Exploring 10 years of dissemination of the F-words for Child Development: A multifaceted case study.

BACKGROUND: There is growing interest in exploring how to move research findings into practice. Since 2014, a team of families and researchers has been working to promote and study the dissemination of the "F-words for Child Development" (Function, Family, Fitness, Fun, Friends, and Future). This case study describes our dissemination strategies and uses the Diffusion of Innovation theory to understand the factors contributing to the uptake of the F-words-a function-promoting, strengths-based, and family-centred innovation in child health and development. METHODS: Between November 2011 and November 2021, we collected data from multiple sources: our dissemination strategies, including affiliated documents/artefacts (e.g., videos and presentations) and evaluation data (e.g., surveys and Google/video analytics). We used a two-step analysis: (1) a chronological time series to describe the processes involved along with indicators of dissemination over time (e.g., increase knowledge and awareness); and (2) Diffusion of Innovation theory to explore the factors that contributed to the uptake of the F-words. RESULTS: Multifaceted dissemination strategies were essential to raise awareness and increase families' and service providers' knowledge of the F-words. These included three primary strategies: (i) development and distribution of educational materials; (ii) presentations at educational meetings; and (iii) educational outreach visits. Additional strategies, such as the use of mass media, collaboration with early adopters/champions, and the involvement of family members further supported dissemination efforts. Diffusion of Innovation factors (innovation characteristics, time, social systems, and communication channels) all contributed to the uptake of this innovation. CONCLUSIONS: Purposeful planned dissemination practice, to increase knowledge and awareness of an innovation, is an important step in the knowledge translation process. Over a period of 10 years, through the use of multiple dissemination strategies conducted in partnership with families and service providers, the F-words have spread globally. Diffusion of Innovation theory has served to help understand how and why the F-words are being shared and adopted around the world.

Implementing participation-focused services: A study to develop the Method for using Audit and Feedback in Participation Implementation (MAPi).

BACKGROUND: It is widely agreed that children's services should use participation-focused practice, but that implementation is challenging. This paper describes a method for using audit and feedback, an evidence-based knowledge translation strategy, to support implementation of participation-focused practice in front-line services, to identify barriers to implementation, and to enable international benchmarking of implementation and barriers. METHOD: Best-practice guidelines for using audit and feedback were followed. For audit, participation-focused practice was specified as clinicians' three observable behaviours: (a) targets participation outcomes; (b) involves child/parent in setting participation outcomes; and (c) measures progress towards participation outcomes. For barrier identification, the Theoretical Domains Framework Questionnaire (TDFQ) of known implementation barriers was used. A cycle of audit and barrier identification was piloted in three services (n = 25 clinicians) in a large U.K. healthcare trust. From each clinician, up to five randomly sampled case note sets were audited (total n = 122), and the clinicians were invited to complete the TDFQ. For feedback, data on the behaviours and barriers were shared visually and verbally with managers and clinicians to inform action planning. RESULTS: A Method for using Audit and feedback for Participation implementation (MAPi) was developed. The MAPi audit template captured clinicians' practices: Clinicians targeted participation in 37/122 (30.3%) of the sampled cases; involved child/parent in 16/122 (13.1%); and measured progress in 24/122 (19.7%). Barriers identified from the TDFQ and fed back to managers and clinicians included clinicians' skills in participation-focused behaviours (median = 3.00-5.00, interquartile range [IQR] = 2.25-6.00), social processes (median = 4.00, IQR = 3.00-5.00), and behavioural regulation (median = 4.00-5.00, IQR = 3.00-6.00). CONCLUSIONS: MAPi provides a practical, off-the-shelf method for front-line services to investigate and support their implementation of participation-focused practice. Furthermore, as a shared, consistent template, MAPi provides a method for generating cumulative and comparable, across-services evidence about levels and trends of implementation and about enduring barriers to implementation, to inform future implementation strategies.

Interpreters' knowledge and perceptions of childhood vaccines: Effect of an educational session.

