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Wiener RC, Waters C, Bhandari R. Association of general anxiety and pediatric dental preventive examination utilization, National Survey of Children's Health, 2021. Spec Care Dentist 2024. [PMID: 38711189 DOI: 10.1111/scd.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/25/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
INTRODUCTION Many factors influence preventive dental health service access for children. The objective of this research was to examine one factor, general anxiety, in accessing at least one preventive dental examination in the past 12 months in children with special healthcare needs (CSHCN) and children without special healthcare needs (CWSHCN). METHODS National Survey of Children's Health (NSCH) 2021 were obtained for this cross-sectional research. Chi-square and logistic regression analyses were used to determine association of anxiety and past 12-month preventive dental examinations. RESULTS The sample included 10 493 CSHCN, and 35 675 CWSHCN. Overall, 72.7% had past 12-month preventive dental examinations, and 9.9% had a healthcare provider indicate they had general anxiety. CSHCN with anxiety, CWSHCN with anxiety, and CSHCN without anxiety were more likely to have a past 12-month preventive dental examination visit than CWSHCN without anxiety (Adjusted Odds Ratios: 1.86, 1.39, 1.32, respectively). CONCLUSION Our results suggest children with general anxiety (both CSHCN and CWSHCN) are more likely to have had at least one regular preventive dental visit within the past 12 months than CWSHCN and without general anxiety. There is a need for further understanding the relationship of general anxiety and dental health to improve the health of all children. PRACTICAL IMPLICATIONS CWSHCN without anxiety need individualized, comprehensive care with enough time, attention, instruction, and rewards to demonstrate to parents/guardians the importance of making routine preventive dental examinations a priority for their child.
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Affiliation(s)
- R Constance Wiener
- Department of Dental Public Health and Professional Practice, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Christopher Waters
- Department of Dental Research, School of Dentistry, West Virginia University, Morgantown, West Virginia, USA
| | - Ruchi Bhandari
- Department of Epidemiology and Biostatistics, School of Public Health, Robert C. Byrd Health Sciences Center North, West Virginia University, Morgantown, West Virginia, USA
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Hieronymus H, Aydin S, Frese C, Huck M, Wolff D, Sekundo C. Dental treatment of children with special healthcare needs: A retrospective study of 10 years of treatment. Int J Paediatr Dent 2024. [PMID: 38594884 DOI: 10.1111/ipd.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/14/2024] [Accepted: 04/01/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND/AIM Children with special healthcare needs (CSHCN) often face oral health challenges. This retrospective cross-sectional study at a university hospital aimed to determine CSHCN's medical spectrum, dental treatment needs, and mode of treatment: general anesthesia (GA) or outpatient dental care (ODC). DESIGN Data from the Department of Conservative Dentistry, Heidelberg University Hospital, 2012-2022, were reviewed, considering age, gender, International Classification of Diseases-10 diagnoses, caries experience (dmft/DMFT), restorative parameters, and treatment under GA/ODC. For patients under GA, their American Society of Anesthesiologists (ASA) classification was considered. Descriptive statistics, Kruskal-Wallis test, Mann-Whitney U-test and logistic regression were utilized. RESULTS Of 669 patients, congenital and chromosomal malformations (34.7%), diseases of the nervous system (19.1%), and mental and behavioral disorders (16.0%) were mainly diagnosed. Dentin caries prevalence was high at 79.1%, with treatments performed mainly under GA (51.4%). The odds of receiving treatment under GA decreased with patient age and increased with higher dmft/DMFT scores. Most under GA were classified as ASA 3 (51.7%), indicating high anesthesia risks. CONCLUSION Children with special healthcare needs often have diseases that can lead to higher challenges related to cooperation. The high prevalence of dentin caries underscores the substantial need for dental treatments, which were consequently often performed under GA, despite the associated risks. These findings stress the need for trained dental professionals.
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Affiliation(s)
- Hanna Hieronymus
- Department of Conservative Dentistry, Heidelberg University, University Hospital Heidelberg, Heidelberg, Germany
| | - Selin Aydin
- Department of Conservative Dentistry, Heidelberg University, University Hospital Heidelberg, Heidelberg, Germany
| | - Cornelia Frese
- Department of Conservative Dentistry, Heidelberg University, University Hospital Heidelberg, Heidelberg, Germany
| | - Matthias Huck
- Clinic for Anesthesiology, Heidelberg University, University Hospital Heidelberg, Heidelberg, Germany
| | - Diana Wolff
- Department of Conservative Dentistry, Heidelberg University, University Hospital Heidelberg, Heidelberg, Germany
| | - Caroline Sekundo
- Department of Conservative Dentistry, Heidelberg University, University Hospital Heidelberg, Heidelberg, Germany
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Geweniger A, Barth M, Haddad A, Högl H, Insan S, Mund A, Langer T. Perceived social support and characteristics of social networks of families with children with special healthcare needs following the COVID-19 pandemic. Front Public Health 2024; 12:1322185. [PMID: 38487183 PMCID: PMC10937572 DOI: 10.3389/fpubh.2024.1322185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024] Open
Abstract
Background Children with special healthcare needs (CSHCN) require more support than the average of their peers. Support systems for CSHCN were particularly affected by pandemic control measures. Perceived social support is a resource for health and wellbeing for CSHCN and their families. Associations of social support, mental health and socioeconomic status (SES) have been described. This study aims to (1) assess perceived social support in families with and without CSHCN; (2) describe structure and types of social networks of families with and without CSHCN; and (3) explore associations between perceived social support, disease complexity, child and caregiver mental health, and SES. Methods This is the third of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤ 18 years in Germany since the beginning of the COVID-19 pandemic, administered between 1st December 2022 and 10 March 2023. The Brief Social Support Scale (BS6) assessed perceived social support. Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire (SDQ) and WHO-5 Wellbeing index. The CSHCN-Screener identified CSHCN. Descriptive statistics and linear regression modeling assessed associations between perceived social support, parent-reported child mental health problems, disease complexity, caregiver mental wellbeing and SES. Results The final sample included 381 participants, among them 76.6% (n = 292) CSHCN. 46.2% (n = 176) of caregivers reported moderate, i.e., at least occasional social support. Social support was largely provided by informal social networks consisting of partners, relatives and neighbors/friends. Linear regression modeling revealed associations of lower perceived social support with higher disease complexity of the child, lower caregiver mental wellbeing, lower SES and increasing caregiver age. Conclusion The results of this study describe inequalities in perceived social support according to disease complexity of the child, caregiver mental health and socioeconomic status. They highlight the importance of social support and support networks as a resource for wellbeing of caregivers and CSHCN. Moving on from the COVID-19 pandemic, recovery strategies should focus on low-threshold interventions based in the community to improve social support for families with CSHCN and actively involve caregivers in identifying needs and co-creating new approaches.
