Mental Health
Adversity, Maltreatment, and Resilience in Young Children
Much of the research on children in high risk environments, particularly those who have been maltreated, has focused on negative outcomes. Yet, much can be learned from some of these children who fare relatively well. The objective was to examine resilience in high-risk preschoolers, and to probe contributors to their adaptive functioning.Is the Use of Physical Discipline Associated with Aggressive Behaviors in Young Children?
To determine the association between use of physical discipline and parental report of physically aggressive child behaviors in a cohort of young children who were without indicators of current or past physical abuse.Parental Predictions and Perceptions Regarding Long-Term Childhood Obesity-Related Health Risks
To assess how parents perceive long-term risks for developing obesity-related chronic health conditions.For Better or Worse? Change in Service Use by Children Investigated by Child Welfare Over a Decade
Children, particularly minority children, referred to child welfare because of suspected maltreatment are vulnerable and need many services. We sought to assess whether service use has improved over the past decade and whether racial-ethnic disparities in service use have decreased.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.Screening for Adolescent Problematic Internet Use: Validation of the Problematic and Risky Internet Use Screening Scale (PRIUSS)
Problematic Internet use (PIU) is an emerging health concern that lacks screening measures validated for use with adolescents and young adults. This study aimed to validate the Problematic and Risky Internet Use Screening Scale (PRIUSS) for use with older adolescents and to increase its clinical utility by determining scoring guidelines and assessing the relationship between PIU and other mental health conditions.Maternal Depressive Symptoms and Attained Size Among Children in the First 2 Years of Life
To evaluate the relation of maternal depressive symptoms with attained size and whether it is stronger for young children in low-income families.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.Association of Adolescent Depressive Symptoms With Health Care Utilization and Payer-Incurred Expenditures
Screening adolescents for depression is recommended by the US Preventive Services Task Force. We sought to evaluate the impact of positive depression screens in an adolescent population on health care utilization and costs from a payer perspective.Can the Neighborhood Built Environment Make a Difference in Children's Development? Building the Research Agenda to Create Evidence for Place-Based Children's Policy
Healthy child development is determined by a combination of physical, social, family, individual, and environmental factors. Thus far, the majority of child development research has focused on the influence of individual, family, and school environments and has largely ignored the neighborhood context despite the increasing policy interest. Yet given that neighborhoods are the locations where children spend large periods of time outside of home and school, it is plausible the physical design of neighborhoods (built environment), including access to local amenities, can affect child development.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.Beyond ADHD: How Well Are We Doing?
There has been increasing emphasis on the role of the pediatrician with respect to behavioral, learning, and mental health (MH) issues, and developmental behavioral rotations are now required in pediatric residency programs. We sought to examine whether this newer emphasis on MH is reflected in pediatricians' reports of their current practices.Primary Care Interventions to Prevent or Treat Traumatic Stress in Childhood: A Systematic Review
To systematically assess the evidence base for prevention and treatment of child traumatic stress in primary care settings.Table of Contents
467 Pediatric Adverse Childhood Experiences: Implications for Life Course Health Trajectories Moira Szilagyi and Neal HalfonSchool-Based Health Centers as Medical Homes: Parents' and Adolescents' Perspectives
Preventive health services are underutilized by US adolescents, especially those from low-income populations. School-based health centers (SBHCs) have been endorsed as primary medical homes for adolescents. This study was undertaken to determine how adolescent SBHC users and their parents perceive SBHCs, particularly whether SBHCs fulfill each of the elements of a medical home as defined by the American Academy of Pediatrics.Barriers to the Identification and Management of Psychosocial Problems: Changes From 2004 to 2013
Pediatricians report many barriers to caring for children with mental health (MH) problems. The American Academy of Pediatrics (AAP) has focused attention on MH problems, but the impact on perceived barriers is unknown. We examined whether perceived barriers and their correlates changed from 2004 to 2013.Household Food Insecurity and Mental Health Problems Among Adolescents: What Do Parents Report?
To investigate whether adolescents living in households with food insecurity have poorer parent-reported mental health (MH) than peers.Do Pediatricians Ask About Adverse Childhood Experiences in Pediatric Primary Care?
