152 Matching Annotations
  1. Sep 2023
    1. using the best availablescience, to maximize physical and psychological safety, facilitate the recovery of thechild and family, and support their ability to thrive.”

      trauma-informed treatment model

    1. Dr. Childress Second Opinion ConsultationThis handout describes various options for incorporating the second-opinionconsultation of Dr. Childress on an assessment, diagnosis, and treatment plan for court-involved family conflict. I am able to provide second opinion consultation to the involvedmental health professionals if they or the court believe this would be helpful in theresolution of the family conflict through my HIPAA compliant online telehealth office atdoxy.me/drchildress.
  2. Apr 2023
    1. Deutsch, R., Drozd, L., & Saini, M. (2021). Trauma as a Potential Distractor or Illuminatorin Exploring Resist/Refuse Dynamics, Association of Family and ConciliationCourts, annual convention, Boston, June 7, 2021.Deutsch, R., Drozd, L., & Ajoku, C. (2020). Trauma-informed interventions in parent-childcontact cases. In B. Fidler & N. Bala (Eds), Parent-child contact problems:Concepts, controversies & conundrums. Family Court Review, 58(2), 470-487.Drozd, L., Saini, M., & Deutsch, R. M. (2018). Assessment and intervention in resist/refusecases: A trauma-informed approach. [Presentation] Presentation at AFCC 55thAnnual Conference, Washington, DC
    2. Don’t necessarily trust your gut


    3. Swift decisions on little evidence – too often gut responses are basedupon personal experience and maybe clouded by emotions

      THIS INFECTION is running rampant

    4. High conflict, entrenched, slow court system
    5. Is the therapist part of the problem?

      to-date...without question

    6. “Don’t Treat the Trauma without (a finding of) Trauma:Treatment without a finding of trauma perpetuatesdysfunction.• Evidence-based or evidence-informed trauma treatment isthe treatment of choice
    7. Child becomes increasingly anxious

      Absolutely she did in the weeks before breaking contact. It was so eerie and inexplicable and happened faster than I could have logic and sense start to coalesce into rational possible explanations and long-term predictions of risk/damage; I was blind-sided by the breaking of contact.

    8. Refusal of treatment / Previous attempts fortreatment unsuccessf

      Hard to say b/c I don't know what is being said and asked to her; but it was reported she would not do family therapy, which again is suspect that this was really asked and/or that was the precise response

    9. Chronic parent-child disruptions
      • lightening fast "out of the blue" onset after 16 years of extremely positive, loving, engaging, connected, attentive, guidance-over-discipline, supportive, exploratory/path-finding/personal-accountability/empathy -over- highly restrictive/controlled/avoident/witholding-emotions&care/avoidant/intoleranceToOthers
      • then 7+ months of 180 change, with increasing flippant ambivilance while contact has been blocked and she's been completely under control and influence of adult influencers; additionally in spite of zero history of depression or suicidality and being high performing academically and numerous positive social peer relationships (and not being the kid who steps on others or excludes them or is on her phone on social media); after the break in contact, soon there were 3 consecutive week mental crisis events at school, a suspension from school for behavioral safety, admission to mental hospital day program and then months later placed on an M1 Hold.
    10. No or very infrequent contact between child and RP

      NONE. no physical, written, or telephone

    11. Rigid / extreme child reaction to rejected paren
      • 100% adament unwavering refusal for ANY contact
      • has continued for months unable to provide an articulated reason, let alone a justifiable one; does not even claim she's unwilling to answer, she simply doesn't/can't/won't; once or twice has stated the often used phrase by caseworkers and legal interpretations that she doesn't "feel safe" despite 7 months of zero influence and is regarding not just 1 on 1 contact, it is her response to phone or meetings in a therapist's office with a therapist present.
    12. Reconciliation – is rejected


    13. Regret and Remorse – absen

      Absent and steady progression of flippant ambivilance

    14. Revision – history is revised to eliminate positiveexperiences

      So far she won't even say them; to my knowledge has only said "I'm confused about my childhood history"

    15. Radical – child’s rejection is extreme and unrelenting
    16. Repetition – of parent’s words

      repetition of [alienator's] words: i.e. Kate, exceptionally unqualified reinforcing "therapists" and social-workers

    17. Rigidity – refusal to consider alternate views
    18. Reasons – trivial, frivolous, unelaborated
    19. Reactions – unjustified or disproportionate
    20. Domestic Abuse in the Context of RRD cases•Screening•Criteria that may disqualify a case from “family systemapproach”•Current & active coercive-control dynamics (with or withoutphysical violence)•Legitimate safety risks•Active substance abuse•Certain types of mental health diagnoses
    21. Multi-FactorTheory of3DUHQW&KLOG&RQWDFW3UREOHPV3&&3
    22. What’s the Research Say?2020 Survey of Resist and/or Refuse Dynamics• Collaboration between National Council of Juvenile andFamily Court Judges (NCJFCJ) and the Association of Familyand Conciliation Courts (AFCC) in 2020• Represents the largest sample of responses on this topic.Over 500 pages of comments were submitted by participants.• Aim – to ‘take the temperature’ of the professional cultures.• Most participants indicated receiving no more than 4 hours oftraining on resist/refuse dynamics• Most (+85%) were unaware of tools available to differentiaterealistic estrangement from alienating behavior by a parent15Saini, 2021Knowns1516Saini, 2021Knowns16

      Multi-Factorial Approach

      • There is a clear consensus about the importance of a multi-factorial approach in cases of RRD
      • 87% of respondents believe that PAB by the preferred parent is "only one of a number of influential factors useful in explaining RRD"
    23. Characteristics of RRD cases

