title: Behavioral Problems and Service Utilization in Children with Chronic Illnesses Referred for Trauma-Related Mental Health Services.
abstract: OBJECTIVE
  Given its prevalence and impact on health and well-being, children's exposure to traumatic experiences is of growing importance to pediatricians and other medical providers. Little is known, however, about the traumatic experiences profiles, trauma-related sequelae, and service use patterns of youth with chronic or recurrent medical problems/disabilities. This study aimed to fill this research gap.
  
  
  METHODS
  Participants were children less than 18 years of age who were referred for assessment and/or treatment services at one of the 56 National Child Traumatic Stress Network centers from 2004 to 2010 across the United States and had experienced at least one of 13 types of traumatic experience(s) (n = 9885; mean = 11 years, SD = 4.3; 52.3% girls). Generalized linear mixed models were used to examine associations among types of trauma, emotional and behavioral problems, and rates of service utilization adjusting for treatment center-level random effects, demographic characteristics, and the total number of types of trauma exposures.
  
  
  RESULTS
  Among children seeking treatment for traumatic stress, those with comorbid medical problems/disabilities had different demographic characteristics, different types of trauma exposure, and more service utilization in multiple sectors before trauma treatment entry than those without comorbid medical problems/disabilities. Those without comorbid medical problems/disabilities had higher levels of some types of traumatic exposures, associated symptoms, and higher levels of behavioral problems at home, school, or day care. Those with medical disorders/disabilities were at 30% to 40% higher odds of meeting clinical criteria for hyperarousal and re-experiencing posttraumatic stress disorder symptoms, used more medical and mental health services for trauma, and had more emotional and behavioral concerns.
  
  
  CONCLUSIONS
  Given that pediatricians are more likely to see children with medical disabilities and concerns than those without, there is an opportunity to ask directly about traumatic exposures and associated symptoms and provide support and interventions to promote resilience. Integrating trauma screening and mental health services into medical care could be especially beneficial for children with chronic medical conditions.
authors.affiliation: *Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD; †Pediatric Integrated Care Collaborative, Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Vienna Mountain Consulting, Vienna, ME; §The Family Center at Kennedy Krieger Institute, Baltimore, MD; ‖Center for Pediatric Traumatic Stress, Children's Hospital of Philadelphia, Philadelphia, PA; ¶Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; **Nemours Center for Healthcare Delivery Science, Wilmington, DE; ††Department of Pediatrics, Sidney Kimmel Medical School of Thomas Jefferson University, Philadelphia, PA; and ‡‡National Center for Child Traumatic Stress, Duke University School of Medicine, Durham, NC.
authors.forename: Holly C
authors.initials: HC
authors.lastname: Wilcox
authors.forename: Mark
authors.initials: M
authors.lastname: Rains
authors.forename: Harolyn
authors.initials: H
authors.lastname: Belcher
authors.forename: Nancy
authors.initials: N
authors.lastname: Kassam-Adams
authors.forename: Anne
authors.initials: A
authors.lastname: Kazak
authors.forename: Robert
authors.initials: R
authors.lastname: Lee
authors.forename: Ernestine C
authors.initials: EC
authors.lastname: Briggs
authors.forename: Tracy
authors.initials: T
authors.lastname: Bethel
authors.forename: Carrie Purbeck
authors.initials: CP
authors.lastname: Trunzo
authors.forename: Lawrence
authors.initials: L
authors.lastname: Wissow
mesh_terms: D000293:Adolescent; D000342:Affective Symptoms / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D000066553:Problem Behavior; D000067073:Psychological Trauma / Q000453:epidemiology*