Expanding the pediatrician's black bag: a psychosocial care improvement model to address the "new morbidities".

BACKGROUND: Behavioral, developmental, and psychosocial problems ("new morbidities") significantly affect the well-being of children ages 0-3 years. Practices generally fail to deliver consistent anticipatory guidance or counseling to parents. A multifaceted intervention was designed to increase the capacity of three very different practice types to adopt and implement Practicing Safety, a child abuse and neglect prevention program. METHODS: Using a feasibility intervention study, a combination of organizational change approaches, including complexity science principles--self-organization, emergence, and co-evolution--were tested. The multimethod assessment process (MAP) was employed to understand the unique characteristics of each practice that could impede or promote innovation. Findings guided a facilitated, team-based change intervention, the Reflective Adaptive Process (RAP) to restructure psychosocial care. FINDINGS: Each practice demonstrated fundamental changes in decision making, developmental assessment, and parent education processes. Practicing Safety tools were adopted and incorporated into daily routines. RAP team members exhibited new patterns of communication and relationships that supported organizationwide preventive service innovations. DISCUSSION: The MAP and RAP interventions enabled study practices to integrate novel methods for prevention of child abuse and neglect into daily routines.

Caring for diverse populations: do academic family medicine practices have CLAS?

BACKGROUND AND OBJECTIVES: The Future of Family Medicine Final Report calls for greater emphasis on training physicians to provide culturally proficient and effective quality care to an increasingly diverse population. It remains unclear, however, how prepared academic family medicine practices are to address this need. METHODS: We carried out a qualitative sub-study (as part of a larger research study) using depth and focus group interviews at two urban family medicine centers to understand the challenges and opportunities involved in meeting the Department of Health and Human Services Office of Minority Health's National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care. The Lewin Group's Organizational Cultural Competence Assessment Profile was used to analyze the qualitative interview data. RESULTS: The main themes that emerged from interviews with faculty physicians, administrators, staff, and patients were: (1) the need for more linguistically appropriate services, (2) lack of communication among those involved in care delivery, and (3) interest in education about cultural and linguistic competence. CONCLUSIONS: The academic family medicine practices studied are frustrated and challenged to integrate cultural and linguistic competence into patient care. Organizational pressures, multiple competing demands, and resource constraints inhibit preparedness to address the CLAS standards and important new national requirements and guidelines.

Assessing diversity and quality in primary care through the multimethod assessment process (MAP).

The U.S. health care system serves a diverse population, often resulting in significant disparities in delivery and quality of care. Nevertheless, most quality improvement efforts fail to systematically assess diversity and associated disparities. This article describes application of the multimethod assessment process (MAP) for understanding disparities in relation to diversity, cultural competence, and quality improvement in clinical practice. MAP is an innovative quality improvement methodology that integrates quantitative and qualitative techniques and produces a system level understanding of organizations to guide quality improvement interventions. A demonstration project in a primary care practice illustrates the utility of MAP for assessing diversity.