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Villegas VC, Bosak DL, Salgado Z, Phoenix M, Parde N, Teplicky R, Khetani MA. Diversified caregiver input to upgrade the Young Children's Participation and Environment Measure for equitable pediatric re/habilitation practice. J Patient Rep Outcomes 2023; 7:87. [PMID: 37639038 PMCID: PMC10462549 DOI: 10.1186/s41687-023-00627-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Practitioner and family experiences of pediatric re/habilitation can be inequitable. The Young Children's Participation and Environment Measure (YC-PEM) is an evidence-based and promising electronic patient-reported outcome measure that was designed with and for caregivers for research and practice. This study examined historically minoritized caregivers' responses to revised YC-PEM content modifications and their perspectives on core intelligent virtual agent functionality needed to improve its reach for equitable service design. METHODS Caregivers were recruited during a routine early intervention (EI) service visit and met five inclusion criteria: (1) were 18 + years old; (2) identified as the parent or legal guardian of a child 0-3 years old enrolled in EI services for 3 + months; (3) read, wrote, and spoke English; (4) had Internet and telephone access; and (5) identified as a parent or legal guardian of a Black, non-Hispanic child or as publicly insured. Three rounds of semi-structured cognitive interviews (55-90 min each) used videoconferencing to gather caregiver feedback on their responses to select content modifications while completing YC-PEM, and their ideas for core intelligent virtual agent functionality. Interviews were transcribed verbatim, cross-checked for accuracy, and deductively and inductively content analyzed by multiple staff in three rounds. RESULTS Eight Black, non-Hispanic caregivers from a single urban EI catchment and with diverse income levels (Mdn = $15,001-20,000) were enrolled, with children (M = 21.2 months, SD = 7.73) enrolled in EI. Caregivers proposed three ways to improve comprehension (clarify item wording, remove or simplify terms, add item examples). Environmental item edits prompted caregivers to share how they relate and respond to experiences with interpersonal and institutional discrimination impacting participation. Caregivers characterized three core functions of a virtual agent to strengthen YC-PEM navigation (read question aloud, visual and verbal prompts, more examples and/or definitions). CONCLUSIONS Results indicate four ways that YC-PEM content will be modified to strengthen how providers screen for unmet participation needs and determinants to design pediatric re/habilitation services that are responsive to family priorities. Results also motivate the need for user-centered design of an intelligent virtual agent to strengthen user navigation, prior to undertaking a community-based pragmatic trial of its implementation for equitable practice.
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Affiliation(s)
- Vivian C Villegas
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA
| | - Dianna L Bosak
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA
| | - Zurisadai Salgado
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA
| | - Michelle Phoenix
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, USA
| | - Natalie Parde
- Department of Computer Science, University of Illinois Chicago, Chicago, IL, USA
| | - Rachel Teplicky
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, USA
| | - Mary A Khetani
- Children's Participation in Environment Research Lab, University of Illinois Chicago, Chicago, IL, USA.
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL, 60612-7250, USA.
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Rizk S, Kaelin VC, Sim JGC, Murphy NJ, McManus BM, Leland NE, Stoffel A, James L, Barnekow K, Papautsky EL, Khetani MA. Implementing an Electronic Patient-Reported Outcome and Decision Support Tool in Early Intervention. Appl Clin Inform 2023; 14:91-107. [PMID: 36724883 PMCID: PMC9891850 DOI: 10.1055/s-0042-1760631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE The aim of the study is to identify and prioritize early intervention (EI) stakeholders' perspectives of supports and barriers to implementing the Young Children's Participation and Environment Measure (YC-PEM), an electronic patient-reported outcome (e-PRO) tool, for scaling its implementation across multiple local and state EI programs. METHODS An explanatory sequential (quan > QUAL) mixed-methods study was conducted with EI families (n = 6), service coordinators (n = 9), and program leadership (n = 7). Semi-structured interviews and focus groups were used to share select quantitative pragmatic trial results (e.g., percentages for perceived helpfulness of implementation strategies) and elicit stakeholder perspectives to contextualize these results. Three study staff deductively coded transcripts to constructs in the Consolidated Framework for Implementation Research (CFIR). Data within CFIR constructs were inductively analyzed to generate themes that were rated by national early childhood advisors for their relevance to longer term implementation. RESULTS All three stakeholder groups (i.e., families, service coordinators, program leadership) identified thematic supports and barriers across multiple constructs within each of four CFIR domains: (1) Six themes for "intervention characteristics," (2) Six themes for "process," (3) three themes for "inner setting," and (4) four themes for "outer setting." For example, all stakeholder groups described the value of the YC-PEM e-PRO in forging connections and eliciting meaningful information about family priorities for efficient service plan development ("intervention characteristics"). Stakeholders prioritized reaching families with diverse linguistic preferences and user navigation needs, further tailoring its interface with automated data capture and exchange processes ("process"); and fostering a positive implementation climate ("inner setting"). Service coordinators and program leadership further articulated the value of YC-PEM e-PRO results for improving EI access ("outer setting"). CONCLUSION Results demonstrate the YC-PEM e-PRO is an evidence-based intervention that is viable for implementation. Optimizations to its interface are needed before undertaking hybrid type-2 and 3 multisite trials to test these implementation strategies across state and local EI programs with electronic data capture capabilities and diverse levels of organizational readiness and resources for implementation.
