Health Insurance
Caregiver Opinion of In-Hospital Screening for Unmet Social Needs by Pediatric Residents
Child health is strongly influenced by social determinants. Little is known about the opinions of primary caregivers regarding the physicians' role in addressing social needs. Our objective was to examine caregivers' opinions about that role and any associations between those opinions, previous exposure to screening for needs by pediatric residents, and socioeconomic status (SES).Hospitalization: Are We Missing an Opportunity to Identify Food Insecurity in Children?
Food security is the ability to access sufficient food to maintain a healthy, active life. Previous studies link food insecurity with adverse health outcomes. Our objectives were to determine the prevalence of food insecurity, identify sociodemographic risk factors, and quantify receipt of public nutrition assistance among recently hospitalized children in the United States.Maintenance of Increased Childhood Influenza Vaccination Rates 1 Year After an Intervention in Primary Care Practices
Influenza vaccination rates among some groups of children remain below the Healthy People 2020 goal of 70%. Multistrategy interventions to increase childhood influenza vaccination have not been evaluated recently.Developmental Screening Disparities for Languages Other than English and Spanish
Limited English proficiency (LEP) is a known barrier to preventive care. Children from families with LEP face socioeconomic circumstances associated with increased odds of developmental delays and decreased participation in early care and education programs. Little is known about developmental surveillance and screening for children from families who speak languages other than English and Spanish. We sought to compare developmental surveillance and screening at well-child visits (WCVs) by preferred parental language.Physician Perspectives on Medical Home Recognition for Practice Transformation for Children
To examine child-serving physicians' perspectives on motivations for and support for practices in seeking patient-centered medical home (PCMH) recognition, changes in practice infrastructure, and care processes before and after recognition, and perceived benefits and challenges of functioning as a PCMH for the children they serve, especially children with special health care needs.Incidence of Urinary Tract Infection Among Siblings of Children With Vesicoureteral Reflux
Siblings of children with vesicoureteral reflux (VUR) are at elevated risk of VUR. Screening siblings may identify VUR before a clinical illness such as a urinary tract infection (UTI), but the benefit of screening has not been demonstrated. We sought to determine the incidence of UTI among siblings, and we hypothesized that the sibling UTI rate is similar between screened and unscreened siblings.Underserved Areas and Pediatric Resident Characteristics: Is There Reason for Optimism?
To examine whether resident characteristics and experiences are related to practice in underserved areas.Juvenile Incarceration and Health
Addressing the health status and needs of incarcerated youth represents an issue at the nexus of juvenile justice reform and health care reform. Incarcerated youth face disproportionately higher morbidity and higher mortality compared to the general adolescent population. Dental health, reproductive health, and mental health needs are particularly high, likely as a result of lower access to care, engagement in high-risk behaviors, and underlying health disparities. Violence exposure and injury also contribute to the health disparities seen in this population.Variation in Educational Services Receipt Among US Children With Developmental Conditions
To examine the relationship between ease of access to needed community-based services (ease of access) and educational services receipt, and variation in educational services receipt by sociodemographic and need factors among a nationally representative sample of children with autism spectrum disorder (ASD), developmental delay (DD), and/or intellectual disability (ID).Parental Use of Electronic Cigarettes
To describe parental use of electronic cigarettes (e-cigs) to better understand the safety risks posed to children.Trends in Type of Health Insurance Coverage for US Children and Their Parents, 1998–2011
To examine trends in health insurance type among US children and their parents.A Comparison of Ambulatory Care Sensitive Hospitalizations Among Children With and Without Autism Spectrum Disorder
To compare the prevalence of hospitalizations for ambulatory care sensitive conditions (ACSC) in children with and without autism spectrum disorder (ASD) and to compare inpatient health care utilization (total charges and length of stay) for the same conditions in children with and without ASD.Trends in Disparities in Low-Income Children's Health Insurance Coverage and Access to Care by Family Immigration Status
To examine time trends in disparities in low-income children's health insurance coverage and access to care by family immigration status.Multiple Behavior Change Intervention to Improve Detection of Unmet Social Needs and Resulting Resource Referrals
It is critical that pediatric residents learn to effectively screen families for active and addressable social needs (ie, negative social determinants of health). We sought to determine 1) whether a brief intervention teaching residents about IHELP, a social needs screening tool, could improve resident screening, and 2) how accurately IHELP could detect needs in the inpatient setting.Enrollment, Expenditures, and Utilization After CHIP Expansion: Evidence From Alabama
In October 2009, Alabama expanded eligibility in its Children's Health Insurance Program (CHIP), known as ALL Kids, from 200% to 300% of the federal poverty level (FPL). We examined the expenditures, utilization, and enrollment behavior of expansion enrollees relative to traditional enrollees (100–200% FPL) and assessed the impact of expansion on total program expenditures.Children with Special Health Care Needs in CHIP: Access, Use, and Child and Family Outcomes
To assess how the Children's Health Insurance Program (CHIP) affects outcomes for children with special health care needs (CSHCN).CHIP and Medicaid: Evolving to Meet the Needs of Children
To examine the evolution of Children's Health Insurance Program (CHIP) and Medicaid programs after passage of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), focusing on policies affecting eligibility, enrollment, renewal, benefits, access to care, cost sharing, and preparation for health care reform.How Well Is CHIP Addressing Primary and Preventive Care Needs and Access for Children?
