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The Centers for Disease Control (CDC), the Brain Injury Association of America (BIAA), and partners from all across the healthcare spectrum are working together this month to spread the word about traumatic brain injury prevention, recognition, and response. PAR is proud to join these advocates in recognizing March as National Brain Injury Awareness Month.

A traumatic brain injury (TBI) is caused by a bump, blow, or jolt to the head or body that disrupts the normal functioning of the brain. Concussion is one of the most common forms of brain injury.

The CDC estimates that 1.7 million Americans sustain a TBI, including concussions, each year. Of those individuals, 52,000 die, 275,000 are hospitalized, and 1.4 million are treated and released from an emergency department.

“Since anyone can sustain a brain injury at any time, it is important for everyone to have access to comprehensive rehabilitation and ongoing disease management,” says Dr. Brent Masel, national medical director for BIAA. “Doing so eases medical complications, permanent disability, family dysfunction, job loss, homelessness, impoverishment, medical indigence, suicide and involvement with the criminal or juvenile justice system.”

Good sources of information about TBI signs and symptoms include the CDC’s Traumatic Brain Injury Web site, as well as their “Heads Up: Concussion in Youth Sports” program.  The BIAA “Anytime, Anywhere, Anyone” awareness campaign site is another excellent resource for understanding and disseminating information about brain injury.

PAR recognizes the importance of brain injury awareness.  To help address this problem, we have partnered with concussion experts from the Children’s National Medical Center in Washington, DC and the Matthew Gfeller Sport-Related Traumatic Brain Injury Research Center at UNC Chapel Hill to produce two new apps designed to help parents, coaches, athletic trainers, and medical professionals recognize and respond to potential concussions.  The Concussion Recognition & Response™: Parent and Coach Version and the Concussion Assessment & Response™: Sport Version are easy-to-use, inexpensive downloads for Apple® or Android™ smartphones, tablets, and other devices.  Click on the links to learn more—and help spread the word about National Brain Injury Awareness Month.

 

 

 

 

According to a new study conducted at Princeton University, many survivors of 2005’s Hurricane Katrina are still struggling with poor mental health even today, years after the storm.

Lead researcher Christina Paxson and her team began this project in 2003 as a study of low-income adults enrolled in community college. They used sites around the country for their research, three of those sites were located in New Orleans. Their original questionnaire asked participants for their opinions on topics related to education, income, families, and health.

After Hurricane Katrina hit in August 2005, the researchers decided to continue to track the New Orleans-based participants because the type of information they had was very rare in disaster studies, as they already knew much about the individual’s mental and physical health. In most disaster studies, researchers are never able to determine if the participants are suffering because of the disaster or because they already had underlying conditions that would have led to poor mental health even before the disaster hit.

With data collected one year before, 7-19 months after, and 43-54 months post-Katrina, they found that although symptoms of posttraumatic stress and psychological distress declined over time, these symptoms were still high 43-54 months after the storm. They also found that damage to the home was an especially important predictor of chronic posttraumatic stress symptoms, with and without symptoms of psychological distress. Those individuals with higher earnings and better social support reported better outcomes in the long run, but results indicate that mental health issues still remain a concern for hurricane survivors.

Even four years after the storm, researchers found that about a third of participants still reported high levels of posttraumatic stress and about 30 percent reported suffering from psychological distress.

According to Paxson, “I think the lesson for treatment of mental health conditions is don’t think it’s over after a year. It isn’t.”

To read more about the study, see January’s issue of Social Science & Medicine.

What do you find most beneficial in working with survivors of traumatic events?

The National Defense Authorization Act recently passed by Congress omitted a key requirement, possibly making it easier for active-duty military personnel and veterans to receive mental health care.

Previously, mental health practitioners were required to be licensed in the state in which care was being administered. The removal of this provision means that military personnel and vets located anywhere in the US may be able to receive counseling through video teleconference technology from a mental health professional  located elsewhere.

A previous exemption allowed cross-state counseling only if both practitioner and patient were located on federal property, but the new law permits care to be provided at any location, including from a civilian location or even inside a patient’s home.

Limitations still exist, however. The delivery of care via telehealth into service members’ homes is not currently authorized under Tricare policy.