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Affiliation(s)
- Sabrin Rizk
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, United States
| | - Vera C. Kaelin
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Julia Gabrielle C. Sim
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Natalie J. Murphy
- Department of Health Systems, Management, and Policy, University of Colorado, Aurora, Colorado, United States
| | - Beth M. McManus
- Department of Health Systems, Management, and Policy, University of Colorado, Aurora, Colorado, United States
| | - Natalie E. Leland
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Ashley Stoffel
- Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, United States
| | - Lesly James
- Department of Occupational Therapy, Lenoir-Rhyne University, Columbia, South Carolina, United States
| | - Kris Barnekow
- Department of Occupational Therapy, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, United States
| | - Elizabeth Lerner Papautsky
- Department of Biomedical and Health Information Sciences, University of Illinois Chicago, Chicago, Illinois, United States
| | - Mary A. Khetani
- Children's Participation in Environment Research Lab, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,Department of Occupational Therapy, University of Illinois Chicago, Chicago, Illinois, United States,Program in Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois Chicago, Chicago, Illinois, United States,CanChild Centre for Childhood Disability Research, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada,Address for correspondence Mary A. Khetani, ScD, OTR/L Department of Occupational Therapy, University of Illinois Chicago1919 West Taylor Street, Room 316A, Chicago, IL 60612-7250United States
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Runco DV, Zimmers TA, Bonetto A. The urgent need to improve childhood cancer cachexia. Trends Cancer 2022; 8:976-979. [PMID: 35931609 PMCID: PMC10029855 DOI: 10.1016/j.trecan.2022.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023]
Abstract
Clinical care and research around cancer cachexia in children is lacking. Cachexia increases treatment-related toxicity and long-term morbidity and potentially affects mortality. We highlight the urgent need for specific focus on childhood cancer cachexia and discuss potential solutions to inform cachexia therapeutics for children.
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Affiliation(s)
- Daniel V Runco
- Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children at IU Health, Indianapolis, IN, USA; Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Teresa A Zimmers
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Otolaryngology - Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA; Richard L Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA
| | - Andrea Bonetto
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Otolaryngology - Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
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Kaelin V, Villegas V, Chen YF, Murphy N, Papautsky E, Litfin J, Leland N, Maheshwari V, McManus B, Khetani M. Effectiveness and scalability of an electronic patient-reported outcome measure and decision support tool for family-centred and participation-focused early intervention: PROSPECT hybrid type 1 trial protocol. BMJ Open 2022; 12:e051582. [PMID: 34983760 PMCID: PMC8728410 DOI: 10.1136/bmjopen-2021-051582] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 12/01/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Early intervention (EI) endorses family-centred and participation-focused services, but there remain insufficient options for systematically enacting this service approach. The Young Children's Participation and Environment Measure electronic patient-reported outcome (YC-PEM e-PRO) is an evidence-based measure for caregivers that enables family-centred services in EI. The Parent-Reported Outcomes for Strengthening Partnership within the Early Intervention Care Team (PROSPECT) is a community-based pragmatic trial examining the effectiveness of implementing the YC-PEM e-PRO measure and decision support tool as an option for use within routine EI care, on service quality and child outcomes (aim 1). Following trial completion, we will characterise stakeholder perspectives of facilitators and barriers to its implementation across multiple EI programmes (aim 2). METHODS AND ANALYSIS This study employs a hybrid type 1 effectiveness-implementation study design. For aim 1, we aim to enrol 223 caregivers of children with or at risk for developmental disabilities or delays aged 0-3 years old that have accessed EI services for three or more months from one EI programme in the Denver Metro catchment of Colorado. Participants will be invited to enrol for 12 months, beginning at the time of their child's annual evaluation of progress. Participants will be randomised using a cluster-randomised design at the EI service coordinator level. Both groups will complete baseline testing and follow-up assessment at 1, 6 and 12 months. A generalised linear mixed model will be fitted for each outcome of interest, with group, time and their interactions as primary fixed effects, and adjusting for child age and condition severity as secondary fixed effects. For aim 2, we will conduct focus groups with EI stakeholders (families in the intervention group, service coordinators and other service providers in the EI programme, and programme leadership) which will be analysed thematically to explain aim 1 results and identify supports and remaining barriers to its broader implementation in multiple EI programmes. ETHICS AND DISSEMINATION This study has been approved by the institutional review boards at the University of Illinois at Chicago (2020-0555) and University of Colorado (20-2380). An active dissemination plan will ensure that findings have maximum reach for research and practice. TRIAL REGISTRATION NUMBER NCT04562038.