BACKGROUND: Interpreters improve the care of patients with limited English proficiency. They can potentially act as unofficial health educators to help dispel misunderstandings about medical risks in a culturally appropriate manner. Somali parents in Minnesota are less likely to immunize their children for MMR than other parents because they believe the MMR vaccine causes autism. The low MMR vaccination rate contributed to measles outbreaks in the state in 2011 and 2017. OBJECTIVE: To investigate the effects of an educational session on interpreter beliefs and knowledge about childhood vaccines. METHODS: A large interpreter service in Minneapolis holds quarterly educational sessions for their interpreters. The investigators presented a one-hour interactive session on childhood vaccinations at one of the meetings. The interpreters were surveyed pre- and post-training to assess their (1) beliefs regarding childhood vaccines, (2) knowledge of childhood vaccination indications and safety, and surveyed pre-training about their perceived impact on patient decision-making. RESULTS: Fifty-five of the 78 interpreters attending the training session completed both the pre- and post-training surveys. Participants made significant improvements in their knowledge of vaccines after the training. Interpreters were less likely to believe that vaccines causes autism after the presentation (p = 0.02), and were more likely to indicate that the current evidence does not support a vaccine - autism connection (p < 0.001). Nineteen percent of the interpreters were from Somalia. Somali interpreters were significantly more likely to expand on what is said by the physician than their non-Somali colleagues (OR = 16.2, 95% CI = 2.8-92.9). They were also significantly more likely to encounter parental worry over vaccine safety (OR = 16.2, 95% CI = 1.9-140.5), and to believe that children get too many vaccines (OR = 30.1, 95% CI = 3.4-271.5). CONCLUSIONS: The training was an effective method to improve interpreters' knowledge and perceptions of vaccine safety. By training Somali interpreters, they can become a part of a team working toward better MMR vaccination rates.

Case series of 148 tongue-tied newborn babies evaluated with the assessment tool for lingual frenulum function.

OBJECTIVE: the Assessment Tool for Lingual Frenulum Function (ATLFF) is the only available tool designed to assess newborn babies for the severity of tongue-tie. The aim of this study was to describe the ATLFF scores obtained on a series of 148 tongue-tied newborn babies. DESIGN: prospective case series. SETTING: a 420-bed community hospital in St. Paul, Minnesota, USA. PARTICIPANTS: newborn babies admitted to the normal newborn nursery from October 1, 2000 to May 1 2002. MEASUREMENTS AND FINDINGS: all babies in the nursery were examined for tongue-tie. One-hundred and forty-eight tongue-tied babies were examined using the ATLFF by at least one of three examiners. The ATLFF could not be completed on five babies. Of the remaining babies, 40 (28%) received 'perfect' scores, five (3.5%) received 'acceptable' scores, and 19 (13.3%) received 'function impaired' scores. The remaining 79 (55.2%) babies received scores that did not fall into any of the three categories of scores. The inter-rater agreement on whether or not the baby had a score of 'function impaired' on the ATLFF was moderate (kappa=0.44). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: few tongue-tied babies had a score of 'function impaired' on the ATLFF. It is a major limitation of the ATLFF that it does not classify most babies. The development and testing of a useful tool to determine which tongue-tied babies will have difficulty with breast feeding remains a research priority.

A Web-Based Knowledge Translation Resource for Families and Service Providers (The "F-Words" in Childhood Disability Knowledge Hub): Developmental and Pilot Evaluation Study.

BACKGROUND: The "F-words in Childhood Disability" (Function, Family, Fitness, Fun, Friends, and Future) are an adaptation and an attempt to operationalize the World Health Organization's (2001) International Classification of Functioning, Disability and Health (ICF) framework. Since the paper was published (November 2011), the "F-words" have attracted global attention (>12,000 downloads, January 2018). Internationally, people have adopted the "F-words" ideas, and many families and service providers have expressed a need for more information, tools, and resources on the "F-words". OBJECTIVE: This paper reports on the development and pilot evaluation of a Web-based knowledge translation (KT) resource, the "F-words" Knowledge Hub that was created to inform people about the "F-words" and to provide action-oriented tools to support the use of the "F-words" in practice. METHODS: An integrated research team of families and researchers at CanChild Centre for Childhood Disability Research collaborated to develop, implement, and evaluate the Knowledge Hub. A pilot study design was chosen to assess the usability and utility of the Web-based hub before implementing a larger evaluation study. Data were collected using a brief anonymous Web-based survey that included both closed-ended and open-ended questions, with the closed-ended responses being based on a five-point Likert-type scale. We used descriptive statistics and a summary of key themes to report findings. RESULTS: From August to November 2017, the Knowledge Hub received >6,800 unique visitors. In 1 month (November 2017), 87 people completed the survey, of whom 63 completed the full survey and 24 completed 1 or 2 sections. The respondents included 42 clinicians and 30 family members or individuals with a disability. The majority of people visited the Knowledge Hub 1-5 times (n=63) and spent up to 45 minutes exploring (n=61) before providing feedback. Overall, 66 people provided information on the perceived usefulness of the Knowledge Hub, of which 92% (61/66) found the Knowledge Hub user-friendly and stated that they enjoyed exploring the hub, and a majority (n=52) reported that the Knowledge Hub would influence what they did when working with others. From the open-ended responses (n=48), the "F-words" videos (n=21) and the "F-words" tools (n=15) were rated as the best features on the Knowledge Hub. CONCLUSIONS: The "F-words" Knowledge Hub is an evidence-informed Web-based KT resource that was useful for respondents, most of whom were seen as "early adopters" of the "F-words" concepts. Based on the findings, minor changes are to be made to improve the Knowledge Hub before completing a larger evaluation study on the impact at the family, clinician, and organizational levels with a wider group of users. Our hope is that the "F-words" Knowledge Hub will become a go-to resource for knowledge sharing and exchange for families and service providers.