The stress associated with adverse childhood experiences (ACEs) has immediate and long-lasting effects. The objectives of this study were to examine 1) how often pediatricians ask patients' families about ACEs, 2) how familiar pediatricians are with the original ACE study, and 3) physician/practice characteristics, physicians' mental health training, and physicians' attitudes/beliefs that are associated with asking about ACEs.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.Pediatric Adverse Childhood Experiences: Implications for Life Course Health Trajectories
Life course health science integrates the extensive literature on early brain development, childhood trauma and adversity, epigenetics, developmental psychology, and mental health and teaches us that many adult health problems have their origins early in life.1 The timing, intensity, and cumulative burden of adversities, especially in the relative absence of protective factors, can affect gene expression, the conditioning of stress responses, and the development of immune system function. Individuals affected by a high burden of adverse experiences may adopt compensatory high-risk behaviors that can further erode their health and mental health.Adverse Childhood Experiences and Mental Health, Chronic Medical Conditions, and Development in Young Children
To determine the relationships between adverse childhood experiences (ACEs) and mental health, chronic medical conditions, and social development among young children in the child welfare system.Association of Pediatric Abusive Head Trauma Rates With Macroeconomic Indicators
We aimed to examine abusive head trauma (AHT) incidence before, during and after the recession of 2007–2009 in 3 US regions and assess the association of economic measures with AHT incidence.Translating Developmental Science to Address Childhood Adversity
Demystifying child development is a defining element of pediatric care, and pediatricians have long appreciated the profound influences that families and communities have on both child development and life course trajectories. Dramatic advances in the basic sciences of development are beginning to reveal the biologic mechanisms underlying well-established associations between a spectrum of childhood adversities and less than optimal outcomes in health, education and economic productivity. Pediatricians are well positioned to translate this new knowledge into both practice and policy, but doing so will require unprecedented levels of collaboration with educators, social service providers, and policy makers.Examining Trends and Coexisting Conditions Among Children Qualifying for SSI Under ADHD, ASD, and ID
To examine the prevalence trends and coexisting conditions in attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID) in the pediatric Supplemental Security Income (SSI) population and general population.Table of Contents
353 Treatment Interventions for Early Childhood Obesity: A Systematic Review Byron A. Foster, Jill Farragher, Paige Parker, and Erica T. SosaPediatric-Based Intervention to Motivate Mothers to Seek Follow-up for Depression Screens: The Motivating Our Mothers (MOM) Trial
To determine the initial effectiveness of a novel, pediatric office-based intervention in motivating mothers to seek further assessment of positive depression screens.A Planned Care Approach and Patient Registry to Improve Adherence to Clinical Guidelines for the Diagnosis and Management of Attention-Deficit/Hyperactivity Disorder
Attention-deficit/hyperactivity disorder (ADHD) affects almost 2.4 million US children. Because American Academy of Pediatrics guidelines for ADHD recommend use of standardized diagnostic instruments, regular follow-up and the chronic care model, this pilot project sought to implement and assess an electronic registry of patients with ADHD combined with care coordination by a planned care team.Are Unmet Breastfeeding Expectations Associated With Maternal Depressive Symptoms?
Most US women intend and initiate breastfeeding, yet many do not breastfeed as long as desired. Not meeting one's own prenatal expectations is a plausible mechanism for the previously observed association between lack of breastfeeding and postpartum depression (PPD). This study explored whether meeting prenatal expectations for exclusive breastfeeding was associated with PPD symptoms.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.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 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.Parent 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.Primary Care Provider Training in Screening, Assessment, and Treatment of Adolescent Depression
Adolescent depression is underrecognized and undertreated. Primary care providers (PCP) require training to successfully identify adolescents with depression. We examined the effects of a PCP training program in the screening, assessment, and treatment of adolescent depression (SAT-D) on adolescents' reports of PCP screening for adolescent depression at annual well visits and PCP SAT-D confidence and knowledge.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.Outside Looking In, Inside Looking Out—Expanding the Concept of Health
I live my life in widening circles that reach out across the world. I might not ever complete this last one but I give myself to it. —Rilke, Book of Hours (1905)Energy Drinks and Youth Self-Reported Hyperactivity/Inattention Symptoms
To describe patterns in sweetened beverage consumption by race/ethnicity and sex, documenting both the amount and types of sweetened beverages consumed; and to examine the association of sweetened beverage consumption with hyperactivity/inattention symptoms among middle school students in a single urban school district.Pediatricians' Responses to Printed Clinical Reminders: Does Highlighting Prompts Improve Responsiveness?
