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Koob C, Griffin SF, Stuenkel M, Cartmell K, Rennert L, Sease K. Bridging the gaps in pediatric complex healthcare: the case for home nursing care among children with medical complexity. BMC Health Serv Res 2024; 24:814. [PMID: 39010079 DOI: 10.1186/s12913-024-11235-1] [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: 12/06/2023] [Accepted: 06/23/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Children with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC). METHODS This mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews (N = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews. RESULTS Overall, 39.87% of CMC experienced ≥ 1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations, and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families. CONCLUSIONS Findings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers' insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.
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Affiliation(s)
- Caitlin Koob
- Department of Public Health Sciences, Clemson University, 501 Epsilon Zeta Dr. (Edwards Hall), Clemson, SC, 29634, USA.
| | - Sarah F Griffin
- Department of Public Health Sciences, Clemson University, 501 Epsilon Zeta Dr. (Edwards Hall), Clemson, SC, 29634, USA
| | | | - Kathleen Cartmell
- Department of Public Health Sciences, Clemson University, 501 Epsilon Zeta Dr. (Edwards Hall), Clemson, SC, 29634, USA
| | - Lior Rennert
- Department of Public Health Sciences, Clemson University, 501 Epsilon Zeta Dr. (Edwards Hall), Clemson, SC, 29634, USA
| | - Kerry Sease
- Prisma Health (Bradshaw Institute for Community Child Health and Advocacy), 255 Enterprise Blvd #110, Greenville, SC, 29615, USA
- Furman University, Greenville, SC, 29613, USA
- Executive Director of the Institute for Advancement of Community Health, Greenville, SC, 29613, USA
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2
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Worrell S, Waling A, Anderson J, Lyons A, Pepping CA, Bourne A. 'It feels meaningful': How informal mental health caregivers in an LGBTQ community interpret their work and their role. CULTURE, HEALTH & SEXUALITY 2024; 26:808-823. [PMID: 37705445 DOI: 10.1080/13691058.2023.2256833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023]
Abstract
Many members of lesbian, gay, bisexual, trans and gender diverse, and queer (LGBTQ) communities provide informal mental health support to peers. This type of support is valuable for people who receive it - even helping to prevent suicide. It is also meaningful to those who provide it. In this article, we focus on how LGBTQ people derive meaning from their experiences of supporting peers. In-depth interviews with 25 LGBTQ people in Melbourne, Australia, indicate that those providing informal mental health support to fellow community members recognise their roles as meaningful in three main ways: in terms of self, relationships and communities. Recognising the meanings that LGBTQ caregivers derive from helping fellow community members provides useful information service providers and policymakers seeking to better address mental distress in LGBTQ communities and support caregivers. It is useful to understand this meaningful work in an LGBTQ context as caregiving that challenges gendered and heteronormative assumptions about what care is, and who provides it.
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Affiliation(s)
- Shane Worrell
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Joel Anderson
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | | | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Bruton L, Storey M, Gentile J, Smith TL, Bhatti P, Davis MM, Cartland J, Foster C. Access to Home- and Community-Based Services for Children with Disability: Academic Institutions' Role and Areas for Improvement. Acad Pediatr 2024; 24:596-604. [PMID: 37939827 PMCID: PMC11056305 DOI: 10.1016/j.acap.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 10/26/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This project sought to describe provider- and parent-identified needs and barriers to obtaining home- and community-based services (HCBS) for children with disability (CWD) and to determine ways pediatric health care institutions can improve access to HCBS services. METHODS In this exploratory sequential mixed methods evaluation, semi-structured interviews and focus groups were conducted with multidisciplinary providers and staff from an independent children's hospital, followed by a survey of English and Spanish-speaking parents of CWD. Data from interviews and surveys were then triangulated for overarching common themes regarding how pediatric health care institutions can better support access to HCBS. RESULTS Among 382 parent respondents, 74.1% reported that their child needed a HCBS, most commonly physical/occupational/speech therapies, school-based support, and case management services. Two-thirds of parents reported at least one barrier to accessing HCBS and one-third experience >3 barriers. While multiple current institutional strengths were noted, internal weaknesses included lack of provider knowledge, staffing difficulties, and lack of protocols for identifying and tracking patients needing or receiving HCBS. External threats included requirements to entry for HCBS and transfer of care, with opportunities for improvement involving dissemination of information, funding support, and connection between providers/support staff and services. CONCLUSIONS Parents of CWD identified HCBS as necessary for the health of this population, but multiple barriers to HCBS were identified by both parents and providers. Multiple internal and external opportunities for improvement relative to pediatric health care institutions were identified, suggesting a need for a comprehensive approach to ensure that CWD receive necessary HCBS.
