Suicide Prevention Takes a Nation: Collaborative Approaches to Universalize Suicide Prevention.

Suicide is a complex public health issue impacting many children and adolescents-and their families-each year, and it requires a complex public health solution. Local, state, and national collaboratives that leverage evidence-based strategies, foster community engagement, and prioritize equity are necessary to holistically address this issue. Here, the authors discuss the necessary steps for fostering inclusive community partnerships and outline the rationale for partnering with schools, youth groups, faith organizations, parent-teacher organizations, clinical settings, and professional organizations, as well as collaborating with the juvenile justice and child welfare systems and working together to foster suicide prevention policy.

An Innovative Approach to Increase Lead Testing by Pediatricians in Children, United States, 2019-2021.

Opportunities for lead exposure are common in the United States. The American Academy of Pediatrics, in collaboration with the Centers for Disease Control and Prevention, launched the Increasing Capacity for Blood Lead Testing Extension for Community Healthcare Outcomes (ECHO) project to educate pediatricians on the importance of testing children for lead exposure and to assess practice behavior change. We found that two weeks to one month after receiving training, more than 80% of participants reported increased lead testing and practice changes. Our results support use of the ECHO model as a mechanism for practice change. (Am J Public Health. 2022;112(S7):S647-S650. https://doi.org/10.2105/AJPH.2022.307084).

Barriers, access and management of paediatric epilepsy with telehealth.

Access to paediatric neurology care is complex, resulting in significant wait times and negative patient outcomes. The goal of the American Academy of Pediatrics National Coordinating Center for Epilepsy's project, Access Improvement and Management of Epilepsy with Telehealth (AIM-ET), was to identify access and management challenges in the deployment of telehealth technology. AIM-ET organised four paediatric neurology teams to partner with primary-care providers (PCP) and their multidisciplinary teams. Telehealth visits were conducted for paediatric epilepsy patients. A post-visit survey assessed access and satisfaction with the telehealth visit compared to an in-person visit. Pre/post surveys completed by PCPs and neurologists captured telehealth visit feasibility, functionality and provider satisfaction. A provider focus group assessed facilitators and barriers to telehealth. Sixty-one unique patients completed 75 telehealth visits. Paired t-test analysis demonstrated that telehealth enhanced access to epilepsy care. It reduced self-reported out-of-pocket costs (p<0.001), missed school hours (p<0.001) and missed work hours (p<0.001), with 94% equal parent/caregiver satisfaction. Focus groups indicated developing and maintaining partnerships, institutional infrastructure and education as facilitators and barriers to telehealth. Telehealth shortened travelling distance, reduced expenses and time missed from school and work. Further, it provides significant opportunity in an era when coronavirus disease 2019 limits in-person clinics.

The Power of Connections: AAP COVID-19 ECHO Accelerates Responses During a Public Health Emergency.

CONTEXT: Pediatric providers across the United States have sought guidance on how to care for the nation's children during the uncertain historic times of the COVID-19 pandemic. The health care community has been challenged by the unprecedented burden of caring for patients when they have evolving guidelines and limited information about the effects of the virus on children. PROGRAM: In response, the American Academy of Pediatrics (AAP) rapidly launched a national initiative to increase child health professionals' knowledge, skills, and self-efficacy. This COVID-19 ECHO (Extension for Community Healthcare Outcomes) program created communities of learners among child health professionals and subject matter expert faculty using didactic and case-based presentations that foster an "all-teach, all-learn" approach. IMPLEMENTATION: The initial AAP COVID-19 ECHO program hosted more than 900 participants in 127 individual virtual sessions, with approximately 25 participants per session. The evolving nature of the pandemic necessitated dynamic and continuous bidirectional flow of concerns and information relevant to participants. Session topics were selected in a "just-in-time" fashion based on participant feedback from the prospective postsession surveys and faculty recommendations; speakers brought data and expert recommendations. EVALUATION: To assess impact, the AAP used a mixed-methods approach to evaluate the program's effectiveness in meeting its educational objectives. The 2-phase evaluation collected quantitative and qualitative data through an integrated feedback structure that utilized prospective postsession and retrospective postprogram surveys, along with postprogram focus groups. DISCUSSION: As the COVID-19 pandemic surges and another influenza season is upon us, the ECHO model is an effective strategy for facilitating bidirectional communication and education to build child health professionals' knowledge, skills, and self-efficacy during an unprecedented and ongoing public health emergency. KEY POINTS: The ECHO model is an effective strategy for health care organizations to facilitate bidirectional communication and education in building health professionals' clinical knowledge, skills, and self-efficacy during the unprecedented and ongoing public health emergency of the COVID-19 pandemic.

