CDC Grand Rounds: Addressing Health Disparities in Early Childhood.

Research suggests that many disparities in overall health and well-being are rooted in early childhood (1,2). Stressors in early childhood can disrupt neurologic, metabolic, and immunologic systems, leading to poorer developmental outcomes (1). However, consistent, responsive caregiving relationships and supportive community and health care environments promote an optimal trajectory (3,4). The first 8 years of a child's life build a foundation for future health and life success (5-7). Thus, the cumulative and lifelong impact of early experiences, both positive and negative, on a child's development can be profound. Although the health, social service, and education systems that serve young children and their families and communities provide opportunities to support responsive relationships and environments, efforts by these systems are often fragmented because of restrictions that limit the age groups they can serve and types of services they can provide. Integrating relationship-based prevention and intervention services for children early in life, when the brain is developing most rapidly, can optimize developmental trajectories (4,7). By promoting collaboration and data-driven intervention activities, public health can play a critical role in both the identification of at-risk children and the integration of systems that can support healthy development. These efforts can address disparities by reducing barriers that might prevent children from reaching their full potential.

Kids are all in the same storm but not in the same boat.

The present article reviews the scholarship and policy landscape about the state of child and youth well-being, as well as the scope of health/mental health and education inequities and the factors driving them. The research and policy literature are reviewed to provide exemplars of innovation in science, practice, prevention, policy, and public education that can advance progress and support optimism. Several guiding principles emerge that provide a foundation for improving well-being and equity for the next generation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Global approaches to integrated care: Best practices and ongoing innovation.

The integration of behavioral health in primary care is critical for addressing worldwide concerns for access to, and quality of, health care services for physical and mental health promotion, prevention, and disease management. Clearly, promoting knowledge exchange internationally is critical to progress. In late 2015, the American Psychological Association convened an interdisciplinary summit on global approaches to integrated health care, bringing together 82 health care professionals (nurses, primary care physicians, psychologists, psychiatrists, and social workers) and scholars from diverse disciplines in medicine, psychology, economics, health policy, public health, and demography; participants came from 10 countries. The Global Summit provided an opportunity to share best practices and innovation in patient-centered integrated health care internationally. In this article, Global Summit participants from different countries reflect on the recommendations for future interprofessional endeavors across the following themes: build international interprofessional communities for change; advocate for, and promote social equity with, a population health and patient focus; advance research and program evaluation in integrated care; advance interprofessional training and education in integrated care; and develop financially sustainable models for integrated primary care. Building upon these recommendations and reflecting on current advancement in health care policy and integrated care research, new directions are suggested for clinicians, researchers, administrators, and policymakers working toward the advancement of integrated care to improve health care services globally. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Primary Health Care: Potential Home for Family-Focused Preventive Interventions.

Family-focused prevention programs have been shown to effectively reduce a range of negative behavioral health outcomes but have had limited reach. Three key barriers must be overcome to expand the reach of family-focused prevention programs and thereby achieve a significant public health impact. These barriers are (1) current social norms and perceptions of parenting programs; (2) concerns about the expertise and legitimacy of sponsoring organizations to offer parenting advice; and (3) a paucity of stable, sustainable funding mechanisms. Primary healthcare settings are well positioned to overcome these barriers. Recent changes within health care make primary care settings an increasingly favorable home for family-focused prevention and suggest possibilities for sustainable funding of family-focused prevention programs. This paper discusses the existing advantages of primary care settings and lays out a plan to move toward realizing the potential public health impact of family-focused prevention through widespread implementation in primary healthcare settings.

What do adolescents want? An exploratory study regarding end-of-life decision-making.

PURPOSE: To explore whether differences exist between chronically ill and healthy adolescents with regard to their attitudes about end-of-life (EOL) issues. METHODS: A convenience sample of 25 adolescents without and 25 with a chronic illness, aged 13 to 21 years, were surveyed in hospital clinics, using a 25-item instrument; 60% were female and 76% were African-American. Items were developed based on previous research, interviews with health care providers, and a focus group with patients. Data were analyzed using the Fisher's exact test for 2-tailed p values. RESULTS: Ninety-six percent of chronically ill and 88% of healthy teens want to share decision-making if they are very ill; 76% prefer to discuss their wishes earlier in the course of a life-threatening illness. There was a trend for chronically ill adolescents to prefer to wait until later in the course of their illness (32% at diagnosis, 32% when first ill, 20% first hospitalization, or 16% if dying), when compared with their healthy peers (68% at diagnosis, 20% first ill, 4% first hospitalization, 8% if dying) (p = .074). Chronically ill adolescents were significantly more likely to prefer to wait to have these discussions, if the data were collapsed for time (first hospitalized and/or dying) (Fisher's p = .037). Half of all adolescents believed that they would be allowed to change their minds once they had made a decision. Eighty percent of chronically ill and 68% of healthy teens believed that their doctor would respect their wishes, while many were uncertain. CONCLUSIONS: Even teenagers without chronic illness have thoughts about end-of-life issues and have opinions remarkably similar to those of chronically ill teens. Those who are chronically ill are less likely to wish to discuss EOL issues early in their illness.