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Affiliation(s)
- Lucas Bruton
- Division of Advanced General Pediatrics and Primary Care (L Bruton, MM Davis, and C Foster), Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics (L Bruton, MM Davis, and C Foster), Northwestern University Feinberg School of Medicine, Chicago, Ill.
| | - Margaret Storey
- Ann and Robert H. Lurie Children's Hospital of Chicago Family Advisory Board (M Storey), Chicago, Ill
| | - Jennifer Gentile
- Tulane University School of Social Work (J Gentile), Tulane University, New Orleans, La
| | - Tracie L Smith
- Department of Data Analytics and Reporting (TL Smith), Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Punreet Bhatti
- Mary Ann and J. Milburn Smith Child Health Outcomes (P Bhatti, MM Davis, J Cartland, and C Foster), Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care (L Bruton, MM Davis, and C Foster), Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics (L Bruton, MM Davis, and C Foster), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann and J. Milburn Smith Child Health Outcomes (P Bhatti, MM Davis, J Cartland, and C Foster), Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill; Department of Medical Social Sciences (MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill; Departments of Medicine and Preventive Medicine (MM Davis), Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Jenifer Cartland
- Mary Ann and J. Milburn Smith Child Health Outcomes (P Bhatti, MM Davis, J Cartland, and C Foster), Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Carolyn Foster
- Division of Advanced General Pediatrics and Primary Care (L Bruton, MM Davis, and C Foster), Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of Pediatrics (L Bruton, MM Davis, and C Foster), Northwestern University Feinberg School of Medicine, Chicago, Ill; Mary Ann and J. Milburn Smith Child Health Outcomes (P Bhatti, MM Davis, J Cartland, and C Foster), Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
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4
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Butts B, Goodwin EJ, Huth K. Patient and Family Partnership in Scholarship. Acad Pediatr 2024:S1876-2859(24)00152-9. [PMID: 38679294 DOI: 10.1016/j.acap.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Breann Butts
- Division of General and Community Pediatrics (B Butts), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Ohio.
| | - Emily J Goodwin
- Division of General Academic Pediatrics (EJ Goodwin), Department of Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City School of Medicine, Mo
| | - Kathleen Huth
- Department of Pediatrics (K Huth), Boston Children's Hospital, Mass
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5
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Sobotka SA, Lynch E, Golden SLS, Nageswaran S. Home Health Nursing Agencies' Services for Children With Medical Complexity: Parent and Nurse Perspectives. Acad Pediatr 2024; 24:477-485. [PMID: 38278479 DOI: 10.1016/j.acap.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Many children with medical complexity (CMC) require the services of home health nurses (HHNs). Home health agencies (HHAs) hire, train, and manage nurses. For children to flourish, families, nurses, and HHAs must establish successful working relationships. Our objective was to understand the perspectives of parents and nurses about HHAs. METHODS In Illinois (IL) from 2019 to 2022, HHNs for and parents of children with invasive mechanical ventilation were interviewed. In North Carolina (NC) from 2012 to 2013, parents of CMC were interviewed, and from 2013 to 2014 HHNs participated in focus groups. Each dataset was initially analyzed separately for main themes relating to HHAs. Using collaborative thematic analysis, we determined themes common across datasets. RESULTS In IL, 23 mothers, 12 fathers, and 20 nurses were interviewed. In NC, 19 mothers, 6 fathers, and 1 grandmother were interviewed; and 4 focus groups of 18 nurses were conducted. Four common themes were identified. 1) HHAs do not have a uniform process for hiring and assigning nurses to cases. 2) HHAs have marked variability in training offered to nurses. 3) Shift scheduling, notifications, and communications with the HHAs frustrate parents and nurses. 4) Nurses and parents have little allegiance to specific HHAs; they frequently change agencies or work with several simultaneously. CONCLUSIONS Parents and nurses perceive practices for hiring, training, and staffing as inconsistent, and experience communication challenges. HHA-level problems may contribute to issues with HHN retention and complicate the lives of the families of CMC. Further research about this critical health care sector is needed.
