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Patterns of Care for Rural and Urban Children with Mental Health Problems

Background

1. All of the following sociodemographic factors are associated with the most common mental health diagnoses in childhood, except for:

A. Young age

B. Male gender

C. Private Insurance

D. Medicaid coverage


2. Girls are more likely to seek mental health treatment than boys and are more likely to use stimulants and antidepressants.

A. True

B. False


3. In examining age at the start of kindergarten, younger children are more likely to be diagnosed with ADHD, suggesting that immaturity may play a role in diagnosis rather than an actual biological condition.

A. True

B. False


4. The U.S. Food and Drug Administration has approved antipsychotics for children in the treatment of all of the following, except:

A. ADHD

B. Schizophrenia

C. Behavioral symptoms in autism

D. Bipolar episodes


5. Controlling for demographic and physician characteristics, the factors impacting receipt of stimulants include which of the following?

A. Living in the South

B. Having health insurance

C. Receiving mental health counseling

D. All of the above


6. At the national level, a greater proportion of generalists prescribe psychotropic drugs to rural youth compared to urban youth.

A. True

B. False


7. Which of the following are steps recommended to health professionals by the American Academy of Child and Adolescent Psychiatry to ensure appropriate and safe use of psychotropic medications for the treatment of children?

A. Patient evaluation.

B. Monitoring the psychosocial and psychopharmacological treatment plan for short and long-term outcomes.

C. Child and parent education by prescriber.

D. All of the above.


8. Only a limited proportion of children receiving medication appear to follow the American Academy of Child and Adolescent Psychiatry recommendations.

A. True

B. False


9. Between 1996 and 2005, treatment with antipsychotic medication and psychotherapy both increased.

A. True

B. False


10. It is suggested that the lack of access to psychotherapists in rural areas may cause rural individuals with depression to rely more on antidepressant medications than on counseling.

A. True

B. False


Findings

11. Rural children are no more likely than urban children to have a possible or likely mental health impairment based on the Columbia Impairment Scale.

A. True

B. False


12. Since diagnosis is likely to occur at the onset of treatment, it is a poor indicator of unmet need.

A. True

B. False


13. When might rural children have their mental health impairments identified?

A. At the start of kindergarten.

B. When their symptoms intensify.

C. During routine doctor visits.

D. None of the above.


14. The higher odds of ADHD diagnosis, receipt of a mental health prescription, and receipt of stimulants among rural children vanish after appropriate controls are included in the partially adjusted model.  This suggest that the observed bivariate differences result from underlying differences in demographic characteristics and risk factors, such as all of the following, except:

A. Higher number of children in the rural home.

B. Higher rates of poverty among rural children.

C. Higher rates of public coverage among rural children.

D. Higher rates of mental health impairment among rural children.


15. Public coverage is shown not to be a strong predictor of psychotropic medication use.

A. True

B. False


Discussion and Policy Implications

16. Non-ADHD mental health problems are significantly less likely to be diagnosed and treated among rural children.

A. True

B. False


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