Rheanna Platt | Johns Hopkins University (original) (raw)

Papers by Rheanna Platt

Research paper thumbnail of A Mixed-Methods Evaluation of Virtually Delivered Group-based Mothers and Babies for Latina Immigrant Mothers

Research paper thumbnail of Mental Health Stigma Among Spanish-Speaking Latinos in Baltimore, Maryland

Journal of Immigrant and Minority Health

z positive healthcare outcomes, greater unmet need for medical care, and lower satisfaction with ... more z positive healthcare outcomes, greater unmet need for medical care, and lower satisfaction with care [6]. In emerging communities, immigrants may face increased psychological stress resulting from few ethnic enclaves, limited Spanish language and infrastructure support, and greater community-level violence [7-9]. While Latino immigrants are at high risk of depression [2, 10] and depression is highly treatable, there are high levels of unmet mental health needs amongst Latino immigrants, particularly for undocumented immigrants, immigrants in emerging communities, and those with limited English proficiency (LEP) [11-15]. Substantial structural barriers, including restrictions in access to insurance and limited supply of culturally and linguistically competent providers, contribute to these unmet needs [16-19]. For those who do access mental health care, Latinos are less likely to receive care meeting best practice guidelines [20, 21], and more likely to end care prematurely [22, 23]. While it is critical to address structural level barriers, sociocultural barriers must also be addressed as these also have a significant impact on access to and utilization of mental health services [16, 17]. One such barrier is mental health stigma, defined as the presence of negative beliefs surrounding mental illnesses, persons with mental illness, and mental health treatment

Research paper thumbnail of Examining Processes of Care Redesign: Direct Observation of Group Well-Child Care

Clinical Pediatrics

We sought to describe processes of psychosocial screening and discussion with immigrant Latino fa... more We sought to describe processes of psychosocial screening and discussion with immigrant Latino families in the context of group well-child care. We conducted longitudinal direct observations of the 1-, 2-, 4-, and 6-month visits of 7 group well-child care cohorts at an academic pediatric clinic using unstructured observations of visit and group processes as well as structured observations to code facilitators’ behavior. A range of psychosocial and social determinants of health topics were incorporated into discussions. In general, providers skillfully navigated group discussions, but inconsistently introduced the visit purpose. Asking participants to define psychosocial terms (eg, stress) and conversations about managing fussy infants were effective strategies to engage families in psychosocial discussions (eg, about postpartum depression). Some challenges with workflow were identified. Strategies to enhance screening and discussion of psychosocial topics may benefit from adaptation...

Research paper thumbnail of A Conceptual Framework for Group Well-Child Care: A Tool to Guide Implementation, Evaluation, and Research

Maternal and Child Health Journal

Objective To use scoping review methods to construct a conceptual framework based on current evid... more Objective To use scoping review methods to construct a conceptual framework based on current evidence of group wellchild care to guide future practice and research. Methods We conducted a scoping review using Arksey and O'Malley's (2005) six stages. We used constructs from the Consolidated Framework for Implementation Research and the quadruple aim of health care improvement to guide the construction of the conceptual framework. Results The resulting conceptual framework is a synthesis of the key concepts of group well-child care, beginning with a call for a system redesign of well-child care to improve outcomes while acknowledging the theoretical antecedents structuring the rationale that supports the model. Inputs of group well-child care include health systems contexts; administration/ logistics; clinical setting; group care clinic team; community/patient population; and curriculum development and training. The core components of group well-child care included structure (e.g., group size, facilitators), content (e.g., health assessments, service linkages). and process (e.g., interactive learning and community building). We found clinical outcomes in all four dimensions of the quadruple aim of healthcare. Conclusion Our conceptual framework can guide model implementation and identifies several outcomes that can be used to harmonize model evaluation and research. Future research and practice can use the conceptual framework as a tool to standardize model implementation and evaluation and generate evidence to inform future healthcare policy and practice.

