Academic Pediatrics最新文献

Objective: Adverse childhood experiences (ACEs) are associated with poor health and educational outcomes on a population level. School-based health centers (SBHCs) may be uniquely positioned to support youth with ACEs, but little is known about ACEs screening and response in that setting. In this qualitative study, we characterized barriers and facilitators to addressing ACEs in SBHCs from the perspectives of SBHC clinicians.

Methods: We conducted semi-structured interviews with clinicians affiliated with a large public school district in Southern California that had implemented ACEs screening in its SBHCs. Interviews explored attitudes toward and experiences with ACEs screening in SBHCs, as well as differences between screening in SBHCs and other settings. We used a thematic analysis approach, continuing until thematic saturation was reached.

Results: The sample included 10 SBHC clinicians. Six major themes emerged. Three themes were considered opportunities: 1) SBHCs serve as a bridge to care and resources for youth with ACEs, 2) SBHC clinicians are versatile in their approach to addressing ACEs, and 3) structural elements of SBHCs facilitate ACEs screening and response. The remaining three were considered challenges: 1) SBHCs have limited capacity for follow-up for youth with ACEs, 2) providers experience challenges with obtaining accurate ACEs screening results, and 3) responding to ACEs screening is complex.

Conclusions: SBHCs have the potential to support identification and response among youth with ACEs, though challenges remain. Policy and practice recommendations may consider how SBHCs can be leveraged as a unique context to support vulnerable populations at risk of toxic stress.

Objective: Trainee assessments have demonstrated gender and race or ethnicity biases across specialties. Assessment based on the Entrustable Professional Activity (EPA) framework involves assigning a supervision level for the professional activities included in the EPA. We analyzed Clinical Competency Committee (CCC) assigned EPA supervision levels for differences by gender and race or ethnicity among pediatric subspecialty fellows.

Methods: This is a secondary analysis of 2 deidentified datasets. CCCs provided supervision levels for each fellow for the Pediatric Subspecialty EPAs from fall 2018 through spring 2022. These data were linked to fellows who participated in a well-being study during residency that included their gender, race, and ethnicity. Based on race or ethnicity, fellows were categorized as underrepresented in medicine, Asian, or White. For each EPA, we fitted an ordinal mixed effects model to supervision ratings, with training year, gender, and race category as covariates, adjusting for clustering of ratings within fellow and institution, and multiple comparisons.

Results: Demographic data were linked for 561 fellows. Asian fellows were more likely to receive a lower supervision level for the Consultation EPA compared with White fellows (adjusted odds-ratio 0.48, 95% CI:0.31-0.77). No other significant differences were found among the common Subspecialty EPAs.

Conclusions: EPA-based assessments of pediatric subspecialty fellows demonstrated no differences by gender and a single difference based on race or ethnicity. Given the national trend toward using EPA-based assessments in medical education for health professions, it's reassuring that this first study in pediatric subspecialty fellows demonstrated almost no bias in these assessments.

Objective: Elicit the perspectives of mothers with substance use disorder (SUD) on child well-being and parental substance use.

Methods: We conducted semistructured focus groups of mothers with SUD on parenting, child well-being, naloxone, and experiences with medical care and Child Protective Services (CPS). Focus group transcripts were iteratively reviewed to generate a codebook, which was applied in NVivo by 2 independent coders. We used inductive thematic analysis to examine codes relevant to child well-being, harm reduction, and clinician reporting to CPS.

Results: Twenty-three women participated in 5 focus groups. Four themes emerged: 1) mothers felt their substance use negatively impacted their ability to provide attentive supervision and emotional support; 2) mothers discussed strategies to minimize harm to children but had limited familiarity with naloxone use for unintentional ingestions; 3) mothers viewed child well-being as a spectrum but felt that clinicians often approached well-being as a binary of "safe" or "unsafe"; and 4) mothers recognized that clinicians are obligated to report child abuse or neglect and recommended transparent CPS reporting.

Conclusions: Participants viewed child well-being in the setting of parental substance use as a multidimensional construct. Mothers acknowledged the potential emotional harms of substance use, an important target for family-based intervention. Mothers used harm reduction strategies to keep their children safe, but not all were aware that naloxone could be used to reverse pediatric overdoses. Improved provider guidance on comprehensively assessing child well-being, supporting harm reduction, and trauma-informed CPS reporting may help clinicians partner with families to support child health and safety.

Objective: Child sexual abuse is associated with mental health (MH) challenges across the lifespan. Black and Latino children are less likely to receive MH services than children of other backgrounds. We aimed to identify facilitators and barriers to MH services for Black and Latino children after sexual abuse.

Methods: We conducted semi-structured interviews with 30 Black and Latino, English and Spanish-speaking caregivers of children who have experienced sexual abuse. Interviews were completed in caregivers' preferred language and modality (phone, video conferencing, or in person). Caregivers were asked about their opinions and experiences with initiating child MH services after sexual abuse. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis.

