development and preliminary validation of the Young Adult Psychos...
There are multiple factors contributing to the poor health of children in protective custody, i.e. foster care, including a critical gap in information sharing. A hospital-driven solution was developed in collaboration with child welfare to facilitate automated information sharing between healthcare and child welfare organizations, resulting in a w...
Background
Emancipated foster youth frequently engage in behaviors that contribute to poor health. Whether health risk behaviors increase following emancipation or are established while in foster care remains unclear.
Objective
This secondary data analysis examined substance use and attitudes toward sexual risk behaviors to understand continuity i...
Background
Childhood sexual abuse (CSA) contributes to increased risk of substance use and mental health disorders in the general population.
Objective
To assess the prevalence and associations of CSA and suicide attempts, substance use, and mental health disorders as a function of sex (female, male) and sexual orientation (lesbian, gay, bisexual,...
Congress enacted the Adoption and Safe Families Act to improve outcomes concerning the permanency, safety, and wellbeing of children in the care of child welfare agencies. However, achieving its goals for the more than 700,000 children who spend time in the custody of child protective services (CPS) every year in the United States is made more diff...
There is an ongoing need to determine best practices for effective transition from pediatric to adult care for adolescents and emerging adults (EAs) with type 1 diabetes given the potential for poor health outcomes post-transfer. This study evaluated self-reported confidence ratings as measured by the Readiness of Emerging Adults with Diabetes Diag...
Substance use among adolescents and young adults (AYAs) is associated with an increased risk of poor physical and mental health outcomes. For AYA childhood cancer survivors (CCSs), substance use may also increase their likelihood of experiencing late effects. As a result, professional organizations recommend that AYA CCSs be regularly screened for...
Objective:
Youth who emancipate from the foster care system often experience poor outcomes during their transition into independent living (e.g., criminal justice involvement and homelessness). Yet, some youth are resilient and achieve positive outcomes. The purpose of this study is to review the resilience factors identified in the literature for...
Objective
Substance use screening in adolescence is unstandardized and often documented in clinical notes, rather than in structured electronic health records (EHRs). The objective of this study was to integrate logic rules with state-of-the-art natural language processing (NLP) and machine learning technologies to detect substance use information...
Objective:
To determine whether current protective custody status (i.e., youth currently in the temporary or permanent custody of child protective services, e.g., foster and kinship care) contributes to increased healthcare utilization compared to youth never in protective custody. Health characteristics (e.g., mental health diagnoses) and behavio...
Children in foster care are at high risk for developmental delay. In this retrospective cohort study of young children presenting to a foster care clinic, 77% were not receiving developmental services and 75% failed developmental screening. Of those potentially eligible, 60% were not referred for developmental services.
Objectives
Turner syndrome (TS) is a complex and chronic medical condition that requires lifelong subspecialty care. Effective transition preparation is needed for successful transfer from pediatric to adult care in order to avoid lapses in medical care, explore health issues such as fertility, and prepare caregivers as adolescents take over respon...
Numerous tutorial publications are available to researchers seeking the procedures needed to analyze longitudinal count response variable data. However, most of the available tutorial publications have drawbacks that limit their usefulness to applied researchers, and to the best of our knowledge, very few publications make both the sample data and...
BACKGROUND | Young adulthood is a vulnerable developmental period associated with increased risk for suboptimal health outcomes in youth with type 1 diabetes. Psychosocial factors have been associated with self-management and glycemic control in younger populations, but the extent to which these associations exist among young adults is poorly under...
Purpose:
As teens in foster care prepare for emancipation, health care navigation is often overlooked, as caseworkers address other social needs. This study examined the impact of health care education materials designed for foster youth, called ICare2CHECK. It was hypothesized that ICare2CHECK would increase nonurgent ambulatory health care use a...
A child maltreatment history is reported more frequently among adults with chronic pain compared to the general population; unfortunately, studies have primarily relied upon retrospective maltreatment reports by adults with chronic pain. This prospective study assessed pain symptoms in a cohort of young adult women with a documented history of chil...
There are ∼443 000 children in child protective custody (ie, foster care) in the United States. Children in protective custody have more medical, behavioral, and developmental problems that require health care services than the general population. These health problems are compounded by poor information exchange impeding care coordination. Health c...
Studying age‐related change in psychosocial behavior is difficult because manifestation differs with development. While the use of age‐appropriate measurement instruments addresses developmental differences, changes in measurement also challenge researchers’ ability to study developmental trajectories. Leveraging 8‐occasion data from 262 girls (bas...
Objective:
The study sought to develop the necessary elements for a personalized health record (PHR) for youth emancipating from child protective custody (eg, foster care) by collecting thoughts and ideas from current and former foster youth and community stakeholders who have a significant amount of experience working with emancipating young peop...
Background
Childhood adversity is linked to a number of adult health and psychosocial outcomes; however, it is not clear how to best assess and model childhood adversity reported by adolescents with known maltreatment exposure.
Objective
This study sought to identify an empirically-supported measurement model of childhood adversity for adolescents...