Research paper thumbnail of The Patient‐Reported Outcomes Measurement Information System (PROMIS) pediatric and parent-proxy short forms for anxiety: Psychometric properties in the Kids FACE FEARS sample

Journal of Anxiety Disorders

Research paper thumbnail of Primary Care Provider Attitudes About Cannabidiol (CBD) Products and Experiences and Practices During Patient-Provider Communication About CBD Use: A Qualitative Study

Research paper thumbnail of Primary care provider attitudes, experiences and practices about cannabidiol (CBD) and barriers to patient-provider communication about CBD use: A qualitative study

Research paper thumbnail of Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth

Academic Pediatrics, 2021

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of 2.35 Addressing Mental Health Needs of Latino Immigrant Parents in Pediatric Primary Care

Journal of the American Academy of Child and Adolescent Psychiatry, 2017

assessments capture some of the children with delirium, both the screeners and psychiatry are sti... more assessments capture some of the children with delirium, both the screeners and psychiatry are still missing a significant proportion of children who have ongoing cognitive dysfunction. Pediatric healthcare needs to improve its evaluation of delirium to minimize ongoing cognitive deficits after admission to the PICU.

Research paper thumbnail of Talking With Adolescents and Their Families About Emotional and Behavioral Concerns

AM:STARs: Evaluation & Management of Adolescent Issues, 2008

Research paper thumbnail of 31.3 Group Well-Child Care Model for Latino Children in Immigrant Families: Adapting to and Learning from the COVID-19 Context

Journal of the American Academy of Child & Adolescent Psychiatry, 2021

Research paper thumbnail of The promise and challenges of integrating mental and physical health

International Review of Psychiatry, 2018

Research paper thumbnail of 43.3 Engaging Immigrant Latina Mothers in Mental Health Promotion in Pediatric Primary Care and Early Childhood Education Settings

Journal of the American Academy of Child & Adolescent Psychiatry, 2020

Conclusions: Despite markedly higher rates of comorbidities for aneurysm patients than for dissec... more Conclusions: Despite markedly higher rates of comorbidities for aneurysm patients than for dissection patients, short-term complication rates are low and do not differ between diseases. Long term, patients with aneurysm have higher mortality than those with dissection, even after accounting for major morbidity.

Research paper thumbnail of 9.7 Pediatric Primary Care Provider Comfort with Mental Health Practices: Assessing Regions with Treatment Shortages

Journal of the American Academy of Child & Adolescent Psychiatry, 2020

Research paper thumbnail of Social media use and depression in adolescents: a scoping review

International Review of Psychiatry, 2020

There have been increases in adolescent depression and suicidal behaviour over the last two decad... more There have been increases in adolescent depression and suicidal behaviour over the last two decades that coincide with the advent of social media (SM) (platforms that allow communication via digital media), which is widely used among adolescents. This scoping review examined the bi-directional association between the use of SM, specifically social networking sites (SNS), and depression and suicidality among adolescents. The studies reviewed yielded four main themes in SM use through thematic analysis: quantity of SM use, quality of SM use, social aspects associated with SM use, and disclosure of mental health symptoms. Research in this field would benefit from use of longitudinal designs, objective and timely measures of SM use, research on the mechanisms of the association between SM use and depression and suicidality, and research in clinical populations to inform clinical practice.

Research paper thumbnail of Implementation of Off-Site Integrated Care for Children: A Scoping Review

Harvard Review of Psychiatry, 2019

Background As an alternative to co-located integrated care, off-site integration (partnerships be... more Background As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. Our goal is to review the existing literature on implementing off-site pediatric integrated care. Methods We systematically searched the literature for peer-reviewed publications on off-site pediatric integrated care interventions. We included studies that involved systematic data collection and analysis, both qualitative and quantitative, of implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability). Results We found 39 original articles from 24 off-site programs with a variety of study designs, most with secondary implementation outcomes. Models of off-site integration varied primarily along two dimensions: direct vs. indirect, and in-person vs. remote. Overall, off-...