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Affiliation(s)
- Vera Kaelin
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Vivian Villegas
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Yi-Fan Chen
- Center for Clinical and Translational Science, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Natalie Murphy
- Health Systems, Management & Policy, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth Papautsky
- Biomedical & Health Information Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jodi Litfin
- Rocky Mountain Human Services, Denver, Colorado, USA
| | - Natalie Leland
- Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Varun Maheshwari
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Beth McManus
- Health Systems, Management & Policy, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Khetani
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois, USA
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
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Kaelin VC, Wallace ER, Werler MM, Collett BR, Khetani MA. Community participation in youth with craniofacial microsomia. Disabil Rehabil 2022; 44:253-260. [PMID: 32478589 PMCID: PMC7704849 DOI: 10.1080/09638288.2020.1765031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To examine differences in community participation and environmental support for youth with and without craniofacial microsomia. METHODS This study involved secondary analyses of a subset of data (n = 396) from a longitudinal cohort study. Multiple linear and Poisson regression analyses and Wilcoxon Mann-Whitney tests were used to estimate differences in community participation and environmental support between youth with craniofacial microsomia and youth without craniofacial microsomia, stratified based on their history of education and health-related service use. Chi-square analyses were used to explore item-level group differences in change desired across community activities. RESULTS Statistically significant differences were found in community participation frequency (ES = -0.52; p < 0.001), level of involvement (r = -0.16; p = 0.010), and desire for change in participation when comparing youth with craniofacial microsomia and non-affected peers not receiving services (p < 0.001). There were no statistically significant differences between youth with craniofacial microsomia and non-affected peers receiving services. CONCLUSIONS Results suggest lower community participation in youth with craniofacial microsomia as compared to non-affected peers not receiving services. This may suggest opportunities for designing and testing interventions to promote community participation among youth with craniofacial microsomia, so as to support their transition to adulthood.Implications for rehabilitationYouth with craniofacial microsomia may have unmet rehabilitation needs related to their community participation.Rehabilitation professionals should pay attention to participation of youth with craniofacial microsomia in activities that place a higher demand on involvement with others.Rehabilitation professionals should appraise participation frequency and involvement of youths with craniofacial microsomia to gain accurate insight into their current community participation.
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Affiliation(s)
- Vera C. Kaelin
- Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA
| | - Erin R. Wallace
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, USA
| | - Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Brent R. Collett
- Child Psychiatry at Seattle Children’s Hospital and Departments of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Mary A. Khetani
- Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.,Corresponding Author: Mary A. Khetani, ScD, OTR/L, Department of Occupational Therapy, University of Illinois at Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL 60612-7250 Telephone: +1 312-996-0942, Fax: +1 312-413-0256,
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Kaelin VC, Wallace ER, Werler MM, Collett BR, Rosenberg J, Khetani MA. Caregiver Perspectives on School Participation Among Students With Craniofacial Microsomia. Am J Occup Ther 2021; 75:7502205100p1-7502205100p10. [PMID: 33657352 PMCID: PMC7929606 DOI: 10.5014/ajot.2021.041277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Importance: Knowledge of unmet school participation needs for students with craniofacial microsomia (CFM) can inform decisions regarding intervention support. Objective: To compare students with and without CFM on school participation (i.e., frequency, involvement, desire for participation to change) and caregivers’ perceptions of environmental support for participation in occupations. Design: Cross-sectional design using secondary analyses of a subset of data. Setting: Multisite cohort study. Participants: Caregivers of students with CFM (n = 120) and of students without CFM (n = 315), stratified by history of education- and health-related service use. Outcomes and Measures: School participation and environmental support, obtained with the Participation and Environment Measure–Children and Youth. Results: Significant group differences were found in frequency of school participation (effect size [ES] = −0.38, 95% confidence interval [−0.64, −0.12], p = .005), level of involvement (ES = −0.14, p = .029), and desired change (p = .001), with students with CFM exhibiting greater participation restriction than students without CFM and no history of service use. No statistically significant group differences were found in environmental support for participation in the school setting. Item-level findings showed statistically significant higher desire for participation to change in three of five school occupations (odds ratio = 1.77–2.39, p = .003–.045) for students with CFM compared with students without CFM and no history of service use. Conclusions and Relevance: The results suggest that students with CFM experience restriction in participation at school. What This Article Adds: Students with CFM may benefit from targeted school-based interventions to optimize their inclusion.