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Affiliation(s)
- Sarah A Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics (SA Sobotka, E Lynch), The University of Chicago, Chicago, IL.
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics (SA Sobotka, E Lynch), The University of Chicago, Chicago, IL
| | | | - Savithri Nageswaran
- Department of Pediatrics (S Nageswaran), Wake Forest University School of Medicine, Winston-Salem, NC
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Kennedy HM, Cole A, Berbert L, Schenkel SR, DeGrazia M. An examination of characteristics, social supports, caregiver resilience and hospital readmissions of children with medical complexity. Child Care Health Dev 2024; 50:e13206. [PMID: 38123168 DOI: 10.1111/cch.13206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 08/18/2023] [Accepted: 11/19/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Children with medical complexity (CMC) account for 1% of children in the United States. These children experience frequent hospital readmissions, high healthcare costs and poor health outcomes. A link between CMC caregiver social support, resilience and hospital readmissions has never been fully investigated. This study examines the feasibility of a prospective, descriptive, repeated measures research design to characterize CMC and their caregivers, social supports, caregiver resilience and hospital readmissions to inform a larger prospective investigation. METHODS Caregivers of CMC with unplanned hospitalizations completed surveys at the index hospitalization and 30 and 60 days after discharge. CMC caregiver and child characteristics, social supports and hospital readmissions were examined using an investigator-developed survey. Resilience was measured using the Resilience Scale-14© (7-Point Likert Scale, score range 14-98), and feasibility was measured by calculating enrolment, attrition, survey completion and item response. Analysis included descriptive statistics and qualitative data visualization. RESULTS Of caregivers who were approached for participation, 81.1% consented and completed 76 surveys. Attrition was 31%. Item response rates were ≥ 90% for all but one item. A total of 62.1% of children had hospital readmissions within 90 days and 37.9% within 30 days. Additionally, 70% of caregivers had home care nursing, but the approved hours were only partially filled. More than 70% of caregiver resilience scores were moderate to high (score range 74-98) and were stable across repeated measures and hospital readmissions. Open-ended question responses revealed the following five categories: All-consuming, Family Reliance, Impact of Covid, Taking Action and Broken System. CONCLUSIONS Studying CMC caregiver social supports and resilience using repeated measures is feasible. CMC caregivers reported stressors including coordinating their child's substantial healthcare needs and managing partially filled home care nursing hours. Caregiver resilience remained stable over time, amidst frequent CMC hospital readmissions. Findings can inform future research priorities and power analyses for CMC caregiver resilience.
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Affiliation(s)
- Heather M Kennedy
- Department of Nursing Patient Care Services, Boston Children's Hospital, Boston, MA, USA
- Department of Neurology and Neurosurgery, Boston Children's Hospital, Boston, MA
| | - Alexandra Cole
- Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, MA, USA
| | - Laura Berbert
- Biostatistics and Research Design Center, Boston Children's Hospital, Boston, MA, USA
| | | | - Michele DeGrazia
- Department of Nursing Patient Care Services, Boston Children's Hospital, Boston, MA, USA
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Huth K, Frankel H, Cook S, Samuels RC. Caring for a Child with Chronic Illness: Effect on Families and Siblings. Pediatr Rev 2023; 44:393-402. [PMID: 37391635 DOI: 10.1542/pir.2022-005649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Affiliation(s)
- Kathleen Huth
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Hilary Frankel
- Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY
| | - Stacey Cook
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Ronald C Samuels
- Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, NY
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Wang Y, Cao J, Zhang W, Chen H, Li M, Liu Z, Wang J. What is needed by parents of constipated infants and toddlers: A cross-sectional study in China. Front Pediatr 2023; 11:1066355. [PMID: 37124178 PMCID: PMC10130535 DOI: 10.3389/fped.2023.1066355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Childhood functional constipation is a worldwide problem that affects the intestinal function of children and the quality of life of their families. Treatment and management of the disease need to be carried out at home by parents. Assessment of caregiving needs is an important link in planning and implementing the intervention. This study aimed to assess the caregiving needs of parents of FC infants and toddlers. Methods The researchers recruited convenience samples of parents from an outpatient pediatric constipation clinic of a children's medical center. Totally 211 fathers/mothers were recruited. Nursing needs were measured by a questionnaire, and associations between nursing needs and potential factors were examined using multiple regression analysis. Results The vast majority of participants (88.7%) expressed the need of receiving support from professionals, and only 44 (20.85%) had obtained help from medical staff. The needs of parents mainly include information needs, health needs, psychological needs, and social needs. Of all the needs, the highest score was for information needs (3.87 ± 0.69), followed by the dimension of health needs (3.74 ± 0.82). Results showed statistically significant differences in parental education, place of residence, age of children, duration of FC, defecation frequency, difficulty of defecation, and stool traits in nursing needs (p < 0.05). The regression model explained 64.2% of the variance of nursing needs. Conclusions Information needs were the major concern for parents, and the unmet needs of parents should be addressed during treatment and care. When developing care plans and providing health education, it should be adjusted according to the specific conditions of the child and parents to improve the compliance of the parents with treatment and care.
