Effect of Virtual Versus In Person Interpreting on Diabetes Outcomes in Non-English Language Preference Patients: A Pilot Study.

OBJECTIVE: The objective of this pilot study was to explore the impact of interpreter format (virtual vs in person) on clinical outcomes in patients with non-English language preference (NELP) and type 2 diabetes mellitus (T2DM) in a primary care setting. We hypothesized that NELP patients utilizing in person interpreters would have improved HbA1c values, better follow-up rate, and more complex care plans compared to patients utilizing virtual interpreters. METHODS: We completed a retrospective chart review of 137 NELP patients with T2DM who required a medical interpreter (February to June 2021). We calculated univariate and bivariate statistics to characterize the sample and assess the extent to which measures of continuity (follow-up visit rate and time to follow-up visit), quality (change in HbA1c), and complexity (medication intervention complexity) were associated with interpreter type. RESULTS: There was no statistically significant difference in follow-up rate or average days to follow-up visit for NELP patients with in person as opposed to virtual interpreters. Patients with virtual interpreters demonstrated a non-statistically significant decrease in HbA1c compared to those with in person interpreters. Finally, there was no statistically significant association between interpreter format and intervention complexity. CONCLUSIONS: Quality medical interpretation contributes to optimal health outcomes in NELP patients with diabetes. Our study suggests that both in person and virtual interpreters can be effective in providing care for NELP patients, especially for chronic disease management in the context of a primary care relationship. It also highlights the importance of pursuing additional qualitative and mixed method studies to better understand the benefits of various interpreter formats across different visit types.

Differences in Receipt of Time Alone with Healthcare Providers Among US Youth Ages 12-17.

BACKGROUND: Time to meet privately with a health care provider can support optimal adolescent health, but numerous barriers exist to implementing this practice routinely. METHODS: We examined parent reports on their children aged 12 to 17 from a nationally generalizable sample to quantify the presence of time alone with health care providers at the state and national level, as well as socio-contextual correlates using logistic regression analysis. RESULTS: We estimated that only 1 in 2 adolescents had a confidential discussion at their last medical visit. Certain child, family, and health care factors were associated with lower likelihood for having had confidential discussions. Specifically, adolescents who were Asian; did not have mental, emotional, or behavioral problems; were uninsured; or lived in households with parents who were immigrants, less educated, or did not speak English had significantly lower odds for having had time alone compared with referent groups. DISCUSSION: Clinical and structural efforts to rectify these gaps may assist a broader share of youth in benefiting from private health care discussions with providers.

Pushed Out and Drawn In: Exclusionary Discipline, Mental Health, and Protective Factors Among Youth in Public Schools.

BACKGROUND: Exclusionary discipline (ED) has long been an educational equity concern, but its relationship with student health and protective factors is less understood. METHODS: Using population-based public school student data (N = 82,216), we examined associations between past-month ED and positive depression and anxiety screening instrument results. We also assessed whether each of 9 potential protective factors moderated the ED-mental health relationship by testing interaction effects. RESULTS: Over 1 in 10 youth experienced past-month ED, with variation by sex, gender identity, special education status, poverty, region, race/ethnicity, and adverse childhood experiences. Net of sociodemographic factors, youth who experienced ED had higher likelihood for current depression (adjusted odds ratio [AOR]: 1.64, 95% confidence interval [CI]: 1.55, 1.73) and anxiety (AOR: 1.49, 95% CI: 1.41, 1.58) symptoms. Significant associations were robust across 5 racial/ethnic groups, except for anxiety among American Indian/Alaska Native youth. Individual, interpersonal, and school-level protective factors appeared to mitigate depression and anxiety regardless of disciplinary experience. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Our findings document ED disproportionality and possible ramifications for emotional well-being. CONCLUSIONS: In concert with structural efforts to reduce reliance on ED, strategies that bolster protective factors may support youth already impacted by ED and/or mental health problems.

Training on Corrections and Health Within U.S. Academic Health Professions Education: A Scoping Review.

