Adapting a preschool disruptive behavior group for the underserved in pediatric primary care practice.

INTRODUCTION: While behavioral parent training (BPT) is the first line treatment for preschool aged children with disruptive behavior, only a fraction of families receive these therapies. The integration of BPT within the pediatric primary care (PPC) setting is a promising way to address this need, as the PPC setting is the first and only point of contact for most children diagnosed with mental health disorders. We piloted a clinical innovation by implementing an adapted BPT group in an urban, academic, PPC practice, serving a low-income, predominantly Black population. METHOD: Using a formative program development approach and a cultural adaptation framework, structural and cultural adaptations to the program were implemented to increase engagement and adaptability of the group to meet the needs of our PPC population. RESULTS: Learnings indicated that these adaptations were feasible and acceptable to families. Specifically, they were effective in engaging families and transforming the practice of primary care providers. DISCUSSION: Our work offers a case example to guide efforts to thoughtfully and effectively adapt evidence-based interventions for disruptive behavior in primary care settings. These processes provide one strategy to ameliorate behavioral health disparities in diverse, racial/ethnic minority populations. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An Assessment of a Socioeconomic Risk Screening Tool for Telemedicine Encounters in Pediatric Primary Care: A Pilot Study.

Socioeconomic adversity negatively affects child health. Telemedicine use in pediatrics is rapidly expanding. We piloted a socioeconomic risk screening tool within telemedicine visits. Using chart review, our primary aim was to assess the rates of screen completion, risk identification, and referral generation during telemedicine visits. Our secondary aim was to assess family satisfaction and barriers to connecting with referrals/interventions through follow-up telephone interviews. This study included 179 telemedicine encounters. The screening tool was completed in 63% of encounters and was positive in 5% of encounters. Of those who identified socioeconomic risks, 90% received a referral/intervention (social work consultation, food pantry, etc.). During follow-up calls, families expressed satisfaction with telemedicine, though 31% described difficulty connecting with the recommended services. High rates of socioeconomic risk screening resulting in interventions are achievable during telemedicine visits. Further work is needed to identify optimal socioeconomic risk screening questions and opportunities, and to ensure successful interventions.

Association Between Unscheduled Pediatric Primary Care Visits and Risk of Developmental Delay.

OBJECTIVE: Primary care centers are trialing open access scheduling models to expand access. Given evidence linking irregular caregiver work schedules with adverse child developmental outcomes, we hypothesized that children presenting for unscheduled "walk-in" visits would have higher odds of developmental concerns than those presenting for scheduled visits. METHODS: We conducted a retrospective review of electronic health record data for children aged 6 to 66 months visiting an academic pediatric primary care center between July 1, 2013 and February 1, 2019. Our primary outcome was presence of developmental concerns, defined by results below cutoff on a child's Ages & Stages Questionnaire, Third Edition (ASQ-3). We examined associations between visit stream (unscheduled vs scheduled; time of day) and ASQ-3 using multivariable logistic regression, adjusting for child demographics, visit type (well-child vs ill), and responses to a standardized social history questionnaire. RESULTS: Of 11,169 eligible total encounters each for a unique child, 8% were unscheduled (n = 848); 19% had developmental concerns in at least one domain (n = 2100). Twenty-eight percent of children presenting for unscheduled visits had developmental concerns compared to 18% of those presenting for scheduled visits (P < .0001). Compared to those presenting for scheduled well-child visits, children presenting for unscheduled ill visits had a higher odds of an ASQ-3 score below cutoff (adjusted odds ratio 2.02; 95% confidence interval, 1.54-2.65). CONCLUSIONS: As pediatric primary care centers implement open access scheduling models, they should be prepared to identify and respond to developmental concerns at a rate that may be higher than what is typically seen during scheduled visits.

Integration and Impact of Telemedicine in Underserved Pediatric Primary Care.

Telemedicine, more novel in provision of pediatric care, rapidly expanded due to the recent coronavirus disease 2019 pandemic. This study aimed to determine the feasibility of telemedicine for acute and chronic care provision in an underserved pediatric primary care center. Items assessed included patient demographic data, chief complaint, and alternative care locations if telemedicine was not available. In our setting, 62% of telemedicine visits were for acute concerns and 38% for chronic concerns. Of acute telemedicine visits, 16.5% of families would have sought care in the Emergency Department/Urgent Care, and 11.3% would have opted for no care had telemedicine not been offered. The most common chronic issues addressed were attention deficit hyperactivity disorder (80.3%) and asthma (16.9%). Racial disparities existed among our telemedicine visits with Black patients utilizing telemedicine services less frequently than non-Black patients. Telemedicine is feasible for pediatric acute and chronic care, but systems must be designed to mitigate widening racial disparities.