Biosocial pathways to functional outcome in schizophrenia.

UNLABELLED: Biosocial models are preeminent in the study of schizophrenia, yet there has been little empirical testing of these models. OBJECTIVE: This study provided the first test of a biosocial causal model of functional outcome in schizophrenia, using neurocognition, social cognition, social competence and social support as predictors of both global and specific domains of functional outcome. METHOD: The design used baseline variables to predict both concurrent functional status and prospective 12-month functional outcome. Subjects were recruited upon admission to outpatient community-based psychosocial rehabilitation programs shown in previous studies to be effective in improving functional outcomes. 139 individuals diagnosed with schizophrenia or schizoaffective disorder participated in the study; 100 participants completed the 12-month assessments. Face-to-face interviews assessed neurocognitive functioning (with five neuropsychological measures), social cognition (as perception of emotion), social competence, social support, and functional outcome which consisted of items covering the domains of social, independent living, and work functioning. RESULTS: Path analysis modeling showed that the proposed biosocial models had strong fit with the data, for both concurrent and 12-month global functional outcomes, with fit indices ranging from .95 to .98. The model explained 21% of the variance in concurrent global functional outcome, and 14% of the variance in 12-month prospective outcome. CONCLUSIONS: The support for this model was strong, and it has implications for understanding the causal factors related to functional outcome, as well as for intervention strategies for improving functional outcomes in schizophrenia.

HelpDesk answers: is it safe to add long-acting ß-2 agonists to inhaled corticosteroids in patients with persistent asthma?

Possibly. Long-acting ß-2 agonists (LABAs) used in combination with inhaled corticosteroids (ICS) don't appear to increase all-cause mortality or serious adverse events in patients with persistent asthma compared with ICS alone. Studies showing an increase in catastrophic events had serious methodologic issues. A large surveillance study is ongoing.

Newborn length of stay, health care utilization, and the effect of Minnesota legislation.

OBJECTIVE: To describe newborn length of stay, postdischarge follow-up, and health care utilization in the context of Minnesota's early discharge legislation. DESIGN AND SETTING: Retrospective study using claims data from a large managed care organization. PARTICIPANTS: Term newborns born from January 1995 through February 1999 (N = 22 944). OUTCOME MEASURES: Newborn length of stay, home or clinic visits within 1 week of discharge (early follow-up), immunizations completed by age 3 months, readmissions within 1 month of discharge, and urgent care or emergency department visits within 2 months of discharge. RESULTS: After enactment of Minnesota's early discharge legislation in 1996, the percentage of newborns with short stays (0-1 days after vaginal birth or 2-3 days after cesarean birth) decreased from 52% to 16% for vaginally born infants and from 87% to 63% for cesarean-born infants (P =.001). Although the legislation mandated coverage for home visits after short stays, only 12.4% of short-stay newborns had early home visits. Overall, 50% of infants had early home or clinic follow-up; compared with those who did not receive early follow-up, these infants were more likely to have complete immunizations (adjusted odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03-1.14), urgent care or emergency department visits (adjusted OR, 1.22; 95% CI, 1.07-1.39), and readmissions (adjusted OR, 2.49; 95% CI, 2.02-3.08). CONCLUSIONS: Although implementation of Minnesota's early discharge legislation corresponded with significantly increased lengths of stay, very few short-stay infants received the postdischarge care for which coverage was mandated. Our findings indicate, however, that infants at higher risk for adverse outcomes were appropriately identified to receive early follow-up.