      "Knowns" Characteristics of RRD cases The continuum of severity of RRD cases

    1. most mental health professionals get it wrong
    2. Targeted parents may present as anxious, depressed, and angry. At the same time, beneath these desperate situational reactions generally lies psychological health. Alienating parents, by contrast, generally often calm, cool, and charming and therefore look more attractive. They lie convincingly. Alienator and child appear credible by telling similar stories. THE BASICS What Is Parental Alienation? Find a therapist near me
    3. When a child's negative reaction stems from verbal, phyiscal or sexual abuse, children still want a relationship with the abusive parent. In addition however, accusations that a targeted parent has been abusive need to be assessed thoroughly to be certain that these kinds of abuse are not occurring, and if so, addressed directly. In contrast, when a child's negative reaction stems from the abuse of alienation, the child becomes resistant, increasingly hostile, and eventually rejects altogether the targeted parent.
    1. DSM-5(3)Childpsychologicalabuse(995.51),whichincludes“harming/ abandoning...peopleorthingsthatthechildcaresabout.”DSM-5, pg. 716,719(5thed. 2013); WilliamBernet,et. al. , ChildAffectedbyParentalRelationshipDistress55J. oftheAm. Acad. ofChildandAdolescentPsychiatry571-579(2016)
    2. DSM-5(2)Parent-childrelationalproblem(V61.20),whichincludes“negativeattributionsoftheother’sintentions,hostilitytowardorscapegoatingoftheother,andunwarrantedfeelingsofestrangement.”DSM-5, pg. 715,719(5thed. 2013); WilliamBernet,et. al. , ChildAffectedbyParentalRelationshipDistress55J. oftheAm. Acad. ofChildandAdolescentPsychiatry571-579(2016)
    3. DSM-5DSM-5 hasTHREEspecificdiagnosesunderwhichParentalAlienationmayfall,albeitbydifferentnames:(1)Childaffectedbyparentalrelationshipdistress(CAPRD)(V61.29),which“shouldbeusedwhenthefocusofclinicalattentionis thenegativeeffectsofparentalrelationshipdiscord(e.g., highlevelsofconflict,distress,ordisparagement)ona childinthefamily,includingeffectsonthechild’smentalorothermedicaldisorders.”DSM-5, pg. 716,719(5thed. 2013); WilliamBernet,et. al. , ChildAffectedbyParentalRelationshipDistress55J. oftheAm. Acad. ofChildandAdolescentPsychiatry571-579(2016
    4. SEVERE: thepreferredparentis obsessedwiththedesiretodestroythechild’srelationshipwiththeotherparent; thebehaviordoesnotrespondtotypicaloutpatientcounseling
    5. World Health OrganizationQE52.0:Caregiver-childrelationshipproblem= “substantialandsustaineddissatisfactionwithinacaregiver-childrelationshipassociatedwithsignificantdisturbanceinfunctioning.”INDEXTERMS◦Parent-childrelationshipproblem◦Parentalalienation◦Parentalestrangemen
    6. Bernet, W. et al. (2018), An Objective Measure of Splitting in Parental Alienation: The Parental Acceptance-Rejection Questionnaire(PARQ
    1. The Five-Factor Model for the Diagnosis of Parental AlienationAuthor links open overlay panelWilliam Bernet MD a, Laurence L. Greenhill MD b
    1. Five-Factor ModelThe Five-Factor Model (FFM) is a method for diagnosing PA byunderstanding and identifying the components of this mental condition. TheFFM includes the following criteria:¢ Factor One: the child manifests contact resistance or refusal, i.e.,avoids a relationship with one of the parents.¢ Factor Two: the presence of a prior positive relationship betweenthe child and the now rejected parent.* Factor Three: the absence of abuse, neglect, or seriously deficientparenting on the part of the now rejected parent.¢ Factor Four; the use of multiple alienating behaviors on the partof the favored parent.* Factor Five: the child exhibits many of the eight behavioralmanifestations of alienation.
    2. Although the actual words “parental alienation” are not in DSM-5 or ICD-11, the concept of PA is found in those diagnostic manuals. In the DSM-5,there are three diagnoses that can be used when PA has been identified in achild or a family. For example, a new diagnosis in DSM-5, child affected byparental relationship distress, can be used in cases involving PA, which wasexplained in an article by Bernet, Wamboldt, and Narrow (2016). Otherdiagnoses in DSM-5—that ts, parent-child relational problem and childpsychological abuse—may also be used in cases involving PA. Likewise, withregard to ICD-11, the diagnosis of caregiver—child relationship problem canbe used in cases involving PA.
    3. PA-detractors seem to think that somewhere thereis arule or a commandment to that effect, but there is no such rule. There aremany examples of medical and psychiatric ailments being routinely diagnosedbefore those conditions were officially included in diagnostic nomenclature.For example, Tourette’s syndrome was described and identified in 1885, longbefore it was officially included in DSM-III in 1980. Human immunodeficiencyvirus (HIV) and autoimmune deficiency syndrome (AIDS) were described,identified, and diagnosed in the early 1980s, years before they found their wayinto ICD-9 (1991).
    1. Conclusions:Indoctrinating a child to hate or fear a parent without a goodreason is a form of child psychological abuse. Clinicians should use theDSM-5diagnosis of child psychological abuse when an alienating parent is deter-mined to cause parental alienation in his or her children. Child protectionpersonnel should investigate cases of parental alienation as instances of childpsychological abuse

      75.4 PARENTAL ALIENATION: A SPECIFIC EXAMPLE OF CHILD PSYCHOLOGICAL ABUSE William Bernet, MD, Vanderbilt University Medical Center, william.bernet@vanderbilt.edu

      Conclusions: Indoctrinating a child to hate or fear a parent without a good reason is a form of child psychological abuse. Clinicians should use the DSM-5 diagnosis of child psychological abuse when an alienating parent is deter- mined to cause parental alienation in his or her children. Child protection personnel should investigate cases of parental alienation as instances of child psychological abuse. CAN, FAM, FCP http://dx.doi.org/l O. 1016/j.jaac.2017.07.439

    1. Consider citing information on:Reasonable efforts to reunify

      ABA list of resources to cite to overcome lack of reunification

    2. When necessary, argue to the court that by not pro-viding a reunified child with appropriate services, the agency is not making mandated reasonable efforts to achieve permanency
    3. Providing states improved access to federal funds for reunification services aligns with the federal Children’s Bureau’s renewed focus on reasonable efforts to achieve permanency requirements. Families should be provided all needed assistance to ensure the safe reunification of the child. (See reasonable efforts resources in Research to Cite: Reunification Services for the Family.)