Research paper thumbnail of 39.2 Implementation of Collaborative Care for Pediatric Mental Health Problems: A Scoping Review and Experiences from the Field

Journal of the American Academy of Child & Adolescent Psychiatry, 2019

Objectives: This Symposium is designed to stimulate the discussion on how to apply the transforma... more Objectives: This Symposium is designed to stimulate the discussion on how to apply the transformational model principles to the delivery of pediatric integrated behavioral health care models, identify successful approaches and challenges to implementing key mental health care processes across a continuum of integrated care models, and introduce innovative approaches tailored to pediatric integrated care, such as the family navigator. Methods: Five research studies are presented using a variety of study designs (ie, cross-sectional cohort, longitudinal cohort) and data sources (ie, electronic health care record data, and parent and youth surveys). Results: Findings from these studies span the vision to practice of pediatric integrated behavioral health care models. Priority is placed on implications for the delivery of care to children and youth from predominantly racial/ ethnic minority backgrounds and from transgender-or gender-nonconforming youth. Challenges for implementation include improving the use of systematic behavioral health screening, onsite evidence-based therapies, continuity of mental health care, and sustained linkage to community-based services. Conclusions: Together, these findings suggest that implementation of pediatric integrated behavioral health care models in community-based settings serving vulnerable child populations is feasible, acceptable, and promising, but challenges remain. Future research is needed to further refine these care models to improve systematic behavioral health screening, the use of evidence-based therapies, continuity of on-site mental health care, and sustained linkage to community-based services.

Research paper thumbnail of Association between maternal and child mental health among US Latinos: variation by nativity, ethnic subgroup, and time in the USA

Archives of Women's Mental Health, 2019

Few studies have examined the association between maternal and youth mental health among US Latin... more Few studies have examined the association between maternal and youth mental health among US Latinos, or its variation by nativity, country of origin, ethnic subgroup, and time in the mainland US. Using 2007-2014 Medical Expenditure Panel Survey data linking Latino youth (N = 15,686 aged 5-17 years) and their mothers, we estimated multivariate models of the relationship between probable maternal mental illness (a composite of measures) and youth mental health impairment (Columbia Impairment Scale). Children of mothers with probable mental illness were more than three times as likely to have impairment as children of mothers without mental illness (p < 0.01). In adjusted models, there was an 8.5-point (95% CI 5.1, 11.8) increased prevalence of child impairment associated with mother's probable mental illness among mainland US-born youth and mothers and a 6.0-point (95% CI 3.7, 8.3) increased prevalence among US-born youth of foreign/island-born mothers. There was no significant difference in the prevalence of youth impairment associated with maternal mental illness when both youth and mother were born outside of the mainland US. For the Puerto Rican subgroup, the association between maternal and youth mental health was greatest among island-born mothers and mainland US-born youth; for the Mexican subgroup, the link was strongest among USborn mothers and youth. While there were large point differences between those groups, the difference was not statistically significant. This study suggests a protective effect of island/foreign-born nativity on symptom association between Latino mothers and children. Considerations for future research and practice stemming from this finding are discussed.

Research paper thumbnail of Severity of mental health concerns in pediatric primary care and the role of child psychiatry access programs

General Hospital Psychiatry, 2018

Research paper thumbnail of What’s known about implementing co-located paediatric integrated care: a scoping review

International Review of Psychiatry, 2018

Several studies have demonstrated clinical benefits of integrated care for a range of child and a... more Several studies have demonstrated clinical benefits of integrated care for a range of child and adolescent mental health outcomes. However, there is a significant gap between the evidence for efficacy of integrated care interventions vs. their implementation in practice. While several studies have examined large-scale implementation of co-located integrated care for adults, much less is known for children. The goal of this scoping review was to understand how co-located mental health interventions targeting children and adolescents have been implemented and sustained. We systematically searched the literature for interventions targeting child and adolescent mental health that involved a mental health specialist co-located in a primary care setting. We included studies reporting on the following implementation outcomes: acceptability, adoption, appropriateness,