Maternal assessment of neonatal jaundice after hospital discharge.

OBJECTIVE: To determine whether mothers can accurately assess the presence and severity of jaundice in their newborns, both visually and with an icterometer, after hospital discharge. STUDY DESIGN: Mothers were taught how to examine their infants for jaundice by determining the extent of caudal progression of jaundice and by using an Ingram icterometer. The mothers documented the examinations for 7 days after discharge. Home health nurses examined the babies for jaundice after discharge and obtained serum bilirubin levels. POPULATION: Mothers of infants cared for in the normal newborn nursery of a 340-bed community hospital. OUTCOMES MEASURED: Maternal assessment of the presence of jaundice and its caudal progression. RESULTS: Jaundice extending below the nipple line had a positive predictive value of 55% and a negative predictive value of 86% for identifying infants with bilirubin levels of = 12 mg/dL. Icterometer readings of = 2.5 had a positive predictive value of 44% and a negative predictive value of 87% for identifying infants with bilirubin levels of = 12 mg/dL. The 3 infants with bilirubin levels = 17 mg/dL were recognized by their mothers as having jaundice below the nipple line and had icterometer readings of = 2.5. CONCLUSIONS: Further study is needed to determine the optimum method of parental education about newborn jaundice. However, maternal use of the Ingram icterometer and determination of jaundice in relation to the infant's nipple line are both potentially useful methods of assessing jaundice after hospital discharge.

Childhood vaccine beliefs reported by Somali and non-Somali parents.

BACKGROUND: In 2011, an outbreak of measles in Minnesota was traced back to an unvaccinated Somali child. The purpose of this project was to (1) ascertain whether Somali parents are more likely than non-Somalis to refuse childhood vaccinations, particularly the measles-mumps-rubella (MMR) vaccine and (2) determine what factors influence the decision not to vaccinate. METHODS: We explored parental perceptions and utilization of vaccines through a survey distributed to a convenience sample of Somali and non-Somali parents of children ≤5 years old in a family medicine clinic in Minneapolis, MN. RESULTS: A total of 99 surveys were completed, 28% (n = 27) by Somali parents. Somali parents were more likely than non-Somali parents to have refused the MMR vaccine for their child (odds ratio, 4.6; 95% confidence interval, 1.2-18.0). Most of them refused vaccines because they had heard of adverse effects associated with the vaccine or personally knew someone who suffered an adverse effect. Somali parents were significantly more likely to believe that autism is caused by vaccines (35% vs. 8% of non-Somali parents). Somalis were also more likely to be uncomfortable with administering multiple vaccines at one visit (odds ratio, 4.0; 95% confidence interval, 1.4-11.9) and more likely to believe that children receive too many vaccines. CONCLUSIONS: Statistically significant differences in perceptions and use of vaccines were reported by Somali and non-Somali participants. Somali parents are more likely to believe that the MMR vaccine causes autism and more likely to refuse the MMR vaccine than non-Somali parents. These beliefs have contributed to an immunization gap between Somali and non-Somali children.

Clinician adherence to guideline for phototherapy use in newborns.

OBJECTIVES: The objectives of this study were (1) to determine clinician adherence to the 2004 American Academy of Pediatrics guideline for phototherapy use in newborns; (2) to compare adherence to the guideline in 2 different hospitals; and (3) to determine whether adherence to the guideline improved after the phototherapy nomogram was available in newborn charts. METHODS: This study was a retrospective review of medical records of 1160 newborns receiving care at the normal newborn nurseries at 2 Twin City, MN, hospitals. Four hundred thirty-six infants received phototherapy. RESULTS: When phototherapy was administered, it was indicated in 37% of cases and not indicated in 8%. In 56% of cases it was considered subthreshold. When phototherapy was not administered, it was appropriate in 99% of cases but was inappropriate or missed in 1% of cases. There was a significant difference in clinician adherence to the phototherapy guidelines between the hospitals. The addition of the phototherapy nomogram to the newborn charts did not change adherence to the guideline. CONCLUSIONS: Clinicians infrequently missed providing phototherapy when it was indicated. Most infants received phototherapy when their bilirubin level was in the "optional" range. The interhospital variability of guideline adherence confirms results found in other studies. Because the addition of the phototherapy nomogram alone did not improve adherence to the guideline, alternative interventions targeted at nurseries should be considered.

Effect of revised nursery orders on newborn preventive services.