Results: Caregivers (27% Black, 47% Latino, 27% Black and Latino) were mostly biological mothers (87%). Half were born outside the U.S. Caregivers reported three facilitators to MH services after sexual abuse: 1) perceived benefits of MH services; 2) trust in MH providers; and 3) support from frontline professionals and systems. Caregivers reported timely support when there was cross-system care coordination. Caregivers described five barriers to MH services after sexual abuse: 1) perceived harms of MH services; 2) concerns about misjudgment and discrimination by MH providers; 3) stigma of sexual abuse; 4) youth's lack of engagement in MH services; and 5) structural obstacles to MH services.

Conclusions: Black and Latino caregivers identified multiple facilitators and barriers to MH services after sexual abuse. Our findings can inform the development and testing of evidence-based strategies to improve MH engagement and outcomes after sexual abuse.

Objective: Age alone is often used to define appropriate child restraint system (CRS) use. Children who lack access to primary care may rely on acute care settings and miss opportunities for anticipatory guidance on child passenger safety. We sought to characterize age- and size-appropriate CRS use among emergency department (ED) and urgent care patients in metropolitan Chicago to inform targets for intervention.

Methods: We conducted a secondary cross-sectional analysis of clinical trial screening data collected from English and Spanish-speaking caregivers of 6-month through 10-year-old children, 1/2021-8/2022. Caregiver-reported transportation behaviors were linked to electronic health record (EHR) data. CRS use was categorized as appropriate or prematurely transitioned for age and size. Descriptive statistics were calculated. Chi-square and logistic regression analyses were used to test for child, family, and visit characteristics associated with premature transitions.

Results: Of the 4,269 caregivers with matched screening and EHR data, 4,045 (94.8%) were included and 933 (23.1%) had prematurely transitioned their child. Premature transitions were most associated with child age 2-4 or 8+, Black race or Hispanic/Latine ethnicity, and being seen in the ED. Premature transitions differed across child age groups and were most common among Hispanic/Latine and Black children (age <8), families with larger household size (age 8+), and children seen in the ED (age 2-4).

Conclusion: Premature transitions are common among children who received acute care in metropolitan Chicago. This population is at risk for crash-related injuries. Child passenger safety interventions targeted to families who seek acute care may benefit specific demographic groups.

Objective: To extend providers' HPV vaccine communication, we sought to understand confidence in nursing staff as vaccine communicators and identify implementation strategies associated with confidence.

Methods: In 2022, we surveyed 2,527 US providers and nursing staff with a role in adolescent HPV vaccination. Topics included perceptions of nursing staff effectiveness at HPV vaccine communication and experiences with vaccine implementation strategies.

Results: A majority of respondents believed nursing staff could effectively announce children are due for HPV vaccine (81%), counsel parents (64%), and recommend the vaccine (51%). Nursing staff were more likely than providers to believe nurses could effectively communicate about HPV vaccine (announce: AOR = 2.7, 95% CI = 1.9, 3.7; counsel: AOR = 7.1, 95% CI = 5.4, 9.3; recommend: AOR = 2.5, 95% CI = 1.9, 3.2). Believing nurses could effectively counsel parents was more common among respondents whose clinics frequently used HPV vaccine standing orders (OR = 1.5, 95% CI = 1.3, 1.9), those who worked most closely with a nurse vaccine champion (AOR = 2.1, 95% CI = 1.6, 2.7), or those who had received HPV vaccine communication training (AOR = 1.4, 95% CI = 1.2, 1.7). The same pattern of findings held for belief about other communication roles (announce and recommend).

Conclusion: Implementation strategies to improve HPV vaccine uptake, including standing orders and vaccine champions, may improve confidence in nursing staff as vaccine communicators. These findings provide opportunities to build capacity for vaccine communication in pediatric primary care.

Objective: We aimed to describe teens' experiences around school-related internet use, focusing on both benefits and drawbacks within the Problematic Internet Use (PIU) Framework. The PIU Framework describes how risky, excessive, or impulsive internet use affects teens' well-being, including emotional, physical, and social health. We defined school-related internet use as all internet use for academic purposes, whether at school or outside of it.

Methods: We recruited 51 teens aged 13 to 18 years in a Midwest metropolitan area to participate in 1 of 9 virtual, semi-structured focus groups between August and December 2022. We analyzed focus group transcripts using thematic analysis and a hybrid inductive-deductive approach.

Results: Most teens identified as White non-Hispanic (61%), male sex (51%), and cisgender (90%), representing 33 schools. Four themes emerged regarding the function of teens' school-related internet use as follows: 1) School-related internet is commonly used for multiple academic purposes, at times replacing traditional teaching methods; 2) Easy access to technology increases modes of communication with peers but can impede opportunities for in-person interactions.; 3) School-related internet use can both alleviate and intensify academic stress; 4) School-related internet use can lead to impulsive internet behavior and overuse, which may result in impairment.

Conclusions: Teens reported school-related internet use is ubiquitous and affects well-being. Clinicians can help teens and families understand these effects and devise strategies to minimize negative effects and optimize benefits. Future research should explore how individual, family, and school practices can support a school-related internet environment for teens to flourish.