Nearly 20% of service members returning from Iraq and Afghanistan report symptoms of PTSD or major depression, according to a Rand Corporation study. And telehealth is a hot topic within the military—last year, the Department of Defense National Center for Telehealth and Technology launched an online educational tool that enables combat veterans to learn more about PTSD within a “second life”-type environment.

How do you feel about using telehealth technology to deliver PTSD therapy? What other changes must be made to make this type of counseling more accessible? Weigh in—we’d love to hear what you think.

PAR author Lisa A. Firestone, PhD will be presenting “Suicide: Treating the Self-Destructive Client” through live CE workshops in Minnesota, Pennsylvania, and New Jersey as well as an online during February and March. These workshops will be helpful for users of the Firestone Assessment of Violent Thoughts™ (FAVT™) ,  the Firestone Assessment of Violent Thoughts^™-Adolescent (FAVT-A^™), and the Firestone Assessment of Self-Destructive Thoughts^™ and Firestone Assessment of Suicide Intent^™ (FAST^™-FASI^™).

For more information or to register, visit The Glendon Association.

Individuals who are deaf and communicate via American Sign Language are “among the most at-risk segments of the population in terms of mental health knowledge, illness prevalence, and treatment access,” according to Robert Pollard, Ph.D., Associate Professor of Psychiatry and Director of the Deaf Wellness Center (DWC) at the University of Rochester Medical Center (DWC News and Updates, January 2012). The DWC focuses on clinical services, teaching, and research activities that pertain to mental health, healthcare, sign language interpreting, and other topics that affect the lives of people who are deaf or hard-of-hearing.

Pollard asserts that the deaf population is severely underserved in the mental health arena, with only 2% of deaf individuals who need mental health services receiving them. A major factor contributing to this problem is that the deaf population lacks access to mental health information via the mass media—TV, radio, newspapers—and Pollard wants to do something to change that.  In a project sponsored by the American Psychiatric Foundation, he is leading an effort to produce a series of television public service announcements featuring deaf actors who will share mental health awareness information using sign language. The PSAs will be aired in the Rochester region where there is a large deaf population; their effectiveness will be evaluated and results disseminated nationally.

Do you have clients who are deaf or hearing impaired, or do you have another connection to the deaf community? If so, PAR wants to hear from you! In the course of standardizing new assessment instruments for publication, we need to obtain clinical subsamples to determine if there are statistically significant differences between the normal sample and those with specific impairments.  PAR is committed to including the deaf population in our standardization process, and we are currently seeking qualified examiners who work with hearing impaired children ages 5 to 18. To learn more, please contact Sue Trujillo, PAR’s Data Collection Coordinator, at strujillo@parinc.com.  Thank you!

According to a recent release from the government’s Agency for Healthcare Research and Quality (AHRQ), mental health disorders were among the five most commonly treated medical conditions in children in 2008. Coming in ahead of mental health treatment were acute bronchitis, asthma, trauma-related disorders, and middle-ear infections. About 40 percent of all children in the U.S. suffered from one of these five conditions in 2008, which accounts for about 60 percent of all children’s ambulatory care visits to a medical office or outpatient hospital.

Although mental disorders were the fifth most commonly treated condition, the average expense per child was the highest, billing out at about $2,480 per child. Five million children in the U.S. were treated for mental disorders in 2008, adding up to a total price tag of $12.2 billion in expenses. While private insurance paid the largest share of treatment costs for bronchitis (at about 55 percent of expenses), Medicaid picked up the largest share of treatment costs for mental disorders, at about 46 percent. Approximately 31 percent of treatment costs for mental disorders were paid for by private insurance, and just fewer than 14 percent of treatment costs were paid out-of-pocket by the family of the patient.

Getting a good night’s sleep is a typical recommendation during times of stress, especially after a unsettling or traumatic experience. A new study, published in the Journal of Neuroscience, questions this standard thinking. Researchers at the University of Massachusetts at Amherst showed 106 participants unsettling images, then showed them again 12 hours later. Subjects who stayed awake during those 12 hours had less emotional reactivity to the same stimuli than did subjects who went to sleep—particularly those who had more time in REM sleep. The same pattern was noted for recognition accuracy 12 hours later—it was better in participants who slept than in those who didn’t.  The study concludes that “sleep enhances emotional memory while preserving emotional reactivity.”

“It is common to be sleep-deprived after witnessing a traumatic scene, almost as if your brain doesn't want to sleep on it," said Rebecca Spencer, one of the authors of the study. In fact, going to sleep may “lock in” the negative emotions associated with the traumatic event.