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Affiliation(s)
- Vera C Kaelin
- Vera C. Kaelin, MScOT, is PhD Student and Graduate Research Assistant, Program in Rehabilitation Sciences, University of Illinois at Chicago
| | - Erin R Wallace
- Erin R. Wallace, PhD, is Research Consultant, Department of Occupational and Environmental Health Sciences, University of Washington, Seattle. At the time this research was conducted, Wallace was Clinical Research Scientist, Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA
| | - Martha M Werler
- Martha M. Werler, DSc, is Professor, Department of Epidemiology, School of Public Health, Boston University, Boston, MA
| | - Brent R Collett
- Brent R. Collett, PhD, is Associate Professor, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Janine Rosenberg
- Janine Rosenberg, PhD, is Pediatric Psychologist, Department of Psychiatry and Surgery, University of Illinois Hospital and Health Science System, Chicago, IL
| | - Mary A Khetani
- Mary A. Khetani, ScD, is Associate Professor, Department of Occupational Therapy, College of Applied Health Sciences and Program in Rehabilitation Sciences, University of Illinois at Chicago, and Research Scientist, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada;
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Albrecht EC, Kaelin VC, Rigau BL, Dooling-Litfin JK, Scully EA, Murphy NJ, McManus BM, Khetani MA. Pilot implementation of an electronic patient-reported outcome measure for planning and monitoring participation-focused care in early intervention. BMC Med Inform Decis Mak 2020; 20:199. [PMID: 32838772 PMCID: PMC7446047 DOI: 10.1186/s12911-020-01189-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/16/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family-centered care is a valued approach to improving child and family outcomes in early intervention (EI), yet there is need to implement interventions that support information exchange for shared decision-making when planning and monitoring EI care. This study aims at estimating the feasibility, acceptability, and value of implementing the Young Children's Participation and Environment Measure (YC-PEM), a valid electronic patient-reported outcome (e-PRO) that is designed to support family engagement when planning care and monitoring outcomes of care. METHODS Data were gathered from caregivers (N = 139) that were enrolled in a Phase 1 trial of the YC-PEM e-PRO as implemented within 1 month of their child's next EI evaluation of progress. YC-PEM e-PRO feasibility was estimated according to enrollment and completion rates, and mean completion time. Chi-square tests were used to examine parent perceptions of YC-PEM e-PRO acceptability by caregiver education and family income. Caregiver feedback via open-ended responses were content coded to inform intervention and protocol optimizations. YC-PEM e-PRO value was estimated via composite and item-level scores to capture the extent of participation difficulty in home and community activities, and common areas of need regarding caregivers desired change in their child's participation. RESULTS Feasibility of implementing the YC-PEM e-PRO in routine EI care was mixed, as evidenced by low enrollment rates (21.0-29.2%), a high completion rate (85.3%), and limited missing data (80.6% of completed cases contained no missing data). More than half of the participants reported that the completion of the YC-PEM e-PRO was at least somewhat helpful, regardless of family income or caregiver education, providing support for its acceptability. As for its value, the YC-PEM e-PRO results were viewed by 64% of caregivers, whose desire for change most often pertained to the child's participation in non-discretionary activities at home and structured activities in the community. CONCLUSIONS Results may support the implementation of YC-PEM e-PRO as a feasible, acceptable, and valued option for engaging families in planning the child's EI care. Results also inform select intervention and protocol optimizations prior to undertaking a multi-site pragmatic trial of its effectiveness on family engagement and shared decision-making within an EI clinical workflow. TRIAL REGISTRATION Trial number: NCT03904797 . Trial registered at Clinicaltrials.gov . Registered 22 March 2019. Retrospectively registered.