Despite the scale, inequity, and consequences of mass incarceration, health care provider knowledge and awareness on correctional health remain limited. Understanding the educational experiences of health professions learners and the studies used to evaluate them can provide useful information about current gaps to guide future curricular improvement. To address this need, we conducted a scoping review of peer-reviewed studies examining United States-based academic health professions educational programs on correctional health. Studies were coded based on study characteristics, learner outcomes, and degree to which they contained elements described in relevant position statements by two professional medical associations. Overall, 27 articles (1975-2021) were included. Learner outcomes were primarily documented at the "reactions" (93%) and "learning" (52%) levels of the Kirkpatrick model (1979), relative to "behaviors" (11%) and "long-term outcomes" (0%). Comparison of curricula to select position statements revealed multiple content gaps in the realms of prevalent conditions requiring expertise (e.g., violence and self-harm); ethical and medical-legal considerations (e.g., privatization of correctional health care); and correctional health care systems, structures, and administration. Taken together, findings highlight gaps in, and opportunities for, correctional health educational programs. Addressing health care workforce training needs is a necessary yet insufficient step to achieving health equity for populations affected by incarceration.

Positive Early Childhood Experiences and School Readiness among US Preschoolers.

OBJECTIVES: To characterize the relationship between positive early childhood experiences (PECEs) and school readiness, and assess whether the PECEs-school readiness relationship was robust to and/or differed across levels of adverse childhood experiences (ACEs). METHODS: We analyzed national data on children ages 3-5 from 2016 to 2020 (n = 26 871) to examine associations between key PECE domains (nurturing relationships, home learning opportunities, safe and stable environments, and family routines) with being on track for school readiness, defined using a pilot, multidimensional measure called "healthy and ready to learn". Weighted univariate, bivariate, and multivariable analyses were conducted to generate nationally representative estimates. Multivariable models adjusted for sociodemographic factors and were assessed both with and without cumulative ACE exposure. RESULTS: Two-fifths of children were healthy and ready to learn. Exposure to PECEs was associated with higher school readiness, irrespective of relative ACE exposure. Compared with those with low PECEs, children with moderate (aOR, 2.19; 95% CI, 1.86-2.58) and high (aOR, 4.37; 95% CI, 3.58-5.34) PECEs had greater odds for being healthy and ready to learn, net of both sociodemographic factors and ACE exposure. Significant associations were robust across demographic groups (eg, race and ethnicity), ACE levels, and ACE types (eg, parental incarceration). CONCLUSIONS: Increasing PECEs correspond with greater likelihood of possessing capacities key for school functioning, even amidst ACEs. In concert with efforts to ameliorate early life trauma, caregivers, health care providers, educators, and systems can consider boosting PECEs to foster healthy development in childhood and beyond.

Health and care utilization among youth with a history of parental incarceration and homelessness.

INTRODUCTION: Despite widespread recognition of the health and social risks posed by parental incarceration (PI) and homelessness, these challenges are rarely considered in unison. We sought to (a) assess the experiences of homelessness among youth with and without a history of PI and (b) compare the health and healthcare utilization among youth with a combined history of PI and homelessness. METHOD: Examining data from eighth-, ninth-, and 11th-grade public school participants in the 2019 Minnesota Student Survey (N = 110,904), we calculated univariate and multivariate analyses to characterize the health status and care utilization of youth who have experienced PI, past-year homelessness, or both. RESULTS: We observed higher prevalence of homelessness among youth with a history of PI compared to those without. The group with dual PI-homelessness experience had a higher proportion of youth that were younger, male, and non-White; and living in poverty or urban areas compared to youth with PI history only. Even after accounting for demographic factors, the dual PI-homelessness group evidenced higher expected odds for several physical health conditions (e.g., asthma, diabetes), and differences in care utilization indicators relative to individual PI and homelessness groups. DISCUSSION: Findings suggest that PI may be overrepresented among recently homeless youth and that youth with such dual experience possess distinct, and often elevated, health service needs. Health, education, housing, and other systems may need intersectoral strategies to better identify and support this at-risk subset of youth through clinical and policy approaches. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"Many people know nothing about us": narrative medicine applications at a student-run free clinic.

Narrative medicine is an approach to healthcare that acknowledges the stories of patients' lives both within and beyond the clinical setting. Narrative medicine has been increasingly recognized as a promising tool to support modern educational needs in health professions training, such as interprofessional practice, while enhancing quality of care. Here, we describe the development, implementation, and application of a narrative medicine program at the University of Minnesota Phillips Neighborhood Clinic. First, in a qualitative analysis of patient stories (n = 12) we identified themes regarding the value of the storytelling experience; patients' personal journeys; and patients' experiences in healthcare and other systems. Second, an interprofessional educational activity for student volunteers (n = 57) leveraging a patient narrative was observed to be satisfactory, significantly improve attitudes toward the underserved, and enhance quality of care from the perspectives of trainees. Together, findings from the two studies imply the potential benefits of broader incorporation of narrative medicine into interprofessional service settings, for both learners and patients.

