Well-child care clinical practice redesign for serving low-income children
Added: July 07, 2014
Tumaini R. Coker, MD, MBA
UCLA researchers partnered with community pediatric practices and a multi-site community health center in greater Los Angeles to develop a new design for preventive health care for children from birth through age 3 from low-income communities. The newly designed delivery models for preventive care use a trained health educator, or "parent coach," who relieves the physician of some of the more routine services and provides preventive health education and guidance, parenting education, and comprehensive but efficient preventive health services related to development, behavior and family psychosocial concerns. A secure Web-based tool customizes the visit to parents’ needs and facilitates pre-visit screening. Scheduled, non–face-to-face methods (text, phone) for parent communication with the health care team are also critical to these new model s of care. The research team is testing the model selected by the two private practices in those clinical settings, with families randomly chosen to receive the care using either the new delivery model and or the old one. Researchers will compare outcomes for the two groups of children by the end of 2014.
MCHB grant # R40MC21516 Well-Child Care Redesign: A New Model of Care for Children in Low-Income Families..
Coker TR, Moreno C, Shekelle PG, Schuster MA, Chung PJ. Well-child care clinical practice redesign for serving low-income children. Pediatrics 2014;134(1):e229-39.
Challenges in Cervical Cancer Prevention: A Survey of U.S. Obstetrician-Gynecologists
Added: March 18, 2014
Dr. Rebecca Perkins
In a recent study in the American Journal of Preventive Medicine, Dr. Rebecca Perkins and her colleagues conducted a Collaborative Ambulatory Research Network (CARN) study to explore the extent to which Obstetrician-Gynecologists were adhering to current guidelines for HPV vaccination and cervical cancer screening. They surveyed a national sample of Obstetrician-Gynecologists in 2012. Researchers found that physicians were over-screening and under-vaccinating their patients. Only one quarter of respondents successfully vaccinated their patients against HPV, citing patient refusal as a common barrier. Approximately half of physicians began cervical cancer screening at age 21, discontinued screening at age 70 or after hysterectomy, and appropriately utilized Pap and HPV co-testing. However, half continued to recommend annual Pap test screening, stating that patients were uncomfortable with extended screening intervals and expressing concerns that patients would not come for annual exams without concurrent Pap testing. These findings from this study highlights the need for interventions aimed both at physicians and the general public to improve rates of HPV vaccination and promote understanding of the rationale behind extended cervical cancer screening intervals for low-risk women.
MCHB grant # UA6MC19010 Maternal and Child Health Research Network on Pregnancy-related Care: The Collaborative Ambulatory Research Network (CARN).
Perkins RB, Anderson BL, Gorin SS, Schulkin JA. Challenges in cervical cancer prevention: a survey of U.S. obstetrician-gynecologists. Am J Prev Med. 2013 Aug; 45(2):175-81.
Stress May Increase Preterm Birth among Adolescent Moms
Added: January 10, 2014
Dr. Whitney Witt
In a recent study published in the American Journal of Public Health, Dr. Whitney Witt from Truven Health Analytics and her colleagues at the University of Wisconsin School of Medicine and Public Health determined whether stress experienced prior to conception influences preterm birth and whether this effect varies by the age of the mother. Using data from 9350 pairs of mothers and children from the Early Childhood Longitudinal Survey-Birth Cohort, a nationally representative study of US children born in 2001 and their parents, the researchers identified that stressful life events prior to conception resulted in a four-fold increased risk of having a preterm birth among women aged 15-19 years. They also found that women aged 20-24 who experienced a stressful life event 1 year or more prior to conception (during adolescence and young adulthood) had greater risk of preterm birth. Overall, these findings highlight adolescence as a potentially important period for interventions aimed at reducing preterm birth, which is one of the leading causes of neonatal death in the United States.
MCHB Grant #: R40MC23625 (SDAS) Impact of Preconception and Contextual Factors on Birth and Child Health Outcomes.
Witt WP, Cheng ER, Wisk LE, Litzelman K, Chatterjee D, Mandell K, Wakeel F. Preterm Birth in the United States: The Impact of Stressful Life Events Prior to Conception and Maternal Age. Am J Public Health. 2013 Dec 19. [Epub ahead of print] PubMed PMID: 24354830.
Witt WP, Cheng ER, Wisk LE, Litzelman K, Chatterjee D, Mandell K, Wakeel F. Maternal Stressful Life Events Prior to Conception and the Impact on Infant Birth Weight in the United States. Am J Public Health. 2013 Dec 19. [Epub ahead of print] PubMed PMID: 24354829.
Recession led to a decline in out-of-pocket spending for children with special health care needs
Added: September 25, 2013
Dr. Pinar Karaca-Mandic
In a recent study published in Health Affairs, Dr. Pinar Karaca-Mandic from the University of Minnesota and her colleagues explored how families’ health care spending was affected by the 2007-09 recession. Using data from the nationally representative Medical Expenditure Panel Survey, researchers found that while the recession was not associated with a decline in out-of-pocket (OOP) spending for most children, adults in those families experienced significant declines in spending during the recession; this suggests that parents may reduce their own medical care in difficult economic times to meet their children’s health care needs. They also found a reversal in the spending trend for children with special health care needs, who had much higher OOP spending at baseline. Overall, these findings suggest that policies affecting health coverage should be considered in the context of the entire family rather than in terms of individuals. Our findings highlighted an emerging theme recognized by the ACA, as it includes various provisions that expand coverage and reduce the financial challenges faced by families with children.