Physicians typically respond to roughly half of the clinical decision support prompts they receive. This study was designed to test the hypothesis that selectively highlighting prompts in yellow would improve physicians' responsiveness.Minority Parents' Perspectives on Racial Socialization and School Readiness in the Early Childhood Period
To describe how minority parents help their young children navigate issues of race and racism and discuss implications this racial socialization may have for school readiness.Taking Stock of the CSHCN Screener: A Review of Common Questions and Current Reflections
Since 2000, the Children with Special Health Care Needs (CSHCN) Screener (CS) has been widely used nationally, by states, and locally as a standardized and brief survey-based method to identify populations of children who experience chronic physical, mental, behavioral, or other conditions and who also require types and amounts of health and related services beyond those routinely used by children. Common questions about the CS include those related to its development and uses; its conceptual framework and potential for under- or overidentification; its ability to stratify CSHCN by complexity of service needs and daily life impacts; and its potential application in clinical settings and comparisons with other identification approaches.Stratification of Children by Medical Complexity
To stratify children using available software, Clinical Risk Groups (CRGs), in a tertiary children's hospital, Seattle Children's Hospital (SCH), and a state's Medicaid claims data, Washington State (WSM), into 3 condition groups: complex chronic disease (C-CD); noncomplex chronic disease (NC-CD), and nonchronic disease (NC).Influence of Maternal Depression on Household Food Insecurity for Low-Income Families
To examine whether maternal depression predicts future household food insecurity for low-income families.Diagnosis of Attention-deficit/Hyperactivity Disorder by Developmental Pediatricians in Academic Centers: A DBPNet Study
To describe the developmental-behavioral pediatricians (DBPs), patients, and clinical practices used in the diagnostic assessments of attention-deficit/hyperactivity disorder (ADHD) within all 12 academic medical centers comprising Developmental-Behavioral Pediatrics Research Network (DBPNet).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.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.Risk Score for Predicting Adolescent Mental Health Problems Among Children Using Parental Report Only: The TRAILS Study
To construct a risk score for adolescent mental health problems among children, using parental data only and without potentially stigmatizing mental health items.The Research Home: Partnering with Families
I want to express my gratitude to the members of the Research Committee for considering me suitable to receive this prestigious award.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.Learning Trajectories of Children With Special Health Care Needs Across the Severity Spectrum
A significant proportion of school-aged children experience special health care needs (SCHN) and seek care from pediatricians with a wide range of condition types and severity levels. This study examines the learning pathways of children with established (already diagnosed at school entry) and emerging (teacher identified) SHCN from school entry through the elementary school years.Care Coordination, the Family-Centered Medical Home, and Functional Disability Among Children With Special Health Care Needs
Children with special health care needs (CSHCN) are at increased risk for functional disabilities. Care coordination has been shown to decrease unmet health service use but has yet been shown to improve functional status. We hypothesize that care coordination services lower the odds of functional disability for CSHCN and that this effect is greater within the context of a family-centered medical home. A secondary objective was to test the mediating effect of unmet care needs on functional disability.The Importance of the Family Voice in Quality Measure Development for Children's Health Care
In 1985, when our youngest son was born with complex medical needs, my husband and I found ourselves learning how to advocate for our son and our family in the health care system. We soon recognized that we could use our experiences to improve how care was provided for others. In the 1980s, families were not routinely allowed to be involved in their child's care in the hospital, or even allowed to stay with their child during hospital physician rounds and many clinical procedures. Families were usually excluded from participation in the development of the care plan for their child.Young and Reckless? Greater Standardization and Transparency of Performance Is Needed for Pediatric Performance Measures
When the Children's Health Insurance Program Reauthorization Act (CHIPRA) was passed in 2009, the secretary of the Department of Health and Human Services was tasked with identifying an initial core set of measures that state Medicaid programs and the Children's Health Insurance Program (CHIP) could voluntarily use to reflect the quality of health care being delivered to children enrolled in these 2 programs. This effort was overdue for this joint federal–state program, as each state had developed its own quality measures, definitions, and performance thresholds, limiting the ability to compare Medicaid programs among states.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.The Current and Ideal State of Mental Health Training: Pediatric Program Director Perspectives