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Affiliation(s)
- Anne Geweniger
- Department of Neuropediatrics and Muscle Disease, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | - Michael Barth
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | - Anneke Haddad
- Department of General Pediatrics, Adolescent Medicine and Neonatology, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | | | - Shrabon Insan
- Department of Neuropediatrics and Muscle Disease, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
| | | | - Thorsten Langer
- Department of Neuropediatrics and Muscle Disease, Center for Pediatrics, Medical Center—University of Freiburg, Freiburg, Germany
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Yeager VA, Gutta J, Kutschera L, Stelzner SM. Perceived Value of the Inclusion of Parent-to-Parent Support in Case Conferences and Care Planning for Children With Special Healthcare Needs. Adv Health Care Manag 2024; 22:211-229. [PMID: 38262017 DOI: 10.1108/s1474-823120240000022010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
This chapter qualitatively explored the impact of including parent liaisons (i.e., parents with lived experience caring for a child with complex needs, who support other caregivers in navigating child and family needs) in a case conferencing model for children with complex medical/social needs. Case conferences are used to address fragmented care, shared decision-making, and set patient-centered goals. Seventeen semi-structured interviews were conducted with clinicians and parent liaisons to assess the involvement of parent liaisons in case conferencing. Two main themes included benefits of parent liaison involvement (10 subthemes) and challenges to parent liaison involvement (5 subthemes). Clinicians reported that liaison participation and support of patients reduced stress for clinicians as well as family members. Challenges to liaison involvement included clinical team/parent liaison communication delays, which were further exacerbated by the COVID-19 pandemic. Parent liaison involvement in case conferences is perceived to be beneficial to children with complex needs, their families, and the clinical team. Integration of liaisons ensures the familial perspective is included in clinical goal setting.
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Affiliation(s)
- Valerie A Yeager
- a Indiana University Richard M. Fairbanks School of Public Health, USA
| | - Jyotsna Gutta
- a Indiana University Richard M. Fairbanks School of Public Health, USA
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Khanijahani A, Pawcio S. Household food insecurity and childhood obesity/overweight among children with special healthcare needs: Results from a nationally representative sample of 10-17 years old U.S. children. Pediatr Obes 2023; 18:e13015. [PMID: 36825692 DOI: 10.1111/ijpo.13015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 12/17/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023]
Abstract
BACKGROUND Food insecurity is linked to an increased risk of childhood obesity and other adverse health issues. OBJECTIVES To examine the disproportionate impact of food insecurity on childhood obesity among children with special healthcare needs (CSHCN). METHODS In this cross-sectional study, we pooled data from 4 years (2016 to 2019) of the National Survey of Children's Health (NSCH) for a nationally representative sample of 10 to 17 years old noninstitutionalized U.S. children (N = 68 942). Using logistic regression models, we examined the odds of childhood obesity or overweight by including an interaction between family food situation and CSHCN status. RESULTS Among 10-17 years old U.S. children, 31% (95% confidence interval [CI]: 30.1%-31.9%) had obesity or overweight, 24.1% had special healthcare needs, 27.2% were from families with food insecurity, and 6.4% were from families with food insufficiency. CSHCN were more likely to be impacted by obesity or overweight than non-CSHCN (Odds Ratio [OR] = 1.29, 95% CI = 1.18-1.141). Moreover, children living in food insecurity (OR = 1.75, 95% CI = 1.52-1.92) and food insufficiency (OR = 2, 95% CI = 1.67-2.4) were more likely than those living in food-secure families to be impacted by obesity or overweight. CSHCN living in food insecurity were significantly more likely to be impacted by obesity or overweight than non-CSHCN in similar households. CONCLUSIONS It appears that food insecurity can put CSHCN at disproportionately greater risk of obesity or overweight than non-CSHCN. The findings underscore considering CSHCN status in conjunction with household food insecurity in designing and implementing medical interventions or public policies targeted at childhood obesity or overweight.
