A Pilot Randomized Controlled Trial of the Family Assessment and Feedback Intervention (FAFI): Effects on Mental Health Literacy and Attitudinal Engagement with Health Supports and Services.

This randomized controlled trial tested the Family Assessment and Feedback Intervention (FAFI), a new intervention to enhance family engagement with emotional and behavioral health services. The FAFI is a guided conversation with families about results of their multidimensional assessment that is set in the context of motivational enhancement. It differs from other assessment-with-feedback interventions by extending the focus of assessment beyond the target child to parents and the family environment, addressing parental emotional and behavioral problems and competencies, spanning a broad range of children's and parents' strengths and difficulties, and being generalizable to many settings and practitioners. Participants were 81 families in primary care pediatrics. The FAFI was associated with a significant increase in parental mental health literacy and with an increase in parental attitudinal engagement with health supports and services that closely approached statistical significance (p = .052), while controlling for children's age and gender and family socioeconomic status.

The Vermont Family Based Approach in Primary Care Pediatrics: Effects on Children's and Parents' Emotional and Behavioral Problems and Parents' Health-Related Quality of Life.

This randomized controlled trial tested the Vermont Family Based Approach (VFBA) in primary care pediatrics. The VFBA is a model of healthcare delivery that shifts the focus from the individual to the family, emphasizes emotional and behavioral health, and uses evidence-based health promotion/prevention along with the treatment of emotional and behavioral problems. Participants were 81 families of 3-15-year-olds. For children, the VFBA was associated with greater reductions than the Control condition on the Child Behavior Checklist Emotionally Reactive, Withdrawn, Sleep Problems, Aggressive Behavior and Total Problems scales. For parents, the VFBA was associated with greater reductions than the Control condition on the Adult Self-Report Anxious/Depressed, Rule-Breaking Behavior, Internalizing Problems and Total Problems scales. The VFBA was also associated with greater improvement than the Control condition in the parents' health-related quality of life, as indicated by all scales of the Medical Outcomes Study Health Survey.

A primary care learning collaborative to improve office systems and clinical management of pediatric asthma.

OBJECTIVE: Pediatric asthma is a common, relapsing-remitting, chronic inflammatory airway disease that when uncontrolled often leads to substantial patient and health care system burden. Improving management of asthma in primary care can help patients stay well controlled. METHODS: The Vermont Child Health Improvement Program (VCHIP) developed a quality improvement (QI) learning collaborative with a primary objective to improve clinical asthma management measures through improvement in primary care office systems to support asthma care. Seven months of medical record review data were evaluated for improvements on eight clinical asthma management measures. Pre and post office systems inventory (OSI) self-assessments detailing adherence to improvement strategies were analyzed for improvement. Logistic regressions were used to test for associations between OSI strategy post scores and the corresponding clinical asthma management measures by month seven. RESULTS: This study found significant improvement from baseline to month seven on seven of the eight clinical asthma management measures and between pre and post OSI for seven of the nine strategies assessed (N = 19 practices). Additionally, one point higher average OSI scores on the assessment and monitoring of asthma severity, asthma control, asthma action plans, and asthma education strategies were associated with significantly greater odds of improvement in their respective clinical asthma management measures. CONCLUSIONS: A QI learning collaborative approach in primary care can improve office systems and corresponding clinical management measures for pediatric patients with asthma. This suggests that linking specific office systems strategies to clinical measures may be a helpful tactic within the learning collaborative model.

The Strengths and Difficulties Questionnaire as a Mental Health Screening Tool for Newly Arrived Pediatric Refugees.

Many refugee children have exposure to trauma prior to arrival and during resettlement. Mental health screening in primary care among resettled refugee children is needed. The Strengths and Difficulties Questionnaire (SDQ) was used to screen refugee children age 4-18 years at their Domestic Medical Examination and three other primary care visits in their first year of resettlement. We tested the association between time and SDQ score or intervention/referral, and differences based on geographic origin. SDQ scores were highest upon arrival (Ps < .0005). Referrals were most common at the six-month visit compared to arrival and one month (Ps < .01). Iraqi children had higher SDQ scores at all visits (Ps < .03). The SDQ can be used in primary care to screen newly arrived refugee children. Practitioners should screen at arrival to identify difficulties. Those with difficulties continuing at six months may need an intervention or referral.

Health Promotion in Primary Care Pediatrics: Initial Results of a Randomized Clinical Trial of the Vermont Family Based Approach.

The Vermont Family Based Approach (VFBA) is an innovative approach to healthcare delivery that addresses challenges of the healthcare system in the United States. The authors conducted a randomized controlled trial of the VFBA at a primary care pediatric clinic. The goal of the trial was to test the feasibility of the VFBA in pediatrics and to improve healthcare engagement and health outcomes for families. This article presents initial results of the trial on feasibility and engagement. The VFBA was found feasible and was associated with a significant increase in engagement with health and wellness supports and services.

The evolution of new business in health care.

The increasing size, growth, and complexity of the health care industry would appear to offer ample opportunity for innovation and entrepreneurship. But is entrepreneurship really on the rise in health care? We performed a sequential cross-sectional analysis of new, rapidly growing health care businesses in the Inc. 500 list to answer this question. We found that, while there appears to be increasing numbers of opportunities for new, privately held businesses, this varies widely by category. In particular, health information management appeared to be an example of emerging industry, characterized by increases in the number of businesses, as well as in the rate of growth and the average revenue. In contrast, the insurance industry seems to have transitioned to maturity. This article argues that companies that introduce disruptive innovations into health care, either through information technology, new ancillary services, or more focused services to the elderly, will likely be good areas for investors who follow the health care industry as well as entrepreneurs who are looking for a niche for market entry.