MCHB grant # R40MC17161 (SDAS) Impact of family health care financial burden on health care access and utilization of children.
Karaca-Mandic P, Yoo SJ, Sommers BD. Recession led to a decline in out-of-pocket spending for children with special health care needs. Health Aff (Millwood). 2013 Jun;32(6):1054-62. doi: 10.1377/hlthaff.2012.1137. PubMed PMID: 23733979.
Racial and ethnic disparities in quality of health care among children with autism and other developmental disabilities
Added: February 5, 2013
In a recent study, Dr. Susan L. Parish from the Lurie Institute for Disability Policy at Brandeis University and her colleagues examined disparities in access, utilization, and quality of health care for Latino children with autism and other developmental disabilities (Project #R40MC19927). Findings were published in the July 2012 issue of the American Journal on Intellectual and Developmental Disabilities. Using data from the 2005-2006 National Survey of Children with Special Health Care needs, the authors found that Latino children with autism and other developmental disabilities consistently experienced worse health care access, utilization, and quality compared to their White peers. The authors then tested mediation models to determine the impact of health care quality on the relationship between ethnicity and health care utilization disparities. Three of four mediators were significant. They concluded that the behavior of the health care provider is a possible intervention point to reduce utilization disparities for Latino children by improving experiences at the clinical encounter, including improving providers’ cultural sensitivity. The authors suggest policy makers consider incentives for providers to meet benchmarks for satisfaction and linking compensation to the provision of quality care. The authors also call for an increase in the pool of Latino health care providers.
MCH Research grant # R40 MC19927 (SDAS) Racial/Ethnic Disparities in Family Burden & Health Care of Children with Autism
Magaña S, Parish SL, Rose RA, Timberlake M, Swaine JG. Racial and ethnic disparities in quality of health care among children with autism and other developmental disabilities. Intellect Dev Disabil. 2012 Aug;50(4):287-99.
Parish S, Magaña S, Rose R, Timberlake M, Swaine JG. Health care of latino children with autism and other developmental disabilities: quality of provider interaction mediates utilization. Am J Intellect Dev Disabil. 2012 Jul;117(4):304-15.
Effects of Welfare and Maternal Work on Recommended Preventive Care Utilization among Low-Income Children
Added: February 5, 2013
Dr. Min-Woong Sohn
In a December issue of the American Journal of Public Health, Dr. Min-Woong Sohn from Northwestern University, an MCH Research Program SDAS grantee (Project # R40MC17178 " Welfare, Maternal Employment, and On-Time Child Immunization Rates") and his colleagues examined how maternal work were associated with children receiving recommended pediatric preventive care services. Based on data from the Illinois Families Study: Child Well-Being (IFS-CWB) during 1997-2004, they found that 485 children in the study cohort received only 41% of all recommended visits during the study period. Children were 60% more likely to make recommended visits when mothers received welfare but did not work compared with when mothers did not receive welfare and did not work. Children were 25% less likely to make recommended visits during periods when mothers received welfare and worked compared with welfare only periods. Maternal work requirement in the Temporary Assistance for Needy Families (TANF) may be a barrier to recommended preventive care utilization for low-income children.
MCHB grant # R40MC17178 (SDAS) Welfare, Maternal Employment, and On-Time Child Immunization Rates
Holl JL, Oh EH, Yoo J, Amsden LB, Sohn MW. Effects of welfare and maternal work on recommended preventive care utilization among low-income children. Am J Public Health. 2012 Dec;102(12):2274-9.
Sohn MW, Yoo J, Oh EH, Amsden LB, Holl JL. Welfare, maternal work, and on-time childhood vaccination rates. Pediatrics. 2011 Dec;128(6):1109-16.
Dr. Mann and colleagues from University of South Carolina. Children Born to Diabetic Mothers May be More Likely to Have Intellectual Disability.
Added: February 5, 2013
Dr. Joshua Mann
Researchers at the University of South Carolina School of Medicine and the Arnold School of Public Health have discovered an association between maternal pre-pregnancy weight and the risk of intellectual disability in their children. The team, led by Drs. Joshua Mann, Suzanne McDermott, and James Hardin utilized linked South Carolina birth certificate, Medicaid, and other data to study the association for children born in South Carolina from 2004 through 2007, in which Medicaid was the payer for the birth. Follow up data for the children were obtained through 2010 and included Medicaid billing records as well as South Carolina public schools and the Department of Disabilities and Special Needs. Children were required to be diagnosed with intellectual disability on at least five occasions in Medicaid billing data or to be enrolled in special education or receiving services from the Department of Disabilities and Special Needs in order to be considered a case. A second case definition was used, in which only children with moderate to profound (not mild) intellectual disability were considered to be cases. The primary independent variable was the mother’s pre-pregnancy body mass index (calculated from weight and height recorded on birth certificates) and weight change during pregnancy, also calculated from birth certificate data. Children diagnosed with conditions known to cause intellectual disability were excluded from the analyses. A wide range of potential confounders were controlled for in the logistic regression modeling.