A Mixed-Methods Evaluation of a Novel Food Pantry in a Pediatric Primary Care Center.

Evidence suggests that management of food insecurity in primary care may enhance preventive care delivery. This study assessed the impact of a food pantry in a pediatric primary care center over 22 months. Quantitative outcome assessments (number of children affected, number of referrals, and completion of preventative services) compared the child receiving food from the pantry to age-matched controls. Commonalities from interviews with pantry-using families were identified using thematic analysis. A total of 504 index patients received food from the pantry during an office visit. There were 546 in-clinic and community referrals. There was no significant relationship between accessing the pantry and preventative service completion by 27 months of age. Themes that emerged during interviews included the need for an emergency food source, facilitation of referrals, and increased trust in the clinic. An in-clinic food pantry is a feasible and family-welcomed approach to address food insecurity in pediatric primary care.

Effective Implementation of Culturally Appropriate Tools in Addressing Overweight and Obesity in an Urban Underserved Early Childhood Population in Pediatric Primary Care.

Overweight and obese children are at an increased risk of remaining obese. The American Academy of Pediatrics recommends addressing healthy habits at well-child checks, but this poses challenges, especially in low-income populations. A clinical innovation project was designed to adapt recommendations in a busy urban clinic and consisted of motivational interviewing, culturally tailored tools, and standardizing documentation. A quasi-experimental design examined innovation outcomes. Of 137 overweight and obese children aged 24 to 66 months, providers' documentation of weight during well-child check visits improved post-innovation ( P < .01), as did development of healthy habits goals ( P < .001). Families were more likely to return for visits post-innovation ( P = .01). A logistic regression analysis showed that adding body mass index to the problem list and establishing a specific follow-up timeframe most predicted follow-up visits to assess progress ( P < .001). Comprehensive innovations consisting of motivational interviewing, implementation of culturally tailored tools, and standardized documentation can enhance engagement in an urban clinic setting.

Watch and learn: an innovative video trigger curriculum to increase resident screening for social determinants of health.

OBJECTIVE: To determine the effectiveness of an innovative curriculum, using trigger videos modeling screening for social determinants of health (SDH), on the comfort and screening practices of pediatric residents during well-child care. METHODS: A nonrandomized controlled study of an educational intervention was performed. Resident surveys assessing knowledge, comfort, and screening practices for SDH were performed pre- and post-intervention. Subsets of control and intervention residents were observed pre- and post-intervention to determine changes in SDH screening practices. RESULTS: Thirty-six residents completed the study. Intervention residents spent more time screening (P = .04), and inquired more frequently about family supports (P = .046) and housing conditions (P = .045). Intervention residents were less likely to note lack of knowledge and discomfort as barriers to screening. CONCLUSIONS: A curriculum incorporating trigger videos modeling SDH screening increased screening time and inquiry for a number of SDH by pediatric residents. Fewer barriers to screening were noted following the curriculum.

Resident confidence addressing social history: is it influenced by availability of social and legal resources?

BACKGROUND: Pediatric residency clinics caring for underserved populations are often staffed with varying levels of social and legal resources, though their effects on residents' knowledge and practice have not been studied. Aim To examine the effects of clinic-based social and legal resources on resident knowledge and screening patterns for social determinants of health. METHODS: A cross-sectional study of residents from 3 continuity clinics with different social and legal resources was performed. Resident surveys assessing their knowledge and screening practices, and direct observation of social history taking was compared. RESULTS: Forty resident surveys revealed that those from clinics with more social and legal resources had greater confidence in their knowledge, screened more frequently, and spent more time taking social histories as assessed on direct observation. CONCLUSIONS: Residents who practiced in continuity clinics with increased social and legal resources were more confident in their knowledge and screened for social determinants of health more frequently.

Are our babies hungry? Food insecurity among infants in urban clinics.

BACKGROUND: Food insecurity (FI) is common, but studies in families with infants are rare. OBJECTIVES: To determine prevalence of FI, assess the effect public benefits have on FI, assess strategies to stretch nutritional resources (eg, using generic formula), and investigate FI's relationship to anthropometric measurements. METHODS: A cross-sectional survey was completed. FI was classified using the US Department of Agriculture's 6-item indicator set. RESULTS: A convenience sample of 144 infant caregivers was surveyed. Thirty-one percent endorsed FI. FI was more common among those receiving WIC and SNAP (39% vs 22%; P < .05). Fifteen percent stretched infant formula (27% FI vs 9% food secure; P < .01), 58% would not use generic formula, and 50% believed that generic and brand name formulas were not equivalent. There was no significant association between FI and anthropometric measurements. CONCLUSIONS: FI and formula stretching were common, even among families receiving public benefits. Many families were cautious about using generic formula.