Research paper thumbnail of A Mixed-Methods Evaluation of Virtually Delivered Group-based Mothers and Babies for Latina Immigrant Mothers

Research paper thumbnail of Mental Health Stigma Among Spanish-Speaking Latinos in Baltimore, Maryland

Journal of Immigrant and Minority Health

z positive healthcare outcomes, greater unmet need for medical care, and lower satisfaction with ... more z positive healthcare outcomes, greater unmet need for medical care, and lower satisfaction with care [6]. In emerging communities, immigrants may face increased psychological stress resulting from few ethnic enclaves, limited Spanish language and infrastructure support, and greater community-level violence [7-9]. While Latino immigrants are at high risk of depression [2, 10] and depression is highly treatable, there are high levels of unmet mental health needs amongst Latino immigrants, particularly for undocumented immigrants, immigrants in emerging communities, and those with limited English proficiency (LEP) [11-15]. Substantial structural barriers, including restrictions in access to insurance and limited supply of culturally and linguistically competent providers, contribute to these unmet needs [16-19]. For those who do access mental health care, Latinos are less likely to receive care meeting best practice guidelines [20, 21], and more likely to end care prematurely [22, 23]. While it is critical to address structural level barriers, sociocultural barriers must also be addressed as these also have a significant impact on access to and utilization of mental health services [16, 17]. One such barrier is mental health stigma, defined as the presence of negative beliefs surrounding mental illnesses, persons with mental illness, and mental health treatment

Research paper thumbnail of Examining Processes of Care Redesign: Direct Observation of Group Well-Child Care

Clinical Pediatrics

We sought to describe processes of psychosocial screening and discussion with immigrant Latino fa... more We sought to describe processes of psychosocial screening and discussion with immigrant Latino families in the context of group well-child care. We conducted longitudinal direct observations of the 1-, 2-, 4-, and 6-month visits of 7 group well-child care cohorts at an academic pediatric clinic using unstructured observations of visit and group processes as well as structured observations to code facilitators’ behavior. A range of psychosocial and social determinants of health topics were incorporated into discussions. In general, providers skillfully navigated group discussions, but inconsistently introduced the visit purpose. Asking participants to define psychosocial terms (eg, stress) and conversations about managing fussy infants were effective strategies to engage families in psychosocial discussions (eg, about postpartum depression). Some challenges with workflow were identified. Strategies to enhance screening and discussion of psychosocial topics may benefit from adaptation...

Research paper thumbnail of A Conceptual Framework for Group Well-Child Care: A Tool to Guide Implementation, Evaluation, and Research

Maternal and Child Health Journal

Objective To use scoping review methods to construct a conceptual framework based on current evid... more Objective To use scoping review methods to construct a conceptual framework based on current evidence of group wellchild care to guide future practice and research. Methods We conducted a scoping review using Arksey and O'Malley's (2005) six stages. We used constructs from the Consolidated Framework for Implementation Research and the quadruple aim of health care improvement to guide the construction of the conceptual framework. Results The resulting conceptual framework is a synthesis of the key concepts of group well-child care, beginning with a call for a system redesign of well-child care to improve outcomes while acknowledging the theoretical antecedents structuring the rationale that supports the model. Inputs of group well-child care include health systems contexts; administration/ logistics; clinical setting; group care clinic team; community/patient population; and curriculum development and training. The core components of group well-child care included structure (e.g., group size, facilitators), content (e.g., health assessments, service linkages). and process (e.g., interactive learning and community building). We found clinical outcomes in all four dimensions of the quadruple aim of healthcare. Conclusion Our conceptual framework can guide model implementation and identifies several outcomes that can be used to harmonize model evaluation and research. Future research and practice can use the conceptual framework as a tool to standardize model implementation and evaluation and generate evidence to inform future healthcare policy and practice.

