Featured

• Adelman, W., Braverman, P.K., Alderman, E.M., Breuner, C.C., Levine, D.A., Marcell, A.V., O’Brien, R.F. Committee on Adolescence. (2016). American Academy of Pediatrics. Achieving Quality Health Services for Adolescents. Pediatrics, 138(2): e20161347.
• American Academy of Pediatrics. Common Factors Approach HEL²P³ to Build a Better Alliance.
• American Academy of Pediatrics. Policy Statement. (2016). Early Childhood Adversity, Toxic Stress, and the Role of the Pediatrician: Translating Developmental Science into Lifelong Health. Pediatrics, 129(1): e224e231.
• American Academy of Pediatrics. (2010). Enhancing Pediatric Mental Health Care: Algorithms for Primary Care. Pediatrics, 125: S109.
• American Academy of Pediatrics. (2021). Guidance for Children and Families Involved with the Child Welfare System During the COVID-19 Pandemic.
• American Academy of Pediatrics. (2021). Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents, and Families During the COVID-19 Pandemic.
• American Academy of Pediatrics. (2014). The Medical Home Approach to Identifying and Responding to Exposure to Trauma.
• American Academy of Pediatrics. Clinical Report. (2015). Promoting Optimal Development: Screening for Behavioral and Emotional Problems. Pediatrics, 135(2):384-395.
• American Academy of Pediatrics, STAR Center. (2021). Social Determinants of Health Screening Resources.
• American Psychological Association (2023). Health advisory on social media use in adolescence.
• Center for the Study of Social Policy. (2020). Protective Factors Action Sheets.
• Centers for Disease Control and Prevention. Violence Prevention. (1998). About the CDC-Kaiser ACE Study.
• Centers for Disease Control and Prevention. (2022). Drug Overdose Deaths Among Persons Aged 10–19 Years — United States, July 2019–December 2021. Morbidity and Mortality Weekly (MMWR). 71(50):1576–1582.
• Centers for Disease Control and Prevention. (2023). Marijuana and Youth: The Impact of Marijuana Use on Teen Health and Wellbeing.
• Foy, J. M., Green, C. M., Earls, M. F., & the AAP Committee on Psychosocial Aspects of Child and Family Health, Mental Health Leadership Work Group. Policy Statement. (2019). Mental Health Competencies for Pediatric Practice. Pediatrics, 144(5): e20192757.
• Garner, A., Yogman, M. (2021). Preventing Childhood Toxic Stress: Partnering With Families and Communities to Promote Relational Health. Pediatrics, 148(2): e2021052582.
• Health Affairs. Health Policy Brief. (2020). Social Isolation and Health.
• U.S. Department of Health and Human Services. Healthy People 2030. (2020). Social Determinants of Health.
• Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review. Perspectives on Psychological Science, 10(2):227–237.
• Horner, G. (2016). Resilience. Journal of Pediatric Health Care, 31(3): 384-390.
• Lyyra, N., Valimaa, R., & Tynjala, J. (2018). Loneliness and subjective health complaints among school-aged children. Scandinavian Journal of Public Health, 2018; 46:87–93.
• Maes, M., Nelemans, S. A., Danneel, S., Fernández-Castilla, B., Van den Noortgate, W., Goossens, L., & Vanhalst, J. (2019). Loneliness and social anxiety across childhood and adolescence: Multilevel meta-analyses of cross-sectional and longitudinal associations. Developmental Psychology, 55(7):1548–1565.
• Mayo Clinic. (2022). Covid-19 infections by race: What’s behind the health disparities?
• National Human Trafficking Training and Technical Assistance Center. (n.d.) The Original ACE Study.
• Orben, A., Tomava, L., & Blakemore, S-J. (2020). The effects of social deprivation on adolescent development and mental health. The Lancet Child & Adolescent Health, 4(8):634-640.
• Petanidou, D., Giannakopoulos, G., Tzavara, C., Dimitrakaki, C., Kolaitis, G., and Tountas, Y. (2014). Adolescents’ multiple, recurrent subjective health complaints: investigating associations with emotional/behavioural difficulties in a cross-sectional, school-based study. Child Adolescent Psychiatry & Mental Health, Jan 24:8(1):3.
• Richter, L. (2020). The Effects of the COVID-19 Pandemic on the Risk of Youth Substance Use. Journal of Adolescent Health, 67(4):267-268.
• Stickley, A., Koyanagi, A., Koposov, R., Blatńy, M., Hrdlička, M., Schwab-Stone, M., & Ruchkin, V. (2016). Loneliness and its association with psychological and somatic health problems among Czech, Russian and U.S. adolescents. BMC Psychiatry, 128 (2016).
• Texas State University. (2024). Texas School Safety Center. School Safety Law Toolkit: Senate Bill 629.
• Thompson, K.N., Agnew-Blais, J.C., Allegrini, A.G., Bryan, B.T., Danese, A., Odgers, C.L., Matthews, T., Arseneault, L. (2023). Do Children With Attention-Deficit/Hyperactivity Disorder Symptoms Become Socially Isolated? Longitudinal Within-Person Associations in a Nationally Representative Cohort. JAACAP Open, Jun;1(1):12-23.
• U.S. Department of Health and Human Services. (2023). Our Epidemic of Loneliness and Isolation 2023: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community.
• U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). (2022). Trauma and Violence.
• Veazie, S., Gilbert, J., Winchell, K., Paynter, R., & Guise, J-M. (2019). Addressing Social Isolation to Improve the Health of Older Adults: A Rapid Review. US. Department of Health and Human Services Agency for Healthcare Research and Quality. Appendix F: Social Isolation and Loneliness Definitions and Measures.