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Affiliation(s)
- Ahmad Khanijahani
- John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Sheridyn Pawcio
- John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
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Min EE, Wheeler H, Hennessy C, Abebe E. Medication management strategies by family caregivers of children with special healthcare needs. Child Care Health Dev 2023. [PMID: 36779227 DOI: 10.1111/cch.13102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Little is known about the strategies utilized by family caregivers managing medications for their children with special healthcare needs (CSHCN), those who require higher than normal care due to their multifaceted healthcare needs. Medication management strategies are a set of methods or techniques developed or adapted by caregivers to overcome medication-related barriers and ensure successful therapeutic outcomes. An in-depth understanding of such strategies is a requisite first step toward developing interventions that support caregiver-mediated medication management. METHODS We conducted semi-structured qualitative interviews with 20 family caregivers of CSHCN who were recruited as part of a community engaged research between Purdue University College of Pharmacy and Indiana Family to Family. Interviews were conducted through zoom and audio recorded. Each participant was provided with a $50 honorarium. Interviews were professionally transcribed and content analyzed to generate categories of medication management strategies. RESULTS Five overarching categories of medication management strategies were identified. These included (1) medications, supplies and equipment inventory management; (2) organizing and tracking medications, supplies and equipment; (3) medication-related communication, coordination and engagement; (4) medication administration and (5) researching and learning about medications. Within each category, caregivers developed or adapted specific strategies to overcome barriers in diverse care contexts (e.g., when interacting with healthcare systems, school staff or other members of their household). CONCLUSION These findings can inform current clinical practice through improved awareness of different strategies employed by caregivers and lay a foundation to develop interventions designed to support caregiver mediated medication management.
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Affiliation(s)
- Elissa E Min
- College of Pharmacy, Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USA
| | - Holly Wheeler
- Indiana Family to Family, Indianapolis, Indiana, USA
| | | | - Ephrem Abebe
- College of Pharmacy, Department of Pharmacy Practice, Purdue University, West Lafayette, Indiana, USA
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Sezgin E, Oiler B, Abbott B, Noritz G, Huang Y. "Hey Siri, Help Me Take Care of My Child": A Feasibility Study With Caregivers of Children With Special Healthcare Needs Using Voice Interaction and Automatic Speech Recognition in Remote Care Management. Front Public Health 2022; 10:849322. [PMID: 35309210 PMCID: PMC8927637 DOI: 10.3389/fpubh.2022.849322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background About 23% of households in the United States have at least one child who has special healthcare needs. As most care activities occur at home, there is often a disconnect and lack of communication between families, home care nurses, and healthcare providers. Digital health technologies may help bridge this gap. Objective We conducted a pre-post study with a voice-enabled medical note taking (diary) app (SpeakHealth) in a real world setting with caregivers (parents, family members) of children with special healthcare needs (CSHCN) to understand feasibility of voice interaction and automatic speech recognition (ASR) for medical note taking at home. Methods In total, 41 parents of CSHCN were recruited. Participants completed a pre-study survey collecting demographic details, technology and care management preferences. Out of 41, 24 participants completed the study, using the app for 2 weeks and completing an exit survey. The app facilitated caregiver note-taking using voice interaction and ASR. An exit survey was conducted to collect feedback on technology adoption and changes in technology preferences in care management. We assessed the feasibility of the app by descriptively analyzing survey responses and user data following the key focus areas of acceptability, demand, implementation and integration, adaptation and expansion. In addition, perceived effectiveness of the app was assessed by comparing perceived changes in mobile app preferences among participants. In addition, the voice data, notes, and transcriptions were descriptively analyzed for understanding the feasibility of the app. Results The majority of the recruited parents were 35–44 years old (22, 53.7%), part of a two-parent household (30, 73.2%), white (37, 90.2%), had more than one child (31, 75.6%), lived in Ohio (37, 90.2%), used mobile health apps, mobile note taking apps or calendar apps (28, 68.3%) and patient portal apps (22, 53.7%) to track symptoms and health events at home. Caregivers had experience with voice technology as well (32, 78%). Among those completed the post-study survey (in Likert Scale 1–5), ~80% of the caregivers agreed or strongly agreed that using the app would enhance their performance in completing tasks (perceived usefulness; mean = 3.4, SD = 0.8), the app is free of effort (perceived ease of use; mean = 3.2, SD = 0.9), and they would use the app in the future (behavioral intention; mean = 3.1, SD = 0.9). In total, 88 voice interactive patient notes were generated with the majority of the voice recordings being less than 20 s in length (66%). Most noted symptoms and conditions, medications, treatment and therapies, and patient behaviors. More than half of the caregivers reported that voice interaction with the app and using transcribed notes positively changed their preference of technology to use and methods for tracking symptoms and health events at home. Conclusions Our findings suggested that voice interaction and ASR use in mobile apps are feasible and effective in keeping track of symptoms and health events at home. Future work is suggested toward using integrated and intelligent systems with voice interactions with broader populations.
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Affiliation(s)
- Emre Sezgin
- Information Technology Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Brannon Oiler
- Information Technology Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Brandon Abbott
- Information Technology Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Garey Noritz
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, United States
| | - Yungui Huang
- Information Technology Research and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
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Van Cleave J, Taft K, Ware A, Stille C. Assessing and Addressing Social Determinants of Health Among Children and Youth With Special Health Care Needs. Acad Pediatr 2022; 22:S28-33. [PMID: 35248245 DOI: 10.1016/j.acap.2021.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/25/2021] [Accepted: 07/01/2021] [Indexed: 01/04/2023]
Abstract
Over several decades, a field of research has emerged to examine social and environmental factors that contribute to health inequities among children and youth with special healthcare needs (CYSHCN), with the goal of reducing inequities through identifying and mitigating these social determinants of health (SDH). The Children and Youth with Special Healthcare Needs National Research Network (CYSHCNet) national research agenda development process, described in a companion article, recognized SDH, as experienced by CYSHCN, and the effects on health inequity and child and family outcomes as a high priority area. Important gaps named included which strategies best identify and mitigate the effects of negative SDH and which outcomes are most meaningful to families receiving SDH-focused interventions. In this area, the highest priority questions were the following: 1) How can SDH be routinely addressed in the course of care for CYSHCN? 2) Which interventions most effectively integrate SDH to improve child and family outcomes? Here, we discuss the impact of SDH on CYSHCN, efforts to screen for and intervene upon SDH in this population, and gaps in the current research on SDH specific to CYSHCN. We make several recommendations for research studies that will move the field forward. This work should achieve a greater understanding of patterns and impacts of SDH experienced by CYSHCN. It will also contribute to optimizing identification of SDH and improving interventions to achieve equity in health outcomes identified by patients and families as important to them.