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Affiliation(s)
- Yuanyuan Wang
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jinjin Cao
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Weiying Zhang
- Department of Emergency, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Hongyu Chen
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Mei Li
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
- Correspondence: Mei Li Zhifeng Liu
| | - Zhifeng Liu
- Department of Gastroenterology, Children's Hospital of Nanjing Medical University, Nanjing, China
- Correspondence: Mei Li Zhifeng Liu
| | - Jianan Wang
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, China
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Ming DY, Jones KA, White MJ, Pritchard JE, Hammill BG, Bush C, Jackson GL, Raman SR. Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics. Matern Child Health J 2022; 26:2407-2418. [PMID: 36198851 PMCID: PMC10026355 DOI: 10.1007/s10995-022-03543-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare differences in healthcare utilization and costs for Medicaid-insured children with medical complexity (CMC) by race/ethnicity and rurality. METHODS Retrospective cohort of North Carolina (NC) Medicaid claims for children 3-20 years old with 3 years continuous Medicaid coverage (10/1/2015-9/30/2018). Exposures were medical complexity, race/ethnicity, and rurality. Three medical complexity levels were: without chronic disease, non-complex chronic disease, and complex chronic disease; the latter were defined as CMC. Race/ethnicity was self-reported in claims; we defined rurality by home residence ZIP codes. Utilization and costs were summarized for 1 year (10/1/2018-9/30/2019) by complexity level classification and categorized as acute care (hospitalization, emergency [ED]), outpatient care (primary, specialty, allied health), and pharmacy. Per-complexity group utilization rates (per 1000 person-years) by race/ethnicity and rurality were compared using adjusted rate ratios (ARR). RESULTS Among 859,166 Medicaid-insured children, 118,210 (13.8%) were CMC. Among CMC, 36% were categorized as Black non-Hispanic, 42.7% White non-Hispanic, 14.3% Hispanic, and 35% rural. Compared to White non-Hispanic CMC, Black non-Hispanic CMC had higher hospitalization (ARR = 1.12; confidence interval, CI 1.08-1.17) and ED visit (ARR = 1.17; CI 1.16-1.19) rates; Hispanic CMC had lower ED visit (ARR = 0.77; CI 0.75-0.78) and hospitalization rates (ARR = 0.79; CI 0.73-0.84). Black non-Hispanic and Hispanic CMC had lower outpatient visit rates than White non-Hispanic CMC. Rural CMC had higher ED (ARR = 1.13; CI 1.11-1.15) and lower primary care utilization rates (ARR = 0.87; CI 0.86-0.88) than urban CMC. DISCUSSION Healthcare utilization varied by race/ethnicity and rurality for Medicaid-insured CMC. Further studies should investigate mechanisms for these variations and expand higher value, equitable care delivery for CMC.