In the U.S., little is known about the neighborhoods where youth in out-of-home care live prior to emancipation. This study describes the socioeconomic characteristics of such neighborhoods. Addresses for 229 youth aged 16–20 years and residing in out-of-home care in a single Midwest county were used. Addresses were geocoded and linked to U.S. Cens...
There are 427,000 children in protective custody in the United States. A lack of integration between the child welfare data system and electronic health record systems complicates the communication of critical health history details to caregivers. We created and evaluated automated 10 custom algorithms linking these data. Deterministic matching was...
Children in child welfare protective custody (e.g., foster care) are known to have increased health concerns compared to children not in protective custody. The poor health documented for children in protective custody persists well into adulthood; young adults who emancipate from protective custody report poorer health, lower quality of life, and...
For adolescents in protective custody (e.g. foster care), decisions about living arrangements, education, and long-term planning are frequently made outside the courtroom, where involvement in decision-making has been less studied. During in-person interviews with 151 adolescents who were aged 16–20 and had been in child welfare protective custody...
This study tested sexual abuse as a unique predictor of subsequent adolescent sexual behaviors, pregnancy, and motherhood when in company with other types of maltreatment (physical abuse, neglect) and alternative behavioral, family, and contextual risk factors in a prospective, longitudinal study of maltreated (n = 275) and comparison (n = 239) nul...
Children with substantiated child maltreatment (CM) experience adverse health outcomes. However, it is unclear whether substantiation vs. an investigation not resulting in substantiation has a greater impact on subsequent adolescent health. Propensity scores were used to examine the effect of investigated reports on the subsequent health of 503 ado...
Objective: Foster caregivers are tasked with developing good relationships with children and managing child behavior; however, these caregivers often do not have access to evidence-based interventions typically designed for custodial parents and children with behavioral and/or traumatic symptoms in the clinical range. This study examined the feasib...
Late physical and emotional effects of cancer treatment pose a burden for adolescent and young adult survivors of childhood cancer, including family milestone achievement. This brief report examined links between ongoing cancer-related post-traumatic stress symptoms (CR-PTSS) and family milestone achievement. Survivors (n = 51; Mage = 24.73, SD = 8...
Background:
Youth in protective custody (e.g.. foster care) are at higher risk for poorer physical and mental health outcomes compared with those who are not in custody. These differences may be due in part to the lack of research on the population to create evidence-based recommendations for health care delivery. A potential contributor to this l...
Objectives:
To determine the prevalence of medical illness detected by laboratory screening in children entering foster care in a single, urban county.
Methods:
All children entering foster care in a single county in Ohio were seen at a consultation foster care clinic and had laboratory screening, including testing for infectious diseases such a...
Background:
Studies of cigarette use and exposure often rely on either self-report or cotinine assay. In adolescence it is not clear how well assays and self-report correspond, or what effect estrogen exposure has on cotinine.
Objectives:
This study sought to identify optimal cut-points for salivary cotinine thresholds for girls with primary, se...
In 2012, the Comprehensive Health Evaluations for Cincinnati’s Kids (CHECK) Center was launched at Cincinnati Children’s Hospital Medical Center to provide health care for over 1,000 children placed into foster care each year in the Cincinnati community. This consultation model clinical program was developed because children in foster care have bee...
Individual differences in the transition to adulthood are well established. This study examines the extent to which heterogeneity in pathways to adulthood that have been observed in the broader U.S. population are mirrored in adolescents' expectations regarding when they will experience key adult role transitions (e.g., marriage). Patterns of chang...
Understanding the impact of fathers in child maltreatment cases has been a neglected area of research. This study evaluated differences in child welfare hearings and children's perceptions of their situation where fathers were and were not present. Father attendance at hearings appeared to positively impact information-gathering. When fathers atten...
Objective:
Identifying differences in transition readiness by chronic condition is essential for understanding whether special emphasis within specific populations is warranted. Chronic conditions (type 1 diabetes, Turner syndrome, spina bifida, autism spectrum disorder [ASD]) representing various types of impairments were compared to youth withou...
This study identified trajectories of morningness-eveningness (M-E) and physical activity when chronological (i.e., time since birth) versus gynecological (i.e., time since menarche) age is used to indicate maturation. Piecewise models were fit for girls (N = 262, ages 11-19) using chronological or gynecological age as the time metric. Girls stayed...
In order to investigate causality in situations where random assignment is not possible, propensity scores can be used in regression adjustment, stratification, inverse-probability treatment weighting, or matching. The basic concepts behind propensity scores have been extensively described. When data are longitudinal or missing, the estimation and...
Approximately 2.3 million children in the United States live separately from both parents; 70%-90% of those children live with a relative. Compared to children living with one or both parents, children in nonparental care are in poorer health, are at heightened risk for experiencing disruptions and instability in caregiving, and are vulnerable to o...
Purpose. We examined patient- and provider-level factors associated with initiation of three adolescent immunizations among 13 to 18 year olds in an adolescent primary care clinic. Methods. Data were extracted retrospectively from medical records. Logistic regression models identified associations with immunization initiation. Post hoc analyses str...