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Wiener RC, Bhandari R. Association between adverse childhood experiences among children with special healthcare needs and dental care utilization. J Public Health Dent 2022; 82:194-203. [PMID: 33751582 PMCID: PMC8426408 DOI: 10.1111/jphd.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/09/2021] [Accepted: 02/25/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) often have consequences beyond the immediacy of any specific event. The purpose of this study is to identify if ACEs in children with special healthcare needs (CSHCN) are associated with oral problems and dental care utilization. METHODS The data source for this cross-sectional, secondary data analysis study was the 2017-2018 National Survey of Children's Health. Children were categorized as CSHCN or children with no special healthcare needs (CNSHCN) who had no, 1, 2, or ≥3 ACEs. Rho-Scott Chi-Square tests and bivariate and multivariable logistic regression analyses were conducted. RESULTS CSHCN who have had 1, 2, or ≥3 ACEs were significantly more likely to have had an oral problem or dental caries within the previous year as compared with CNSHCN who did not have any ACE. For no dental visits for any reason and no preventive visits, CSHCN at all levels of ACE were not significantly different from CNSHCN and no ACE in adjusted analyses. However, CNSHCN who had ≥3 ACEs were significantly more likely to not have had a preventive dental or any dental visit within the previous year. CONCLUSIONS In this nationally representative study of children and adolescents in the United States, CSHCN who have had ACE were more likely to have oral health problems within the previous year as compared with CNSHCN who did not have ACE.
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Affiliation(s)
- R. Constance Wiener
- Department of Dental Practice and Rural Health, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Ruchi Bhandari
- Department of Epidemiology, School of Public Health, Robert C Byrd Health Sciences Center, West Virginia University, Morgantown, WV, USA
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Geweniger A, Barth M, Haddad AD, Högl H, Insan S, Mund A, Langer T. Impact of the COVID-19 Pandemic on Mental Health Outcomes of Healthy Children, Children With Special Health Care Needs and Their Caregivers-Results of a Cross-Sectional Study. Front Pediatr 2022; 10:759066. [PMID: 35223688 PMCID: PMC8866820 DOI: 10.3389/fped.2022.759066] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/18/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Several studies have described widening inequalities as a result of the COVID-19 pandemic, mostly for adult populations. Children and adolescents are particularly impacted by the indirect effects of the pandemic and lockdown measures, such as reduced access to or delays in health care and school closures. National surveys in several countries also show a rising mental health burden in children and adolescents during the COVID-19 pandemic. Children with special health care needs are a particularly vulnerable group in this context as they rely on a wide range of services, which were mostly suspended during the first wave of the pandemic. This study aims: (1) to describe the mental health outcomes of children with and without special healthcare needs and of their caregivers following the first national lockdown in Germany; (2) to investigate variations in mental health outcomes and measures of pandemic burden according to socioeconomic status; (3) to assess the impact of socioeconomic status, disease complexity and psychosocial burden on parent-reported child mental health problems. METHODS We conducted an online survey among 1,619 caregivers of children aged 1-18 years from August 11th until October 5th 2020. Participants were recruited both from families of children with special healthcare needs and of healthy children. Inequalities were analysed by descriptive statistics, simple and hierarchical logistic regression modelling to explore the association between socioeconomic status and psychological outcome measures, disease complexity and general burden related to COVID-19. RESULTS There was a high prevalence of 57.4% of parent-reported mental health problems in children and of a positive screening score for depression in 30.9% of parents. Parent-reported mental health problems were more likely to affect children with low socioeconomic status, with complex chronic disease and those whose parents screened positive for depression. CONCLUSIONS This study highlights inequalities in parent-reported child mental health outcomes by socioeconomic status and disease complexity in a large sample of German families with and without children with special health care needs. Political measures should put children at the centre and aim to mitigate the unequal impact of the COVID-19 pandemic, particularly on the mental health of vulnerable children.
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Affiliation(s)
- Anne Geweniger
- Center for Pediatrics, Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
| | - Michael Barth
- Center for Pediatrics, Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Anneke D Haddad
- Center for Pediatrics, Department of General Pediatrics, Adolescent Medicine and Neonatology, Medical Center - University of Freiburg, Freiburg, Germany
| | | | - Shrabon Insan
- Center for Pediatrics, Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
| | | | - Thorsten Langer
- Center for Pediatrics, Department of Neuropediatrics and Muscle Disorders, Medical Center - University of Freiburg, Freiburg, Germany
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Kikuhara M, Hirakami K, Tamasaki A, Maegaki Y, Hanaki K. The process by which mothers of children with special healthcare needs evolve their connections with the community. Nurs Health Sci 2021; 23:957-966. [PMID: 34689418 DOI: 10.1111/nhs.12887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/29/2022]
Abstract
Mothers of children with special healthcare needs often face many extra difficulties, such as being isolated in the community. This study, conducted in the San'in region of Japan between December 2017 and February 2019, aimed to clarify how the mothers established and adapted their connections within their communities through a qualitative descriptive design study. Participants were 12 mothers caring for children with special healthcare needs. Verbatim data on adapting to life after hospital discharge was collected through interviews and analyzed by the modified grounded theory approach. The data generated 14 concepts, which were grouped into four categories, as follows: Difficulties in life that arise from caring for children in social isolation; gaining an objective view of the current situation and future of caring for children with special healthcare needs; collaboration based on the understanding of relationships with others; and feeling fulfilled in life. These describe four phases that the mothers went through which are similar to each stage of the transition theory. Providing support via a collaborative partnership may be effective for mothers experiencing anxiety during the transition stages.
