Caregiver experiences of developmental screening.

BACKGROUND: The American Academy of Pediatrics (AAP) has called for a universal system of developmental screening and surveillance to enhance early detection and intervention for children. While the need and potential impact of universal screening is well documented, recent reports show that screening rates have not reached expected goals and gaps remain in terms of effective follow-up and referral to early intervention (EI) services. Few studies have explored parent and child experiences of developmental screening, which would aid researchers, practitioners and policymakers in improving early detection and referral to EI. The purpose of this qualitative study was to understand the experiences of caregivers and children who received developmental screening across different service sectors, including the type of screening received, location of screening, experiences during the screening process and the follow-up interventions received following screening. METHODS: Individual interviews were conducted with 31 caregivers. A descriptive qualitative design allowed for the exploration of caregiver experiences with developmental screening. Thematic analysis was utilized to categorize caregiver reflections prior to, during and following developmental screening events. RESULTS: Analysis revealed five themes that described caregivers' experiences with screening and assessment for their child: (1) parent's goals of screening; (2) screening preparation and support; (3) parent/child response to screening; (4) result reporting and follow-up; (5) overall satisfaction with screening process. Each theme was composed of several subthemes. CONCLUSIONS: Caregivers see the importance of developmental screening, caregivers and children respond well to screening delivered by various providers in multiple settings and caregivers find the information gleaned from screening events important in planning for their child's developmental trajectory. Key places where improvements can be made to further bolster parental engagement and satisfaction include screening preparation and follow-up.

Strategies for implementation of virtual home visitation in the United States.

Utilising telepractice videoconferencing technology to offer home visitation services has the potential to provide access and parenting support through a high-tech and high-touch service delivery option. Families can receive evidence-based, family support intervention from their home via videoconferencing technology, removing the need for the provider to be physically in the home. While the expansion of telehealth and telepractice services for families is essential for meeting the needs of both parents and their children, well-documented engagement barriers to digital health/computer-mediated interventions exist across treatment modalities and technology platforms. Semi-structured interviews with 15 providers were conducted and analysed to identify engagement strategies utilised to sustain families in a home visitation model offered through live videoconferencing technology on a telehealth platform. Analysis revealed four themes that were deemed essential for successfully attracting and maintaining families in a telepractice-based home visitation programme: (a) engagement strategies to encourage families to participate; (b) clinical skills used within sessions; (c) articulation of benefits to the family; and (d) exploration of rationale for ending services. This study was able to identify strategies for engagement and sustained involvement of families in telehealth-based home visitation. Findings include evidence that providers should be able to move between telehealth and on-ground service provision with relative ease.

10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial.

BACKGROUND: If carotid artery narrowing remains asymptomatic (ie, has caused no recent stroke or other neurological symptoms), successful carotid endarterectomy (CEA) reduces stroke incidence for some years. We assessed the long-term effects of successful CEA. METHODS: Between 1993 and 2003, 3120 asymptomatic patients from 126 centres in 30 countries were allocated equally, by blinded minimised randomisation, to immediate CEA (median delay 1 month, IQR 0·3-2·5) or to indefinite deferral of any carotid procedure, and were followed up until death or for a median among survivors of 9 years (IQR 6-11). The primary outcomes were perioperative mortality and morbidity (death or stroke within 30 days) and non-perioperative stroke. Kaplan-Meier percentages and logrank p values are from intention-to-treat analyses. This study is registered, number ISRCTN26156392. FINDINGS: 1560 patients were allocated immediate CEA versus 1560 allocated deferral of any carotid procedure. The proportions operated on while still asymptomatic were 89·7% versus 4·8% at 1 year (and 92·1%vs 16·5% at 5 years). Perioperative risk of stroke or death within 30 days was 3·0% (95% CI 2·4-3·9; 26 non-disabling strokes plus 34 disabling or fatal perioperative events in 1979 CEAs). Excluding perioperative events and non-stroke mortality, stroke risks (immediate vs deferred CEA) were 4·1% versus 10·0% at 5 years (gain 5·9%, 95% CI 4·0-7·8) and 10·8% versus 16·9% at 10 years (gain 6·1%, 2·7-9·4); ratio of stroke incidence rates 0·54, 95% CI 0·43-0·68, p<0·0001. 62 versus 104 had a disabling or fatal stroke, and 37 versus 84 others had a non-disabling stroke. Combining perioperative events and strokes, net risks were 6·9% versus 10·9% at 5 years (gain 4·1%, 2·0-6·2) and 13·4% versus 17·9% at 10 years (gain 4·6%, 1·2-7·9). Medication was similar in both groups; throughout the study, most were on antithrombotic and antihypertensive therapy. Net benefits were significant both for those on lipid-lowering therapy and for those not, and both for men and for women up to 75 years of age at entry (although not for older patients). INTERPRETATION: Successful CEA for asymptomatic patients younger than 75 years of age reduces 10-year stroke risks. Half this reduction is in disabling or fatal strokes. Net benefit in future patients will depend on their risks from unoperated carotid lesions (which will be reduced by medication), on future surgical risks (which might differ from those in trials), and on whether life expectancy exceeds 10 years. FUNDING: UK Medical Research Council, BUPA Foundation, Stroke Association.

Telehealth Training and Provider Experience of Delivering Behavioral Health Services.

The exclusion of telehealth training and education in behavioral health degree programs contributes to the challenges in telehealth delivery. This qualitative study was designed to assess the impact of telehealth training during a behavioral health degree program on perceptions of providing telehealth services. Fifteen interviews were conducted using a semi-structured interview guide. A narrative inquiry approach was employed, allowing for the participants to use narrative story to describe and discuss experiences. Analysis revealed three themes: (1) facilitators for delivering telehealth services; (2) challenges encountered when delivering telehealth service; and (3) overall satisfaction with delivering telehealth services. Key facilitators for delivering telehealth services include training, intervention curriculum, and ongoing telehealth supervision. Barriers to telehealth service delivery included issues of telehealth operations and technology. Making telehealth training widely accessible, as opposed to a continuing education option, is essential to promoting the utilization of the treatment modality.