Analyses demonstrated that pre-pregnancy BMI, as a continuous variable, was significantly associated with the odds of child intellectual disability. Pre-pregnancy BMI was then categorized as underweight, normal weight, overweight, mildly obese, moderately obese, or severely obese. Compared to normal weight women (BMI 18.5 to 24.99), those with mild (BMI 30 to 34.99), moderate (BMI 35 to 39.99), or severe obesity (BMI 40 or greater) were 18%, 26% and 52% (respectively) more likely to have a child with ID. The associations appeared to be even stronger when the case definition of ID was restricted to those with moderate to profound ID (OR = 1.83, 95% CI 1.31 – 2.56 for severe obesity). Weight change during pregnancy was not associated with odds of ID. The study team concludes that maternal obesity may be a preventable risk factor for intellectual disability.
MCH Research grant # R40MC21523 Maternal Obesity, Excessive Weight Gain, Diabetes Mellitus, and Hypertension During Pregnancy and Risk of Neuro-developmental Disability in Children.
Mann JR, Pan C, Rao GA, McDermott S, Hardin JW. Children born to diabetic mothers may be more likely to have intellectual disability. Matern Child Health J. 2012 Jul 14. PubMed PMID: 22798077.
Mann J, McDermott S, Hardin J, Pan C, Zhang Z. Pre-pregnancy body mass index, weight change during pregnancy, and risk of intellectual disability in children. BJOG. 2012 Nov 27.
Mann JR, McDermott S, Pan C, Hardin JW. Maternal hypertension and intrapartum fever are associated with increased risk of ischemic stroke during infancy. Dev Med Child Neurol. 2013 Jan;55(1):58-64.
A web-based validated screening tool is now available to assess psychosocial risks among pregnant women.
Added: November 16, 2012
Dr. Pat Harrison
The Prenatal Risk Overview (PRO) automated screening interview, originally developed for the Twin Cities Healthy Start program, was tested by Dr. Patricia Harrison and colleagues from the Minneapolis Department of Health and Family Support.
Prenatal risk screening ensures that factors that pose a threat to a healthy pregnancy and healthy baby can be identified and that case management resources can be targeted to the women who need them most. The PO differs from other prenatal risk screening approaches because it is the only validated multidimensional instrument that quickly and systematically assesses a constellation of risk factors. For example, in addition to depression and substance use, the PRO screens for lack of telephone or transportation, food insecurity, housing instability, lack of social support, sexual or physical abuse victimization by a partner or other person, PTSD, anxiety, cigarette smoking, legal problems, and involvement with child protective services.
The study found that the PRO identified women who met criteria for diagnoses of current major depression and alcohol and drug use disorders with a high degree of accuracy. Based on depression symptom levels and substance use patterns that did not meet diagnostic thresholds, the PRO also classified a substantial number of pregnant women as “at risk,” thus identifying patients who could benefit from an early intervention that could reduce potential harm to the baby or mother.
The rescreening study consisted of a second administration of the PRO during pregnancy, approximately 12 weeks after the initial intake interview. The authors concluded that a second PRO interview was a worthwhile investment for high-risk clinical populations whose life circumstances change rapidly or who may need time to trust their provider enough to disclose sensitive information. The research produced critically important information about the PRO’s utility for use in clinical settings like Healthy Start.
The validated PRO screening tool is available for use by any health care or social service agency that serves pregnant women or conducts outreach to high-risk communities. For this network of users, the PRO can provide the basis for development of an individualized care plan or a decision to refer a pregnant woman to a program such as Healthy Start which provides intensive health education and case management services. More information about this resource is available by contacting Dr. Harrison (Pat.Harrison@minneapolismn.gov). MCH Research grant # R40MC07840 Pregnancy Psychosocial Risk Screening Validation Study.
Harrison PA, Godecker A, Sidebottom AS. Psychosocial risk screening during pregnancy: additional risks identified during a second interview. Journal of Health Care for the Poor and Underserved, 2011;22:1344-1357.
Harrison PA, Godecker A, Sidebottom AS. Validation of the alcohol use module from a multidimensional prenatal psychosocial risk screening instrument. Maternal and Child Health Journal, 2012; 16:1791-1800.