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Affiliation(s)
- Mio Kikuhara
- School of Health Science, Faculty of Medicine, Tottori University, Tottori, Japan.,Division of Nursing, National Defense Medical College, Saitama, Japan
| | - Kumiko Hirakami
- Department of Nursing, Himeji Dokkyo University, Himeji, Japan
| | - Akiko Tamasaki
- Hakuai Child Development, Home Care Support Clinic, Tottori, Japan
| | - Yoshihiro Maegaki
- Division of Child Neurology, Brain and Neuroscience, Faculty of Medicine, Tottori University, Tottori, Japan
| | - Keiichi Hanaki
- School of Health Science, Faculty of Medicine, Tottori University, Tottori, Japan
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Roesler M, Obst B. Hidden Devices in the School Setting: What the School Nurse Needs to Know About Vagus Nerve Stimulation. NASN Sch Nurse 2019; 34:257-261. [PMID: 30920895 DOI: 10.1177/1942602x19836439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The Specialized Health Needs Interagency Collaboration (SHNIC) program at the Kennedy Krieger Institute is a community-based program that provides on-site training and technical assistance to safely manage the integration of children with special health needs into educational and community settings. SHNIC frequently receives seizure education requests throughout the school year, specifically regarding vagus nerve stimulation. Vagus nerve stimulation involves an implanted medical device used to deliver electrical pulses to the vagus nerve for additional seizure management. The school nurse needs to understand the purpose and function of the hidden medical device, including the parameters for use of the device and magnet, safety considerations, and side effects. SHNIC has developed educational materials specific to vagus nerve stimulation to aid the school nurse in providing staff training, developing care plans, and creating a safe school experience for students with special health needs.
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Affiliation(s)
- Megan Roesler
- Nurse Educator, Kennedy Krieger Institute, Baltimore, MD
| | - Barbara Obst
- SHNIC Program Coordinator, Kennedy Krieger Institute, Baltimore, MD
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Boone KM, Nelin MA, Chisolm DJ, Keim SA. Gaps and Factors Related to Receipt of Care within a Medical Home for Toddlers Born Preterm. J Pediatr 2019; 207:161-168.e1. [PMID: 30579584 PMCID: PMC6440840 DOI: 10.1016/j.jpeds.2018.10.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/10/2018] [Accepted: 10/30/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To characterize gaps and factors related to receipt of care within a medical home for toddlers born preterm. STUDY DESIGN Participants were 202 caregivers of children born at <35 weeks of gestation. At 10-16 months of corrected age, caregivers completed the National Survey of Children's Health (2011/2012) medical home module and a sociodemographic profile. Care within a medical home comprised having a personal doctor/nurse, a usual place for care, effective care coordination, family-centered care, and getting referrals when needed. Gestational age and neonatal follow-up clinic attendance were abstracted from the medical record. The Bayley Scales of Infant and Toddler Development, Third Edition assessed developmental status. Log-binomial regression examined factors related to receiving care within a medical home. RESULTS Fifty-three percent (n = 107) of the children received care within a medical home. Low socioeconomic status (young caregiver: risk ratio [RR] = 0.73; 95% CI 0.55, 0.97; low education: RR= 0.69; 95% CI 0.49, 0.98) and delayed language (RR = 0.63; 95% CI 0.42, 0.95) were associated with a lower likelihood of receiving care within a medical home. Degree of prematurity and neonatal clinic follow-up participation were unrelated to receipt of care within a medical home. CONCLUSIONS Receipt of care within a medical home was lacking for nearly one-half of preterm toddlers, especially those with lower socioeconomic status and poorer developmental status. Discharge from a neonatal intensive care unit may be an optimal time to facilitate access to a primary care medical home and establish continuity of care. TRIAL REGISTRATION ClinicalTrials.gov: NCT01576783.
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Affiliation(s)
- Kelly M Boone
- Schoenbaum Family Center and Crane Center for Early Childhood Research and Policy, The Ohio State University, Columbus, OH.
| | - Mary Ann Nelin
- Nationwide Children's Hospital, Columbus, OH; Division of Ambulatory Medicine, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Deena J Chisolm
- Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH; Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH
| | - Sarah A Keim
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH; Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Division of Epidemiology, College of Public Health, The Ohio State University; Columbus, OH
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DeGuzman P, Altrui P, Doede AL, Allen M, Deagle C, Keim-Malpass J. Using Geospatial Analysis to Determine Access Gaps Among Children with Special Healthcare Needs. Health Equity 2018; 2:1-4. [PMID: 30283844 PMCID: PMC6071900 DOI: 10.1089/heq.2017.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose: To examine geospatial gaps in identification and evaluation of children with special healthcare needs (CSHCN) within public child development centers (CDCs). Methods: A descriptive geospatial design was used to visually depict service gaps, proximity, and clustering of area-level sociodemographic attributes of Virginia counties, and patient-level data within each CDC. Results: Geospatial analysis shows population density of uninsured children against CDC resources. Data visualization facilitates policy advocacy based on the identification of care and screening gaps for CSHCN. Conclusion: This project illustrates the collaborative potential between researchers and Health Department members to identify gaps in access to care.