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Affiliation(s)
- E. C. Albrecht
- Invest in Kids, 1775 Sherman Street, Suite 1445, Denver, CO 80203 USA
| | - V. C. Kaelin
- Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612 USA
| | - B. L. Rigau
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL 60612-7250 USA
| | | | - E. A. Scully
- Rocky Mountain Human Services, 9900 E Iliff Ave, Denver, CO 8023 USA
| | - N. J. Murphy
- Health Systems, Management, and Policy, Colorado School of Public Health, 13001 E. 17th Place, Mail Stop B119, Aurora, CO 80045 USA
| | - B. M. McManus
- Health Systems, Management, and Policy, Colorado School of Public Health, 13001 E. 17th Place, Mail Stop B119, Aurora, CO 80045 USA
| | - M. A. Khetani
- Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL 60612 USA
- Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL 60612-7250 USA
- CanChild Centre for Childhood Disability Research, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4L8 Canada
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Jarvis JM, Kaelin VC, Anaby D, Teplicky R, Khetani MA. Electronic participation-focused care planning support for families: a pilot study. Dev Med Child Neurol 2020; 62:954-961. [PMID: 32259292 PMCID: PMC7332406 DOI: 10.1111/dmcn.14535] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the feasibility, acceptability, and preliminary effects of Participation and Environment Measure-Plus (PEM+) 2.0, an optimized version of a web-based, participation-focused, care-planning tool. METHOD Twenty-two caregivers of children aged 0 to 5 years receiving rehabilitation services, who reported dissatisfaction with their child's participation, had internet access, and could read and write English, were recruited for this 2-week, single-arm pilot trial. Feasibility was assessed through retention rates, completion time, percentage of care plans developed relative to caregiver reported need, and independent completion of PEM+ 2.0. Acceptability was assessed by the Usefulness, Satisfaction, and Ease of Use Questionnaire. Preliminary effects were assessed by two items on caregiver reported impact of PEM+ 2.0 on confidence for addressing their child's participation. RESULTS Eighteen caregivers completed at least one iteration of PEM+ 2.0; of those, 17 were female and 15 were 30 to 39 years old. The median completion time was 12.99 minutes (quartile 1, 6.30; quartile 3, 17.33), mean care plan creation relative to need was 50% (standard deviation [SD] 31), and 17 completed PEM+ 2.0 independently. Mean acceptability scores were 3.80 to 4.97 (SD 1.25-1.97) and mean preliminary effect scores were 4.61 to 4.72 (SD 1.85-2.24), out of 7.0. There were strong and significant positive associations between two of the three estimates of PEM+ 2.0 acceptability and caregiver confidence (r=0.577-0.793, p<0.01). INTERPRETATION Electronic health tools have the potential for facilitating family-centered care in pediatric rehabilitation. PEM+ 2.0 is a feasible tool within pediatric rehabilitation and has potential to be an acceptable tool for improving caregiver confidence for promoting their child's participation in valued activities. WHAT THIS PAPER ADDS Participation and Environment Measure-Plus (PEM+) 2.0 is feasible for collaboratively engaging caregivers in the care-planning process. Caregivers perceived PEM+ 2.0 as helpful for thinking about their child's participation and what can be done to improve it. Feasibility and acceptability results will inform PEM+ 2.0 optimizations.
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Affiliation(s)
- Jessica M Jarvis
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vera C Kaelin
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Dana Anaby
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Rachel Teplicky
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
| | - Mary A Khetani
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL, USA
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, IL, USA
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada
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Khetani MA, McManus BM, Albrecht EC, Kaelin VC, Dooling-Litfin JK, Scully EA. Early intervention service intensity and young children's home participation. BMC Pediatr 2020; 20:330. [PMID: 32620161 PMCID: PMC7333381 DOI: 10.1186/s12887-020-02182-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 05/29/2020] [Indexed: 02/07/2023] Open
Abstract
Background Young children with developmental disabilities and delays spend significant amounts of time at home, show decreased participation in home-based activities, and receive home-based early intervention services to improve participation in activities. Yet, knowledge about the relationship between EI service use and children’s home participation in activities remains poorly understood but needed for program improvement. The purpose of this study was to understand the relationships between EI service use and children’s home participation. Methods In a cross-sectional design, data were gathered from caregivers (N = 139) who enrolled in a pilot trial of the Young Children’s Participation in Environment Measure (YC-PEM) electronic patient-reported outcome (e-PRO), as implemented within 1 month of their child’s next EI progress evaluation. A series of path analytic models were used to estimate EI service intensity as a predictor of parent-reported young children’s home participation 1) frequency, 2) level of involvement, and 3) desired change, adjusting for family and child social and functional characteristics. Models included caregiver perceptions of home environmental support to test its indirect (i.e., mediation) effects on the relationship between EI service intensity and each of the three home participation dimensions. Results All three models fit the data well (comparative fit index = 1.00). EI service intensity was not a significant predictor of participation frequency. However, EI service intensity had a significant direct effect on a child’s participation according to level of involvement and desired change, explaining between 13.3–33.5% of the variance in home participation. Caregiver perceptions of environmental support had a small yet significant indirect effect on the relationship between EI service intensity and level of involvement and desired change; these models explained between 18.5–38.1% of the variance in home participation. Conclusions EI service intensity has important links with involvement in and desired change for home-based activities. Caregiver perceptions of environmental support appears to be a factor in the relationship between EI service intensity and home participation. Results warrant longitudinal replication with a control group, which would be possible with the implementation of the YC-PEM e-PRO in a routine EI clinical workflow. Trial retrospectively registered NCT03904797.