Medical Definitions

The medical definitions in this module were obtained or adapted from the American Academy of Pediatrics, American Heart Association, American Psychiatric Association, Merriam-Webster and State of California Department of Health Care Services.

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians. 

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) of Continuing Nursing Education.

Certified Health Education Specialists

Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES®) and/or Master Certified Health Education Specialists (MCHES®) to receive up to 1.00 total Category I contact education contact hours. Maximum advanced-level continuing education contact hours available are 1.00.

Licensed Marriage and Family Therapists

The Texas Department of State Health Services, Continuing Education Service is an approved provider (#466) by the Texas State Board of Examiners of Marriage and Family Therapists to offer continuing education contact hours to Licensed Marriage and Family Therapists. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) for Licensed Marriage and Family Therapists. 

Licensed Professional Counselors

The Texas Department of State Health Services, Continuing Education Service is an approved provider (#690) by the Texas State Board of Examiners of Professional Counselors to offer continuing education contact hours to Licensed Professional Counselors. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) for Licensed Professional Counselors.

Licensed Psychologists

The Texas Department of State Health Services is authorized by the Texas State Board of Examiners of Psychologists as a (c)(2)(A) provider of professional development hours for licensed psychologists. Per the Texas State Board of Examiners of Psychologists Act and Rules, at least half (10) of the required 20 hours of professional development must be obtained by a provider listed in section (c)(2)(A). The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) for Licensed Psychologists.

Social Workers

The Texas Department of State Health Services, Continuing Education Service under sponsor number CS3065 has been approved by the Texas State Board of Social Worker Examiners to offer continuing education contact hours to social workers. The approved status of The Texas Department of State Health Services, Continuing Education Service expires annually on December 31. The Texas Department of State Health Services, Continuing Education Service has awarded 1.00 contact hour(s) of Continuing Social Work Education.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.00 hour(s) for attendance.

Certified Community Health Worker

The Texas Department of State Health Services, Promotor(a)/Community Health Worker Training and Certification Program has certified this course for 1.00 contact hour(s) of continuing education for Certified Community Health Workers and Community Health Worker Instructors.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

1. Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
   • Create a Texas Health Steps account.
   • Complete on-line registration process.
   • Thoroughly read the content of the module.
   • Complete the on-line examination.
   • Complete the evaluation.
2. Commercial Support.
   The THSTEPS Web-based Continuing Education Series has received no commercial support.
3. Disclosure of Relevant Financial Relationships.
   The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
4. Non-Endorsement Statement.
   Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
5. Off-Label Use.
   Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

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