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de Sousa RCR, de Paula WKAS, Alves FAP, de Albuquerque MIN, Albuquerque GA, Coriolano-Marinus MWDL. Continuing education on child development in primary care: healthcare workers' perspectives. Rev Esc Enferm USP 2023; 57:e20230189. [PMID: 38131442 PMCID: PMC10743572 DOI: 10.1590/1980-220x-reeusp-2023-0189en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/10/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE To analyze the contributions of a continuing education with Primary Health Care professionals that promotes child development. METHOD A continuing education intervention, utilizing a qualitative approach, was conducted among healthcare workers at a Primary Health Care facility in a low-income neighborhood in the city of Recife. The intervention consisted of eight workshops conducted between July and October 2019, with the participation of fifteen healthcare workers. All data from the focus groups were recorded, transcribed, and analyzed thematically using Bronfenbrenner's bioecological model as the theoretical framework. RESULTS Through the continuing education intervention, healthcare professionals were able to reflect on their work processes and personal lives and propose actions to improve child development. CONCLUSION The study findings highlight the significant impact of such interventions in changing perceptions and professional practices related to child development. Overall, this research provides valuable insights into the effectiveness of continuing education interventions for promoting healthy child development in primary care settings.
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Spain AK, Korfmacher J, McCrae JS. Coordination challenges and promising practices for pediatric healthcare-community partnerships: A multi-site study. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2117-2132. [PMID: 36811161 DOI: 10.1002/jcop.23015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/16/2023] [Accepted: 02/02/2023] [Indexed: 06/14/2023]
Abstract
There have been delays integrating universal screening and referral for social needs in pediatric practice. The study investigated two frameworks for clinic-based screen-and-refer practice in eight clinics. The frameworks depict different organizational strategies to bolster family access to community resources. We conducted semi-structured interviews with healthcare and community partners at two timepoints (n = 65) to investigate start-up and ongoing implementation experiences, including continuing challenges. Results highlighted common within-clinic and clinic-community coordination challenges across diverse settings as well as promising practices supported by the two frameworks. In addition, we identified ongoing implementation challenges that face efforts to integrate these approaches and to translate screening results into activities that help children and families. Assessing the existing service referral coordination infrastructure of each clinic and community in early implementation is critical to screen-and-refer practice as this influences the continuum of supports available to meet family needs.
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Affiliation(s)
- Angeline K Spain
- Chapin Hall at the University of Chicago, Chicago, Illinois, USA
| | - Jon Korfmacher
- Chapin Hall at the University of Chicago, Chicago, Illinois, USA
| | - Julie S McCrae
- Chapin Hall at the University of Chicago, Chicago, Illinois, USA
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Purtle J, Nelson KL, Gollust SE. Public Opinion About Adverse Childhood Experiences: Social Stigma, Attribution of Blame, and Government Intervention. CHILD MALTREATMENT 2022; 27:344-355. [PMID: 33769126 DOI: 10.1177/10775595211004783] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Adverse childhood experiences (ACEs) are receiving increasing attention in academic, policy, and media discourses. However, no public opinion research has focused on ACEs. We conducted a nationally representative survey of U.S. adults to address this knowledge gap. A web-based survey was conducted using the Ipsos KnowledgePanel (N = 503, completion rate = 60.5%) in fall 2019. We found that inter-personal stigma and parental blame related to ACEs were prevalent, with 25.0% of respondents unwilling to have a person with "a lot of ACEs" as a close co-worker and 65.2% believing that parents were very much to blame for the consequences of ACEs. Fifty percent of respondents believed that government intervention to prevent ACEs was very important. After adjustment for demographic characteristics, inter-personal stigma toward people with ACEs and conservative ideology were significantly associated with lower perceived importance of government intervention to prevent ACEs. Black race, Hispanic ethnicity, and female gender were significantly associated with higher perceived importance of government intervention. These findings provide an empirical foundation to inform strategies to communicate ACE science to public and policymaker audiences.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Katherine L Nelson
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Sokol RL, Ammer J, Stein SF, Trout P, Mohammed L, Miller AL. Provider Perspectives on Screening for Social Determinants of Health in Pediatric Settings: A Qualitative Study. J Pediatr Health Care 2021; 35:577-586. [PMID: 34521572 DOI: 10.1016/j.pedhc.2021.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Pediatric settings often screen children and/or caregivers for social determinants of health (SDH) needs. Although SDH awareness rose with COVID, questions remain regarding best practices for SDH screening in pediatric settings. METHOD We assessed pediatric providers' perspectives on integrating SDH screening into patient care. Semistructured interviews were conducted with providers (n = 13) from 10 clinics. Interviews were transcribed, and themes were analyzed using the constant comparative method. RESULTS Themes highlighted providers' awareness of structural limitations to address social needs identified by screening; implementation concerns; the unique role of pediatric providers for child health and well-being; provider comfort with assessing patients' social needs; patient considerations; the importance of relational health between pediatric providers and families, and between providers and community supports for effective screening; and unintended consequences. DISCUSSION Pediatric providers endorse the need for SDH screening, but barriers in pediatric settings may hamper the process and reduce efficacy.