Harrison PA, Godecker A, Sidebottom AS. Validity of the prenatal risk overview for detecting drug use disorders in pregnancy. Public Health Nursing. 2012;29:563-573. DOI: 10.1111/j.1525-1446.2012.01030.x
Sidebottom AB, Harrison PA, Godecker A. Validation of the Patient Health Questionnaire (PHQ)-9 for prenatal depression screening Archives of Women’s Mental Health. 2012;15:367-374. DOI: 10.1007/s00737-012-0295-x
Maternal depressive symptoms and participation in early intervention services for young children
Added: Nov 16, 2012
Dr. Emily Feinberg
Published in the Maternal and Child Health Journal, Dr. Emily Feinberg, from Boston University School of Public Health, a MCH Research Program Secondary Data Analysis Studies project titled: Maternal depressive symptoms and participation in early intervention services. Dr. Feinberg and her colleagues, Drs. Donahue, Bliss, and Silverstein, published their analysis of the relationship between maternal depressive symptoms in mothers and receipt of Part C early intervention services by their eligible children using data from the Early Childhood Longitudinal Study – Birth Cohort. In analyses that controlled for child risk and demographic factors and stratified children by the age when the child became eligible to receive EI services, the authors found that among children who first became eligible for EI services as infants there was no difference in receipt of EI service by mothers’ depression status depressed (aOR 1.8; 95% CI 0.8, 4.0). Among children who were newly eligible for EI services at 24 months, children whose mothers were depressed were, on average, 4 times more likely to receive services compared to children of nondepressed mothers (aOR 4.6, 95% CI 1.5, 14.6). Based on research describing decreased health management skills among depressed women and less utilization of preventive health services among their children, the investigators hypothesized that children whose mothers experienced depressive symptoms would be less likely to receive EI services as a result of the lack of energy, motivation, and organization associated with depressive illness. However, study findings do not support this hypothesis. While the study could not determine the mechanism by which maternal depressive symptoms were linked to a child’s receipt of EI services, the elevated symptom burden among mothers of children enrolled in EI programs identified in the study’s analyses suggests a need to address maternal mental health as part of Part C early intervention programs.
MCH Research grant # R40MC08953 Trustees of Boston University.
Feinberg E, Donahue S, Bliss R, Silverstein M. Maternal depressive symptoms and participation in early intervention services for young children. Matern Child Health J. 2012 Feb;16(2):336-45.
Housing Transitions and Low Birth Weight Among Low-Income Women: Longitudinal Study of the Perinatal Consequences of Changing Public Housing Policy.
Added: Nov 16, 2012
Dr. Michael Kramer
This study combined maternal longitudinal linkage of birth records with spatial linkage to Atlanta public housing locations to test for the perinatal consequences of changing public housing policy between 1994 and 2007 in Atlanta, GA. During this period traditional concentrated public housing projects were decommissioned in favor of mixed-income housing developments and rental vouchers for use in the private market. Using traditional regression and marginal structural models, we found that women who were forced to move as a result of housing project decommissioning were at elevated risk of preterm LBW in a subsequent pregnancy. However women whose transitions out of public housing was not associated with change in policy had no significant change in risk. MCH Research grant # R40MC17180 Emory University Inter-conceptional social mobility and racial disparities in adverse pregnancy.
Kramer MR, Waller LA, Dunlop AL, Hogue CR. Housing Transitions and Low Birth Weight Among Low-Income Women: Longitudinal Study of the Perinatal Consequences of Changing Public Housing Policy. Am J Public Health. 2012 Oct 18. PubMed PMID: 23078464. View article in AJPH
Changes over time in reducing developmental and behavioral co-morbidities of asthma in children
Added: August 1, 2012
Dr. James Blackman
In a paper published in January's (2012) Journal of Developmental and Behavioral Pediatrics, Dr. James Blackman from the University of Virginia, MCH Research Program SDAS grantee (Project #R40 MC 20610-01 (SDAS) Progress in Reducing Developmental and Behavioral Co-morbidities of Asthma in Children with Emphasis on Health Disparities Risk Factors) and his colleague Dr. Mark Conaway compared rates of asthma, asthma severity, and developmental and behavioral problems among children with asthma between the 2003 and 2007 National Surveys of Children's Health. Asthma rates remained stable between the two surveys, but there was a shift from moderate to mild and, to a lesser extent, severe asthma. Co-morbid rates of developmental and behavioral problems were about twice as high among children with asthma compared to those without asthma. Rates of all problems increased for both groups between surveys but at a significantly greater pace for repeated grades among children with asthma. They concluded that children with asthma continue to have high rates of developmental and behavioral problems and that these problems appear to be becoming more frequent. Primary and asthma specialty caregivers should be attuned to these co-morbidities of asthma and implement methods to screen for, assess, and remediate these problems as early as possible.
Blackman JA, Conaway MR. Changes over time in reducing developmental and behavioral co-morbidities of asthma in children. J Dev Behav Pediatr 2012;33(1):24-31. 2011 [Epub ahead of print].
Neal Halfon, MD, MPH
LCRN - A Profound New Way to Understand Health
Added: July 9, 2012
By Neal Halfon, MD, MPH and Ericka Tullis, MPP
Life Course Research Network
In October 2010, the UCLA Center for Healthier Children, Families and Communities was awarded a three-year grant from the Health Resources and Services Administration (HRSA) Maternal and Child Health Bureau (MCHB) to develop the MCH Life Course Research Network (LCRN). This project represents an exciting and unique opportunity to improve our understanding of how health develops over the life span. LCRN was featured in the May/June issue of Pulse, monthly e-newsletter of AMCHP.