      Families should be provided all needed assistance to ensure the safe reunification of the child

    4. Key Federal Laws to Incorporate into Advocacy

      ABA FFPSA Guide:

      Prevention Services

      • 42 U.S.C. $ 671 (a)(15) Requires child welfare agencies to make reasonable efforts to preserve families and pre- vent removal, unless certain exceptions apply. See also
      • 45 CFR 1356.21(1). (e) Explains requirement for states to receive 50% federal funding reimbursement.
      • 42 U.S.C. $ 672 (a)(2)(A) Foster care placement requires either a voluntary placement agreement entered into by the child's parent or legal guardian or a judicial determination that child's continuation in the home would be "contrary to the welfare of the child" and "reasonable efforts" to prevent removal have been made by the child welfare agency as required by 42 U.S.C. $ 671(a)(15).
      • 42 U.S.C. S 675 (13) Defines the term "candidate tor foster care generally as a child identified in a prevention plan.. as being at imminent risk of entering foster care...but who can remain safely in the child's home or in kinship placement as long as services. necessary to prevent the entry of the child into foster care are provided

      Reunification Services

      • 42 U.S.C. § 629a
      • 42 U.S.C. § 671 (a) (7) Defines family reunification services eligible for federal funding under Title IV-B that are no longer time limited while in foster care and may be available to families for up to 15 months after the child returns home. (a)(15) Requires reasonable efforts to make it possible for a child to safely return to the child's ome.
    5. Ensure reunification services begin promptly
    6. reunification services that can begin as soon as a child enters foster care
    7. The Title IV-B Family Reunification Services section de-scribes the services that should be provided to a child and family when the child has been removed from the home “to facilitate the reunification of the child safely and appropri-ately within a timely fashion and to ensure the strength and stability of the reunification.”60 These services may include counseling, substance use treatment, assistance to address domestic violence, peer mentoring, visitation, and transpor-tation
    8. Placement determinations using evidence-based assessments
    9. through evidence-based, trau-ma-informed treatment models
    10. Family First Act requires state and tribal child welfare agencies develop procedures and protocols to prevent children from being inappropriately diag-nosed with mental illness
    11. Segrue, Erin. Ph.D., LICSW. Evidence Base for Avoiding Family Separation in Child Welfare Practice: An Analysis of Current Research. Alia Innovations, July 2019

      have a hypothesis link to this

    12. rendered by a “qualified clinician.”

      ABA Guide

    1. The American Professional Society on theAbuse of Children (APSAC) suggests thatthese children and families deserve anapproach that is collaborative, respectful,and includes interventions that are most likelyto lead to outcomes on family-identifiedand programmatic goals. This individualizedapproach is a focused, assessment-driven, andscience-informed approach that both favorsplans
    2. interventions should be selected based on the needs of the family and the availability of strategies and interventions wi

      interventions should be selected based on the needs of the family and the availability of strategies and interventions with the highest level of evidence

    3. Principles for Matching Change Strategies and/or Interventions to Key Desired Outcome


    4. It is important to note, however, that only a minority of child welfare-involved children develop clinically significant levels of self-reported, post-traumatic stress symptoms, so assessment is essential (Kolko et al., 2010).

      Child Protective Services:A Guide for Caseworkers 2018

    6. Evidence-based practice is generally meant when the caseworker considers the current best evidence about a particular problem or need, family preferences, the specific family circumstances, and the practitioner’s clinical expertise (Gibbs, 2003; Shlonsky & Benbenishty, 2014)
    7. emphasized throughout this manual, it is crucial that agencies support families to receive tailored interventions or change strategies based on the families’ unique strengths and needs, best available research, practice exper-tise, and available resources
    1. Ten Parental Alienation Fallacies That Compromise Decisions in Courtand in Therapy

      Richard A. Warshak Professional Psychology: Research and Practice © 2015 American Psychological Association 2015, Vol. 46, No. 4, 235–249 0735-7028/15/$12.00 http://dx.doi.org/10.1037/pro0000031

    2. Alienated adolescents’ stated preferences should domi-nate custody decisions.Practice recommendations.Custody evaluators and educativeexperts should be aware, and be prepared to inform the court, thatadolescents are suggestible, highly vulnerable to external influ-ence, and highly susceptible to immature judgments, and thus weshould not assume that their custodial preferences reflect matureand independent judgment. If an adolescent’s best interests wouldbe served by repairing a damaged relationship with a parent,evaluators’ recommendations and court decisions should reflectthe benefits of holding adolescents accountable for complying withappropriate authority. Although adolescents protest many of soci-ety’s rule and expectations, they will generally respond to reason-able limits when these are consistently and firmly enforced.8. Children who irrationally reject a parent but thrive inother respects need no intervention.Practice recommendations.Evaluators should be careful notto overlook an alienated child’s psychological impairments thatmay be less apparent than the child’s good adjustment in domainssuch as school and extracurricular activities. Evaluators can assistthe court’s proper disposition of a case by identifying the cogni-tive, emotional, and behavior problems that accompany irrationalaversion to a parent, as well as the potential long-term negativeconsequences of remaining alienated from a paren

      !!! IMPORTANT!!!

    3. need not identify scholastic or social adjust-ment problems outside the family to be concerned about an alien-ated child’s psychological state. Harboring irrational

      Psychological problems inherent in irrational rejection of a loving parent. We need not identify scholastic or social adjat ment problems outside the family to be concemed about an alien- ated child's psychological state. Harboring irrational alienation from a parent, as with most significant irrational aversions, is sign of a psychological problem in itself. Unreasonable anxieties or obsessive hatred and fixed negative stereotypes justify interven tion to alleviate suffering and this is no less true when the target of aversion is a parent.

    4. Children Who Irrationally Reject a Parent ButThrive in Other Respects Need No Interventio


    1. Family Involvement & After Care•Family members will be involved in treatment


    2. level of care assessment is intended to be collaborative with the family, identified family supports and all who may be providing services and supports to the youth/


    3. assessment process, the caseworker must arrange a "Family and Permanency Team meeting”

      assessment process, the caseworker mustarrange a "Family and Permanency Team meeting

    4. placement provides the most effective level of care

      The COURT MUST approve placement provides MOST EFFECTIVE LEVEL OF CARE

    5. Counties will continue to use Child Welfare Block, Core and County-onlyfunding to provide services that best meet the needs of theircommunities

      Not all youth and families will benefit from the limited set of Clearinghouse approved services

      Counties will continue to use Child Welfare Block, Core and County-only funding to provide services that best meet the needs of theircommunities


      Evidence-based in Family First Programs that can show positive outcomes for children, youth and families and meet the established evidence standards by the Title IV-E Clearinghouse




      The following values were developed to ground Colorado's Family First Implementation * Family and youth voices are the loudest-heard, considered and respected

      • Improve policy, practice and quality of services based on scientific evidence

      Mental health services and/or substance abuse prevention and treatment services for a child AND parent or kin caregivers

      In-home parenting skill support for parent

    9. preventionservices that are evidence-based

      Creates new federal funding for prevention services that are evidence-based and trauma- informed • The aim of these services is to keep families safely together