Integrating quality improvement into the ECHO model to improve care for children and youth with epilepsy.

OBJECTIVE: Project ECHO (Extension for Community Healthcare Outcomes), a telementoring program, utilizes lectures, case-based learning, and an "all teach-all learn" approach to increase primary care provider (PCP) knowledge/confidence in managing chronic health conditions. The American Academy of Pediatrics (AAP) Epilepsy and Comorbidities ECHO incorporated quality improvement (QI) methodology to create meaningful practice change, while increasing PCP knowledge/self-efficacy in epilepsy management using the ECHO model. METHODS: Monthly ECHO sessions (May 2018 to December 2018) included lectures, case presentations/discussion, and QI review. Pediatric practices were recruited through the AAP. Practices engaged in ECHO sessions and improvement activities including monthly Plan-Do-Study-Act cycles, team huddles, chart reviews, and QI coaching calls to facilitate practice change. They were provided resource toolkits with documentation templates, safety handouts, and medication side effects sheets. QI measures were selected from the American Academy of Neurology Measurement Set for Epilepsy. The AAP Quality Improvement Data Aggregator was used for data entry, run chart development, and tracking outcomes. Participants completed retrospective surveys to assess changes in knowledge and self-efficacy. RESULTS: Seven practices participated across five states. Average session attendance was 14 health professionals (range = 13-17). A total of 479 chart reviews demonstrated improvement in six of seven measures: health care transition (45.3%, P = .005), safety education (41.6%, P = .036), mental/behavioral health screening (32.2% P = .027), tertiary center referral (26.7%, not significant [n.s.]), antiseizure therapy side effects (23%, n.s.), and documenting seizure frequency (7.1%, n.s.); counseling for women of childbearing age decreased by 7.8%. SIGNIFICANCE: This project demonstrated that integrating QI into an ECHO model results in practice change and increases PCP knowledge/confidence/self-efficacy in managing epilepsy.

Reducing the risk of sudden infant death syndrome in child care and changing provider practices: lessons learned from a demonstration project.

OBJECTIVE: The goal was to evaluate, through an American Academy of Pediatrics demonstration project, the effectiveness of a curriculum and train-the-trainer model in changing child care providers' behaviors regarding safe infant sleep practices. METHODS: Participating licensed child care centers and family child care homes were assigned randomly to intervention and control groups. Observers performed an initial unannounced visit to each site, to watch infants being placed for sleep, to inventory sleep policies, and to administer questionnaires to center staff members. Trainers then used the American Academy of Pediatrics curriculum in educational sessions at intervention sites. Three months later, observers conducted a follow-up observation at each site, and staff members completed a questionnaire about logistic barriers encountered in implementation of safe sleep recommendations. RESULTS: A total of 264 programs and 1212 providers completed the study; the care of 1993 infants was observed. Provider awareness of the American Academy of Pediatrics infant supine sleep position recommendation increased from 59.7% (both groups) to 64.8% (control) and 80.5% (intervention). Exclusive use of the supine position in programs increased from 65.0% to 70.4% (control) and 87.8% (intervention). Observed supine placement increased from 51.0% to 57.1% (control) and 62.1% (intervention). CONCLUSIONS: A sudden infant death syndrome risk reduction curriculum using a train-the-trainer model is effective in improving the knowledge and practices of child care providers. Perceived parental objections, provider skepticism about the benefits of supine positioning, and lack of program policies and training opportunities are important barriers to implementation of safe sleep policies. Continued education of parents, expanded training efforts, and statewide regulations, mandates, and monitoring are critical to ongoing efforts to decrease further the risk of sudden infant death syndrome in child care.