Research Consortium on Children with Chronic Conditions (RCCCC): a vehicle for interdisciplinary collaborative research

Scaling Family Voices and Engagement to Measure and Improve Systems Performance and Whole Child Health: Progress and Lessons from the Child and Adolescent Health Measurement Initiative

BACKGROUND

The 1997 legislation authorizing the United States Child Health Insurance Program sparked progress to measure and publicly report on children's healthcare services quality and system performance. To meet the moment, the national Child and Adolescent Health Measurement Initiative (CAHMI) public-private collaboration was launched to put families at the center of defining, measuring and using healthcare performance information to drive improved services quality and outcomes.

METHODS

Since 1996 the CAHMI followed an intentional path of collaborative action to (1) articulate shared goals for child health and advance a comprehensive, life-course and outcomes-based healthcare performance measurement and reporting framework; (2) collaborate with families, providers, payers and government agencies to specify, validate and support national, state and local use of dozens of framework aligned measures; (3) create novel public-facing digital data query, collection and reporting tools that liberate data findings for use by families, providers, advocates, policymakers, the media and researchers (Data Resource Center, Well Visit Planner); and (4) generate field building research and systems change agendas and frameworks (Prioritizing Possibilities, Engagement In Action) to catalyze prevention, flourishing and healing centered, trauma-informed, whole child and family engaged approaches, integrated systems and supportive financing and policies.

CONCLUSIONS

Lessons call for a restored, sustainable family and community engaged measurement infrastructure, public activation campaigns, and undeterred federal, state and systems leadership that implement policies to incentivize, resource, measure and remove barriers to integrated systems of care that scale family engagement to equitably promote whole child, youth and family well-being. Population health requires effective family engagement.

Social anxiety symptoms among youth with chronic health conditions: trajectories and related factors

Purpose: This study explored three-year trajectories of social anxiety symptoms among youth with chronic health conditions and investigated factors influencing those trajectories.Methods: Participants (N = 439) were recruited from eight pediatric rehabilitation centers. The Social Anxiety Scale for Children-Revised measured social anxiety across four time points. Latent Class Growth Analysis was used to study trajectories and logistic regression to identify related factors.Results: A three-class solution was supported: a "high anxiety and stable" group (17.1%), a "moderate anxiety and stable" group (44.4%), and a "low anxiety and stable" group (38.5%). Youth in the "moderate and stable" group were less likely to be male compared to the "low and stable" group. Youth in the "high and stable" group were more likely to have greater cognitive symptoms and less likely to have higher levels of social participation compared to the "low and stable" group. Youth in both the "high and stable" and "moderate and stable" groups were less likely to have high support from classmates or close friends compared to the "low and stable" group. Moreover, both the "high and stable" and "moderate and stable" groups were less likely to have positive family functioning.Conclusion: Youth with chronic conditions belonging to "high and stable" and "moderate and stable" social anxiety trajectories can be distinguished from those in a "low and stable" trajectory using personal, functional, and environmental level variables.Implications for RehabilitationYouth with chronic health conditions are at risk of developing and maintaining moderate to high levels of social anxiety symptoms as they move through adolescence.Compared to youth with "low and stable" social anxiety, those with "moderate and stable" social anxiety are less likely to be male, have high peer support or high family functioning.Compared to youth with "low and stable" social anxiety, those with "high and stable" social anxiety are more likely to have greater cognitive symptoms, and less likely to have high social participation, high peer support, or high family functioning.Rehabilitation and other professionals should not only consider factors that are functional in nature; they should also consider personal and environmental level factors when supporting youth with chronic health conditions who experience social anxiety symptoms.

The status of international collaborations in compilation of Iranian scientific articles on environmental health engineering

BACKGROUND

Scientific cooperation is one of the effective methods to access current knowledge and technologies and also to use successful experiences of researchers in developed countries by academicians living in developing countries. This study aimed to determine the level of international contribution in compilation of scientific articles in Iranian journals published in the field of environmental health engineering.

METHODS

This descriptive and retrospective study was conducted within a 10-year period (2008-2017), in which all articles published in five specialized Iranian journals of environmental health engineering were reviewed using a researcher-made checklist. The information collected in the checklist included: the year of publication, number of issues and articles, information about the status of authors' participation in terms of number of authors, sex, institutional affiliation, country, continents, and research centers. Descriptive and inferential statistics such as index of dispersion, measures of central tendency, and Chi-square and t tests were used to statistically analyze the data. Besides, VOSviewer software was used to visualize the data.

RESULTS

The review of 1276 articles published in 102 issues of the five journals of environmental health engineering in Iran showed that 184 articles were written with the participation of researchers from other countries. Most articles with the participation of international authors during the last decade were published in 2014. Chi-square test indicated a significant difference in the publication of these articles within 2014-2015 than other years (P = 0.001). Among the five journals, the best participation of international researchers was observed in J Environ Health Sci Engineer (168 articles, 91.3%). Considering the number of joint articles with Iran, the top continents were Asia, Europe, and Africa each with 117, 52, and 32 articles, respectively. India, Turkey, and Malaysia had the highest level of cooperation with Iranian researchers with 53, 16, and 14 articles, respectively. 637 authors contributed in 184 articles, of whom 469 (73.6%) were male and 121 (18.9%) were female. T test was used to compare the mean number of male and female authors in the articles with or without the participation of international researchers, which showed no significant difference.