Presentation at 2012 PAS Meeting
Added: May 14, 2012
Comparative Effectiveness Research in the EHR Tower of Babel: Creation of a Multi-Vendor EHR Practice-Based Research Network
Richard Wasserman, MD, MPH
Richard Wasserman, MD, MPH1,2, Jennifer Steffes, MSW1, Akiba Hollins-Thomas, BS1, Banita McCarn, MEd1, Alexander Fiks, MD, MSCE3, Eric Slora, PhD1, Edward Gotlieb, MD1,4 and Benyamin Margolis, PhD, MPH5.
1Pediatric Research in Office Settings (PROS), American Academy of Pediatrics, Elk Grove Village, IL 60007, United States; 2Department of Pediatrics, University of Vermont, Burlington, VT 05405, United States; 3Children's Hospital of Philadelphia, Philadelphia, PA 19104, United States; 4The Pediatric Center, Stone Mountain, GA 30083, United States and 5Maternal and Child Health Bureau, Health Resources and Services Administration, DHHS, Rockville, MD 20857, United States.
Background: Data from electronic health records (EHRs) represent a rich resource for primary care comparative effectiveness research (CER), but the heterogeneity of EHR systems complicates both data extraction and aggregation and limits the diversity of practices available to obtain an accurate picture of U.S. pediatric primary care.
Objective: To describe the complexity of the multi-EHR-system environment and the potential impact of an EHR practice-based research subnetwork (ePROS) using a vendor-based, multi-EHR-system data extraction model.
Design/Methods: Design: Network survey conducted from 2009-2010.
Subjects: Contact practitioners in 744 practices in Pediatric Research in Office Settings (PROS), the practice-based research network of the AAP.
Data collected: A survey sent to all PROS practices asked whether the practice currently used EHR and if so, the type of EHR and years in use.
Analysis: Data from the survey, combined with previously collected PROS practice data, were analyzed to determine selected practice factors (i.e., practice type, rural/urban, patient insurance) associated with use of EHR. Data were also analyzed to determine suitability for inclusion in ePROS based on concordance of EHR systems with the capabilities of the ePROS data extraction vendor.
Results: The survey had a 68% response rate (n=506). Forty-five percent of respondents (n=226) indicated they had an all-electronic EHR, 24% (n=120) indicated a part electronic and part paper system, and 31% (n=155) indicated no EHR. The two most prevalent EHR systems accounted for 10.5% and 9.6% of practices with only two other systems at ≥5% prevalence. The 19 systems used by at least 1% of practices accounted for 73% of practices. The only practice factor associated with EHR use was having >50% of patients with private insurance (X2 (3) = 15.42, p < .001). The 20 EHR systems compatible with ePROS data extraction vendor capability (incomplete overlap with the 19 cited above) are used by 217 (63%) of EHR practices in PROS.
Conclusions: Because of the plethora of EHR systems in use, CER based on single-EHR-system data could produce misleading results by failing to account for the diversity of primary care pediatrics. CER using the ePROS multi-system approach can better represent care delivered to a substantial proportion of children seen in U.S. pediatric practice.
MCH R40 Research Project Featured Article in JAMA
Added: May 3, 2012
Dr. Melissa Stockwell
Text Message Reminders Could Help Encourage Vaccinations
In a paper published in the April 25, 2012 issue of the Journal of the American Medical Association (JAMA), Dr. Melissa Stockwell and her colleagues found that text message reminders to low-income, urban parents helped to increase the rate of flu vaccinations among their children.
Traditional flu vaccine reminders have shown limited effectiveness among hard to reach, urban populations. This study examines the use of text messaging as a novel approach to reminding parents about the importance of flu vaccination, and providing information regarding the availability of Saturday flu clinics. In this randomized controlled trial, the parents of 9213 children and adolescents aged 6 months to 18 years who were receiving care at four community-based health clinics, were randomized prior to the start of the 2010-2011 flu season into intervention and usual-care control groups. Both groups received an automated telephone reminder, and access to informational flyers posted at study sites (usual care). In addition, parents of children assigned to the intervention received up to 5 weekly immunization registry-linked text messages that provided educational information and instructions regarding Saturday flu clinics. Receipt of a flu vaccine dose was recorded in the immunization registry.
The study children were primarily minority, 88% were publicly insured, and 58% were from Spanish-speaking families. By March, 2011, and again later in the fall of 2011, a slightly higher proportion of children in the intervention group compared with the usual care control group had received flu vaccinations. The authors conclude that a text message reminder may help to boost flu vaccination rates among low-income, urban populations. However, the overall flu vaccination rate remained low in this population.
Entitled "Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population," this study is funded by grant R40 MC 17169 through the U.S. Department of Health & Human Services, Health Resources and Services Administration, Maternal and Child Health (MCH) Research Program. It has received media attention through ASPH and JAMA.
Stockwell MS, Kharbanda EO, Martinez RA, Vargas CY, Vawdrey DK, Camargo S. Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: a randomized controlled trial. JAMA. 2012 Apr 25;307(16):1702-8. http://jama.ama-assn.org/content/307/16/1702.full
View article in ASPH.