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Affiliation(s)
- M A Khetani
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, USA. .,Occupational Therapy, University of Illinois at Chicago, Chicago, USA. .,CanChild Centre for Childhood Disability Research, Hamilton, Canada.
| | - B M McManus
- Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, USA
| | | | - V C Kaelin
- Rehabilitation Sciences, University of Illinois at Chicago, Chicago, USA
| | | | - E A Scully
- Rocky Mountain Human Services, Denver, USA
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10
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Cordeiro L, Villagomez A, Swain D, Deklotz S, Tartaglia N. Adaptive Skills in FXS: A Review of the Literature and Evaluation of the PEDI-Computer Adaptive Test (PEDI-CAT) to Measure Adaptive Skills. Brain Sci 2020; 10:E351. [PMID: 32517224 PMCID: PMC7349498 DOI: 10.3390/brainsci10060351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
As adaptive skills (AS) are dynamic and may indicate the success of an intervention, they are a common domain measured in clinical trials. Typical interview tools for measuring AS are time-consuming, and questionnaire measures often lead to inconsistent information. The present study was designed to evaluate the feasibility, validity and test-retest performance of the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI-CAT) in Fragile X syndrome (FXS). The PEDI-CAT is administered via tablet and uses the item response theory to efficiently determine the items administered. The PEDI-CAT was administered to 42 individuals with FXS (27 males; 15 females) aged 1.6-50.9 years (M = 14.9; SD = 11.2), followed by the Vineland-3 (VABS-3) interview for comparison. Administration was efficient (M = 21.7 min; SD = 9.5; range 8-45 min; mode = 19). Males and females did not significantly differ on the PEDI-CAT domains, except for daily activities (t(40) = -2.22, p = 0.037). Floor effects were significant for both measures, although the PEDI-CAT showed more floor effects in the mobility (35.7%) and social-cognitive (50%) domains. PEDI-CAT daily activities, mobility, social-cognitive and responsibility domains were all significantly correlated with most of the VABS-3 domains (all rho > 0.5; p < 0.01). Test-rest of the PEDI-CAT was comparable to the VABS-3. Results suggest that the PEDI-CAT is efficient, and minimal training is needed to administer it; however, it lacks specificity and shares a high rate of floor effects with the VABS-3.
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Affiliation(s)
- Lisa Cordeiro
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (L.C.); (A.V.); (S.D.)
| | - Adrienne Villagomez
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (L.C.); (A.V.); (S.D.)
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
| | - Deanna Swain
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
- Department of Psychiatry, Weill Cornell Medicine, White Plains, NY 10605, USA
| | - Sophia Deklotz
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (L.C.); (A.V.); (S.D.)
| | - Nicole Tartaglia
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO 80045, USA; (L.C.); (A.V.); (S.D.)