CONCLUSION

International contribution of researchers in compilation of specialized environmental health articles was good. Given the low level of cooperation between researchers from developed European and American countries and their Iranian counterparts, it seems necessary to adopt different methods to attract more collaboration from researchers working in developed countries considering their significant role in health-related areas.

Questionário para identificação de crianças com condições crônicas (QuICCC-R): tradução e adaptação

Resumo Objetivo Realizar a tradução e adaptação cultural do Questionnaire for Identifying Children With Chronic Conditions-Revised (QuICCC-R, publicado em 1999) para a língua portuguesa do Brasil. O questionário foi desenvolvido para identificar crianças com condições crônicas por meio da aplicação, aos seus pais ou responsável, de 16 questões sobre as repercussões dessas condições, como limitações funcionais, dependência de mecanismos compensatórios ou de cuidados e utilização de serviços acima do esperado para a idade. O método utilizado é independente de diagnósticos. A aplicação do questionário pode ser feita pessoalmente ou por telefone, com duração média de 2 minutos. Métodos Estudo metodológico, realizado nas seguintes etapas: tradução, tradução reversa, revisão por especialistas 1, pré-teste, revisão por especialistas 2 e cálculo do índice de validade de conteúdo. Resultados O questionário foi traduzido e adaptado para português garantindo a equivalência semântica, idiomática e cultural. O pré-teste e a validação de conteúdo por comitê (índice 0,99) possibilitaram aperfeiçoar o instrumento para aplicação e compreensão pela população alvo. Conclusão Por ser um instrumento de rápida e fácil aplicação, o questionário pode contribuir para identificação da condição crônica na infância, na prática clínica e em estudos epidemiológicos, subsidiando o planejamento em saúde.

Perspectives on "Disease" and "Disability" in Child Health: The Case of Childhood Neurodisability

Chronic health conditions are often associated with what is termed disability. Traditional thinking has focused on diagnosis and treatment of chronic diseases and disorders, with less attention to people's functional abilities and their contextual determinants. Understanding all of these factors is integral to addressing the predicaments and needs of persons with chronic conditions. However, these complementary yet distinct "worldviews" reflected in what we call disease and disability perspectives often remain, at best, only vaguely articulated. In this paper, we explore and expand on these perspectives in light of conceptual advances, specifically the framework of the World Health Organization's International Classification of Functioning, Disability and Health, and their epistemic underpinnings with reference to Wilhelm Windelband's notions of nomothetic and idiographic types of knowledge. Our primary focus is the children with neurodisability - life-long conditions that onset early in life and have functional consequences that impact developmental trajectories. We critically review and analyze conceptual material, along with clinical and research evidence relevant to the experiential and clinical realities of this population, to demonstrate the limitations of a biomedically based diagnostic-therapeutic paradigm at the expense of a developmental and disability-oriented perspective. Our main aim in this paper is to argue for an explicit recognition of both disease and disability perspectives, and a more balanced and appropriate deployment of these concepts across the continuum of clinical services, research, policy-making and professional and public education in relation to children with neurodisability; we also provide concrete recommendations to advance this progressive strategy. The relevance of these aims and strategies, however, extends beyond this particular population.

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. This review recaps the development, design, and findings from the use of the CS and synthesizes findings from studies conducted over the past 13 years as well as updated findings on the CS to briefly address the 12 most common questions asked about this tool through technical assistance provided regarding the CS since 2001. Across a range of analyses, the CS consistently identifies a subset of children with chronic conditions who need or use more than a routine type or amount of medical- and health-related services and who share common needs for health care, including care coordination, access to specialized and community-based services, and enhanced family engagement. Scoring algorithms exist to stratify CSHCN by complexity of needs and higher costs of care. Combining CS data with clinical diagnostic code algorithms may enhance capacity to further identify meaningful subgroups. Clinical application is most suited for identifying and characterizing populations of patients and assessing quality and system improvement impacts for children with a broad range of chronic conditions. Other clinical applications require further implementation research. Use of the CS in clinical settings is limited because integration of standardized patient-reported health information is not yet common practice in most settings or in electronic health records. The CS continues to demonstrate validity as a non-condition-specific, population-based tool that addresses many of the limits of condition or diagnosis checklists, including the relatively low prevalence of many individual conditions and substantial within-diagnosis variations and across-diagnoses similarities in health service needs, functioning, and quality of care.

Functional difficulties and health conditions among children with special health needs

OBJECTIVES

To describe the functional difficulties of children with special health needs and to demonstrate the shared and unique contributions in predicting health outcomes and informing therapeutic interventions, policies, and research by using data from the 2005-2006 National Survey of Children With Special Health Care Needs.

RESULTS

Children with special health care needs experience an array of health conditions and functional difficulties that are interrelated. Although health conditions tend not to change, the characteristics of functional difficulties are subject to changes over time with age or as a result of interventions. Descriptive data highlight common functional difficulties across health conditions. Multiple regression analyses support both health conditions and functional difficulties predicting (1) health services, such as emergency department visits, (2) personal limitations such as impairment of daily activities and school absences, and (3) family impact, stopping or reducing work. Functional difficulties were, however, the stronger predictor for all outcomes except school absences.

CONCLUSIONS

The results support the utility of expanding measures of children with special health care needs to include functional difficulties in survey research, as well as clinical and public health practice. Systematic inclusion of functional difficulties will inform policy development, program planning, outcome assessment, and resource allocation for this vulnerable population. A focus on functional difficulties facilitates stronger coordination of services across sectors including physical health, mental health, education, and other social services to improve the health and well-being for these children and youth.