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Flower KB, Massie S, Janies K, Bassewitz JB, Coker TR, Gillespie RJ, Macias MM, Whitaker TM, Zubler J, Steinberg D, DeStigter L, Earls MF. Increasing Early Childhood Screening in Primary Care Through a Quality Improvement Collaborative. Pediatrics 2020; 146:peds.2019-2328. [PMID: 32769199 DOI: 10.1542/peds.2019-2328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Multiple early childhood screenings are recommended, but gaps persist in implementation. Our aim for this project was to improve screening, discussion, referral, and follow-up of development, autism spectrum disorder (ASD), maternal depression, and social determinants of health (SDoH) to 90% by July 2018. METHODS This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes. RESULTS Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening. CONCLUSIONS Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.
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Affiliation(s)
- Kori B Flower
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; .,Population Health Improvement Partners, Cary, North Carolina
| | - Sara Massie
- Population Health Improvement Partners, Cary, North Carolina
| | | | | | - Tumaini R Coker
- Department of Pediatrics, School of Medicine, University of Washington and Seattle Children's Research Institute, Seattle, Washington
| | | | - Michelle M Macias
- Division of Developmental-Behavioral Pediatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Toni M Whitaker
- Division of Developmental Pediatrics, Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jennifer Zubler
- Learn the Signs. Act Early Program, Division of Birth Defects, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | | | | | - Marian F Earls
- Community Care of North Carolina, Raleigh, North Carolina
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Domek GJ, Szafran LH, Bonnell LN, Berman S, Camp BW. Using Finger Puppets in the Primary Care Setting to Support Caregivers Talking With Their Infants: A Feasibility Pilot Study. Clin Pediatr (Phila) 2020; 59:380-387. [PMID: 32037858 DOI: 10.1177/0009922820903407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Disadvantaged children often show disparities in early language development. We tested the feasibility, acceptability, and preliminary efficacy of introducing finger puppets in the primary care setting at the 2-month well visit to support caregivers talking with their infants. Caregivers completed a sociodemographic survey and were contacted by phone 2 weeks later to assess initial usage and satisfaction. Ages & Stages Questionnaires (ASQ-3) were independently recorded at well visits. A family cumulative risk score was calculated from the sociodemographic survey. Thirty-four caregiver-child pairs were enrolled. Caregivers reported high satisfaction with the intervention. ASQ-3 Communication and Total scores at 6, 12, and 18 months were significantly higher for high puppet users across all age levels with no significant interactions with age or cumulative risk. Finger puppets provide a low-cost way to promote language-rich interactions. Preliminary evidence suggests that high puppet usage may have long-lasting effects on child development and should be further evaluated.
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Affiliation(s)
- Gretchen J Domek
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Colorado School of Public Health, Aurora, CO, USA
| | | | - Levi N Bonnell
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stephen Berman
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Colorado School of Public Health, Aurora, CO, USA
| | - Bonnie W Camp
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Clinician Experiences and Attitudes Regarding Screening for Social Determinants of Health in a Large Integrated Health System. Med Care 2020; 57 Suppl 6 Suppl 2:S197-S201. [PMID: 31095061 DOI: 10.1097/mlr.0000000000001051] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Clinical screening for basic social needs-such as food and housing insecurity-is becoming more common as health systems develop programs to address social determinants of health. Clinician attitudes toward such programs are largely unexplored. OBJECTIVE To describe the attitudes and experiences of social needs screening among a variety of clinicians and other health care professionals. RESEARCH DESIGN Multicenter electronic and paper-based survey. SUBJECTS Two hundred fifty-eight clinicians including primarily physicians, social workers, nurses, and pharmacists from a large integrated health system in Southern California. MEASURES Level of agreement with prompts exploring attitudes toward and barriers to screening and addressing social needs in different clinical settings. RESULTS Overall, most health professionals supported social needs screening in clinical settings (84%). Only a minority (41%) of clinicians expressed confidence in their ability to address social needs, and less than a quarter (23%) routinely screen for social needs currently. Clinicians perceived lack of time to ask (60%) and resources (50%) to address social needs as their most significant barriers. We found differences by health profession in attitudes toward and barriers to screening for social needs, with physicians more likely to cite time constraints as a barrier. CONCLUSIONS Clinicians largely support social needs programs, but they also recognize key barriers to their implementation. Health systems interested in implementing social needs programs should consider the clinician perspective around the time and resources required for such programs and address these perceived barriers.