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Affiliation(s)
- Pamela DeGuzman
- School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Paige Altrui
- School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Aubrey L Doede
- School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Marcus Allen
- Children and Youth with Special Health Care Needs, Virginia Department of Health, Richmond, Virginia
| | - Cornelia Deagle
- Division of Child and Family Health, Virginia Department of Health, Richmond, Virginia
| | - Jessica Keim-Malpass
- School of Nursing, University of Virginia, Charlottesville, Virginia.,Department of Pediatrics, School of Medicine, University of Virginia, Charlottesville, Virginia
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15
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Lebrun-Harris LA, Parasuraman SR, Desrocher R. Prevalence of Brain Injuries among Children with Special Healthcare Needs. J Pediatr 2018; 200:125-131. [PMID: 29885754 DOI: 10.1016/j.jpeds.2018.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/23/2018] [Accepted: 05/08/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To investigate differences in brain injury prevalence among US children by special healthcare needs status, accounting for sociodemographic and family characteristics, and to examine correlated health conditions among children with special healthcare needs (CSHCN). STUDY DESIGN We conducted cross-sectional analyses using parent/caregiver responses to the 2016 National Survey of Children's Health (n = 50 212 children). CSHCN status was based on responses to a 5-item tool designed to identify children through assessment of functional limitations, prescription medication use, elevated service use or need, use of specialized therapies, and ongoing emotional, developmental, or behavioral conditions. Brain injury history was reported by parents/caregivers based on healthcare provider diagnosis. Bivariate and multivariable analyses were conducted. RESULTS Lifetime history of brain injury was significantly higher among CSHCN than non-CSHCN (6.7% vs 2.3%, P < .001). CSHCN make up 19% of the total US child population but comprise 42% of children with lifetime brain injuries. In addition, the prevalence of a number of comorbid conditions and functional limitations was significantly higher among CSHCN with lifetime brain injury vs those without brain injury. CONCLUSIONS The prevalence of lifetime history of brain injury is nearly 3 times greater among CSHCN than among non-CSHCN. Several comorbid conditions among CSHCN are significantly associated with lifetime history of brain injury. Further studies are needed to examine the extent to which brain injury in CSHCN may exacerbate or be misdiagnosed as other comorbid conditions.
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Affiliation(s)
- Lydie A Lebrun-Harris
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD
| | - Sarika Rane Parasuraman
- Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD.
| | - Rebecca Desrocher
- Bureau of Health Workforce, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, MD
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16
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Whitmore KE, Snethen J. Respite care services for children with special healthcare needs: Parental perceptions. J SPEC PEDIATR NURS 2018; 23:e12217. [PMID: 29697186 PMCID: PMC6202162 DOI: 10.1111/jspn.12217] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/28/2018] [Accepted: 03/30/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Parents of children with special healthcare needs may become overwhelmed with the ongoing caregiving needs of their children. Caring for a child with special healthcare needs is often challenging, requiring specialized training in many cases. As a result, parents can struggle to find qualified caregivers capable of providing them a break from the 24/7 care of their child. Respite care programs are designed to provide caregivers with a much-needed temporary break. The purpose of this study was to examine parental perceptions of utilizing a respite care program. DESIGN AND METHODS Twenty-two parents who had a child with special healthcare needs who attended a Midwestern respite care program completed a Participant Characteristic Form addressing their experiences caring for their child with special healthcare needs and using respite care services. Parents participated in a focus group (N = 4) to explore their perceptions and experiences of respite care participation. Multistage thematic analysis and descriptive statistics were used to analyze the data. RESULTS Themes emerging from the data included: Constant care demands; It is just so stressful; Respite is a gift, we get a break; Respite program "fit"; and Respite is their special time too. Parents emphasized the benefits of respite care for their marital relationship, as well as the benefits to the children with special healthcare needs and their siblings. Parents also described the importance of tailoring respite care to the unique needs of their family. PRACTICE IMPLICATIONS Nurses and other healthcare professionals play a critical role in addressing the unmet respite care needs of parents of children with special healthcare needs by identifying unmet needs and making appropriate referrals to services that will meet the unique needs of the family. Healthcare professionals can also volunteer with existing programs to help expand access to respite care services and increase the availability of adequately trained respite care providers whom parents can trust to provide for the complex healthcare needs of their children.
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Affiliation(s)
- Kim E Whitmore
- Assistant Professor, School of Nursing, University of Wisconsin-Madison, Madison, WI, USA
| | - Julia Snethen
- Associate Professor, College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Nugent J, Gorman G, Erdie-Lalena CR. Disparities in Access to Healthcare Transition Services for Adolescents with Down Syndrome. J Pediatr 2018; 197:214-20. [PMID: 29571933 DOI: 10.1016/j.jpeds.2018.01.072] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/26/2017] [Accepted: 01/26/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To compare healthcare transition planning in adolescents with Down syndrome with adolescents with other special healthcare needs. STUDY DESIGN Data were drawn from the 2009-2010 National Survey of Children with Special Health Care Needs, a nationally representative sample with 17 114 adolescents aged 12-17 years. Parents were asked whether providers and the study child had discussed shifting to an adult provider, changing healthcare needs, maintaining health insurance coverage, and taking responsibility for self-care. The transition core outcome was a composite measure based on the results of these 4 questions. Multivariable logistic regression determined the association between Down syndrome and the transition core outcome as well as each of the 4 individual component measures. RESULTS Although 40% of adolescents with other special healthcare needs met the transition core outcome, 11.0% of adolescents with Down syndrome met this outcome. Adolescents with Down syndrome were less likely to be encouraged to take responsibility for their health (32.2% vs 78.4%). After adjustment for demographic, socioeconomic, and health-related factors, adolescents with Down syndrome had 4 times the odds of not meeting the transition core outcome. For the component measures, Down syndrome adolescents had 4 times the odds of not being encouraged to take responsibility for self-care. Medical home access increased the odds of transition preparation. CONCLUSIONS Adolescents with Down syndrome experience disparities in access to transition services. Provider goals for adolescents with Down syndrome should encourage as much independence as possible in their personal care and social lives.