Have you found this to be true in your practice? Do patients who get more rest after a negative event have a harder time recovering than those who get little sleep? Could insomnia be considered as a recommended treatment for people with PTSD?

A new Facebook initiative attempts to prevent more suicides by allowing users to report comments under a new “Report Suicidal Content” link. The person who posted the concerning comment will immediately receive an e-mail from Facebook that encourages them to call the U.S. National Suicide Prevention Lifeline or to click on a chat session with a crisis counselor.

The Lifeline, which is funded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), has answered more than 3 million calls since its inception in 2005. Before this initiative began, the Lifeline was responding to dozens of individuals every day who had expressed suicidal thoughts on Facebook, so this new service is simply an extension of that work. As many suicidal individuals do not want to pick up the phone, this online chat service allows them another way to get the help they need and enables friends to intervene immediately and help identify those who may be in urgent need of help.

Approximately 36,000 individuals commit suicide in the U.S. every year – twice the number of murders in the country. Do you think this initiative will help to lower that number in the coming years?

Research from the Agency for Healthcare Research and Quality has found that following a steady increase in the number of hospitalizations for eating disorders from 1999 to 2007, the number of individuals checking into hospitals with these principal diagnoses has fallen by 23 percent from 2007 to 2009, the latest year for which numbers are available. Eating disorders have the highest mortality rate of any psychiatric disorder, with anorexia specifically being the leading cause of mortality in women between the ages of 15 and 24. During this time period, the severity of reported eating disorders decreased, as well.

However, patients found to have eating disorders were often hospitalized for other presenting conditions, such as depression, fluid or electrolyte disorders, schizophrenia, or alcohol-related issues. Statistics showed that although 90 percent of those suffering from eating disorders were female, eating disorders in men increased 53 percent since 2007.

In light of the recent decrease in eating disorders, from 1999 to 2009, hospitalizations skyrocketed 93 percent for the disorder pica. Pica is usually diagnosed in women and children and causes them to eat inedible materials like clay, dirt, chalk, or feces. During the 10-year period, the number of hospitalizations for patients with pica increased from 964 to 1,862.

Why do you think the number of eating disorders in general has gone down while the number of individuals diagnosed with pica has increased?

Although touch-screen phones have only been in existence for about the past three years, and iPads only hit the market within the last two years, these digital tools have completely changed the way people look at the world – including how we learn.

According to new research, 40 percent of all 2 to 4-year-olds have used touch screen technology. About 10 percent of babies less than a year have used it as well. Many schools have introduced iPads in the classroom. At the Catherine Cook School in Chicago, they teach kids to write letters, identify shapes, and interact with each other using the tablet technology.

Although the American Academy of Pediatrics (AAP) recommends limiting screen time for those in the 2 to 4-year-old bracket, the organization says that it can be enriching if there is interaction with an adult. Though proponents of technology in the classroom believe that access to these tools at younger ages may spur growth and development in children’s abilities to use and create technology, any real research on the topic is still years away – and by then, today’s technology will be obsolete.

However, there is a growing opposing school of thought, and it comes from a very interesting place – the heart of technology in the U.S. The Waldorf method, nearly a century old, uses a teaching philosophy that focuses on physical activity and learning through hands-on, creative tasks. Proponents believe that computers inhibit creative thinking, human interaction, and attention spans. Of the 160 Waldorf schools in the country, 40 of them are in California, many of those in tech-heavy Silicon Valley, where 75 percent of the students have parents with careers in high-tech fields (students include offspring of executives from Google, Apple, Yahoo, and more). Waldorf schools have no computers, frown upon home use of screen technology, and only begin to introduce the use of gadgets in the eighth grade. Instead of iPads, Waldorf schools employ blackboards, pencils, even encyclopedias.

Is learning through activity more effective than learning with technology? It’s hard to compare – as Waldorf schools are private schools, they do not administer standardized tests. Furthermore, they admit that their youngest students may not perform well on such measures, as they do not cover a standardized curriculum. However, advocates will point to the schools’ effectiveness by showing that 94 percent of graduates from Waldorf high schools from 1994 to 2004 attended college, with 91 percent stating that they are active in lifelong education.

What is your take on technology in the classroom? Is it a distraction or is it the new way of learning?