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J Dev Behav Pediatr ; 41(1): 58-64, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31567857


OBJECTIVES: To identify the diverse services required by families of children with special health care needs (CSHCN) and identify the specific care coordination (CC) efforts associated with the most common types of observed diagnoses. Requested services were categorized into specific sectors, and CC efforts were quantified by observed diagnoses and defined sectors. METHODS: CC service data were extracted and analyzed from patient encounters over 4 years (2009-2013) in a department database. This included descriptive information about referrals and linkages to medical, dental, and behavioral health providers and to state, private, and community agencies. Diagnostic classifications and CC sectors were defined to enable categorization. RESULTS: A total of 2682 CSHCN records were reviewed. The majority (59%) required services/resources in 1 to 2 sectors, 24% required services/resources in 3 to 5 sectors, and 17% required services/resources in 6 or more sectors. Including informational service, the most frequently required sectors across the study population were education, financial, medical/dental, social connections, and advocacy. Children diagnosed with autism spectrum disorder had the highest needs across all sectors. CONCLUSION: Most CSHCN and their families use a substantial amount of CC time and effort to secure services from diverse sectors. High-quality and efficient CC requires an understanding of the specific needs of these CSHCN and their families and how to link them to a diverse array of services and resources.

MMWR Morb Mortal Wkly Rep ; 66(29): 769-772, 2017 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-28749927


Research suggests that many disparities in overall health and well-being are rooted in early childhood (1,2). Stressors in early childhood can disrupt neurologic, metabolic, and immunologic systems, leading to poorer developmental outcomes (1). However, consistent, responsive caregiving relationships and supportive community and health care environments promote an optimal trajectory (3,4). The first 8 years of a child's life build a foundation for future health and life success (5-7). Thus, the cumulative and lifelong impact of early experiences, both positive and negative, on a child's development can be profound. Although the health, social service, and education systems that serve young children and their families and communities provide opportunities to support responsive relationships and environments, efforts by these systems are often fragmented because of restrictions that limit the age groups they can serve and types of services they can provide. Integrating relationship-based prevention and intervention services for children early in life, when the brain is developing most rapidly, can optimize developmental trajectories (4,7). By promoting collaboration and data-driven intervention activities, public health can play a critical role in both the identification of at-risk children and the integration of systems that can support healthy development. These efforts can address disparities by reducing barriers that might prevent children from reaching their full potential.

Serviços de Saúde da Criança/organização & administração , Disparidades nos Níveis de Saúde , Centers for Disease Control and Prevention, U.S. , Criança , Pré-Escolar , Humanos , Estados Unidos
J Dev Behav Pediatr ; 38(3): 224-227, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28240649


OBJECTIVE: We aimed to identify characteristics of parents who do not voice developmental concerns when prompted by their children's nurse and/or primary care provider (PCP), despite reporting concerns on parent-completed questionnaires. METHODS: We reviewed 376 medical records of children seen for a 9-month well-child visit in an urban pediatric clinic between September 2011 and December 2012 for sociodemographic variables hypothesized to affect parents' sharing of developmental concerns: the child's birth order and gender; parents' education level, employment, relationship status, and primary language; and family size and racial/ethnic background. The target population was parents who reported concerns on the Parents' Evaluation of Developmental Status (PEDS), a routinely administered, parent-completed screening questionnaire. We subdivided parents who reported concerns on the PEDS (N = 86) based on whether they voiced developmental concerns when prompted by their children's nurse and/or PCP. Two-sided Fisher's exact tests and logistic regression evaluated the relationship between sociodemographic variables and parents' voicing of developmental concerns. RESULTS: Only parent education approached significance, as parents with less than a high school education (

Deficiências do Desenvolvimento/diagnóstico , Escolaridade , Pais/psicologia , Relações Profissional-Paciente , Diagnóstico Precoce , Feminino , Humanos , Lactente , Masculino , Inquéritos e Questionários
Child Adolesc Psychiatr Clin N Am ; 25(2): 307-17, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26980132


What if the goal of child health services was not "merely" treating, or even preventing, childhood diseases and disorders, but was expanded to that of promoting children's optimal healthy development? Pediatrics has evolved from an exclusive focus on the treatment of illness to the opportunity to promote children's healthy development. This evolution has profound implications for the content of child health services and programs, for system transformation, and for public policy. Enhanced understanding of the impact of social determinants on children's health and developmental outcomes underscores the importance of an evolving framework for system transformation with key policy implications.

Desenvolvimento Infantil , Serviços de Saúde da Criança/normas , Política de Saúde , Promoção da Saúde/normas , Saúde Pública/normas , Criança , Serviços de Saúde da Criança/organização & administração , Humanos
J Dev Behav Pediatr ; 32(5): 418-26, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21522019


Within the medical home, understanding the family and community context in which children live is critical to optimally promoting children's health and development. How to best identify psychosocial issues likely to have an impact on children's development is uncertain. Professional guidelines encourage pediatricians to incorporate family psychosocial screening within the context of primary care, yet few providers routinely screen for these issues. The authors propose applying the core principles of surveillance and screening, as applied to children's development and behavior, to also address family psychosocial issues during health supervision services. Integrating psychosocial surveillance and screening into the medical home requires changes in professional training, provider practice, and public policy. The potential of family psychosocial surveillance and screening to promote children's optimal development justifies such changes.

Deficiências do Desenvolvimento/diagnóstico , Assistência Centrada no Paciente , Criança , Desenvolvimento Infantil , Família/psicologia , Humanos , Programas de Rastreamento , Assistência Centrada no Paciente/métodos , Assistência Centrada no Paciente/organização & administração , Vigilância da População , Psicologia , Fatores de Risco
Clin Pediatr (Phila) ; 48(1): 32-6, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18566347


The goals of this cross-sectional study were to (a) describe the prevalence of 5 basic social needs in a cohort of parents attending an urban teaching hospital-based pediatric clinic, (b) assess parental attitudes toward seeking assistance from their child's provider, and (c) examine resident providers' attitudes and behaviors toward addressing these needs. Parents (n = 100) reported a median of 2 basic needs at the pediatric visit. The most common was employment (52%), followed by education (34%), child care (19%), food (16%), and housing (10%). Most parents (67%) had positive attitudes toward requesting assistance from their child's pediatrician. The majority of resident providers (91%) believed in the importance of addressing social needs; however, few reported routinely screening for these needs (range, 11% to 18%). There is great potential for assisting low-income parents within the medical home. Further practice-based interventions are needed to enhance providers' self-efficacy to screen and address low-income families' needs at pediatric visits.

Serviços de Saúde da Criança/normas , Necessidades e Demandas de Serviços de Saúde/tendências , Pobreza , Adolescente , Atitude , Criança , Pré-Escolar , Estudos Transversais , Acesso aos Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Pais/psicologia , Estados Unidos , Adulto Jovem