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Affiliation(s)
- David Y Ming
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Pediatrics, Duke University School of Medicine, Box 102376, Durham, NC, 27710, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michelle J White
- Department of Pediatrics, Duke University School of Medicine, Box 102376, Durham, NC, 27710, USA
| | - Jessica E Pritchard
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - George L Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Currie G, Finlay B, Seth A, Roth C, Elsabbagh M, Hudon A, Hunt M, Jodoin S, Lach L, Lencucha R, Nicholas DB, Shakako K, Zwicker J. Mental health challenges during COVID-19: perspectives from parents with children with neurodevelopmental disabilities. Int J Qual Stud Health Well-being 2022; 17:2136090. [PMID: 36309898 PMCID: PMC9629071 DOI: 10.1080/17482631.2022.2136090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background The global pandemic and subsequent denials, delays, and disruptions in essential daily activities created significant challenges for children with neurodevelopmental disorders (NDDs) and their parents. Public health restrictions during the COVID-19 pandemic limited access to supports and services required by children with NDDs to maintain their health and well-being. Objective This study sought to understand the impacts of these public health measures and restrictions on mental health from the perspective of parents with children with NDDs to inform pathways for public health policies responsive to the needs of this population. Method Interpretive descriptive design was used to guide data collection and data analysis. Forty caregivers were interviewed about their experience with pandemic restrictions. Findings Generic policy measures contributed to many gaps in families’ social support systems and contributed to mental health challenges for children and their parents. Four themes emerged: 1) lack of social networks and activities, 2) lack of access to health and social supports, 3) tension in the family unit, and 4) impact on mental health for children and their parents. Recommendations Emergency preparedness planning requires a disability inclusive approach allocating resources for family supports in the home and community. Families identified supports to minimize further pandemic disruptions and enhance recovery.
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Affiliation(s)
- Genevieve Currie
- School of Public Policy, University of Calgary, Calgary, AB, Canada.,School of Nursing and Midwifery, Mount Royal University, Calgary, AB, Canada
| | - Brittany Finlay
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Ashish Seth
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Christiane Roth
- School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Myada Elsabbagh
- Faculty of Medicine, McGill University, Montreal, Que., Canada
| | - Anne Hudon
- Faculty of Medicine, Universite de Montreal, Montreal, Que., Canada
| | - Matthew Hunt
- Faculty of Medicine and Health Sciences School of Physical and Occupational Therapy, McGill University, Montreal, Que., Canada
| | | | - Lucyna Lach
- School of Social Work, McGill University, Montreal, Que., Canada
| | - Raphael Lencucha
- Faculty of Medicine and Health Sciences School of Physical and Occupational Therapy, McGill University, Montreal, Que., Canada
| | - David B Nicholas
- Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | - Keiko Shakako
- Faculty of Medicine and Health Sciences School of Physical and Occupational Therapy, McGill University, Montreal, Que., Canada
| | - Jennifer Zwicker
- School of Public Policy; Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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11
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Smiley Y, Silberholz E, Bekele E, Brodie N. Caregiver stress and social determinants of health in key populations: immigrant parents, parents of children with medical complexity, and adolescent parents. Curr Opin Pediatr 2022; 34:521-530. [PMID: 35993274 DOI: 10.1097/mop.0000000000001163] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To examine the five domains of social determinants of health - economic stability, education access, healthcare access and quality, neighborhood and built environment, and social and community context - and how these relate to caregiver stress in under-resourced populations. RECENT FINDINGS Socioeconomic and family factors are increasingly understood as drivers of child health. Caregiver stress can impact family stability and child wellbeing. Immigrant parents, caregivers of children with medical complexity, and adolescent parents experience stressors due to the unique needs of their families. These groups of parents and caregivers also face various challenges identified as social determinants of health. Interventions to mitigate these challenges can promote resilience, care coordination, and community-based supports. SUMMARY Current research describes caregiver stress in key populations, how caregiver stress affects children, and approaches to minimize and mitigate these effects. Pediatric providers can implement best practices to support families who are navigating stress due to caregiving and social determinants of health.
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Affiliation(s)
- Yael Smiley
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Elizabeth Silberholz
- Division of General Pediatrics, Boston Children's Hospital; Harvard Medical School, Boston, Massachusetts, USA
| | - ElShadey Bekele
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Nicola Brodie
- Division of General and Community Pediatrics, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
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Abstract
Theory of guided participation for clinical practice presents teaching and learning in the context of the teacher and learner relationship. The teacher functions as a guide bringing the learner as a participant into a reciprocal, dynamic process that addresses issues learners are working on, acknowledging and directing learning activity to personal and clinical goals. Outcomes of this process are competencies in health-related functions. The process proceeds with understanding of the learner's internal working model (IWM) of self, other, and relationships. The IWM goals, intentions, and expectations formulate guided participation processes for development of competencies specific to the learner's cultural and personal situation and health need.