Research paper thumbnail of The Patient‐Reported Outcomes Measurement Information System (PROMIS) pediatric and parent-proxy short forms for anxiety: Psychometric properties in the Kids FACE FEARS sample

Journal of Anxiety Disorders

Research paper thumbnail of Primary Care Provider Attitudes About Cannabidiol (CBD) Products and Experiences and Practices During Patient-Provider Communication About CBD Use: A Qualitative Study

Research paper thumbnail of Primary care provider attitudes, experiences and practices about cannabidiol (CBD) and barriers to patient-provider communication about CBD use: A qualitative study

Research paper thumbnail of Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth

Academic Pediatrics, 2021

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

Research paper thumbnail of 2.35 Addressing Mental Health Needs of Latino Immigrant Parents in Pediatric Primary Care

Journal of the American Academy of Child and Adolescent Psychiatry, 2017

assessments capture some of the children with delirium, both the screeners and psychiatry are sti... more assessments capture some of the children with delirium, both the screeners and psychiatry are still missing a significant proportion of children who have ongoing cognitive dysfunction. Pediatric healthcare needs to improve its evaluation of delirium to minimize ongoing cognitive deficits after admission to the PICU.

Research paper thumbnail of Talking With Adolescents and Their Families About Emotional and Behavioral Concerns

AM:STARs: Evaluation & Management of Adolescent Issues, 2008

Research paper thumbnail of 31.3 Group Well-Child Care Model for Latino Children in Immigrant Families: Adapting to and Learning from the COVID-19 Context

Journal of the American Academy of Child & Adolescent Psychiatry, 2021

Research paper thumbnail of The promise and challenges of integrating mental and physical health

International Review of Psychiatry, 2018

Research paper thumbnail of 43.3 Engaging Immigrant Latina Mothers in Mental Health Promotion in Pediatric Primary Care and Early Childhood Education Settings

Journal of the American Academy of Child & Adolescent Psychiatry, 2020

Conclusions: Despite markedly higher rates of comorbidities for aneurysm patients than for dissec... more Conclusions: Despite markedly higher rates of comorbidities for aneurysm patients than for dissection patients, short-term complication rates are low and do not differ between diseases. Long term, patients with aneurysm have higher mortality than those with dissection, even after accounting for major morbidity.

Research paper thumbnail of 9.7 Pediatric Primary Care Provider Comfort with Mental Health Practices: Assessing Regions with Treatment Shortages

Journal of the American Academy of Child & Adolescent Psychiatry, 2020

Research paper thumbnail of Social media use and depression in adolescents: a scoping review

International Review of Psychiatry, 2020

There have been increases in adolescent depression and suicidal behaviour over the last two decad... more There have been increases in adolescent depression and suicidal behaviour over the last two decades that coincide with the advent of social media (SM) (platforms that allow communication via digital media), which is widely used among adolescents. This scoping review examined the bi-directional association between the use of SM, specifically social networking sites (SNS), and depression and suicidality among adolescents. The studies reviewed yielded four main themes in SM use through thematic analysis: quantity of SM use, quality of SM use, social aspects associated with SM use, and disclosure of mental health symptoms. Research in this field would benefit from use of longitudinal designs, objective and timely measures of SM use, research on the mechanisms of the association between SM use and depression and suicidality, and research in clinical populations to inform clinical practice.

Research paper thumbnail of Implementation of Off-Site Integrated Care for Children: A Scoping Review

Harvard Review of Psychiatry, 2019

Background As an alternative to co-located integrated care, off-site integration (partnerships be... more Background As an alternative to co-located integrated care, off-site integration (partnerships between primary care and non-embedded specialty mental health providers) can address the growing need for pediatric mental health services. Our goal is to review the existing literature on implementing off-site pediatric integrated care. Methods We systematically searched the literature for peer-reviewed publications on off-site pediatric integrated care interventions. We included studies that involved systematic data collection and analysis, both qualitative and quantitative, of implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability). Results We found 39 original articles from 24 off-site programs with a variety of study designs, most with secondary implementation outcomes. Models of off-site integration varied primarily along two dimensions: direct vs. indirect, and in-person vs. remote. Overall, off-...