Development of a Shelter-based Health Empowerment Program for Pregnant and Parenting Youth Experiencing Homelessness.

BACKGROUND: Pregnancy and parenthood are common among youth experiencing homelessness and are associated with significant health risk for both parent and child. Yet, little is known regarding how to best promote health among this vulnerable population. OBJECTIVES: To understand stakeholder perceptions of needs and factors required for successful implementation of a shelter-based health empowerment program for pregnant and parenting youth experiencing homelessness and their children. METHODS: Applying frameworks from implementation science, we conducted interviews and focus groups with three groups of stakeholders (youth experiencing homelessness [n = 17], shelter staff [n = 8], community experts [n = 5]). We used qualitative content analysis to identify program content areas and design elements required for successful implementation. We then used a consensus-building process to engage community stakeholders in selecting and adapting an evidence-informed intervention. RESULTS: Stakeholders described several desired content areas for a group-based curriculum: sexual and reproductive health, mental health and child health. With respect to program design, stakeholders emphasized adaptability; a strengths-based, culturally responsive, and trauma-informed approach; a skills-oriented focus; staff training; access to health care; and the integration of youth voices. Driven by these findings, our community-based team proposed a health empowerment program with three elements: 1) a weekly health empowerment group, 2) health training and support for shelter staff, and 3) shelter-based health care services. CONCLUSIONS: Our study is among the first to assess the health care needs of pregnant and parenting youth in shelter, and to describe factors associated with the development and implementation of a shelter-based health empowerment program specifically targeting this vulnerable population.

Centering Community Voices: Establishment of a Community Advisory Board at a Student-Run Free Clinic.

Student-run free clinics (SRFCs) are common throughout the U.S. and have potential to meet the needs of both health professions trainees and patients in underserved communities. Here, we describe our SRFC's initial process for recruiting, implementing, and evaluating a Community Advisory Board to better align clinic offerings with community needs.

Childhood Physical Health and Attention Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Modifiable Factors.

Although neurobiologic and genetic factors figure prominently in the development of attention deficit/hyperactivity disorder (ADHD), adverse physical health experiences and conditions encountered during childhood may also play a role. Poor health is known to impact the developing brain with potential lifelong implications for behavioral issues. In attempt to better understand the relationship between childhood physical health and the onset and presence of ADHD symptoms, we summarized international peer-reviewed articles documenting relationships between a select group of childhood diseases or health events (e.g., illnesses, injuries, syndromes) and subsequent ADHD outcomes among children ages 0-17 years. Drawing on a larger two-phase systematic review, 57 longitudinal or retrospective observational studies (1978-2021) of childhood allergies, asthma, eczema, head injury, infection, or sleep problems and later ADHD diagnosis or symptomatology were identified and subjected to meta-analysis. Significant associations were documented between childhood head injuries, infections, and sleep problems with both dichotomous and continuous measures of ADHD, and between allergies with dichotomous measures of ADHD. We did not observe significant associations between asthma or eczema with ADHD outcomes. Heterogeneity detected for multiple associations, primarily among continuously measured outcomes, underscores the potential value of future subgroup analyses and individual studies. Collectively, these findings shed light on the importance of physical health in understanding childhood ADHD. Possible etiologic links between physical health factors and ADHD are discussed, as are implications for prevention efforts by providers, systems, and communities.

"We want to be heard": Perspectives on mental health care among patients at a federally qualified health center.

Context: Depression is a debilitating condition associated with significant medical, social, and economic costs for individuals and communities. Despite its widespread prevalence, depression is typically under-identified and under-treated, particularly for people of color and lower socioeconomic status. Primary care settings such as federally qualified health centers (FQHCs) offer an ideal opportunity to rectify this gap for underserved communities. Objective: From 2020-2021, we conducted a phone-based, qualitative assessment to understand what factors hindered and helped patients diagnosed with depression at a FQHC in receiving needed mental healthcare. Study Design: Qualitative study employing inductive (i.e., grounded theory) and deductive techniques to identify core themes. Setting: Patients of a single FQHC in Minneapolis with major depressive disorder or dysthymia (per ICD-10 diagnosis) were included. Patients with other mood disorders or receiving palliative care were excluded. Population Studied: 906 FQHC patients were eligible in the overall sample, and a purposive sampling approach was used to interview 34 patients with diverse functional status, race/ethnicity, and insurance status. The analytic sample was majority non-White (32% Black, 24% Latinx, 15% Other), 20% Spanish-speaking, and 60% publicly insured. Results: Interviews revealed multiple barriers (factors that impeded access) and facilitators (factors that enabled access) to the uptake of mental healthcare that patients encountered, from first presentation for care, initial depression diagnosis, all the way through to remission of depression symptoms. Salient barriers included feeling dismissed by providers, cost concerns, internal and external communication breakdowns, gaps in provider continuity, the patient portal, and perceptions of mental health among certain sub-populations (e.g., Black community). Salient facilitators included the clinic organization's, staff friendliness and warmth, strategies to provide care in light of patients' financial situation, existing provider relationships for physical health needs, language concordance, the option for telehealth visits, and the clinic's overall social mission. Conclusion: The identified factors cast light on opportunities at multiple levels for community-based outpatient clinics to better support patients with mental health needs, and ultimately narrow persistent gaps in access.

