No abstract

For many children, trauma exposure is a common and chronic experience. Chronic trauma exposure during childhood significantly increases the risk for emotional/behavioral disorders and academic failure. There is a critical need for school psychologists, and the schools in which they work, to understand the unique needs of students with or at risk for emotional disorders or academic difficulties secondary to trauma exposure. This article reviews the effects of trauma exposure on the psychosocial and academic functioning of children and discusses a public health framework for building social‐emotional protective factors into the school setting to foster resilience to trauma. © 2011 Wiley Periodicals, Inc.

Chronic constipation is a common and challenging childhood problem. Effective treatment for chronic constipation and fecal incontinence includes a combination of medical and behavioral treatments. This study evaluates the outcomes associated with providing these treatments in a specialty outpatient clinic consisting of a nurse practitioner and behavioral psychologist. Fifty-seven patients were followed up for initial and follow-up appointments in this multidisciplinary chronic constipation clinic. In addition, 65% of the patients did not return after the initial visit; from this cohort, 21 patients (20%) were randomly selected and outcomes were derived by phone interview. Results showed a reduction in bowel accident frequency, abdominal pain, use of diapers, and perceptions of having constipation. In most cases, these outcomes were achieved after a single visit; however, a more extended treatment was required to achieve optimal benefits for patients who initially presented with frequent bowel accidents. These results suggest that a multidisciplinary clinic comprised of a nurse practitioner and behavioral psychologist provides an effective and efficient way to provide a combined treatment protocol for constipation in children. Future research should evaluate long-term effects of this intervention on constipation symptoms and overall health care utilization.

There is much to like about the randomized clinical trial reported by Weersing et al 1 in JAMA Psychiatry this month. Most importantly, this is a clinical trial that evaluated an adapted, transdiagnostic mental health intervention for use in pediatric primary care settings. Brief behavioral therapy (BBT) demonstrated efficacy compared with assisted referral to usual care for children and adolescents ages 8 to 16 years and older with anxiety and depression. The efficacy of BBT is particularly telling given the low response rate to treatment as usual in the control condition (57% vs 28%), especially for Hispanic populations (76% vs 7%). Bringing mental health care to pediatric primary care is the only chance we have to meet the behavioral health needs of the approximately 20% of children and adolescents who are likely to develop mental health problems before graduating from high school. 2 Although we still have a long way to go, 3,4 the pioneering intervention, BBT, is a big step in the right direction.