To assess pediatric residency program director (PD) perceptions of the current state of mental health (MH) training, their receptivity to curricular changes, and perceptions of their residents' knowledge and skills in MH care.Facebook as a Recruitment Tool for Adolescent Health Research: A Systematic Review
Researchers are increasingly using social media to recruit participants to surveys and clinical studies. However, the evidence of the efficacy and validity of adolescent recruitment through Facebook is yet to be established.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.Considerations and Evidence for an ADHD Outcome Measure
The 2011 American Academy of Pediatrics attention-deficit/hyperactivity disorder (ADHD) guideline emphasizes monitoring and measuring outcomes of children diagnosed with ADHD; however, recommendations for how to measure improvement are less clear. A long-term goal was to develop an outcome measure that assesses the quality of care for children with ADHD. As a first step in that process, we conducted a literature synthesis on the efficacy and effectiveness of guideline-recommended ADHD treatments on patient outcomes.Developing Measures for Pediatric Quality: Methods and Experiences of the CHIPRA Pediatric Quality Measures Program Grantees
Monitoring quality is an important way of understanding how the health care system is serving children and families. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Pediatric Quality Measures Program (PQMP) funded efforts to develop and enhance measures to assess care for children and adolescents. We describe the processes used by the PQMP grantees to develop measures to assess the health care of children and adolescents in Medicaid and the Children's Health Insurance Program.Using Medicaid and CHIP Claims Data to Support Pediatric Quality Measurement: Lessons From 3 Centers of Excellence in Measure Development
We sought to explore the claims data-related issues relevant to quality measure development for Medicaid and the Children's Health Insurance Program (CHIP), illustrating the challenges encountered and solutions developed around 3 distinct performance measure topics: care coordination for children with complex needs, quality of care for high-prevalence conditions, and hospital readmissions.Policy, Politics, and Procedure: Our Role in Building Systems That Improve the Health of Children
It has been a tremendous honor to serve as President of the Academic Pediatric Association (APA) for the past year. As President, I have seen the breadth and depth of the work of our members in a variety of venues, and have come to better understand the many ways in which APA members live their academic lives. There is no “typical” APA member; we take a myriad of paths in our quest to serve the needs of children. Wherever I went, however, I heard a common theme voiced by all of our members: pediatric practice, teaching, and research do not fully benefit children unless we incorporate what we do into the policies of the systems in which children live.Table of Contents
425 Policy, Politics, and Procedure: Our Role in Building Systems That Improve the Health of Children David M. KellerWhich African American Mothers Disclose Psychosocial Issues to Their Pediatric Providers?
To determine if parents' self-efficacy in communicating with their child's pediatrician is associated with African American mothers' disclosure of psychosocial concerns during pediatric primary care visits.Family Impacts Among Children With Autism Spectrum Disorder: The Role of Health Care Quality
To compare health care quality and family employment and financial impacts among children with special health care needs (CSHCN) with autism spectrum disorder (CSHCN + ASD), CSHCN with functional limitations (CSHCN + FL), and CSHCN lacking these conditions (other CSHCN); to test whether high health care quality was associated with reduced family impacts among CSHCN + ASD.Determinants of Career Satisfaction Among Pediatric Hospitalists: A Qualitative Exploration
To characterize determinants of career satisfaction among pediatric hospitalists working in diverse practice settings; to develop a framework to conceptualize factors influencing career satisfaction.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.Parents' Obesity-Related Behavior and Confidence to Support Behavioral Change in Their Obese Child: Data From the STAR Study
Successful childhood obesity interventions frequently focus on behavioral modification and involve parents or family members. Parental confidence in supporting behavior change may be an element of successful family-based prevention efforts. We aimed to determine whether parents' own obesity-related behaviors were related to their confidence in supporting their child's achievement of obesity-related behavioral goals.Latino Parents' Perspectives on Barriers to Autism Diagnosis