To examine differences in primary care outcomes under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states.Enrollment and Disenrollment Experiences of Families Covered by CHIP
To understand why families enroll in and disenroll from Children's Health Insurance Program (CHIP), their experience with the CHIP application and renewal process, and the insurance coverage of their children after disenrolling.The Children's Health Insurance Program Lessons for Health Reform
The articles in this special Academic Pediatrics' supplement present a thoughtful analysis of the Children's Health Insurance Program (CHIP) contribution to the advancement of child health policy in the United States. CHIP has played a significant role in reducing the proportion of uninsured children in the United States, not only through the coverage subsidies it provides to millions of children, but also because of the heightened policy focus it has brought to the question of how to structure insurance for children and make coverage accessible.The Children's Health Insurance Program Strengthens Children's Health Care
The Children's Health Insurance Program (CHIP) has provided substantial coverage for critical groups of children and youth since its inception in the 1990s. Meant to cover children in households with incomes greater than financial eligibility for Medicaid but unable to obtain health insurance through a parent's workplace, CHIP has played a major role in achieving the lowest rate of uninsurance among America's children ever.1 With current funding through the Affordable Care Act (ACA) (and due to expire in September 2015), CHIP also serves, along with Medicaid's Early and Periodic Screening, Diagnosis, and Treatment program, as health insurance tailored specifically to the needs of children.The Children's Health Insurance Program and the Goldilocks Effect
Did you ever read the story of Goldilocks to your children? In one version of this story, Goldilocks is a tired, hungry, and lost little girl who encounters a house owned by 3 bears. She finds 3 bowls of porridge and judges whether each is too hot, too cold, or just right. She then finds 3 chairs, and determines whether each is too big, too small, or just right. Finally she is tired and finds 3 beds, and she assesses whether each bed is too hard, too soft, or just right. After she eats the porridge, sits in the chair, and lies on the bed that are all “just right,” she falls asleep.Alabama's Perspective of the Child Health Insurance Program
The articles in this supplement report on a Congressionally mandated evaluation of the Children's Health Insurance Program (CHIP) and highlight the effects of the program on insurance coverage and access to care in 10 study states. Here, we provide some insights on how CHIP has found success in Alabama by providing coverage to uninsured children and ensuring they have access to quality health care.The Children's Health Insurance Program Reauthorization Act Evaluation Findings on Children's Health Insurance Coverage in an Evolving Health Care Landscape
The Children's Health Insurance Program (CHIP) Reauthorization Act (CHIPRA) reauthorized CHIP through federal fiscal year 2019 and, together with provisions in the Affordable Care Act, federal funding for the program was extended through federal fiscal year 2015. Congressional action is required or federal funding for the program will end in September 2015. This supplement to Academic Pediatrics is intended to inform discussions about CHIP's future. Most of the new research presented comes from a large evaluation of CHIP mandated by Congress in the CHIPRA.Table of Contents
245 Integrating the Learner's Perspective in the Refinement of Competency-Based Assessments Jacob Robson, Duncan Henry, James Moses, Robert Vinci, and Daniel SchumacherParent Reports of Mental Health Concerns and Functional Impairment on Routine Screening With the Strengths and Difficulties Questionnaire
This study used the Strengths and Difficulties Questionnaire (SDQ) to describe the prevalence of parent-reported mental health (MH) concerns in youth presenting for primary care appointments and to examine relationships between children's MH issues and functional impairment. We hypothesized that increased MH symptomology would be associated with increased impairment and family burden.Assuring Adequate Health Insurance for Children With Special Health Care Needs: Progress From 2001 to 2009–2010
To report on coverage and adequacy of health insurance for children with special health care needs (CSHCN) in 2009–2010 and assess changes since 2001.Freelisting on Costs and Value in Health Care by Pediatric Attending Physicians