View videos related to this article:
Author interview on JAMA or on YouTube
JAMA News Report
Presentation at 2012 PAS Meeting
Added: May 3, 2012
Developing a consensus national research agenda for Developmental-Behavioral Pediatrics (DBP): Results from Delphi Study by MCH DBP Research Network (DBPNet)
Nathan J. Blum, MD
Title: Consensus Research Priorities for Developmental-Behavioral Pediatrics: A DBPNet Delphi Study
Nathan J Blum, MD1, Heidi M Feldman, MD, PhD2, William J Barbaresi, MD3, David J Schonfeld, MD4, Robin L Hansen, MD5 and Christopher B Forrest, MD, PhD1. 1Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; 2Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States; 3Pediatrics, Children's Hospital Boston, Boston, MA, United States; 4Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States and 5Pediatrics, MIND Institute, University of California at Davis, Sacramento, CA, United States.
Background: Developmental-Behavioral Pediatrics (DBP) is a relatively young subspecialty with many questions related to the most effective and efficient diagnostic and management strategies. The Developmental-Behavioral Pediatrics Research Network (DBPNet) is a collaboration among 12 academic DBP programs including 95 developmental-behavioral pediatricians and the Society for Developmental-Behavioral Pediatrics (SDBP) that was launched in September 2010 in order to facilitate investigation of these research questions. With many potential questions there is a need to identify the high priority questions.
Objective: To develop a consensus regarding the most important research questions for the field of DBP.
Design/Methods: Individuals from three stakeholder groups, 27 developmental-behavioral pediatricians, 16 psychologists, and 12 parents, participated in a 3-round Delphi survey. Participation was 100% in Rounds I and III and 96% in Round II. In Round I, each participant suggested up to 10 research questions important for DBP to address in the next 5 years. In Round II, participants rated the importance of each unique question on a 9-point likert scale. Questions were rated as consensus important questions if they had a median score of 7 and a coefficient of variation (CV) < 30 indicating low variation in scores (high agreement). Questions were rated as potentially important if they had a median of 7, but a CV>30 or if specific stakeholder group ratings suggested they were important. After providing participants the results from Round II, potentially important questions were rated a second time (Round III), and responses were evaluated using the same criteria as in Round II.
Results: In Round I, 216 unique research questions were identified. In Round II, 29 of these questions met the criteria for a consensus important question and 60 questions were rated as potentially important. In Round III, ten additional questions were rated as meeting the criteria for a consensus important question. Of the 39 consensus important research questions, 20 were efficacy, effectiveness, or comparative effectiveness studies; 8 related to epidemiology or analysis of risk factors; 5 related to assessing or developing methods to assess outcomes. The other six questions related to issues such as screening, diagnostic testing, identifying practice variation across DBP sites, and teaching DBP to residents. Approximately 40% of the questions related to autism spectrum disorders. Although the Delphi procedure developed a consensus around most questions, there were 7 in which 75% or more of parent participants rated the question as important, but the question did not reach consensus criteria. No other question that failed to reach consensus criteria was rated as important by more than 70% of a stakeholder group.
Conclusions: This Delphi process has produced a set of high priority research topics for the field of DBP. These topics cover a broad range of DBP concerns, but focus on evaluating interventions and studying autism. Parents of children with disabilities prioritize some research topics that were not prioritized by most developmental-behavioral pediatricians or psychologists.
Mexican-American youth add pounds as they lose native eating
Added: March 6, 2012
Dr. Jihong Liu
In a paper published in February's Journal of Nutrition, Dr. Jihong Liu from the University of South Carolina (USC), an MCH Research Program SDAS grantee, and her colleagues at USC published the results of their analysis of the 1999-2004 National Health and Nutrition Examination Survey. Dr. Liu et al. found that among the 2300 children aged 12-19 years old, Mexican American youth born into the second- and third-generation families are more likely to be obese than those who were not born in the United States. Adolescents from the second and third generations have diets high in saturated fat and sodium and they consume high levels of sweetened beverages. Their consumption of fruits, vegetables, grains, meat and beans is lower than first-generation Mexican-American youth. The findings suggest that Mexican-American adolescents face challenges in terms of poorer diet and excessive weight gain associated with their immigration and acculturation experience. The study has received media attention through the American Society for Nutrition, MSN.com, Yahoo.com.
The paper entitled "Generation and acculturation status are associated with dietary intake and body weight in Mexican American adolescents" is funded by grant R40 MC 17167 through the U.S. Department of Health & Human Services, Health Resources and Services Administration, Maternal & Child Health Research Program.
Liu J, Chu YH, Frongillo EA, Probst JC. Higher Generational and Acculturation Status are associated with Poorer Diet and Greater Body Weight Among Mexican American Adolescents. Journal of Nutrition. 2012 Feb; 142(2): 298-305. PMID: 22223572.