Latino children are diagnosed with autism spectrum disorders (ASDs) at older ages and at the point of more severe symptoms. We sought to qualitatively describe community, family, and health care system barriers to ASD diagnosis in Latino children.Children and the Patient Protection and Affordable Care Act: Opportunities and Challenges in an Evolving System
The Patient Protection and Affordable Care Act (ACA), passed in 2010, focused primarily on the problems of adults, but the changes in payment for and delivery of care it fosters will likely impact the health care of children. The evolving epidemiology of pediatric illness in the United States has resulted in a relatively small population of medically fragile children dispersed through the country and a large population of children with developmental and behavioral health issues who experience wide degrees of health disparities.Parental Limited English Proficiency and Health Outcomes for Children With Special Health Care Needs: A Systematic Review
One in 10 US adults of childbearing age has limited English proficiency (LEP). Parental LEP is associated with worse health outcomes among healthy children. The relationship of parental LEP to health outcomes for children with special health care needs (CSHCN) has not been systematically reviewed.Depression Screening in Adolescents in the United States: A National Study of Ambulatory Office-Based Practice
To determine the frequency of depression screening during ambulatory, office-based visits for adolescents seen in general/family medicine or pediatric practices in the United States using nationally representative data; to determine the patient-, provider-, and visit-level factors associated with depression screening during ambulatory visits to inform recommendations to promote screening.Transition Care: Future Directions in Education, Health Policy, and Outcomes Research
All youth must transition from pediatric to adult-centered medical care. This process is especially difficult for youth with special health care needs. Many youth do not receive the age-appropriate medical care they need and are at risk during this vulnerable time. Previous research has identified barriers that may prevent effective transition, and protocols have been developed to improve the process. Health outcomes related to successful transition have yet to be fully defined. Health care transition can also be influenced by education of providers, but there are gaps in medical education at the undergraduate, graduate, and postgraduate levels.Competency 8. Recognize that ambiguity is part of clinical medicine and respond by utilizing appropriate resources in dealing with uncertainty
The practice of medicine is fraught with uncertainty. Uncertainty arises in the world, our knowledge of the world, the structure of the decisions we face, and the preferences and values that are brought to bear in making those decisions.1Keeping Children Safe and Well: An APA Symphony in Four Movements
I am honored to have been president of the Academic Pediatric Association (APA) this year. Some of you may remember a recent newsletter column I titled “How Can I keep From Singing?” I mentioned that I sing in the Gateway Men's Chorus. In fact, I have been a member of one or another performing arts group almost continuously since I have been in elementary school. It seemed natural to me to use music as a metaphor for the work of the APA. Whatever genre of music you enjoy, great music has the ability to stir the soul, to inspire, and indeed to transform.Pediatricians Can Learn to Play Well With Others
When Amal and I were expecting our second child, we considered the stress it would create for Maya, our first. Maya had spent the first 2 years of her life in a home where she was wanted, where her parents were healthy and educated and safe, and where we had enough money for all of her food, diapers, clothing, and great child care.Financial and Nonfinancial Burden Among Families of CSHCN: Changes Between 2001 and 2009–2010
We use the latest data to explore multiple dimensions of financial burden among children with special health care needs (CSHCN) and their families in 2009–2010 and changes since 2001.The National Improvement Partnership Network: State-Based Partnerships That Improve Primary Care Quality
Improvement partnerships (IPs) are a model for collaboration among public and private organizations that share interests in improving child health and the quality of health care delivered to children. Their partners typically include state public health and Medicaid agencies, the local chapter of the American Academy of Pediatrics, and an academic health care organization or children's hospital. Most IPs also engage other partners, including a variety of public, private, and professional organizations and individuals.Use of Complementary and Alternative Medical Therapies Among Youth With Mental Health Concerns
Use of complementary and alternative medical (CAM) therapies is common among adults with mental health concerns, but little is known about CAM use among adolescents with mental health concerns.Persistence of Mental Health Problems in Very Young Children Investigated by US Child Welfare Agencies
To document the persistence and predictors of mental health problems in children aged 12 to 18 months investigated for alleged maltreatment.Strict Smoke-free Home Policies Among Smoking Parents in Pediatric Settings