Epidemic Intelligence Service Alumni in Public Health Leadership Roles.

Since 1951, the Epidemic Intelligence Service (EIS) of the U.S. Centers for Disease Control and Prevention (CDC) has trained physicians, nurses, scientists, veterinarians, and other allied health professionals in applied epidemiology. To understand the program's effect on graduates' leadership outcomes, we examined the EIS alumni representation in five select leadership positions. These positions were staffed by 353 individuals, of which 185 (52%) were EIS alumni. Among 12 CDC directors, four (33%) were EIS alumni. EIS alumni accounted for 29 (58%) of the 50 CDC center directors, 61 (35%) of the 175 state epidemiologists, 27 (56%) of the 48 Field Epidemiology Training Program resident advisors, and 70 (90%) of the 78 Career Epidemiology Field Officers. Of the 185 EIS alumni in leadership positions, 136 (74%) were physicians, 22 (12%) were scientists, 21 (11%) were veterinarians, 6 (3%) were nurses, and 94 (51%) were assigned to a state or local health department. Among the 61 EIS alumni who served as state epidemiologists, 40 (66%) of them were assigned to a state or local health department during EIS. Our evaluation suggests that epidemiology training programs can serve as a vital resource for the public health workforce, particularly given the capacity strains brought to light by the COVID-19 pandemic.

When Words Fail: Love's Rightful Place in Medicine.

Early in my medical training, I shared an intimate connection with a patient that took me by surprise. How was it that I could come to feel so strongly about someone I had only just met? The experience prompted me to contemplate the transcendent, curious relationship entwining patients and clinicians, and reflect on how such a relationship squared with my own conceptions of love and caregiving. Though it is sometimes argued that transferring our emotions onto patients beyond direct clinical concerns can bias or tarnish the medicine we provide, I contend these emotions can be cherished and prudently explored rather than swept away.

Adolescent Sleep and Mental Health Across Race/Ethnicity: Does Parent-Child Connectedness Matter?

OBJECTIVE: Sleep is vital for healthy development, yet most adolescents do not meet recommended nightly hours. Although racial/ethnic minorities often experience relatively worse sleep outcomes compared with White peers, little is known about how the sleep-mental health relationship holds across diverse groups or how family relationships affect this association. METHOD: Using data on 8th, 9th, and 11th grade public school respondents to the 2016 Minnesota Student Survey (N = 113,834), we conducted univariate, bivariate, and multivariate analyses to examine whether sleep duration was associated with depressive symptoms, suicide ideation, and suicide attempt, adjusting for sociodemographic covariates. Furthermore, we examined the effect of the parent-child connectedness by sleep interaction on these relationships. Analyses were conducted for 9 racial/ethnic groups collectively and separately. RESULTS: Overall, youth sleep duration and parent-child connectedness were independently associated with reduced rates of depressive symptoms, suicide ideation, and suicide attempt. There was significant interaction between parent-child connectedness and sleep, demonstrating that connectedness magnifies the benefits of the sleep-mental health relationship. Main effects of sleep and parent-child connectedness for mental health were similar for most individual racial/ethnic groups, although magnitudes varied. The connectedness-sleep interaction only remained significant for White and Asian youth on select suicide-related outcomes. CONCLUSION: Despite racial/ethnic differences, adolescent sleep and parent-child connectedness both seem to buffer youth from poor mental health in a large, multiethnic sample. On the whole, these factors demonstrate a synergistic protective effect and reflect promising intervention targets. The extent to which their interactive benefit translates across diverse populations requires additional study.

Understanding Initial and Sustained Engagement of Spanish-Speaking Latina Mothers in the Legacy for Children Program™: A Qualitative Examination of a Group-Based Parenting Program.

