Promoting social emotional development during the paediatric well-child visit: a demonstration project.

Supporting social emotional development, beginning at birth, can improve lifelong health. The American Academy of Paediatrics recommends 12 well-child visits between birth and age 3 years. Each well-child visit provides a unique opportunity to interact with and support families to promote social emotional development of children. Eighteen US paediatric practices joined a learning community to use improvement science to test and implement evidence-informed strategies that nurture parent-child relationships and promote the social emotional development of young children.Quality improvement methods were used to integrate 11 strategies into well-child visits between birth and age 3 years and measure the improvements with a set of outcome, process and balancing measures. Participation among the 18 paediatric practices was high with 72% of teams attending monthly webinars and 97% of teams attending the three learning sessions. Over 12 months, the percentage of children receiving age-appropriate social emotional development screens at participating practices' well-child visits increased from a baseline median of 83% to 93%.Current paediatric practice in the USA focuses primarily on cognitive and physical development, and paediatric providers are less familiar with established practices to screen for social emotional development and promote the caregiver-child relationship. This project suggests that improvement methods show promise in increasing the number of children who receive age-appropriate social emotional development screens or assessments at well-child visits.

Improving Access to Care at Autism Treatment Centers: A System Analysis Approach.

OBJECTIVE: The prevalence of autism spectrum disorder is steadily increasing and placing more demands on already overburdened diagnostic and treatment systems. A thoughtful, systematic reorganization of autism service delivery may reduce delays and better meet the growing need. METHODS: Two clinical centers in the Autism Intervention Research Network on Physical Health, Cincinnati Children's Hospital Medical Center (CCHMC) and Nationwide Children's Hospital (NCH), undertook a year-long access improvement project to reduce delays to care by using system analysis to identify sources of delay and to target changes by using a set of defined access principles. Although both sites addressed access, they focused on slightly different targets (reducing number of patients with autism spectrum disorders waiting for follow-up appointments at NCH and reducing delay to new diagnosis at CCHMC). RESULTS: Both sites achieved dramatic improvements in their complex, multidisciplinary systems. A 94% reduction in number of patients on the waitlist from 99 to 6 patients and a 22% reduction in median delay for a new ongoing care appointment were realized at NCH. A 94% reduction in third next available appointment for new physician visits for children 3 to 5 years old was realized at CCHMC. CONCLUSIONS: This article demonstrates that 2 different clinical systems improved access to care for autism diagnosis and follow-up care by identifying sources of delay and using targeted changes based on a set of access change principles. With appropriate guidance and data analysis, improvements in access can be made.

Health professional students in community service: insights from trainees and their mentors.

OBJECTIVES: To gain insights from the experiences of student health professionals working with agencies caring for the underserved. METHODS: Five hundred and sixty-six (566) U.S. Albert Schweitzer Fellows from 90 professional schools in six sites participated in year-long mentored, entrepreneurial service and leadership development projects in community agencies. Focusing on their experiences, Fellows completed pre- and post-service surveys, and agency mentors completed a post-service survey about their experiences. RESULTS: Fellows' confidence in 11 of 16 service-related skills increased, and their concerns about lack of knowledge, skills, experience, recognition, and mentoring as barriers to service decreased. Their concerns about time constraints increased. Agency mentors reported that 85% of Fellows' projects made significant contributions to their agencies or clients. CONCLUSIONS: An entrepreneurial, mentored service experience can have a positive impact on health professional students and may provide benefits to the communities served.