The social work discipline in the management of Failure to thrive in infants and children: an integrated behavioral health approach to pediatric programming.

Failure to thrive (FTT) is a DSM-5/ICD-10 diagnosis which describes infants and children who fail to grow within expected norms. The causes for poor growth are multifactorial and often include psychosocial factors. Social workers are important players in an interdisciplinary team approach to this diagnosis. This research and manuscript focus on the use of an integrated infant mental health pediatric model of practice, and outcomes for one case study. The article will review the social worker's role in the treatment of FTT, effective social work services provided in an integrated behavioral health approach, and a review of a cost-benefit analysis of treatment of FTT in a Primary Care Facility verses a hospital setting.

Whole Child Well-Child Visits: Implementing ACEs and SDOH Screenings in Primary Care.

Adverse childhood experiences (ACEs) and social determinants of health (SDOH) negatively affect health outcomes. This program was developed to screen for ACEs and SDOH in the primary care setting in families with children 9 months to 5 years of age at well-child checks and provide interventions that support families and build resiliency. Programmatic criteria were identified, referral resources were developed, and a database was implemented, with 246 families enrolled in year 1; 56.9% of caregivers reported 1 or more ACEs for their child, 63% of caregivers reported an SDOH need, and 39.4% of caregivers reported both. The average number of ACEs was 0.94. This program was created to address ACEs and SDOH, to empower families, build resiliency, and provide buffers to mitigate and prevent ACEs. It provides a model that can be implemented in a primary care setting while providing wraparound resources, including integrated mental health resources and referrals, to measure the success of these interventions.

Evaluation of a Language and Literacy Enhancement Program.

Reading aloud to children encourages language development. Pediatricians promote reading practices through Reach Out and Read (ROR) and other methods. This exploratory study sought to examine the value that supplemental materials promoting "Touch, Talk, Read, Play" (TTRP) might provide in addition to ROR. This study was a pre- and postintervention design to assess response to the TTRP curriculum. Caregivers of children ages 12 to 24 months completed the communication portion of the Ages and Stages Questionnaire-Third Edition and a Literacy Education Survey to assess current literacy practices. The caregiver and child were then introduced to the TTRP materials. Data were obtained on 98 subjects preintervention with follow-up data collected on 30 participants 6 months later. Significant differences were found in the Ages and Stages Questionnaire scores and parent-reported importance of reading and conversing frequently with their child. TTRP provides an effective curriculum for literacy promotion in a ROR program.

Improving Human Papilloma Virus Vaccination Rates: Quality Improvement.

BACKGROUND: Human papilloma virus (HPV) is a sexually transmitted infection with a national prevalence of greater than 70 million. Most infections are among persons 15-24 years of age. The HPV vaccine has nearly 100% efficacy when administered before natural exposure. However, national vaccination rates remain less than 50%. Our objective was to improve the rate of initiation of the HPV vaccination series in a resident teaching practice. METHODS: We used the Plan Do Study Act methodology for quality improvement. Eligible patients included children 9 through 13 years of age who presented to a general pediatric clinic. We established baseline data by reviewing HPV immunization rates taken from a convenience sample of ≤20 patients per month over 7 months. A key driver diagram guided interventions including resident communication, nursing staff education, family knowledge, and an electronic medical record prompt beginning at age 9. Using standard run chart rules, we plotted monthly postintervention vaccination rates over 7 months of data collection. RESULTS: Baseline data included 136 patients age 9-13. Run chart monitoring revealed an increase in our HPV vaccination rate from 53% at baseline to 62% by October 2015. Additionally, we observed a statistically significant increase in mean vaccination rates from 50% to 69% (odds ratio 2.071; P = 0.0042). We noted an increase in vaccination rates after resident education initiatives and after implementation of an electronic medical record prompt. CONCLUSIONS: Simple and practical interventions involving residents led to a marked increase in HPV vaccination in our patient population.