In preparation for the development of a curriculum on health care costs and value for pediatricians, the goal of this study was to assess pediatricians' baseline perceptions about the concepts of “cost” and “value” in health care, and topics that should be included in a curriculum that teaches about costs and value in pediatrics.Access to Private Coverage for Children Enrolled in CHIP
To provide updated information on the potential substitution of public for private coverage among low-income children by examining the type of coverage held by children before they enrolled in Children's Health Insurance Program (CHIP) and exploring the extent to which children covered by CHIP had access to private coverage while they were enrolled.How Well Is CHIP Addressing Health Care Access and Affordability for Children?
We examine how access to care and care experiences under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states.Spotlight on Express Lane Eligibility (ELE): A Tool to Improve Enrollment and Renewal
We examine a new simplification policy, Express Lane Eligibility (ELE), introduced by the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA), to understand ELE's effects on enrollment, renewal, and administrative costs.How Well Is CHIP Addressing Oral Health Care Needs and Access for Children?
We examine how access to and use of oral and dental care under the Children's Health Insurance Program (CHIP) compared to private coverage and being uninsured in 10 states.The Stepped Wedge Cluster Randomized Trial and Its Potential for Child Health Services Research: A Narrative Review
We foresee an increasing role for the stepped wedge cluster randomized trial design in child health services research. Although a recent systematic review only identified 25 such studies,1 those studies offer themselves as compelling examples to consider. As we will demonstrate, the stepped wedge cluster randomized trial is particularly apt as a research design for health services research. Furthermore, the stepped wedge cluster randomized trial is particularly attractive for health services research concerning children and adolescents because its design addresses problems that complicate child health services research and differentiate those efforts from adult health services research.Children's Emergency Department Use for Asthma, 2001–2010
Although the emergency department (ED) provides essential care for severely ill or injured children, past research has shown that children often visit the ED for potentially preventable illnesses, including asthma. We sought to determine how children's rate of ED visits for asthma has changed over the last decade and to analyze what factors are associated with a child's potentially preventable ED visit for asthma.A Successful Program for Training Parent Mentors to Provide Assistance With Obtaining Health Insurance for Uninsured Children
Seven million US children lack health insurance. Community health workers are effective in insuring uninsured children, and parent mentors (PMs) in improving asthmatic children's outcomes. It is unknown, however, whether a training program can result in PMs acquiring knowledge/skills to insure uninsured children. The study aim was to determine whether a PM training program results in improved knowledge/skills regarding insuring uninsured minority children.Health Status and Type of Out-of-Home Placement: Informal Kinship Care in an Investigated Sample
To assess the sociodemographic, health, and mental health of children in different types of out-of-home placements after investigation by child welfare agencies; to determine whether there are systematic differences in the children and their caregivers by type of out-of-home placements; and to provide the first description of these characteristics in a nationally representative sample for children in informal kinship care after child welfare involvement.Predictors of Unmet Dental Need in Children With Autism Spectrum Disorder: Results From a National Sample
Unmet dental need in children with autism spectrum disorder (ASD) is common. We tested hypotheses that lacking a medical home or having characteristics of more severe ASD is positively associated with having unmet dental need among children with ASD.Mental Health Beliefs and Barriers to Accessing Mental Health Services in Youth Aging out of Foster Care
To examine the perspectives of youth on factors that influence mental health service use after aging out of foster care.Kinship Care
About 4.2% (3.1 million) of children in the United States, according to census data,1 reside with relatives or close family connections and with neither parent, an arrangement termed kinship care (KC). Health professionals frequently encounter children in KC and may better serve these children if they are aware of both the benefits and complexities of kinship arrangements.Concept and Measurement of Pediatric Value