    10. FAMILY FIRST 101

      Comprehensive training on FFPSA by the state

    1. arents have the right to both expect and demand professional competence in the diagnosis and treatment of their children and families. That’s all we’re asking for.
    2. Mental health professionals are NOT ALLOWED to abandon children to psychological child abuse
    3. Standard 2.01: Boundaries of Competence In cases of attachment-based “parental alienation” the potential violations likely center on Standard 2.01: Boundaries of Competence, in which the mental health professional failed to possess the necessary knowledge and professional competence in personality disorder pathology, family systems pathology, and attachment trauma pathology necessary to assess, diagnose, and treat the particular type of pathology being evidenced in your family
    4. . I define these domains of professional competence in Chapter 11 of Foundations, specifically on pages 341-351. I did this for you. You can use the description of the required “Domains of Professional Competence” for the pathology of an attachment-based model of “parental alienation” (i.e., attachment-trauma reenactment pathology mediated by narcissistic/borderline personality pathology) to establish the boundaries of professional competence required under Standard 2.01 (and 9.01) of the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association.
    1. Heitler agrees a support system is vital. Because targeted parents often experience severe symptoms of depression and anxiety as a result of feeling miscast, she is intentional about outlining the difference between warranted estrangement from children (based on prior abuse in the household) and being alienated (based on no factual forms of abuse in the household before separation) to help reality test a client under the spell of manipulation.
    2. “What’s happening in outpatient reunification therapy is not only not helping [but] it’s making things far worse,” Baker stresses. “One major problem in general is that clinicians often let these cases go on and on with middle-of-the-road treatments without getting to the underlying cause. Many therapists let these cases go for years without saying, ‘Gee, I’m not really doing anything good here.’” “There’s this false belief that it’s impossible to tell what’s really going on,” she continues. But “it’s not impossible to tell if clinicians were trained specifically in this subspecialization.”
    3. Bernet developed the five-factor model, which is an effective method to use when diagnosing parental alienation. This model includes five criteria for diagnosis: Contact refusal: Is the child refusing contact with a parent? Previous relationship: Did the child previously have a positive relationship with the rejected parent? Lack of abuse: Does the rejected parent show signs of being abusive or neglectful Alienating behaviors: Is the preferred parent engaging in alienating behaviors? Child symptoms: Is the child manifesting symptoms of alienation?
    4. “Parental alienation leads to highly complicated and difficult cases that require far more knowledge and specialization,” notes Amy Baker, a psychologist and parental alienation expert who has written over 65 peer-reviewed articles on the matter. “In other words, even seasoned clinicians with experience in family systems are still, in a way, a novice when dealing with alienation. Humility would be the most important thing for clinicians to have in this regard.”
    1. however, in describing the models on which their program is based, administrators tend to focus on service delivery characteristics (most notably caseload size and service duration) rather than on the theoretical underpinnings of the service delivery model.
    1. Teenagers often make choices while failing to consider the possible consequences of their actions

      More highlights below:

      These tasks become even harder for teenagers because of their incomplete brain development, lack of experience, rebelliousness, and need to express their individuality even if this puts them in harm’s way.

      knowledge of inconvenient facts sometimes is suppressed

    1. The Independent Assessment is completed by a licensed behavioral health professional who completes a full psychosocial assessment, reviews all provided documentation, meets with the child or youth, speaks with a wide variety of individuals, and has completed a robust set of training. The CANS tool is used after the psychosocial assessment to help the behavioral health professional identify key needs and strengths with the family and child or youth. The CANS tool is also used to frame the assessment in a measurable way and to work with all parties involved to gain a consensus of the needs and strengths
      • meets with wide variety of individuals
      • completed a robust set of training, esp in FFPSA
      • what is the CANS tool, and how did it frame and document in a measurable way; is this in the summary report?
      • and it's supposed to ensure all parties involved are included, documented, and give consensus on needs and strengths
  3. Mar 2023
    1. Criterion #2: Programs should be based on well-articulated theories

      as in...DHS's, attorneys', magistrates', untrained counselors' flippant remarks regarding intervention about what's best and right and should and shouldn't ... are not well-articulated theories

    1. While older youth, like younger children, usually come into care for multiple reasons, the most common reasons for older youth are the Adoption and Foster Care Analysis and Reporting System (AFCARS) categories of neglect, child behavior problem, and caretaker inability to cope. Effective prevention services for older youth will need to respond to these removal reasons and likely need to enlist the behavioral health system to formulate effective interventions.
    1. Family First requires that states ensure that, “consistent with the agency’s five-year title IV-E prevention plan, section 471(e)(4)(B) of the Social Security Act requires the title IV-E agency [CDHS] to provide services or programs to or on behalf of a child under an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma and in accordance with recognized principles of a trauma-informed approach and trauma-specific interventions to address trauma’s consequences and facilitate healing.”
    2. Family First requires that states ensure that, “consistent with the agency’s five-year title IV-E prevention plan, section 471(e)(4)(B) of the Social Security Act requires the title IV-E agency [CDHS] to provide services or programs to or on behalf of a child under an organizational structure and treatment framework that involves understanding, recognizing, and responding to the effects of all types of trauma and in accordance with recognized principles of a trauma-informed approach and trauma-specific interventions to address trauma’s consequences and facilitate healing.”
    1. When a child is at risk of not being safe, this report fortifiesthe call for alternative interventions that strengthen ratherthan undermine the sense of feeling safe, which familyconnections provide
    2. For decades child welfare systems have assessed risk ofphysical safety and made decisions based on the probabilityof physical harm (being safe), without fully considering theeffects psychological and emotional harm (feeling safe).
    3. eelingsafe comes from the love and belonging children receive fromtheir families, and separation undermines this critical piece ofthe two-part safety equation
    4. When a child is at risk of not being safe, this report fortifiesthe call for alternative interventions that strengthen ratherthan undermine the sense of feeling safe, which familyconnections provide
    1. Program eligibility requirements:o Mental health services, substance use services, or parenting skillso Evidence-based & trauma-informed