Objective. To investigate, using qualitative methodology, foster caregivers’ perspectives related to the medical needs of children placed in their care. Study design. Fifteen foster caregivers were individually interviewed using a semistructured open-ended question guide. Data were coded, and the analysis was conducted in an inductive manner, allow...
This issue of AM:STARs, Hot Topics in Adolescent Health, presents a wide array of articles exploring some of the most exciting advances and controversies in adolescent health. These topics and other evolving areas are presented to guide the reader toward providing state of the art clinical care to adolescents, as well as reviewing new research that...
Objective:
This study examined the association between depressive and menstrual symptoms in adolescent girls in a 3-year longitudinal study. It was hypothesized that menstrual symptoms would increase in early adolescence and decrease in later adolescence, that girls with greater depressive symptoms would report greater menstrual symptoms, and that...
Theoretically, the measurement of cytokines in saliva may have utility for studies of brain, behavior, and immunity in youth. Cytokines in saliva and serum were analyzed across three annual assessments in healthy adolescent girls (N = 114, 11-17 years at enrollment). Samples were assayed for GM-CSF, IFNγ, IL-1β, IL-2, IL-6, IL-8, IL-10, IL-12p70, T...
This longitudinal study examines links among adolescent internalizing and externalizing symptoms, the prenatal environment (e.g., nicotine exposure) and pre/perinatal maternal health, and cardiovascular risk factors. Girls (N = 262) ages 11-17 reported internalizing and externalizing behaviors and mothers reported about the prenatal environment and...
The use of propensity scores as a method to promote causality in studies that cannot use random assignment has increased dramatically since its original publication in 1983. While the utility of these approaches is important, the concepts underlying their use are complex. The purpose of this article is to provide a basic tutorial for conducting ana...
There is a growing consensus that results generated through multiplex genetic tests, even those produced as a part of research, should be reported to providers and patients when they are considered "actionable," that is, when they could be used to inform some potentially beneficial clinical action. However, there remains controversy over the precis...
Adolescence is an important period for initiation of smoking and manifestation of depression, which are often comorbid. Researchers have examined associations between depressive symptoms and smoking to elucidate whether those with increased depressive symptoms smoke more to self-medicate, whether those who smoke experience increased subsequent depr...
Family involvement in the legal system is unique, especially with regard to dependency and divorce court. Resolution to the problems and struggles families are experiencing is sought, but resolution is often ambiguous, without a clear sense of what a fair outcome would be. Additionally, children are profoundly impacted by court proceedings and deci...
Purpose:
Osteoporosis is primarily evident in postmenopausal women, but its roots are traceable to periods of growth, including during adolescence. Depression, anxiety, and smoking are associated with lower bone mineral density (BMD) in adults. These associations have not been studied longitudinally across adolescence, when more than 50% of bone a...
This study was designed to examine the roles of emotional reactivity, self‐regulation, and pubertal timing in prosocial behaviors during adolescence. Participants were 850 sixth graders (50 percent female, mean age = 11.03, standard deviation = .17) who were followed up at the age of 15. In hierarchical regression models, measures of emotional reac...
Adolescents' expectations about the timing of adult role transitions have the potential to shape their actual transitions, setting the stage for their adult lives. Although expectations about timing emerge by early adolescence, little is known about how these expectations develop across adolescence. This longitudinal study examined developmental tr...
This technical report is the third in a series of reports evaluating the impact of the Army’s Comprehensive Soldier Fitness (CSF) Program. This report focused on determining the efficacy of the train-the-trainer component of CSF – Master Resilience Trainer (MRT) – in influencing Soldier resilience and psychological health (R/PH) across time. Four B...
While many adolescents and young adults experiment with substances (e.g., alcohol, cigarette smoking, marijuana), recent research suggests that rural youth and young adults may be more at risk for substance use than their urban counterparts. This study was designed to examine the longitudinal relationships between rural adolescents' prosocial behav...
Future orientation has been conceptualized in a variety of ways across literatures in psychology, sociology, education, and vocation. The lack of a shared definition and measurement across theoretical perspectives has resulted in a challenge in comparing findings across literatures and organizing results in a way that provides a coherent sense of h...
This technical report presents an analysis of reported resilience and psychological health among the U.S. Army’s Officer Corps. The focus of the current report is on linking resilience and psychological health (hereafter referred to as R/PH) to objective outcomes associated with high job performance.
Specifically, this report examines the statistic...
Empirical research regarding potential risks and benefits of children's participation in the legal system generally, and in the child dependency legal system in particular, is sparse and mostly characterized by small studies without comparison groups. The current study was designed to address the following questions regarding children's participati...
This longitudinal study explored adolescents' future-oriented cognitions, current activities, and later educational attainment using data from 317 adolescents (55% female; mean age = 14.98 years, SD = 0.85) followed into early adulthood. Aspirations and expectations regarding work and education showed modest stability from year to year. Exploration...
