Who is in Your Waiting Room? Social Determinants of Health and Adverse Childhood Experiences in Pediatric Surgery Clinics.

BACKGROUND: Social determinants of health (SDoH) influence overall health, although little is known about the SDoH for pediatric patients requiring surgical services. This study aims to describe SDoH for pediatric surgical patients attending out-patient, community, and outreach clinics, as well as demonstrate the feasibility of identifying and addressing SDoH and Adverse Childhood Experiences (ACEs) when appropriate. METHODS: A cross-sectional study using surveys evaluating SDoH that were distributed to families attending pediatric surgical clinics over a two-year period. The pilot survey used validated questions and was later refined to a shorter version with questions on: Barriers to care, Economic factors, Adversity, Resiliency and Social capital (BEARS). Data was analyzed with descriptive and inferential statistics. RESULTS: 851 families across 13 clinics participated. One third of families reported not having a primary health care provider or being unable to turn to them for additional support. One in four families were found to have a household income less than the Canadian after-tax low-income threshold (<$40,000 CAD). Two-thirds of families answered questions about ACEs, and those with more ACEs were more likely to report a low income. Forty percent of families rarely or only sometimes had adequate social support. CONCLUSION: This survey tool enabled discussions between families and care providers, which allowed clinicians to appropriately follow-up with families and refer them to social work for further support when indicated. Addressing concerns around SDoH within a busy surgical clinical is feasible and may positively affect long-term health outcomes and equitable resource allocation. LEVEL OF EVIDENCE: IV.

A Cross-Sectional Analysis of the BC Children's Hospital Cleft Palate Program Waitlist.

OBJECTIVE: A 2016 review of the BC Children's Hospital Cleft Palate - Craniofacial Program (CPP) revealed that one-third of patients met the program's care recommendations and half met the American Cleft Palate-Craniofacial Association guidelines. This study reviews patients on the CPP waitlist and determines median wait times and missed clinical assessments as well as identifies how wait times are influenced by medical complexity, specialized speech service needs, vulnerability, and distance from clinic. DESIGN: Cross-sectional. SETTING: BC Children's Hospital Cleft Palate-Craniofacial Program. PATIENTS: Five hundred seventy-six waitlisted patients. MAIN OUTCOME MEASURES: Additional wait time after recommended appointment date. Correlation of additional wait time with diagnosis, number of specialists required, speech services needed, vulnerability, and distance from the clinic. Missed plastic surgery, speech, and orthodontic assessments according to CPP team recommendations and ACPA guidelines. RESULTS: Patients had a median additional wait time of 11 months (interquartile range: 5-27). Longer additional wait times were associated with a craniofacial diagnosis (P = .019), a need for formal speech assessments or evaluations (P < .001), or a requirement to see multiple specialists (P < .001). Vulnerability and distance from clinic did not affect wait times. Plastic surgery assessments were not available at the preschool and preteen time points for 45 (8%) patients, 355 (62%) patients were unable to access speech assessments, and 120 (21%) were unable to complete an orthodontic assessment. CONCLUSION: Patients wait up to an additional year to be seen by the CPP and miss speech, orthodontic, and surgical assessments at key developmental milestones. Additional resources are required to address these concerns.

OBJECTIF: Une analyse du programme de chirurgie labiofaciale et crâniofaciale (PCLC) du BC Children's Hospital réalisée en 2016 a révélé que le tiers des patients respectaient les recommandations du programme et la moitié, les lignes directrices de l'American Cleft Palate-Craniofacial Association (ACPA). La présente étude visait à passer en revue les patients sur la liste d'attente du PCLC, à déterminer la liste d'attende médiane et les évaluations cliniques ratées et à établir l'effet de la complexité médicale, des besoins en orthophonie, de la vulnérabilité et de la distance de la clinique sur les temps d'attente. MÉTHODOLOGIE: Transversale. CONTEXTE: Programme de chirurgie labiofaciale et crâniofaciale du BC Children's Hospital. PATIENTS: 576 sur la liste d'attente. PRINCIPALES MESURES DE RÉSULTATS: Temps d'attente supplémentaire après la date recommandée du rendez-vous. Corrélation du temps d'attente supplémentaire avec le diagnostic, le nombre de spécialistes requis, les besoins en orthophonie, la vulnérabilité et la distance de la clinique. Évaluations ratées en chirurgie plastique, en orthophonie et en orthodontie en fonction des recommandations de l'équipe du PCLC et des lignes directrices de l'ACPA. RÉSULTATS: Les patients devaient subir un temps d'attente supplémentaire médian de 11 mois (plage interquartile de 5 à 27). Des temps d'attente supplémentaires plus longs s'associaient à un diagnostic crâniofacial (P = 0,019), à la nécessité de subir une évaluation officielle en orthophonie (P < 0,001) ou à la nécessité de consulter de multiples spécialistes (P < 0,001). La vulnérabilité et la distance de la clinique n'avaient pas d'incidence sur les temps d'attente. Les évaluations en chirurgie plastique n'étaient pas disponibles pour 45 patients (8 %) pendant la période préscolaire et à la préadolescence, alors que 355 patients (62 %) n'avaient pas eu accès à une évaluation en orthophonie et 120 (21 %), en orthodontie. CONCLUSION: Les patients attendent jusqu'à une année supplémentaire avant d'être vus par le PCLC et ratent des évaluations en orthophonie, en orthodontie et en chirurgie lors d'étapes importantes de leur développement. Des ressources supplémentaires s'imposent pour corriger ces lacunes.

Sleep Health Issues for Children with FASD: Clinical Considerations.

This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD) focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders. The sleep promotion techniques used for typical children are less suitable for children with FASD who need individually designed interventions. The types, causes, and adverse effects of sleep disorders, the modification of environment, scheduling and preparation for sleep, and sleep health for their caregivers are discussed. It is our hope that parents and also researchers, who are interested in the sleep disorders of children with FASD, will benefit from this presentation and that this discussion will stimulate much needed evidence-based research.