- Developmental Pediatrics, Children’s Hospital Colorado, Aurora, CO 80045, USA;
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11
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McManus BM, Murphy N, Richardson Z, Khetani MA, Schenkman M, Morrato EH. Family-centred care in early intervention: Examining caregiver perceptions of family-centred care and early intervention service use intensity. Child Care Health Dev 2020; 46:1-8. [PMID: 31782824 PMCID: PMC6949406 DOI: 10.1111/cch.12724] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/15/2019] [Accepted: 11/23/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Family-centred care (FCC) is an approach to paediatric rehabilitation service delivery endorsing shared decision making and effective communication with families. There is great need to understand how early intervention (EI) programmes implement these processes, how EI caregivers perceive them, and how they relate to EI service use. Therefore, the purpose of this study is to examine (a) parent and provider perceptions about EI FCC processes and (b) the association between FCC perceptions and EI service intensity. METHODS In this cross-sectional study, parent perceptions of EI FCC were measured using the electronically administered Measures of Processes of Care (MPOC-56 and MPOC-SP; using 7-point scales). Participants included EI parents (n = 29) and providers (n = 9) from one urban EI programme (1/1/18-6/1/18). We linked survey responses with child characteristics and service use ascertained through EI records. We estimated parent-provider MPOC score correlations and the association between EI service intensity (hr/month) and parent MPOC scores using adjusted linear regression accounting for child characteristics. RESULTS Parents (M = 4.2, SD = 1.1) and providers (M = 5.8, SD = 1.3) reported low involvement related to general information exchange. Parent and provider subscale scores were not correlated except that parent-reported receipt of specific information was inversely associated with provider-reported provision of general information (r = -0.4, P < .05). In adjusted models, parent perceptions related to respectful and supportive (b = 1.57, SE = 0.56) and enabling (b = 1.42, SE = 0.67) care were positively associated with EI intensity, whereas specific information exchange and general information exchange were not associated with intensity. CONCLUSION We found that EI parents and providers reported high levels of investment in the family centredness of their EI care, with the exception of information sharing. Greater EI service intensity was associated with higher perception of involvement with some metrics of family centredness.
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Affiliation(s)
- Beth M. McManus
- Department of Health Systems, Management and Policy, Colorado School of Public Health
| | - Natalie Murphy
- Physical Therapy Program, University of Colorado School of Medicine
| | - Zachary Richardson
- Data Science to Patient Value (D2V), University of Colorado Anschutz Medical Campus
| | - Mary A. Khetani
- Department of Occupational Therapy, University of Illinois at Chicago
| | | | - Elaine H. Morrato
- Department of Health Systems, Management and Policy, Colorado School of Public Health
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12
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Richardson ZS, Scully EA, Dooling-Litfin JK, Murphy NJ, Rigau B, Khetani MA, McManus BM. Early Intervention Service Intensity and Change in Children's Functional Capabilities. Arch Phys Med Rehabil 2019; 101:815-821. [PMID: 31778660 DOI: 10.1016/j.apmr.2019.10.188] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/08/2019] [Accepted: 10/13/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To estimate correlates of early intervention (EI) service dosage and gains in children's functional capabilities from EI entry and discharge. DESIGN Retrospective cohort study. SETTING Secondary analyses of a subset of data (N=1005) collected from an EI administrative database on children discharged from a large, urban EI program between October 1, 2014 and September 30, 2016. PARTICIPANTS Children who were EI eligible due to developmental delay, had received an EI care plan and at least 1 billable EI service, and had outcomes data at EI entry and exit (N=1005). Measured child characteristics included age (49.0% 12-24mo; n=492), sex (36.0% female; n=362), number of developmental delays (76.1% had 1 developmental delay; n=765), and number of EI services received (78.5% received multiple; n=789). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Outcomes were EI service intensity (hours per month) and change in functional capabilities as measured via the state-mandated Child Outcomes Summary (COS). Adjusted quantile median regression estimated EI intensity. Adjusted linear regression estimated change in function for social-emotional, cognitive, and adaptive domains of the COS. Measures of children's developmental delay severity, age at EI entry, race and ethnicity, sex, and language. RESULTS Children older than 24 months old experienced significantly higher EI service intensity (b=0.40; 95% confidence interval, 0.18-0.63). Child age and EI service intensity were significantly linked to gains in social and cognitive COS score changes from EI entry to exit. CONCLUSIONS Older children receive a higher intensity of EI services. EI service intensity and age were linked with positive changes in functional gains.
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Affiliation(s)
- Zachary S Richardson
- Department of Health Systems, Management and Policy, University of Colorado at Denver, Denver, Colorado
| | | | | | - Natalie J Murphy
- Department of Physical Medicine and Rehabilitation, University of Colorado at Denver, Denver, Colorado
| | - Briana Rigau
- Children's Participation in Environment Research Lab, University of Illinois at Chicago, Chicago, Illinois
| | - Mary A Khetani
- Departments of Occupational Therapy and Disability and Human Development, University of Illinois at Chicago, Chicago, Illinois.