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Shriver AE, Bonnell LN, Berman S, Camp BW. Cumulative risk, the cognitive home environment and vocabulary in early childhood. Child Care Health Dev 2020; 46:244-246. [PMID: 31849078 DOI: 10.1111/cch.12738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 12/02/2019] [Accepted: 12/14/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Early home support for language development is critical for later developmental progress. Paediatricians have the opportunity to identify families at risk of failing to provide this support in infancy but often lack simple tools to do so. This study explores the potential of a simple count of sociodemographic risk factors, a cumulative risk (CR) index, to identify families likely to need help in providing literacy support from an early age. METHODS CR scores were calculated for 308 families who completed the STIMQ and MacArthur Communicative Development Inventory (MCDI) at 11-15 months) and 197 (64%) again at 23-37 months. Analysis of variance with linear contrasts examined the effect of CR on the STIMQ and the MCDI at baseline and follow-up. Correlation analysis explored the relationship between STIMQ and MCDI. RESULTS At both baseline and follow-up, CR index showed a significant effect (p<0.006) on the STIMQ along with a significant linear trend for STIMQ scores to decrease as CR increased (p<0.05-0.005). No significant effects of CR effects on MCDI were observed at baseline or follow-up, whereas MCDI percentiles correlated significantly (p<0.03-0.001) with STIMQ scores (r=0.18-0.26.) at both times. CONCLUSIONS The CR index is a simple tool that can help identify families needing support for providing a language stimulating home environment in the first 2 years before long-term ill effects of sociodemographic barriers are established.
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Affiliation(s)
- Amy E Shriver
- Pediatrics, Blank Children's Hospital, Des Moines, Iowa
| | - Levi N Bonnell
- General Internal Medicine Research, University of Vermont School of Medicine, Burlington, Vermont
| | - Stephen Berman
- Center for Global Health, Colorado School of Public Health, Aurora, Colorado
| | - Bonnie W Camp
- Departments of Pediatrics and Psychiatry,, University of Colorado at Denver - Anschutz Medical Campus, Aurora, Colorado
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Caldwell A, Erickson E, Shearman N, Sharif I, Garbe MC, Tyrrell H, Needlman R, Dunlap M. Literacy Promotion Training and Implementation in Pediatric Continuity Clinics. Acad Pediatr 2020; 20:1013-1019. [PMID: 32304778 PMCID: PMC9217096 DOI: 10.1016/j.acap.2020.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Despite endorsement by the American Academy of Pediatrics, there are no national data on literacy promotion (LP) training and behaviors. OBJECTIVE To describe LP training experiences and behaviors of pediatric and internal medicine/pediatrics residents and faculty nationally, and the association between LP training and behaviors. METHODS The Academic Pediatric Association's Continuity Research Network and Reach Out and Read National Center sent an online survey to faculty and residents at participating Continuity Research Network clinics. Respondents were asked about LP training experiences and behaviors. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression modeling. RESULTS 473 faculty and 1216 residents at 42 institutions participated. More faculty than residents reported completing online Reach Out and Read training (63% vs 45%, P < .0001). More residents reported learning in clinic from others (92% vs 89%, P = .04). Training experiences did not differ otherwise. More faculty reported providing anticipatory guidance (87% vs 77%, P < .0001); modeling shared reading (69% vs 45%, P < .0001); and using books for developmental assessment (80% vs 62%, P < .0001). Both groups (97%) reported distributing books. The training modality most often endorsed as "very/extremely influential" was learning in clinic from others. Some LP behaviors were associated more strongly with online training while others were associated more strongly with in-person training. CONCLUSIONS Online training and in-person training are both associated with high quality delivery of LP. Faculty members are more likely to have completed online training and to report engaging in the full range of recommended LP behaviors. These data have implications for LP training.