Grantee Publication Highlight
Added: January 24, 2012
The Developmental-Behavioral Pediatrics Research Network (DBPNet): Another Step in the Development of the Field
By Nathan J. Blum, MD and the DBPNet Steering Committee
Nathan J. Blum, MD
The Developmental-Behavioral Pediatric Research Network (DBPNet) published its first paper in the January 2012 issue of the Journal of Developmental & Behavioral Pediatrics describing the creation and development of an innovative research infrastructure. Interest in the field now called developmental-behavioral pediatrics can be traced to early training programs related to aspects of behavioral pediatrics and developmental disabilities in the late 1950s and early 1960s. During the past two decades impressive advances related to diagnosis and management of many of the conditions frequently treated by developmental-behavioral pediatricians have occurred through research in the cognitive neurosciences, behavioral sciences, and genetics, among other fields. The DBPNet will stimulate multi-site research and effectively and efficiently investigate issues that will improve the scientific understanding and clinical practice in the field. The paper is now available online.
The Maternal and Child Health Bureau began to support DBPNet in the fall of 2010. Learn more about the DBPNet.
Grantee Publication Highlight
Added: December 9, 2011
Dr. Gregory D. Stevens
A paper published in April 2010 issue of the Journal of Asthma by Dr. Gregory D. Stevens from the Keck School of Medicine of the University of Southern California was selected as one of the most important papers of 2010 for school health physicians by the members of the Physician Section of the American School Health Association and the American Academy of Pediatrics Council on School Health.
Dr. Stevens, an MCH Research Program SDAS grantee, along with colleagues Trevor Pickering and Sheila Laqui, used the 2007 National Survey of Children's Health to complete their analysis. The study demonstrated that among children aged 6-17 years with asthma, those with better medical home experiences--particularly the features of access, comprehensiveness, and family-centered care--had better daily life experiences, including better school engagement (e.g., fewer school days missed and a lower likelihood of repeating a grade since kindergarten) and greater after-school activity participation (e.g., more days with exercise and a higher likelihood of doing community service or volunteer work).
The study titled "National Prevalence of A Quality Medical Home for Vulnerable Children and the Relationship with School Performance and After-School Activity Participation" was funded by grant R40MC11270-0 through the U.S. Department of Health & Human Services, Health Resources and Services Administration, Maternal & Child Health Research Program.
DRTE Director receives the AAP's Dale Richmond/Justin Coleman Award
Added: October 13, 2011
Laura Kavanagh, MPP
MCHB's Director of the Division of Research, Training and Education (DRTE) - Laura Kavanagh, MPP - named the 2011 Recipient of the Dale Richmond/Justin Coleman Award, conferred by the American Academy of Pediatrics (AAP)!
This annual award of the Academy is given for "outstanding contributions in the field of Child Development and Behavior." Laura joins the ranks of notables in the field such as Jerome Kagan, Lee Schorr, Vince Hutchins,and Margaret Haggerty, among others. The letter nominating Laura noted her "leadership efforts that emphasize the importance of including family members as faculty in training programs…", as well as her "efforts to define leadership training for the field." Her nominator notes, "[Laura]…is an accessible and highly responsive federal official who has consistently worked to facilitate the development of the field of developmental-behavioral pediatrics and improve services for children and families."
This award is named for Dale Richmond, son of Julius and Rhee Richmond - Dr. Richmond was a founding member of the AAP Section on Developmental Behavioral Pediatrics, and Justin Coleman, son of Dr. William and Julie Coleman. Dr. Coleman is Professor of Pediatrics at the University of North Carolina, Chapel Hill. Dale and Justin were both "politically conscious and active individuals with a deep desire to improve the social condition through public service and acts of kindness." How fitting a tribute for Laura!
Dr. Jay Schulkin
Physicians' communication of Down syndrome screening test results: The influence of physician numeracy
Added: August 4, 2011
Published in Genetics in Medicine, the Research Department at the American College of Obstetricians and Gynecologists (Jay Schulkin, PhD, an MCH Research Program grantee (Project number: UA6MC19010) and Britta Anderson, PhD) and colleagues (Natalie Obrecht, PhD, Gretchen Chapman, PhD, and Deborah Driscoll, MD) report results from a study assessing the association between obstetrician-gynecologists' health literacy and how these physicians communicate Down syndrome screening test results to their patients. Open-ended questions revealed that communication strategies vary greatly, with approximately one in three obstetrician-gynecologists providing numerical information. Those who rated themselves as having high ability with numbers (high health literacy) were more likely to use numbers to explain the test results to patients. The paper is now available online.
HHS Announces Proposal to Improve Rules Protecting Human Research Subjects
Added: July 27, 2011
The advance notice of proposed rulemaking (ANPRM) to enhance protections for research subjects and reduce burden, delay, and ambiguity for investigators was published in the Federal Register yesterday. Changes under consideration would ensure the highest standards of protections for human subjects involved in research, while enhancing effectiveness of oversight. The 30-day comment period is an opportunity for the research community to provide valuable input to update the current human subjects regulations which have been in place for over 20 years. To submit a comment, visit Regulations.gov , enter ID number: HHS-OPHS-2011-005, and click on "Submit a Comment."
Visit the HHS web site for additional information about the changes under consideration.