Research paper thumbnail of 39.2 Implementation of Collaborative Care for Pediatric Mental Health Problems: A Scoping Review and Experiences from the Field

Journal of the American Academy of Child & Adolescent Psychiatry, 2019

Objectives: This Symposium is designed to stimulate the discussion on how to apply the transforma... more Objectives: This Symposium is designed to stimulate the discussion on how to apply the transformational model principles to the delivery of pediatric integrated behavioral health care models, identify successful approaches and challenges to implementing key mental health care processes across a continuum of integrated care models, and introduce innovative approaches tailored to pediatric integrated care, such as the family navigator. Methods: Five research studies are presented using a variety of study designs (ie, cross-sectional cohort, longitudinal cohort) and data sources (ie, electronic health care record data, and parent and youth surveys). Results: Findings from these studies span the vision to practice of pediatric integrated behavioral health care models. Priority is placed on implications for the delivery of care to children and youth from predominantly racial/ ethnic minority backgrounds and from transgender-or gender-nonconforming youth. Challenges for implementation include improving the use of systematic behavioral health screening, onsite evidence-based therapies, continuity of mental health care, and sustained linkage to community-based services. Conclusions: Together, these findings suggest that implementation of pediatric integrated behavioral health care models in community-based settings serving vulnerable child populations is feasible, acceptable, and promising, but challenges remain. Future research is needed to further refine these care models to improve systematic behavioral health screening, the use of evidence-based therapies, continuity of on-site mental health care, and sustained linkage to community-based services.

Research paper thumbnail of Association between maternal and child mental health among US Latinos: variation by nativity, ethnic subgroup, and time in the USA

Archives of Women's Mental Health, 2019

Few studies have examined the association between maternal and youth mental health among US Latin... more Few studies have examined the association between maternal and youth mental health among US Latinos, or its variation by nativity, country of origin, ethnic subgroup, and time in the mainland US. Using 2007-2014 Medical Expenditure Panel Survey data linking Latino youth (N = 15,686 aged 5-17 years) and their mothers, we estimated multivariate models of the relationship between probable maternal mental illness (a composite of measures) and youth mental health impairment (Columbia Impairment Scale). Children of mothers with probable mental illness were more than three times as likely to have impairment as children of mothers without mental illness (p < 0.01). In adjusted models, there was an 8.5-point (95% CI 5.1, 11.8) increased prevalence of child impairment associated with mother's probable mental illness among mainland US-born youth and mothers and a 6.0-point (95% CI 3.7, 8.3) increased prevalence among US-born youth of foreign/island-born mothers. There was no significant difference in the prevalence of youth impairment associated with maternal mental illness when both youth and mother were born outside of the mainland US. For the Puerto Rican subgroup, the association between maternal and youth mental health was greatest among island-born mothers and mainland US-born youth; for the Mexican subgroup, the link was strongest among USborn mothers and youth. While there were large point differences between those groups, the difference was not statistically significant. This study suggests a protective effect of island/foreign-born nativity on symptom association between Latino mothers and children. Considerations for future research and practice stemming from this finding are discussed.

Research paper thumbnail of Severity of mental health concerns in pediatric primary care and the role of child psychiatry access programs

General Hospital Psychiatry, 2018

Research paper thumbnail of What’s known about implementing co-located paediatric integrated care: a scoping review

International Review of Psychiatry, 2018

Several studies have demonstrated clinical benefits of integrated care for a range of child and a... more Several studies have demonstrated clinical benefits of integrated care for a range of child and adolescent mental health outcomes. However, there is a significant gap between the evidence for efficacy of integrated care interventions vs. their implementation in practice. While several studies have examined large-scale implementation of co-located integrated care for adults, much less is known for children. The goal of this scoping review was to understand how co-located mental health interventions targeting children and adolescents have been implemented and sustained. We systematically searched the literature for interventions targeting child and adolescent mental health that involved a mental health specialist co-located in a primary care setting. We included studies reporting on the following implementation outcomes: acceptability, adoption, appropriateness,