Comparative Effectiveness of Parent-Based Interventions to Support Injured Children.

OBJECTIVES: A comparative effectiveness trial tested 2 parent-based interventions in improving the psychosocial recovery of hospitalized injured children: (1) Link for Injured Kids (Link), a program of psychological first aid in which parents are taught motivational interviewing and stress-screening skills, and (2) Trauma Education, based on an informational booklet about trauma and its impacts and resources. METHODS: A randomized controlled trial was conducted in 4 children's hospitals in the Midwestern United States. Children aged 10 to 17 years admitted for an unintentional injury and a parent were recruited and randomly assigned to Link or Trauma Education. Parents and children completed questionnaires at baseline, 6 weeks, 3 months, and 6 months posthospitalization. Using an intent-to-treat analysis, changes in child-reported posttraumatic stress symptoms, depression, quality of life, and child behaviors were compared between intervention groups. RESULTS: Of 795 injured children, 314 children and their parents were enrolled into the study (40%). Link and Trauma Education was associated with improved symptoms of posttraumatic stress, depression, and pediatric quality of life at similar rates over time. However, unlike those in Trauma Education, children in the Link group had notable improvement of child emotional behaviors and mild improvement of conduct and peer behaviors. Compared with Trauma Education, Link was also associated with improved peer behaviors in rural children. CONCLUSION: Although children in both programs had reduced posttrauma symptoms over time, Link children, whose parents were trained in communication and referral skills, exhibited a greater reduction in problem behaviors.

Steering teens safe: a randomized trial of a parent-based intervention to improve safe teen driving.

BACKGROUND: Crashes are the leading cause of death for teens, and parent-based interventions are a promising approach. We assess the effectiveness of Steering Teens Safe, a parent-focused program to increase safe teen driving. METHODS: Steering Teens Safe aimed to improve parental communication with teens about safe driving using motivational interviewing techniques in conjunction with 19 safe driving lessons. A randomized controlled trial involved 145 parent-teen dyads (70 intervention and 75 control). Intervention parents received a 45-minute session to learn the program with four follow-up phone sessions, a DVD, and a workbook. Control parents received a standard brochure about safe driving. Scores were developed to measure teen-reported quantity and quality of parental communication about safe driving. The main outcome measure was a previously validated Risky Driving Score reported by teens. Because the Score was highly skewed, a generalized linear model based on a gamma distribution was used for analysis. RESULTS: Intervention teens ranked their parent's success in talking about driving safety higher than control teens (p = 0.035) and reported that their parents talked about more topics (non-significant difference). The Risky Driving Score was 21% lower in intervention compared to control teens (85% CI = 0.60, 1.00). Interaction between communication quantity and the intervention was examined. Intervention teens who reported more successful communication had a 42% lower Risky Driving Score (95% CI = 0.37, 0.94) than control parents with less successful communication. CONCLUSIONS: This program had a positive although not strong effect, and it may hold the most promise in partnership with other programs, such as Driver's Education or Graduated Driver's License policies. TRIAL REGISTRATION: ClinicalTrials.gov NCT01014923. Registered Nov. 16, 2009.

Parent and teen agreement on driving expectations prior to teen licensure.

OBJECTIVES: To examine pre-licensure agreement on driving expectations and predictors of teen driving expectations among parent-teen dyads. METHODS: Cross-sectional survey of 163 parent-teen dyads. Descriptive statistics, weighted Kappa coefficients, and linear regression were used to examine expectations about post-licensure teen driving. RESULTS: Teens reported high pre-licensure unsupervised driving (N = 79, 48.5%) and regular access to a car (N = 130, 81.8%). Parents and teens had low agreement on teen driving expectations (eg, after dark, κw = 0.23). Each time teens currently drove to/from school, their expectation of driving in risky conditions post-licensure increased (ß = 0.21, p = .02). CONCLUSIONS: Pre-licensure improvement of parent-teen agreement on driving expectations are needed to have the greatest impact on preventing teens from driving in high risk conditions.

Scooter injuries in children in a midwestern metropolitan area.

OBJECTIVES: We describe the use of nonmotorized scooters and utilization of safety equipment in a Midwestern suburb. METHODS: Schoolchildren in second to sixth grades of a local school district completed a survey distributed by school nurses and teachers in spring 2001, including topics of scooter ownership, riding patterns, and utilization of safety gear. RESULTS: Three thousand eighty-seven surveys were distributed, with a 74.4% response rate; 93.2% of children had ridden a scooter, and 71.4% owned a scooter. Children rode in many locations, with 93% riding on the sidewalk, 86.5% in the driveway, 35.5% in a parking lot, and 20% in the street. Of those owning scooters, 91.2% reported owning a helmet, 61.2% kneepads, 59.4% elbow pads, 43.8% wrist guards, and 35.5% riding gloves. Among those owning scooters, 54.6% reported wearing helmets while using their scooter, whereas 10% or less wore riding gloves, kneepads, elbow pads, or wrist guards. Helmet use decreased as grade increased; 50.7% of all second graders reported wearing helmets, compared with 22.7% of sixth graders (P < 0.001). Of those owning scooters, 32.2% reported being injured while riding their scooter. Of those injured, 54% reported wearing helmets. CONCLUSIONS: Many children ride scooters and own safety gear; however, few children wear their safety equipment when riding their scooter. Children wear helmets less frequently as they age. Physicians should continue to educate patients and their parents as to potential injuries on scooters and encourage the use of safety gear, especially helmets, when riding scooters.

Teaching Spanish to pediatric emergency physicians: effects on patient satisfaction.

BACKGROUND: Language barriers are known to negatively affect patient satisfaction. OBJECTIVE: To determine whether a course of instruction in medical Spanish for pediatric emergency department (ED) physicians is associated with an increase in satisfaction for Spanish-speaking-only families. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTION: Nine pediatric ED physicians completed a 10-week medical Spanish course. Mock clinical scenarios and testing were used to establish an improvement in each physician's ability to communicate with Spanish-speaking-only families. Before (preintervention period) and after (postintervention period) the course, Spanish-speaking-only families cared for by these physicians completed satisfaction questionnaires. Professional interpreters were equally available during both the preintervention and postintervention periods. MAIN OUTCOME MEASURES: Responses to patient family satisfaction questionnaires. RESULTS: A total of 143 Spanish-speaking-only families completed satisfaction questionnaires. Preintervention (n = 85) and postintervention (n = 58) cohorts did not differ significantly in age, vital signs, length of ED visit, discharge diagnosis, or self-reported English proficiency. Physicians used a professional interpreter less often in the postintervention period (odds ratio [OR], 0.34; 95% confidence interval [CI], 0.16-0.71). Postintervention families were significantly more likely to strongly agree that "the physician was concerned about my child" (OR, 2.1; 95% CI, 1.0-4.2), "made me feel comfortable" (OR, 2.6; 95% CI, 1.1-4.4), "was respectful" (OR, 3.0; 95% CI, 1.4-6.5), and "listened to what I said" (OR, 2.9; 95% CI, 1.4-5.9). CONCLUSIONS: A 10-week medical Spanish course for pediatric ED physicians was associated with decreased interpreter use and increased family satisfaction.