      evidence-based...trauma informed

    1. If a child moves from one QRTP program to another, will a new 30-dayassessment/60-day court review be required?Yes. The assessment and court review process apply to each QRTP setting in which ajurisdiction places a child. [§475A(c)(1)(A); P.L. 115-123 §50742]
    2. How is the child’s family involved in assessment process?Family First requires that, as part of the assessment to determine whether a QRTP is anappropriate setting for a child, the Title IV-E agency work to convene a family and permanencyteam to provide input on the process of determining the most appropriate and least restrictiveenvironment for the child. The purpose of this team is to ensure that those adults closest to achild and who best know the child’s needs can share their perspectives as part of the process ofdetermining the most appropriate setting for the child. A family and permanency team mustconsist of all of a child’s appropriate birth family members, relatives, and other individuals whohave an emotionally significant relationship with the child but are unrelated by birth or marriage,known as fictive kin. The team must also include, as appropriate, professionals who are aresource to the child’s family, including teachers, medical or mental health providers who havetreated the child, or clergy. The team’s role is to provide input during the assessment process,particularly during the determination of whether a child’s needs can be met with family membersor in a foster family home, or if not, what type of non-family setting is appropriate to meet theirneeds. The team also helps to develop a list of child-specific short- and long-term mental andbehavioral health goals. To ensure the voice and perspective of youth is a part of this process, forchildren 14 and older, the team must include individuals that the young person selects from theirpermanency planning team as required by Sec. 475(5)(C)(iv). This youth engagement practicebuilds upon pre-existing policies in federal law that promote youth engagement (See Youthengagement in case plans - what Federal Law Requires). The qualified individual conducting theassessment will work with the family and permanency team when making the assessment.[§475A(c)(1)(B)(i); P.L. 115-123 §50742

      Assessment protocol mandates

    3. What happens if a jurisdiction places a child in a QRTP, but the assessmentdetermines that is not an appropriate setting for them?Title IV-E FCMPs may continue for no longer than 30 days following a determination that theplacement is no longer recommended or approved for that child.
    4. Are there requirements that the Title IV-E agency document how it engaged thefamily in the assessment process?Family First requires that a child’s case plan include documentation on how to contact the familyand permanency team members, as well as evidence that the meetings are held at times andplaces convenient to the family. If a child’s assessment outcome is different than the wishes of

      Assessment protocol mandates

    5. the family and permanency team, the case plan must also outline why the assessment does notrecommend those preferences. [§475A(c)(1)(B)(iii)(VII); P.L. 115-123 §50742]

      Assessment protocol mandates

      IMPORTANT: if recommendations do not agree with family, must document why

    6. As part of the QRTP model, Family First creates a new process for ensuring that a Title IV-Eeligible child needs the level of treatment intervention that a QRTP offers. Within 30 days ofentering a QRTP, a child must receive an assessment from a qualified individual using anappropriate functional assessment tool to determine whether they need care in a QRTP andwhether that particular QRTP can meet their specific treatment needs. The purpose of thisprocess is to acknowledge that QRTPs are a treatment intervention, and that through the processof specialization, not every QRTP will be appropriate for each child’s specific needs
    7. Effective training of assessment professionals in child development, childtrauma, and the types of particular QRTPs and how they meet the needs of individual childrenwill be essential to the effective implementation of this aspect of Family First.
    8. What if our jurisdiction does not have anyone available who meets the qualifiedindividual criteria?There is a process for Title IV-E agencies to obtain from the HHS Secretary a waiver from therequirement that a qualified individual conduct the assessment. Title IV-E agencies must submitdocumentation to the HHS Secretary certifying that trained professionals or licensed cliniciansconducting these assessments shall maintain objectivity in determining the most effective andappropriate placement for a child. This certification process is required to prevent conflicts ofinterest in placing children in QRTPs
    1. AFCC Guidelines for Court-Involved Therap
    2. Children may have become accustomed to avoiding problemsrather than dealing with them and may never have developed the active coping skills that are so criti-cal to developmen
    3. . Avoidance is a powerful, if extremelyunhealthy coping strategy and in court-involved families there may be an even greater impetus toresist change
    4. hildren who resist contact with a parent may be more likely to come to the attention of the court,as the excluded parent may seek orders to enforce the parenting plan, provide counseling, a child custo-dy evaluation, or an order for some of the more specialized milieu programs that address disrupted rela-tionships. Many of these families are also poorly served, as they may initially be referred to therapythat is not adequately structured or specialized for this situation. Outmoded and often demonstrablyineffective treatment approaches, such as counseling that is limited to the rejected parent and child, areoften among the first to be attempted. (This is a common structure when courts order “reunificationtherapy,” but a one-sided approach is rarely successful and may exacerbate the problem.
    5. responsive to treatment or fail to elicit the sympathy of authority figures. This underscores

      Older children may be less responsive to treatment or fail to elicit the sympathy of authority figures. This underscores an additional risk of failing to intervene when children are in distress.

    6. others.Critical among these abilities is that the childactivelyengages with others, in an appropriate way,to get his/her needs met.
    7. (Dunn, Davies, O’Connor, & Sturgess,2001; Pedro-Carroll, 2005; Pedro-Carroll, Sandler, & Wolchik, 2005; Sandler, Tein, Mehta,Wolchik, & Ayers, 2000). These include both coping abilities and coping efficacy, as well as accessto the normal peer and developmental activities that other children enjoy (Pedro-Carroll, 2005). Cop-ing abilities include, but are not limited to, the ability to differentiate one’s own feelings from some-one else’s, appropriately express independent needs and feelings, regulate emotions, managedistress, recognize danger, know the difference between anxiety or discomfort and danger, ask forhelp, and form healthy relationships with others
    8. studies underscore commonelements in successful outcome
    9. symptoms.Trained professionals can identify problem behaviors and intervene early, before problems become entrenched
    10. investigation and litigationmay precede any meaningful attempt at intervention, based on the questionable belief that all elements of causality (or blame)must be established before any effective treatment can occur. Children’s functioning may continue to deteriorate during thistime, undermining their future adjustment and reducing the chance of successful intervention later.

      FAMILY COURT REVIEW, Vol. 00 No. 00, Month 2016 00-00 © 2016 Association of Family and Conciliation Courts

    1. Treatment Necessary health care services must be made available for treatment of all physical and mental illnesses or conditions discovered by any screening and diagnostic procedures.
    2. Diagnostic Services When a screening examination indicates the need for further evaluation of an individual's health, diagnostic services must be provided. Necessary referrals should be made without delay and there should be follow-up to ensure the enrollee receives a complete diagnostic evaluation. States should develop quality assurance procedures to assure that comprehensive care is provided.
    3. Other Necessary Health Care Services States are required to provide any additional health care services that are coverable under the Federal Medicaid program and found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in a state's Medicaid plan. It is the responsibility of states to determine medical necessity on a case-by-case basis.
    1. Toni spent months reading up on federal Medicaid law, and she learned the state-federal health insurance program is supposed to cover all medically necessary treatments for eligible children.
    2. To Get Mental Health Help For A Child, Desperate Parents Relinquish Custody
  4. Dec 2021
  5. Mar 2021
  6. Sep 2020
    1. The lowest value for false positive rate was 0.8%. Allow me to explain the impact of a false positive rate of 0.8% on Pillar 2. We return to our 10,000 people who’ve volunteered to get tested, and the expected ten with virus (0.1% prevalence or 1:1000) have been identified by the PCR test. But now we’ve to calculate how many false positives are to accompanying them. The shocking answer is 80. 80 is 0.8% of 10,000. That’s how many false positives you’d get every time you were to use a Pillar 2 test on a group of that size.