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Hart LC, Pollock M, Hill S, Maslow G. Association of Transition Readiness to Intentional Self-Regulation and Hopeful Future Expectations in Youth With Illness. Acad Pediatr 2017; 17:450-455. [PMID: 27979748 DOI: 10.1016/j.acap.2016.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 12/04/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about how transition readiness relates to other developmental skills of adolescence in youth with chronic illness. Better understanding of how transition readiness relates to these other developmental skills could lead to a broader array of tools to improve transition readiness. Intentional self-regulation (ISR) and hopeful future expectations (HFE) are 2 developmental skills of adolescence that improve with participation in developmental programming and thus are modifiable. METHODS We explored associations between transition readiness, as measured by the Transition Readiness Assessment Questionnaire 29 (TRAQ-29) and ISR and HFE in youth with chronic illness recruited from a variety of subspecialty clinics from a major southeast medical center. RESULTS A total of 71 adolescents with chronic illness were included in the analysis. The TRAQ-29 Self-Advocacy domain showed positive associations to both ISR (P = .03) and HFE (P = .009). In addition, the TRAQ-29 overall had positive associations to HFE (P = .04). CONCLUSIONS The significant associations between TRAQ-29 Self-Advocacy domain scores and ISR and HFE suggest that transition readiness is developing within the context of other developmental areas in adolescence. More work is needed to see if the programming that improves these other developmental skills might also improve transition readiness.
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Affiliation(s)
- Laura C Hart
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | | | - Sherika Hill
- Center for Developmental Epidemiology, Duke University, Durham, NC
| | - Gary Maslow
- Duke University School of Medicine, Durham, NC
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Rice CE, Zablotsky B, Avila RM, Colpe LJ, Schieve LA, Pringle B, Blumberg SJ. Reported Wandering Behavior among Children with Autism Spectrum Disorder and/or Intellectual Disability. J Pediatr 2016; 174:232-239.e2. [PMID: 27157446 PMCID: PMC4983701 DOI: 10.1016/j.jpeds.2016.03.047] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 01/15/2016] [Accepted: 03/21/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To characterize wandering, or elopement, among children with autism spectrum disorder (ASD) and intellectual disability. STUDY DESIGN Questions on wandering in the previous year were asked of parents of children with ASD with and without intellectual disability and children with intellectual disability without ASD as part of the 2011 Survey of Pathways to Diagnosis and Services. The Pathways study sample was drawn from the much larger National Survey of Children with Special Health Care Needs conducted in 2009-2010. RESULTS For children with special healthcare needs diagnosed with either ASD, intellectual disability, or both, wandering or becoming lost during the previous year was reported for more than 1 in 4 children. Wandering was highest among children with ASD with intellectual disability (37.7%) followed by children with ASD without intellectual disability (32.7%), and then children with intellectual disability without ASD (23.7%), though the differences between these groups were not statistically significant. CONCLUSIONS This study affirms that wandering among children with ASD, regardless of intellectual disability status, is relatively common. However, wandering or becoming lost in the past year was also reported for many children with intellectual disability, indicating the need to broaden our understanding of this safety issue to other developmental disabilities.
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Affiliation(s)
- Catherine E Rice
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.
| | - Benjamin Zablotsky
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Rosa M Avila
- University of Washington, School of Public Health, Seattle, WA
| | - Lisa J Colpe
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Beverly Pringle
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Stephen J Blumberg
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
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DeJong NA, Wood CT, Morreale MC, Ellis C, Davis D, Fernandez J, Steiner MJ. Identifying Social Determinants of Health and Legal Needs for Children With Special Health Care Needs. Clin Pediatr (Phila) 2016; 55:272-7. [PMID: 26130392 DOI: 10.1177/0009922815591959] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children with special health care needs (CSHCN) require comprehensive care with high levels of community and government assistance. Medical-legal partnerships may be particularly suited to address needs for this population. To explore this, we conducted in-depth telephone interviews of families of CSHCN cared for in the primary care practice of our tertiary care children's hospital. The majority of the sample (N = 46) had been late on housing payments and 17% of homeowners had been threatened with foreclosure. Families frequently reported denial of public benefits. Approximately 10% had executed advance planning documents such as guardianship plans for the children or wills for the parents. A minority of families had sought help from community agencies or lawyers. Less than one third had ever discussed any of the issues with health care providers, but two thirds were likely or very likely to in the future. CSHCN may especially benefit from the social support of a medical-legal partnership.