OBJECTIVE: Aspects of neonatal care that are the subject of evolving guidelines include hepatitis B virus (HBV) immunization; discharge follow-up recommendations; and prevention of perinatal group B streptococcal (GBS) disease. In 2007, a university hospital's standardized newborn nursery orders were changed to reflect current recommendations in these areas. The objective of the study was to determine the effect of new nursery orders on the quality of care provided to these newborns. METHODS: The study was a retrospective review of medical records, birth certificates, and a computer database of 857 infants. The nursery orders changed in the following ways: (1) physicians had to "opt out" of HBV immunization; (2) discharge follow-up recommendations were based on American Academy of Pediatrics (AAP) recommendations; and (3) AAP recommendations for GBS were followed except blood cultures were not required for certain infants. RESULTS: The percentage of infants receiving HBV immunizations increased from 74% in 2007 to 83% in 2008 (P = .0018). The percentage of infants whose mothers received antibiotics for GBS less than 4 hours before delivery and who received a complete blood count increased from 36% to 83% (P < .0001). The percentage of newborns who had discharge follow-up plans consistent with AAP recommendations did not change significantly. CONCLUSION: A simple change in nursery orders was associated with significant improvement in newborn care.

Intervention with abused older males: conceptual and clinical perspectives.

Men and women experience abuse in different ways and older men have particular treatment needs that must be addressed by clinicians. The current design and configuration of clinical services may create barriers to abused older men receiving treatment fully suited to their needs. In this article, the unique experiential dynamics and help seeking behaviors of older men who experience abuse are delineated and recommendations are given for structuring services to better meet their needs. Gender-sensitive clinical techniques and modalities are described and suggestions for interventions that could prove particularly efficacious in the treatment of older men are offered.

Factors that influence the receipt of well baby care in the first 2 weeks of life.

PURPOSE: To determine the percentage of babies born at a community hospital who received follow-up visits at home or clinic by 2 weeks of age. Also to describe the characteristics of the mothers whose newborns received visits within 2 weeks of birth. METHODS: A convenience sample of 335 mothers giving birth at a 430-bed community hospital in St. Paul, MN from September 2003 to September 2004 were surveyed by telephone when their infants were approximately 3- to 4-weeks old. RESULTS: 84% of the infants had a home or clinic visit within 2 weeks of birth. In bivariate analyses, the likelihood of having a visit within 2 weeks was significantly lower for mothers having more children (P = .002), lower maternal education level (P = .002), lower income (P = .02), mothers' lack of knowledge of baby's insurance (P = .02), mothers of nonwhite race (P = .03), and mothers' having no medical insurance (P = .04). The likelihood of a visit was not significantly related to whether English was spoken in the home or marital status. In logistic regression analyses, lower maternal education, and more children were significant predictors of the lack of visits. CONCLUSIONS: Infants whose mothers had little education and had other children were a high-risk group that was less likely to receive care. When discharging newborns belonging to this group, extra effort should be made to ensure that appropriate postdischarge follow-up occurs.

Maternal postpartum health care utilization and the effect of Minnesota early discharge legislation.

PURPOSE: To describe maternal postdischarge follow-up and health care utilization in the context of Minnesota's early discharge legislation, which mandates coverage for a home visit for a mother and baby who voluntarily leave the hospital early. METHODS: Claims data from a large managed care organization were used to identify 22,944 women giving birth from January 1995 through February 1999. Study variables included home or clinic visits within 1 week of discharge (early follow-up), readmissions within 1 month of discharge, and urgent care or emergency department visits within 2 months of discharge. RESULTS: After enactment of Minnesota's legislation, the percentage of mothers with short stays decreased from 52% to 16% for vaginal births and from 87% to 63% for cesarean births (P =.001). Overall, 33% of mothers with vaginal births and 40% with cesarean births had early home or clinic follow-up (P =.001). Mothers who stayed 0 or 1 hospital days after vaginal births were more likely to have early follow-up than those with longer stays (37% vs 32%, P =.01). However, mothers who stayed 2 or 3 days after cesarean birth were no more likely to have early follow-up than mothers who stayed 4 or more days (39% vs 42%, P =.08). Rates of early follow-up were significantly higher after enactment of Minnesota's legislation, regardless of length of stay. CONCLUSIONS: Implementation of Minnesota's early discharge legislation corresponded with significantly increased lengths of stay and an increase in the percentage of mothers who received early follow-up visits. However the majority of mothers with short stays continued to lack early follow-up.