      Take Away: The exact frequency of false positive test results for COVID-19 is unknown. Real world data on COVID-19 testing suggests that rigorous testing regimes likely produce fewer than 1 in 10,000 (<0.01%) false positives, orders of magnitude below the frequency proposed here.

      The Claim: The reported numbers for new COVID-19 cases are overblown due to a false positive rate of 0.8%

      The Evidence: In this opinion article, the author correctly conveys the concern that for large testing strategies, case rates could become inflated if there is (a) a high false positive rate for the test and (b) there is a very low prevalence of the virus within the population. The false positive rate proposed by the author is 0.8%, based on the "lowest value" for similar tests given by a briefing to the UK's Scientific Advisory Group for Emergencies (1).

      In fact, the briefing states that, based on another analysis, among false positive rates for 43 external quality assessments, the interquartile range for false positive rate was 0.8-4.0%. The actual lowest value for false positive rate from this study was 0% (2).

      An upper limit for false positive rate can also be estimated from the number of tests conducted per confirmed COVID-19 case. In countries with low infection rates that have conducted widespread testing, such as Vietnam and New Zealand, at multiple periods throughout the pandemic they have achieved over 10,000 tests per positive case (3). Even if every single positive was false, the false positive rate would be below 0.01%.

      The prevalence of the virus within a population being tested can affect the positive predictive value of a test, which is the likelihood that a positive result is due to a true infection. The author here assumes the current prevalence of COVID-19 in the UK is 1 in 1,000 and the expected rate of positive results is 0.1%. Data from the University of Oxford and the Global Change Data Lab show that the current (Sept. 22, 2020) share of daily COVID-19 tests that are positive in the UK is around 1.7% (4). Therefore, based on real world data, the probability that a patient is positive for the test and does have the disease is 99.4%.

      Sources: (1) https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/895843/S0519_Impact_of_false_positives_and_negatives.pdf

      (2) https://www.medrxiv.org/content/10.1101/2020.04.26.20080911v3.full.pdf+html

      (3) https://ourworldindata.org/coronavirus-data-explorer?yScale=log&zoomToSelection=true&country=USA~DEU~IND~ITA~AUS~VNM~FIN~NZL~GBR&region=World&testsPerCaseMetric=true&interval=smoothed&aligned=true&smoothing=7&pickerMetric=location&pickerSort=asc

      (4) https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&country=USA~DEU~IND~ITA~AUS~VNM~FIN~NZL~GBR&region=World&positiveTestRate=true&interval=smoothed&aligned=true&smoothing=7&pickerMetric=location&pickerSort=asc

    1. He added that while it would not be possible to check every test to see whether there was active virus, the likelihood of false positive results could be reduced if scientists could work out where the cut-off point should be.

      Take Away: This is an incorrect usage of the term "false positive." A positive PCR test result from a recovered infection is a valid and true positive.

      Claim: PCR tests for SARS-CoV-2 give false positive results when there is no active virus.

      Evidence: The diagnostic PCR tests currently in widespread use are designed to detect the presence of the SARS-CoV-2 viral RNA in a clinical sample. The RNA is only a part of the complete virus and is not infectious on its own. Research has shown that viral RNA can be detected in some samples up to 12 weeks after onset of symptoms (1). In other words, this is like testing if an oven is warmer than the room temperature - it could be hot even after it has been turned off.

      By definition, in the context of SARS-CoV-2 PCR tests, a "false positive" means that a test result is deemed positive when in reality there was no viral RNA in the sample. If a person is recovering from an infection, gets tested, and then is given a positive test result, that is a true positive regardless of whether they are infectious or not.

      Sources: 1) https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html

    1. Take away: People are infectious for only part of the time they test positive. The tests for COVID-19 were granted emergency status by the FDA so some debate concerning the most ideal number of cycles is to be expected. It is worth noting that the FDA has the disclaimer "Negative results do not preclude 2019-nCoV infection and should not be used as the sole basis for treatment or other patient management decisions. Negative results must be combined with clinical observations, patient history, and epidemiological information (2)."

      The claim: Up to 90 percent of people diagnosed with coronavirus may not be carrying enough of it to infect anyone else

      The evidence: Per Walsh et al. (1), SARS-CoV-2 virus (COVID-19) is most likely infectious if the number of PCR cycles is <24 and the symptom onset to test is <8 days. RT-PCR detects the RNA, not the infectious virus. Therefore, setting the cycle threshold at 37-40 cycles will most likely result in detecting some samples with virus which is not infectious. As the PCR tests were granted emergency use by the FDA (samples include 2-9), it is not surprising that some debate exists currently about where the cycle threshold should be. Thresholds need to be set and validated for dozens of PCR tests currently in use. If identifying only infectious individuals is the goal, a lower cycle number may be justified. If detection of as many cases as possible to get closer to the most accurate death rate is the goal, setting the cycle threshold at 37-40 makes sense. A lower threshold will result in fewer COVID-19 positive samples being identified. It is worth noting that the emergency use approval granted by the FDA includes the disclaimer that a negative test does not guarantee that a person is not infected with COVID-19. RNA degrades easily. If samples are not kept cold or properly processed, the virus can degrade and result in a false negative result.

      Source: 1 https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa638/5842165

      2 https://www.fda.gov/media/134922/download

      3 https://www.fda.gov/media/138150/download

      4 https://www.fda.gov/media/137120/download

      5 https://www.fda.gov/media/136231/download

      6 https://www.fda.gov/media/136472/download

      7 https://www.fda.gov/media/139279/download

      8 https://www.fda.gov/media/136314/download

      9 https://www.fda.gov/media/140776/download

    1. Your Coronavirus Test Is Positive. Maybe It Shouldn’t Be.

      Take Away: Diagnostic tests are most useful when they are both sensitive and rapid. The sensitivity of SARS-CoV-2 PCR tests is not the issue, but rather the time it takes to get a result. Additionally, the "90%" statistic is likely misleading due to the data source and not generalisable to all testing results.