To examine strict smoke-free home policies among smoking parents assessed in pediatric offices.Quality Improvement in Pediatric Emergency Medicine
Pediatric patients, who accounted for 17.4% of US emergency department (ED) visits in 2010, present unique challenges that can impede an ED’s ability to provide optimal care. To meet the growing demand for comprehensive, high-quality care, health care systems are incorporating quality improvement (QI) methods to reduce costs and variations in care and to improve access, safety, and ultimately the outcomes of medical care. This overview of QI initiatives within the field of pediatric emergency medicine explores how proven QI strategies are being integrated into efforts that target the care of children within the broader emergency care community.Integrating Mental Health Services in Primary Care Continuity Clinics: A National CORNET Study
To determine whether pediatric continuity clinics integrate mental health (MH) services into care delivery; and to determine whether the level of MH integration is related to access to MH services, types of MH screening performed, self-efficacy, satisfaction with referral sites, and communication with the primary care provider.Table of Contents
489 Youth Tobacco Exposure: The Pediatrician's Role in Addressing a Persistent Problem Veronica L. GunnMoving From Research to Practice in the Primary Care of Children With Autism Spectrum Disorders
Autism spectrum disorders (ASD), once thought rare, are now commonly encountered in clinical practice. Academic pediatricians may be expected to teach medical students and pediatric residents about ASD, but most likely received limited exposure to ASD during their training. In recent years, research that informs the clinical guidance provided to pediatricians regarding surveillance, screening, and ongoing management of children with ASD has accelerated. By 24 months of age, children with ASD exhibit delays across multiple domains of development, yet the diagnosis is frequently made much later.Community Health Centers: Medical Homes for Children?
To explore medical home attributes of community health centers (CHCs) that provide care to low-income children nationwide compared to other providers for the poor.Maternal Depressive Symptoms and Child Obesity in Low-Income Urban Families
To characterize the relationship between maternal depressive symptoms and child weight status, obesity-promoting feeding practices, and activity-related behaviors in low-income urban families.Assessing the Impact of a Web-Based Comprehensive Somatic and Mental Health Screening Tool in Pediatric Primary Care
To evaluate how parents and physicians perceive the utility of a comprehensive, electronic previsit screener, and to assess its impact on the visit.Family Physical Activity and Meal Practices Associated With Disordered Weight Control Behaviors in a Multiethnic Sample of Middle-School Youth
Family practices around weight-related behaviors can shape children's development of disordered weight control behaviors (DWCB), such as vomiting, taking laxatives, or taking diet pills without a prescription. This study examined family meal and physical activity (PA) practices associated with DWCB among a multiethnic sample of youth.QI Project: Bullying
The 2008-2009 School Crime Supplement indicates that, nationwide, 28% of students in grades 6-12 experienced bullying . Children and adolescents bullied have a higher incidence of anxiety, depression and psychiatric/psychosocial impairment.Health Status, Emotional/Behavioral Problems, Health Care Use, and Expenditures in Overweight/Obese US Children/Adolescents
To examine the association of overweight/obesity with health, health care utilization, and expenditures in a national sample of 10- to 17-year-old children and adolescents.The Challenge of Reaching Adolescents to Promote Health Care
The challenge of providing appropriate preventive health services to adolescents is one familiar to all pediatricians who care for this population. Adolescents have fewer recommended preventive health medical visits than young children and may not have regular contact with the health care system. In recent years, new adolescent vaccines have been developed and recommended to provide protection against pertussis (TdaP), meningococcal meningitis (MCV4), and human papillomavirus (HPV), increasing the need for appropriate preventive health care.Developmental and Health Services in Head Start Preschools: A Tiered Approach to Early Intervention
To describe a tiered approach to identifying and addressing developmental and health concerns among low-income preschool children in Head Start.To Create a Better World for Children and Families: The Case for Ending Childhood Poverty
The Academic Pediatric Association (APA) is a great and unique organization. The best minds and hearts in pediatrics are our members. We are a family of teachers and scholars and advocates and healers presiding over academic pursuits, over the education and nurturing of our young, fertilizing the ground of the future of society. We have our eyes on protecting and supporting and improving the lot of the most vulnerable children and families. We do so many good things. We are open to all levels of diversity.Table of Contents
83 To Create a Better World for Children and Families: The Case for Ending Childhood Poverty Benard P. Dreyer