Dr. Janice Bell
Shortened Nighttime Sleep Duration in Early Life and Subsequent Childhood Obesity
Added: May 3, 2011
In a paper published in September's Archives of Pediatric and Adolescent Medicine, Dr. Janice Bell from the University of Washington, an MCH Research Program SDAS grantee (Project #R40 MC 08965-01 "Exposure to Stress as a Mediator of Disparities in Childhood Obesity"), and her colleague Dr. Frederick Zimmerman published the results of their analysis of the Panel Survey of Income Dynamics Child Development Supplement. Drs. Bell and Zimmerman found that among the 1930 children surveyed in 1997, children whose parents reported them to be on the low end of nighttime sleep from infancy through their early preschool years (ages 0-4) had an 80% increased risk of having a body mass index (BMI) in the overweight or obese range at follow-up in 2002. This effect was found even when controlling for birth weight, parents' BMI, daily hours of TV viewing, birth order, race, sex, and family income, as well as other demographic variables. There was not a significant relationship between sleep and BMI in the children between 5 and 13 years old at baseline, and in both groups, napping had a minimal effect on later obesity. This study has received media attention domestically through the New York Times , CNN , NPR and internationally .
Read more »
The Exposure to Stress as a Mediator of Disparities in Childhood Obesity is funded by grant R40 MC 08965 through the U.S. Department of Health & Human Services, Health Resources and Services Administration, Maternal & Child Health Research Program.
Health Insurance and Access to Care for Children and Adolescents Knowledge Path
Added: May 3, 2011
The Maternal and Child Health Library released a new edition of the knowledge path, Health Insurance and Access to Care for Children and Adolescents. The knowledge path points to resources that analyze data, describe effective programs, and report on policy and research aimed at advancing health coverage and improving health care access for children and adolescents. Emphasis is placed on Medicaid and the Children's Health Insurance Program (CHIP). Separate sections present resources for professionals (health professionals, program administrators, policymakers, and researchers) and for families. A special topics section points to resources that address health reform, outreach and enrollment, and school-based and school-linked care. View the Health Insurance and Access to Care for Children and Adolescents Knowledge Path page. For more knowledge paths on other maternal and child health (MCH) topics, visit the The Maternal and Child Health Library web site.
Oral Health for Infants, Children, Adolescents, and Pregnant Women Knowledge Path
Added: May 3, 2011
The Maternal and Child Health Library released a new edition of the knowledge path, Oral Health for Infants, Children, Adolescents, and Pregnant Women. View the Oral Health for Infants, Children, Adolescents, and Pregnant Women Knowledge Path page. For more knowledge paths on other maternal and child health (MCH) topics, visit the The Maternal and Child Health Library web site.
Physical Activity and Children and Adolescents Knowledge Path
Added: May 3, 2011
The Maternal and Child Health Library released a new edition of the knowledge path, Physical Activity and Children and Adolescents. View the Physical Activity and Children and Adolescents Knowledge Path page. For more knowledge paths on other maternal and child health (MCH) topics, visit the The Maternal and Child Health Library web site.
Announcing the Cultural and Linguistic Competence Family Organization Assessment
Added: May 3, 2011
The Cultural and Linguistic Competence Family Organization Assessment Instrument (CLCFOA) was developed to specifically address the unique functions of family organizations concerned with children and youth with behavioral-emotional disorders, special health care needs, and disabilities. Organizational self-assessment is a necessary, effective, and systematic way to plan for and incorporate cultural and linguistic competency. An assessment should address the attitudes, behaviors, policies, structures and practices of an organization, including those of its board, staff, and volunteers.
New and Improved National Center for Medical Home Implementation Web Site
Added: May 3, 2011
The National Center for Medical Home Implementation has launched a new and improved Web site! The new site features a plethora of resources and information designed to help you learn more about family-centered medical home and how practices, families, communities and states are working on implementation. Informational destinations on the Web site include:
- Medical Homes@Work e-Newsletter: Spotlights timely information and resources related to implementing medical home.
- How to Implement Tools/Resources: Features an extensive list of user-friendly tools and resources for implementation of medical home in the pediatric practice. Visit this section to see how you can adapt these tools to best meet the needs of your patient, client, or child.
- Training Resources: Houses a variety of tools and resources targeted towards pediatricians and the medical home care team that may also be of interest and/or use for families, youth, communities, and states.
- State Pages: Highlights information on state pediatric medical home initiatives, key contacts, partners, and related grant activities and initiatives.
- Quick Links: Contains links to valuable resources and information including the Building Your Medical Home toolkit , upcoming conferences, emerging issues and marketing materials.
- For Families: Presents links to tools and resources aimed at assisting families including the Building Your Care Notebook, Family-to-Family Health Information Centers, tips for partnering with your physician, and Title V.
- National Initiatives: Consists of information that the National Center tracks on the many national medical home initiatives, including multi-payor demonstration projects and state grant initiatives that are rapidly increasing across the country.
For additional information about the Web site or the National Center for Medical Home Implementation, please contact Heather Stob at 847-434-4902 or firstname.lastname@example.org.