In the new health care marketplace, families will be making important decisions concerning choice of health plan, health provider, and even accountable care organizations. Ideally, they would make these decisions using information on health care value, which comprises the relationships between patient/family-centered outcomes (the outputs of health care services) and costs of providing care to achieve these outcomes. Providing information on pediatric value will require new investments in data collection systems that include outcomes that matter to children and families and costs measured at the level of the child.Quality Concerns in Antipsychotic Prescribing for Youth: A Review of Treatment Guidelines
Antipsychotic prescribing for youth has increased rapidly, is linked with serious health concerns, and lacks clear measures of quality for pediatric care. We reviewed treatment guidelines relevant to 7 quality concepts for appropriate use and management of youth on antipsychotics: 1) use in very young children, 2) multiple concurrent antipsychotics, 3) higher-than-recommended doses, 4) use without a primary indication, 5) access to psychosocial interventions, 6) metabolic screening, and 7) follow-up visits with a prescriber.Patient Reported Outcomes as Indicators of Pediatric Health Care Quality
Health care reform has increased demand for pediatric health care quality evaluations, particularly those that assess the impact of care on patient and population health outcomes. Many of today's most common childhood conditions are characterized by symptoms, behaviors, and functional limitations that are best assessed as patient reported outcomes (PROs). Although they remain greatly underutilized, PROs have the potential to improve pediatric health care quality assessment at the point of care and through system-level performance evaluations.Advancing the Science of Measurement in Pediatric Quality of Care
The Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 provides an opportunity to consider and enhance the measurement of children's health care quality as a means to improve child health.1 The legislation required the identification of an initial child core set of measures for voluntary use by Medicaid/Child Health Insurance (CHIP) programs. The initial child core set was published in 2009, and after its most current update in 2014, the list now includes 23 pediatric measures.The Transition Readiness Assessment Questionnaire (TRAQ): Its Factor Structure, Reliability, and Validity
National consensus statements recommend that providers regularly assess the transition readiness skills of adolescent and young adults (AYA). In 2010 we developed a 29-item version of Transition Readiness Assessment Questionnaire (TRAQ). We reevaluated item performance and factor structure, and reassessed the TRAQ's reliability and validity.Growing Up Poor: A Pediatric Response
The original mission of Boston City Hospital, established in 1864, now Boston Medical Center (BMC), was to provide medical care to all regardless of race, ethnicity, or ability to pay. Nationally, health insurance for children has increased, although disparities by race and income remain.1 However, despite the largest expansion of health insurance in the nation, covering 97% of Massachusetts children and biomedical treatment advances, the low-income and minority children seen at BMC continue to suffer disproportionally from low birth weight, asthma, learning disabilities, and most health problems compared to their nonpoor peers.Parental Psychological Distress and Children's Mental Health: Results of a National Survey
Questions persist as to which dimensions of child mental health are most associated with parental mental health status and if these associations differ by parental gender. We assessed associations between parental psychological distress and children's mental health.Identifying Sickle Cell Disease Cases Using Administrative Claims
To develop and test the accuracy of administrative claims method for identifying children with sickle cell disease (SCD) to enable quality of care assessments among children enrolled in Medicaid.School-Located Influenza Vaccination With Third-Party Billing: Outcomes, Cost, and Reimbursement
To assess rates of immunization; costs of conducting clinics; and reimbursements for a school-located influenza vaccination (SLIV) program that billed third-party payers.School-Located Influenza Vaccination With Third-Party Billing: What Do Parents Think?
School-located influenza vaccination (SLIV) may be instrumental in achieving high vaccination rates among children. Sustainability of SLIV programs may require third-party billing. This study assessed, among parents of elementary school students, the attitudes about SLIV and billing at school, as well as factors associated with being supportive of SLIV.