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Affiliation(s)
- Neal A DeJong
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Charles T Wood
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | | | - Darragh Davis
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | | | - Michael J Steiner
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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21
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Goodhue CJ, Demeter NE, Burke RV, Toor KT, Upperman JS, Merritt RJ. Mixed-Methods Pilot Study: Disaster Preparedness of Families With Children Followed in an Intestinal Rehabilitation Clinic. Nutr Clin Pract 2015; 31:257-65. [PMID: 26449891 DOI: 10.1177/0884533615605828] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Children with special healthcare needs are a vulnerable population in disasters. Special-needs families tend to be less prepared for a disaster than the general public. The purpose of this pilot project was to examine the disaster preparedness levels of families in an intestinal rehabilitation (IR) clinic. MATERIALS AND METHODS We administered an anonymous survey to a convenience sample of IR clinic families and conducted 2 focus groups. Descriptive analyses were used for survey data; Atlas.ti was used to analyze focus group data. RESULTS Survey findings revealed that 69% of families lacked an emergency supply kit, and 93% did not have a clinician-completed emergency information form. On a scale of 1-10, the mean confidence in their family's disaster preparations was 4.9. The overarching theme from focus group discussions was challenges and/or barriers to disaster preparedness. CONCLUSION IR clinic families are generally unprepared for a disaster. These findings are highly relevant to our goal of developing a disaster survival toolkit for the IR families. Toolkits are being distributed in the IR clinic.
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Affiliation(s)
- Catherine J Goodhue
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Natalie E Demeter
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Rita V Burke
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California Keck School of Medicine, University of Southern California, California
| | - Khadija T Toor
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, California
| | - Jeffrey S Upperman
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, California Keck School of Medicine, University of Southern California, California
| | - Russell J Merritt
- Keck School of Medicine, University of Southern California, California Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, California
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22
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Webb L, Shah PK, Harisiades JP, Boudos R, Agrawal R. Health care transition from pediatric care to adult care: opportunities and challenges under the Affordable Care Act. J Pediatr Rehabil Med 2015; 8:53-64. [PMID: 25737348 DOI: 10.3233/prm-150318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Enrollment of young adults is foundational to the success of the Affordable Care Act (ACA). This article analyzes the implications for young adults transitioning from pediatric to adult care with the implementation of the ACA. We review the key characteristics of this population relevant to health care utilization and access as well as the impact of private insurance market reforms, health insurance marketplaces, Medicaid expansion, and workforce development provisions on this population. We then analyze how reform is impacting and will continue to impact specific populations of young adults, including individuals with disabilities, college students, immigrants, young adults who age out of the foster care system and individuals involved with the criminal justice system. Finally, we look at the socio-economic and political factors influencing outreach efforts, and make recommendations to maximize the benefits of the law for young adults to empower them to have access to care and financial security.
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Affiliation(s)
- Lauren Webb
- School of Social Services Administration, University of Chicago, Chicago, IL, USA Ann & Robert H. Lurie Children's Hospital of Chicago, Neuromuscular Program, Chicago, IL, USA
| | - Parag K Shah
- Ann & Robert H. Lurie Children's Hospital of Chicago, Transition Program, Chicago, IL, USA Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James P Harisiades
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA Office of Child Advocacy, Chicago, IL, USA
| | - Rebecca Boudos
- Ann & Robert H. Lurie Children's Hospital of Chicago, Transition Program, Chicago, IL, USA Department of Family Services, Chicago, IL, USA
| | - Rishi Agrawal
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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Adams S, Cohen E, Mahant S, Friedman JN, MacCulloch R, Nicholas DB. Exploring the usefulness of comprehensive care plans for children with medical complexity (CMC): a qualitative study. BMC Pediatr 2013; 13:10. [PMID: 23331710 PMCID: PMC3570291 DOI: 10.1186/1471-2431-13-10] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 01/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Medical Home model recommends that Children with Special Health Care Needs (CSHCN) receive a medical care plan, outlining the child's major medical issues and care needs to assist with care coordination. While care plans are a primary component of effective care coordination, the creation and maintenance of care plans is time, labor, and cost intensive, and the desired content of the care plan has not been studied. The purpose of this qualitative study was to understand the usefulness and desired content of comprehensive care plans by exploring the perceptions of parents and health care providers (HCPs) of children with medical complexity (CMC). METHODS This qualitative study utilized in-depth semi-structured interviews and focus groups. HCPs (n = 15) and parents (n = 15) of CMC who had all used a comprehensive care plan were recruited from a tertiary pediatric academic health sciences center. Themes were identified through grounded theory analysis of interview and focus group data. RESULTS A multi-dimensional model of perceived care plan usefulness emerged. The model highlights three integral aspects of the care plan: care plan characteristics, activating factors and perceived outcomes of using a care plan. Care plans were perceived as a useful tool that centralized and focused the care of the child. Care plans were reported to flatten the hierarchical relationship between HCPs and parents, resulting in enhanced reciprocal information exchange and strengthened relationships. Participants expressed that a standardized template that is family-centered and includes content relevant to both the medical and social needs of the child is beneficial when integrated into overall care planning and delivery for CMC. CONCLUSIONS Care plans are perceived to be a useful tool to both health care providers and parents of CMC. These findings inform the utility and development of a comprehensive care plan template as well as a model of how and when to best utilize care plans within family-centered models of care.
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Affiliation(s)
- Sherri Adams
- Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, Ontario, M5T 1P8, Canada
| | - Eyal Cohen
- Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, University of Toronto, 1 King’s College Circle, Toronto, Ontario, M5S 1A8, Canada
- Department of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T 3M6, Canada
- CanChild Center for Childhood Disability Research, 1400 Main Street West, Room 408, Hamilton, Ontario, L8S 1C7, Canada
| | - Sanjay Mahant
- Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, University of Toronto, 1 King’s College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Jeremy N Friedman
- Division of Paediatric Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Department of Paediatrics, University of Toronto, 1 King’s College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Radha MacCulloch
- School of Social Work, McGill, University of Montreal, 3506 University Street, Montreal, Quebec, H3A 2A7, Canada
| | - David B Nicholas
- Faculty of Social Work, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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