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Belzer LT, Wright SM, Goodwin EJ, Singh MN, Carter BS. Psychosocial Considerations for the Child with Rare Disease: A Review with Recommendations and Calls to Action. CHILDREN 2022; 9:children9070933. [PMID: 35883917 PMCID: PMC9325007 DOI: 10.3390/children9070933] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
Rare diseases (RD) affect children, adolescents, and their families infrequently, but with a significant impact. The diagnostic odyssey undertaken as part of having a child with RD is immense and carries with it practical, emotional, relational, and contextual issues that are not well understood. Children with RD often have chronic and complex medical conditions requiring a complicated milieu of care by numerous clinical caregivers. They may feel isolated and may feel stigmas in settings of education, employment, and the workplace, or a lack a social support or understanding. Some parents report facing similar loneliness amidst a veritable medicalization of their homes and family lives. We searched the literature on psychosocial considerations for children with rare diseases in PubMed and Google Scholar in English until 15 April 2022, excluding publications unavailable in full text. The results examine RD and their psychosocial ramifications for children, families, and the healthcare system. The domains of the home, school, community, and medical care are addressed, as are the implications of RD management as children transition to adulthood. Matters of relevant healthcare, public policies, and more sophisticated translational research that addresses the intersectionality of identities among RD are proposed. Recommendations for interventions and supportive care in the aforementioned domains are provided while emphasizing calls to action for families, clinicians, investigators, and advocacy agents as we work toward establishing evidence-based care for children with RD.
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Affiliation(s)
- Leslee T. Belzer
- Division of Developmental and Behavioral Health, Section of Pediatric Psychology, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
- Correspondence: ; Tel.: +1-816-960-2849
| | - S. Margaret Wright
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Emily J. Goodwin
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Division of General Academic Pediatrics, The Beacon Program, Children’s Mercy Kansas City, Kansas City, MO 64111, USA
- School of Medicine, University of Kansas, Kansas City, KS 66160, USA
| | - Mehar N. Singh
- Department of Psychology, Clinical Child Psychology Program, University of Kansas, Lawrence, KS 66045, USA;
| | - Brian S. Carter
- Department of Pediatrics, School of Medicine, University of Missouri-Kansas City, Kansas City, MO 64108, USA; (S.M.W.); (E.J.G.); (B.S.C.)
- Department of Medical Humanities & Bioethics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
- Bioethics Center, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
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Stille CJ, Coller RJ, Shelton C, Wells N, Desmarais A, Berry JG. National Research Agenda on Health Systems for Children and Youth With Special Health Care Needs. Acad Pediatr 2022; 22:S1-S6. [PMID: 35248242 DOI: 10.1016/j.acap.2021.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/27/2022]
Abstract
Children and youth with special health care needs (CYSHCN) "have or are at increased risk for chronic physical, developmental, behavioral or emotional conditions and also require health and related services of a type or amount beyond that required by children generally." CYSHCN rely on health systems, which extend beyond traditional health care entities, to optimize their health and well-being. The current US health system is not fully equipped and functioning to meet the needs of CYSHCN. Recognizing this, the Maternal and Child Health Bureau and the US Health Resources and Services Administration established the Research Network on Health Systems for CYSHCN (CYSHCNet, http://www.cyshcnet.org). With input from >800 US stakeholders, CYSHCNet developed a national research agenda on health systems for CYSHCN designed to: 1) highlight important health system challenges faced by key stakeholders (ie, patients and families, health care providers, insurers, administrators, etc.); 2) organize research topics and goals to identify opportunities for improvement, to address challenges and to promote progress toward the ideal health system; and 3) provide a blueprint for health systems research ideas and studies that will guide CYSHCN investigators and other stakeholders going forward. We introduce the 6 research topics currently included in the research agenda-transition to adulthood, caregiving, family health, child health care, principles of care, and financing-to inform and guide investigators as they embark on a trajectory of health systems research on CYSHCN.
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Affiliation(s)
- Christopher J Stille
- Division of General Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine (CJ Stille and C Shelton), Aurora, Colo.
| | - Ryan J Coller
- Division of Hospital Medicine, American Family Children's Hospital, University of Wisconsin School of Medicine (RJ Coller), Madison, Wis
| | - Charlene Shelton
- Division of General Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine (CJ Stille and C Shelton), Aurora, Colo
| | - Nora Wells
- Family Voices (N Wells), Lexington, Mass
| | - Anna Desmarais
- Complex Care, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School (A Desmarais and JG Berry), Boston, Mass
| | - Jay G Berry
- Complex Care, Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School (A Desmarais and JG Berry), Boston, Mass
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