      The Claim: The usual PCR diagnostic tests may be too sensitive and too slow, with up to 90% of positive cases due to trace amounts of virus.

      The Evidence: Polymerase Chain Reaction (PCR)-based tests, which are currently in the most widespread use for detection of SARS-CoV-2 RNA, involves a molecular process that amplifies target DNA sequences in repeated temperature-dependent cycles. The amount of target DNA is measured after each cycle and the number of the cycle when the target can be reliably detected is often referred to as the cycle threshold (Ct). The Ct value is proportional to the amount of starting DNA in the sample and can be used to estimate the viral load of a patient. In some ways this is like a teacher making photocopies of a chapter from a textbook until they have enough for all their students.

      However, Ct values are relative measurements and need to be directly compared to controls for every sample - a Ct value taken alone can be meaningless. For instance, consider an infected patient who is tested twice: the first time they are gently swabbed and the sample is relatively dilute, the second time they are vigorously swabbed and the sample is relatively concentrated. The resulting Ct values could be drastically different. Therefore, Ct values need to be considered carefully in the proper context for making medical or policy decisions. The FDA also recommends that a PCR result alone should not be used to determine infection status.

      Positive results are indicative of the presence of SARS-CoV-2 RNA; clinical correlation with patient history and other diagnostic information is necessary to determine patient infection status. (1)

      Current PCR test results are generally given as a binary positive/negative based on a cutoff value for Ct. The cutoff needs to be determined based on the performance of each individually developed SARS-CoV-2 test, of which there are currently over 160 that have been granted emergency use authorization by the FDA (2). Based on unpublished data from the CDC, setting a stringent Ct cutoff of 30 could return negative results in patients who are both infected and potentially infectious (3 Fig 5). Furthermore, a 30 cycle cutoff would return invalid results for samples which are too diluted. Based on the same CDC data, up to 30% of potentially infectious patients would get invalid results and need to be re-swabbed, thereby extending the time between getting infected and getting a positive result.

      The period of time when RNA from SARS-CoV-2 can be detected (and a positive PCR test result returned) may extend up to 12 weeks after recovery, with Ct values trending higher over time (3,4). According to The New York Times article, they looked at Ct values from people who tested positive in Massachusetts in July and found 85-90% of results had Ct values greater than 30. The epidemiology of COVID-19 is highly time and region dependent. Massachusetts had a peak in COVID-19 hospitalizations on April 21 (5), which is 9-12 weeks prior to the testing data analyzed by The NY Times. Therefore, the detection of a large proportion of people with lingering viral RNA is not surprising. These results are likely not universal and can not be applied to other regions, especially where community spread is still significant.


      (1) https://www.fda.gov/media/135900/download

      (2) https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/vitro-diagnostics-euas

      (3) https://www.cdc.gov/coronavirus/2019-ncov/hcp/duration-isolation.html

      (4) Li N, Wang X, Lv T. Prolonged SARS-CoV-2 RNA Shedding: Not a Rare Phenomenon. J Med Virol 2020 Apr 29. doi: 10.1002/jmv.25952.

      (5) https://www.bostonherald.com/2020/05/22/massachusetts-finally-seeing-downward-coronavirus-trends/

    1. If we are now going to hold our nation hostage because of this obsession over PCR (polymerase chain reaction) swab tests, we should at the very least make certain they’re accurate. What happens when we have expedited and chaotic test results driving an epidemic curve rather than actual symptoms? You get what happened to Ohio Governor Mike DeWine last Thursday. He tested positive for the virus after experiencing absolutely no symptoms. But because he is such a VIP, he got a second, more accurate test that showed he was in fact negative for SARS-CoV-2. The same thing happened to Detroit Lions quarterback Matthew Stafford, who tested negative after receiving a false positive and was therefore allowed out of coronavirus prison.

      Take away: Current polymerase chain reaction (PCR) testing technology is very sensitive and specific. Even for rapidly developed new tests for the novel coronavirus, SARS-CoV-2, available clinical data indicates they are highly accurate.

      The claim: SARS-CoV-2 testing is unreliable and plagued by false positive results.

      The evidence: Any diagnostic test has some degree of error that is typically very low for FDA approved products. For SARS-CoV-2 tests, which detect the presence of the virus that causes COVID-19, although rare, it is possible to get a positive result when you may not have been exposed or infected by the virus. In other words, a false positive. So how frequently do false positives occur?

      There is no universal false positive rate for SARS-CoV-2 test results because there are dozens of different tests that have been developed and deployed, each with their own error rate. As of August 26, 2020, there are 146 commercial diagnostic tests that have received emergency use authorization from the FDA. Data from clinical performance testing submitted to the FDA indicates that PCR tests are highly accurate. For example, the specific PCR test mentioned by the author, Quest Diagnostics SARS-CoV-2 rRT-PCR, obtained 100% correct results in clinical evaluation studies (n = 60), and 100% true negative results in a random population of samples from before the pandemic (n = 72).

      Additional considerations: In addition to PCR technology-based tests, which detect the viral RNA genome and require lab processing, there are antigen tests, which use antibodies to detect viral proteins and can be rapidly performed in point-of-care settings. Antigen tests are much easier to perform than PCR tests, but they can be less sensitive. For example, the LumiraDx SARS-CoV-2 Ag Test, when compared to PCR, has an overall agreement of 96.9%.

      The author provides two anecdotes of high-profile personnel who obtained false positive test results. For the Ohio Governor, his initial positive was from an antigen test, not a PCR test. The NFL quarterback is part of a unique population that is presumed to be largely SARS-CoV-2 negative but is being tested frequently and repeatedly. This scenario increases the probability that a positive test result may be false. However, the NFL in early August said it has conducted over 75,000 tests, so unless there are many additional cases of false positives, this suggests that their testing methodology is over 99.99% accurate.

  7. Aug 2020
    1. Although public health officials have warned that the presence of antibodies does not guarantee immunity from the disease, the common perception that this is the case makes the issue of bogus tests nothing short of a matter of life and death.

      Take away: COVID-19 infections result in antibodies in almost all cases. These antibodies probably give immunity to future infection for at least some time, although how long is still not known.

      The claim: The presence of antibodies to SARS-CoV2 does not guarantee future immunity from future COVID-19 infection.