Culturally congruent parenting programs delivered during early childhood have the potential to support diverse families. Legacy for Children™ (Legacy) is a group-based prevention program designed to promote child development by reinforcing sensitive, responsive mother-child relationships, building maternal self-efficacy, and fostering peer networks of support among mothers living in poverty (Perou et al., 2012). The Legacy program was translated and culturally adapted for Spanish-speaking Latina mothers and their infants (hereafter referred to as Latina mothers) with a feasibility trial conducted to determine the cultural congruency of the adaptation. Feasibility results were positive with no previous studies validating the adapted Legacy Spanish language program (Legacy Spanish). The current manuscript focuses on understanding factors of engagement of the culturally adapted model. Specifically, we examined the factors that were perceived to have enhanced or hindered both initial and sustained engagement in the adapted Legacy Spanish program for Latina mothers. Individual interviews were conducted with Latina mothers (N=26) who attended the Legacy Spanish program. We used a template approach within NVivo 11© software to identify broad themes in Latina mothers' responses. Themes emerged regarding the importance of using home-based recruitment strategies and pairing verbal information with written brochures to foster initial engagement. Sustained engagement themes focused on the provision of support from other Latina mothers in the Legacy group and the relationships with the group leaders. Having group leaders who were perceived as genuine, kind, positive, "good" at teaching, and persistent emerged as themes that facilitated initial and ongoing engagement. Barriers to engagement centered primarily on logistics rather than characteristics of the program itself. Thus, Latina mothers attributed importance to aspects of the curriculum, logistics, and implementation with respect to program engagement. Application of similar engagement strategies could enhance the success of early childhood parenting programs and linkages with early educational programming.

An LGBTQIA+ Symposium to Improve Care for Sexual and Gender Minority Youth.

BACKGROUND AND OBJECTIVES: Multilevel factors drive health disparities experienced by sexual and gender minority (SGM) populations. We developed a 3-hour symposium focusing on care for SGM youth to address this. The symposium was a free, extracurricular event open to the public, with an emphasis on health professional students and providers from all disciplines and involved interprofessional didactic and interactive components. METHODS: Participants completed optional retrospective pre/postsurveys immediately and 10-months postsymposium. Surveys contained Likert-scale questions addressing five indicators of symposium effectiveness related to knowledge, confidence, and comfort in providing care for SGM populations. We used 1-tailed paired t tests to evaluate the effectiveness of the symposium, and analysis of variance tests to compare differences by professional role. RESULTS: Of 208 individuals who attended the symposium, 67 completed the initial survey, and 23 completed the 10-months postsymposium survey. Participants reported significantly higher ( P<.001) scores across all five measures of effectiveness from pre- to immediately postsymposium, and remained at significantly higher ( P<.05) scores across all measures from presymposium to 10 months postsymposium, except for comfort recommending care for SGM pediatric patients or clients. CONCLUSION: Results suggest that the symposium improved participants' perceived effectiveness in serving SGM pediatric patients, although selection bias is a concern. Dissemination of educational approaches that incorporate interprofessional didactic and active learning components may help improve workforce capacity to improve SGM health.

Characteristics Associated With Presence of Pediatric Mental Health Care Policies in Emergency Departments.

OBJECTIVES: The majority of US children do not have access to an emergency department (ED) with a pediatric mental health care policy in place. Our objective was to understand factors associated with whether US EDs have a pediatric mental health care policy. METHODS: We analyzed data from the National Pediatric Readiness Project, a nationally representative cross-sectional survey of US EDs. Nurse managers reported whether their hospitals had a policy to care for children with social/mental health concerns (n = 3612). We calculated prevalence estimates, prevalence ratios (PRs), and confidence intervals (CIs) for regional and ED characteristics (eg, rurality and types of personnel) by whether EDs had a pediatric mental health care policy. RESULTS: Overall, 46.2% (n = 1668/3612) of EDs had a pediatric mental health care policy. Emergency departments located in remote areas were 60% less likely to have such a policy compared with EDs in urban areas (PR, 0.4; CI, 0.3-0.5). Emergency department characteristics associated with having a pediatric mental health care policy included having a policy to transfer children with social/mental health concerns (PR, 5.4; CI, 4.7-6.2), having a policy to address maltreatment (PR, 3.4; CI, 2.6-4.4), and having nurse and physician pediatric emergency care coordinators (PR, 1.6; CI, 1.5-1.8). CONCLUSIONS: Lower prevalence of pediatric mental health policies in rural EDs is concerning considering EDs are often the first point of contact for pediatric patients. This work highlights the importance of pediatric emergency care coordinators in fostering ED capacity to meet children's mental health needs.