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Affiliation(s)
- Alexandria Caldwell
- University of Oklahoma Health Sciences Center, Department of Pediatrics, Section of General and Community Pediatrics (A Caldwell, MC Garbe, and M Dunlap), Oklahoma City, Okla.
| | - Elizabeth Erickson
- Duke University, Department of Pediatrics; 4020 N Roxboro St., Durham, NC 27710
| | - Nikki Shearman
- Reach Out and Read, Inc.; 89 South St., Boston, MA 02111
| | - Iman Sharif
- NYU Langone,5610 2nd Avenue, Brooklyn, NY 11220
| | - M. Connor Garbe
- University of Oklahoma Health Sciences Center, Department of Pediatrics, Section of General and Community Pediatrics; 1200 Children’s Avenue, Suite 12400, Oklahoma City, OK 73104
| | - Hollyce Tyrrell
- Academic Pediatric Association; 6728 Old McLean Village Drive, McLean, VA 22101
| | - Robert Needlman
- Case Western Reserve University School of Medicine, Division of Developmental and Behavioral Pediatrics, MetroHealth Medical Center; 2500 MetroHealth Drive, Cleveland OH 44109
| | - Marny Dunlap
- University of Oklahoma Health Sciences Center, Department of Pediatrics, Section of General and Community Pediatrics; 1200 Children’s Avenue, Suite 12400, Oklahoma City, OK 73104
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Abstract
PURPOSE OF REVIEW Recent research on childhood trauma has focused on the effects of in-utero and early life stress (ELS) as well as improving access to care. This review includes the previous year's clinically relevant research with attention to gaps that require further research that should improve patient care. RECENT FINDINGS The current article focuses on the latest understanding of ELS effects on the neuroendocrine, inflammatory, immune, and neurologic systems, as well as epigenetic effects with a focus on research examining sex-specific differences. Resilience and innovative treatment delivery models are reviewed with emphasis on integrated care models and technology-based treatments. SUMMARY The findings reviewed point toward clinically relevant research avenues. The call for more and better treatment options can only be realized with a better understanding of ELS effects. There is a specific need for more in depth exploration and application of sex-specific differences as well as an examination of the effects of age of onset and chronicity of stressors. New developments in the delivery of interventions and treatment allow the potential to provide broader early access to care.
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Purtle J, Lê-Scherban F, Wang X, Brown E, Chilton M. State Legislators' Opinions About Adverse Childhood Experiences as Risk Factors for Adult Behavioral Health Conditions. Psychiatr Serv 2019; 70:894-900. [PMID: 31272336 PMCID: PMC6773502 DOI: 10.1176/appi.ps.201900175] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) increase risk of adult behavioral health conditions. State legislators are an important audience to target with evidence about ACEs because they make policy decisions that can prevent ACE exposure and enhance resilience. This study sought to describe state legislators' opinions about ACEs as risk factors for adult behavioral health conditions and identify how opinions vary between legislators with different characteristics. METHODS A multimodal survey was conducted in 2017 (response rate, 16.4%; N=475). Dependent variables were the extent to which legislators thought that four ACEs-sexual abuse, physical abuse, witnessing domestic violence, and childhood neglect-increase risk of adult behavioral health conditions. Independent variables were legislator characteristics (e.g., ideology and gender). Rao-Scott chi-square tests and multivariable logistic regression were conducted. RESULTS Childhood sexual abuse was identified as a major risk factor by the largest proportion of respondents (77%), followed by childhood physical abuse (59%), witnessing domestic violence (39%), and childhood neglect (38%). The proportion identifying each ACE as a major risk factor was significantly higher among Democrats than among Republicans, liberals than among conservatives, and women than among men. For example, 56% of liberals identified witnessing domestic violence as a major risk factor, compared with 29% of conservatives (p<.001). CONCLUSIONS Opinions about ACEs as risk factors for adult behavioral health conditions varied between legislators with different characteristics, especially liberals and conservatives. To enhance the policy impact of evidence about ACEs, advocates might consider developing multiple versions of ACE evidence summaries that are tailored on the basis of these characteristics.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Félice Lê-Scherban
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Xi Wang
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Emily Brown
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
| | - Mariana Chilton
- Department of Health Management and Policy (Purtle, Brown, Chilton), Department of Epidemiology and Biostatistics (Lê-Scherban), and Center for Hunger Free Communities (Brown, Chilton), all at Dornsife School of Public Health, Drexel University, Philadelphia; PolicyLab, Children's Hospital of Philadelphia, Philadelphia (Wang)
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Making the case for ACEs: adverse childhood experiences, obesity, and long-term health. Pediatr Res 2019; 86:420-422. [PMID: 31330528 DOI: 10.1038/s41390-019-0509-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 11/08/2022]
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Green C, Stein REK, Storfer-Isser A, Garner AS, Kerker BD, Szilagyi M, Hoagwood KE, Horwitz SM. Do Subspecialists Ask About and Refer Families with Psychosocial Concerns? A Comparison with General Pediatricians. Matern Child Health J 2018; 23:61-71. [DOI: 10.1007/s10995-018-2594-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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