Art and activism in medical education: a modern necessity.

Artivism is the use of visual art to promote activism and foster meaningful action and change. This commentary argues that artivism should be embraced and utilised more consistently in medical education and healthcare advocacy related efforts. A brief history of artivism, rationale for use, and one approach for implementation based on the author's experience is shared.

Skipping the Line: Inequality in Access to Developmental-Behavioral Care.

CASE: The mother of an 18-month-old boy contacted the developmental and behavioral pediatrics clinic to request an evaluation because of concerns that her son is not using any words and only recently began walking. The child's mother became upset when she was notified that the clinic policy requires receipt of a formal request for evaluation from the primary care physician and that the first available appointment was in 9 months. Later that day, the child's grandmother contacted the clinic and reported that she is a member of the Donor Society affiliated with the university/medical system. Membership in the Donor Society is granted to individuals who have met specific philanthropic thresholds benefiting the university. One benefit to members of the Donor Society is the ability to access subspecialty medical services for themselves and their family members, across all disciplines, within 5 business days of their request.After confirming the details of the Donor Society promise with the philanthropic department of the hospital, a small committee of professionals within the clinic gathered to discuss the implications of this promised benefit to Donor Society members. This clinic is the only source for specialized, multidisciplinary developmental-behavioral health care that accepts public insurance within a 200-mile radius. The current waitlist for evaluation is 9 to 15 months depending on the reason for referral, and approximately 75% of patients on the waitlist receive some form of public assistance and/or live in a rural or underserved area. During the discussion, it was noted that there are 2 developmental-behavioral pediatric clinicians who practice within a cash-based private practice setting in the community. The waitlist for that practice was recently reported to be 3 to 6 months depending on the reason for evaluation, but that practice also requires a referral from the primary care physician before scheduling an initial evaluation.How would you recommend that the clinicians in the developmental and behavioral pediatrics clinic respond to the request to fulfill the promises made by the university to members of the Donor Society? How does a promise such as this one made to the Donor Society affect structural inequalities within the health care system and what strategies could be used to mitigate further inequalities that may result?

Validation of the Behavioral Health Checklist in Diverse Pediatric Primary Care Settings.

OBJECTIVE: Examine the validity and clinical utility of the Behavioral Health Checklist (BHCL), a screening tool with 2 forms (4-7, 8-12 years) developed for use with children of diverse backgrounds. METHOD: At pediatric primary care appointments, the parents of 1274 children completed a demographic form, the BHCL, and the Child Behavior Checklist (CBCL). Concurrent validity was examined by conducting correlations between the BHCL and the diagnostic scales of the CBCL. Diagnostic prediction was examined by conducting logistic regression analyses and plotting receiver operating characteristics (ROC) curves. Clinical utility was investigated by examining sensitivity, specificity, and kappa corrections for total predictive power. RESULTS: The pattern of correlations with the CBCL provided evidence of convergent and discriminant validity for both versions of the BHCL. ROC curve plots provided clear evidence of predictive validity (area under curve values ranged from .84 to .96 across factors and both age-determined versions). Cut-points achieving sensitivity and specificity values of at least .70 were identified for each BHCL factor for each version. CONCLUSION: The BHCL was demonstrated to have strong construct and predictive validity. The predictive validity of each version was demonstrated across genders, socioeconomic status, and racial groups (black or African American and white). The BHCL has promise as a developmentally and culturally effective behavioral health screener for use in pediatric primary care practices.

Assent as an ethical imperative in the treatment of ADHD.

The American Academy of Paediatrics endorses obtaining assent when prescribing medications for attention-deficit/hyperactivity disorder (ADHD) in older children whenever possible. Studies indicate the concept of assent may not be well understood by clinicians, possibly effecting effective and widespread implementation. We argue that though the concept of assent continues to evolve, it is critical in the context of patient-centred care, shared decision-making and in supporting minors' transition to adulthood. Based on the principle of respect for young persons, we argue that obtaining assent is an ethical imperative when prescribing medication for ADHD. We highlight the instrumental benefits of obtaining assent in the paediatric clinical encounter when prescribing medications for treatment of ADHD.

Developmentally and culturally appropriate screening in primary care: development of the behavioral health checklist.

OBJECTIVE: To evaluate the construct validity of the Behavioral Health Checklist (BHCL) for children aged from 4 to 12 years from diverse backgrounds. METHOD: The parents of 4-12-year-old children completed the BHCL in urban and suburban primary care practices affiliated with a tertiary-care children's hospital. Across practices, 1,702 were eligible and 1,406 (82.6%) provided consent. Children of participating parents were primarily non-Hispanic black/African American and white/Caucasian from low- to middle-income groups. Confirmatory factor analyses examined model fit for the total sample and subsamples defined by demographic characteristics. RESULTS: The findings supported the hypothesized 3-factor structure: Internalizing Problems, Externalizing Problems, and Inattention/Hyperactivity. The model demonstrated adequate to good fit across age-groups, gender, races, income groups, and suburban versus urban practices. CONCLUSION: The findings provide strong evidence of the construct validity, developmental appropriateness, and cultural sensitivity of the BHCL when used for screening in primary care.