      The evidence: COVID-19 has not been present in the human population long enough to know how long immunity will last. There is some evidence to suggest that having COVID-19 typically leads to antibodies will provide at least some immunity to future infections. The vast majority (>90%) of serious (1-3) and mild (4,5) COVID-19 infections do result in the production of antibodies and it has been found that neutralizing antibodies provide immunity to reinfection in monkeys (6). We do not know how long immunity lasts. The best evidence is from the related coronavirus infections SARS and MERS. SARS and MERS infections result in antibodies that last for at least 1-3 years (7-9).


      1. https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa344/5812996
      2. https://erj.ersjournals.com/content/early/2020/05/13/13993003.00763-2020.abstract
      3. https://www.nature.com/articles/s41591-020-0897-1)
      4. https://www.sciencedirect.com/science/article/pii/S2352396420302905
      5. https://www.medrxiv.org/content/10.1101/2020.07.11.20151324v1
      6. https://www.biorxiv.org/content/10.1101/2020.03.13.990226v2.abstract
      7. https://www.jimmunol.org/content/jimmunol/181/8/5490.full.pdf
      8. https://wwwnc.cdc.gov/eid/article/13/10/07-0576_article,
      9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512479/
    1. Vogels, C. B. F., Brackney, D., Wang, J., Kalinich, C. C., Ott, I., Kudo, E., Lu, P., Venkataraman, A., Tokuyama, M., Moore, A. J., Muenker, M. C., Casanovas-Massana, A., Fournier, J., Bermejo, S., Campbell, M., Datta, R., Nelson, A., Team, Y. I. R., Cruz, C. D., … Grubaugh, N. (2020). SalivaDirect: Simple and sensitive molecular diagnostic test for SARS-CoV-2 surveillance. MedRxiv, 2020.08.03.20167791. https://doi.org/10.1101/2020.08.03.20167791

  8. Jul 2020
    1. Zhong, H., Wang, Y., Shi, Z., Zhang, L., Ren, H., He, W., Zhang, Z., Zhu, A., Zhao, J., Xiao, F., Yang, F., Liang, T., Ye, F., Zhong, B., Ruan, S., Gan, M., Zhu, J., Li, F., Li, F., … Zhao, J. (2020). Characterization of Microbial Co-infections in the Respiratory Tract of hospitalized COVID-19 patients. MedRxiv, 2020.07.02.20143032. https://doi.org/10.1101/2020.07.02.20143032

    1. Meyer, B., Torriani, G., Yerly, S., Mazza, L., Calame, A., Arm-Vernez, I., Zimmer, G., Agoritsas, T., Stirnemann, J., Spechbach, H., Guessous, I., Stringhini, S., Pugin, J., Roux-Lombard, P., Fontao, L., Siegrist, C.-A., Eckerle, I., Vuilleumier, N., & Kaiser, L. (2020). Validation of a commercially available SARS-CoV-2 serological immunoassay. Clinical Microbiology and Infection, 0(0). https://doi.org/10.1016/j.cmi.2020.06.024

    1. Pollán, M., Pérez-Gómez, B., Pastor-Barriuso, R., Oteo, J., Hernán, M. A., Pérez-Olmeda, M., Sanmartín, J. L., Fernández-García, A., Cruz, I., Larrea, N. F. de, Molina, M., Rodríguez-Cabrera, F., Martín, M., Merino-Amador, P., Paniagua, J. L., Muñoz-Montalvo, J. F., Blanco, F., Yotti, R., Blanco, F., … Villa, A. V. de la. (2020). Prevalence of SARS-CoV-2 in Spain (ENE-COVID): A nationwide, population-based seroepidemiological study. The Lancet, 0(0). https://doi.org/10.1016/S0140-6736(20)31483-5

    1. Sapoval, N., Mahmoud, M., Jochum, M. D., Liu, Y., Elworth, R. A. L., Wang, Q., Albin, D., Ogilvie, H., Lee, M. D., Villapol, S., Hernandez, K., Berry, I. M., Foox, J., Beheshti, A., Ternus, K., Aagaard, K. M., Posada, D., Mason, C., Sedlazeck, F. J., & Treangen, T. J. (2020). Hidden genomic diversity of SARS-CoV-2: Implications for qRT-PCR diagnostics and transmission. BioRxiv, 2020.07.02.184481. https://doi.org/10.1101/2020.07.02.184481

  9. Jun 2020
  10. May 2020
    1. Shweta, F., Murugadoss, K., Awasthi, S., Venkatakrishnan, A., Puranik, A., Kang, M., Pickering, B. W., O’Horo, J. C., Bauer, P. R., Razonable, R. R., Vergidis, P., Temesgen, Z., Rizza, S., Mahmood, M., Wilson, W. R., Challener, D., Anand, P., Liebers, M., Doctor, Z., … Badley, A. D. (2020). Augmented Curation of Unstructured Clinical Notes from a Massive EHR System Reveals Specific Phenotypic Signature of Impending COVID-19 Diagnosis [Preprint]. Infectious Diseases (except HIV/AIDS). https://doi.org/10.1101/2020.04.19.20067660

  11. Apr 2020
    1. Adams, E. R., Anand, R., Andersson, M. I., Auckland, K., Baillie, J. K., Barnes, E., Bell, J., Berry, T., Bibi, S., Carroll, M., Chinnakannan, S., Clutterbuck, E., Cornall, R. J., Crook, D. W., Silva, T. D., Dejnirattisai, W., Dingle, K. E., Dold, C., Eyre, D. W., … Sanchez, V. (2020). Evaluation of antibody testing for SARS-Cov-2 using ELISA and lateral flow immunoassays. MedRxiv, 2020.04.15.20066407. https://doi.org/10.1101/2020.04.15.20066407

    1. Newton, P. N., Bond, K. C., Adeyeye, M., Antignac, M., Ashenef, A., Awab, G. R., Babar, Z.-U.-D., Bannenberg, W. J., Bond, K. C., Bower, J., Breman, J., Brock, A., Caillet, C., Coyne, P., Day, N., Deats, M., Douidy, K., Doyle, K., Dujardin, C., … Zaman, M. (2020). COVID-19 and risks to the supply and quality of tests, drugs, and vaccines. The Lancet Global Health, S2214109X20301364. https://doi.org/10.1016/S2214-109X(20)30136-4

  12. Sep 2017
    1. One Test May Spot Cancer, Infections, Diabetes and More

      based on cell free DNA fragments in blood; DNA methylation patterns and fragment length distributions can inform on organ of origin.