| | - Beth M McManus
- Department of Health Systems, Management and Policy, University of Colorado at Denver, Denver, Colorado
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13
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Bosak DL, Jarvis JM, Khetani MA. Caregiver creation of participation-focused care plans using Participation and Environment Measure Plus (PEM+), an electronic health tool for family-centred care. Child Care Health Dev 2019; 45:791-798. [PMID: 31313843 DOI: 10.1111/cch.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/03/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Family-centred care (FCC) is a model for rehabilitation practice that focuses on collaborative partnerships between providers and clients (i.e., children and their caregivers). FCC is a best-practice standard and is expected to yield better outcomes for children and greater caregiver satisfaction with rehabilitation services. A commonly cited barrier to implementing FCC is perceptions about caregiver capability to contribute to designing an initial plan of care, due to lack of skill and/or interest. OBJECTIVES The aim of this study is to address FCC barriers through three objectives: (a) report the proportion of caregivers that created multiple care plans using PEM+, an electronic health tool, (b) assess the proportion of caregivers that created complete and participation-focused care plan(s) and that exceeded criteria of a complete plan, and (c) describe characteristics of caregivers that did not create a complete care plan. METHODS Study objectives were addressed via secondary analyses of a subset of data from the PEM + pilot trial. Participants were caregivers (N = 18) of children with developmental disabilities (aged 0-5 years) receiving rehabilitation services in an early childhood programme. A deductive analytic approach was used to code care plan content to criteria and to determine proportion of caregivers with a complete and participation-focused care plan and those that exceeded the criteria. RESULTS Multiple care plans were created by 72% of the caregivers, 83% caregivers created at least one care plan that was complete and participation-focused per criteria, and 83% exceeded the criteria. CONCLUSION The high occurrence of caregivers who developed multiple care plans and who developed high-quality care plans, in their completeness and participation-focused features, suggests that caregivers are interested and capable of participating in a collaborative goal setting process when using PEM+. This indicates that FCC is feasible to implement in clinical workflow with the use of an electronic health tool, which may better facilitate such care. PEM+ warrants further efficacy testing prior to implementation.
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Affiliation(s)
- Dianna L Bosak
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois
| | - Jessica M Jarvis
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Mary A Khetani
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Illinois
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Lancaster GA, Thabane L. Guidelines for reporting non-randomised pilot and feasibility studies. Pilot Feasibility Stud 2019; 5:114. [PMID: 31608150 PMCID: PMC6778655 DOI: 10.1186/s40814-019-0499-1] [Citation(s) in RCA: 178] [Impact Index Per Article: 35.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/10/2019] [Indexed: 01/08/2023] Open
Abstract
As the number of submissions to Pilot and Feasibility Studies increases, there is a need for good quality reporting guidelines to help researchers tailor their reports in a way that is consistent and helpful to other readers. The publication in 2016 of the CONSORT extension to pilot and feasibility trials filled a much-needed gap, but there still remains some uncertainty as to how to report pilot and feasibility studies that are not randomised. This editorial aims to provide some general guidance on how to report the most common types of non-randomised pilot and feasibility studies that are submitted to the journal. We recommend using the CONSORT extension to pilot and feasibility trials as the main reference document—it includes detailed elaboration and explanation of each item, and in most cases, simple adaptation, or non-use of items that are not applicable, will suffice. Several checklists found on the Equator website may provide helpful supplementary guidance, when used alongside the CONSORT extension, and we give some examples.
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Affiliation(s)
- Gillian A Lancaster
- School of Primary, Social and Community Care, Keele University, Newcastle-under-Lyme, UK
| | - Lehana Thabane
- School of Primary, Social and Community Care, Keele University, Newcastle-under-Lyme, UK
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15
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Community engagement to pilot electronic patient-reported outcomes (e-PROs) in early intervention: Lessons learned. J Clin Transl Sci 2018; 2:20-26. [PMID: 30333929 PMCID: PMC6188646 DOI: 10.1017/cts.2018.15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Electronic data capture is essential to advancing family-centered coordinated care in early intervention (EI). The purpose of this paper is to report on EI service coordinator response to piloting an electronic parent-reported outcome (e-PRO) assessment as part of their routine workflow, including lessons learned that may inform future phases of e-PRO implementation. Methods This second pilot study involved families enrolled in a large EI program (n=1040 families) in concert with their implementation of a statewide quality improvement initiative for care plan development and outcomes reporting. A total of 22 EI service coordinators and supervisors were engaged in three phases: initial e-PRO intervention, peer mentor enhancement, and standard recruitment protocol. Results Implementation of the e-PRO intervention and peer mentoring enhancement yielded low enrollment rates over the first six months (n=17). A standard recruitment protocol has resulted in enrollment growth (n=83) towards the targeted enrollment rate (n=832). Conclusions This study reports on early insights for building and sustaining a productive academic-community partnership for e-PRO implementation to support family-centered coordinated care. Lessons learned from this academic-community partnership with respect to strategies for enhancing community significance, collaboration, return, and control are discussed as they inform further development of this intervention prior to scale-up.
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