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Purpose -- The purpose of this paper is to explore perceptions of family-to-family (F2F) information centres by health care providers serving Hispanic and African American families of children with special healthcare needs (CSHCN) and how that information can be used to enhance effective collaboration to address disparities in access to services. Design/methodology/approach -- In this second phase of a formative, qualitative multi-phase, collaborative study by a university centre and three F2Fs to develop strategies to increase the use of their centres by Hispanic and African American populations, the authors report the results of key informant interviews with healthcare providers serving the African American and Hispanic families who participated in focus groups at the three centres. Findings -- Healthcare providers reported that F2Fs play a unique role in providing families support and skills to advocate within systems. However, barriers to healthcare providers recommending F2Fs to families include a lack of knowledge about the specific services provided, the need for face-to-face contact to feel comfortable making a referral and a lack of a formalised referral and feedback process that is in line with their experiences in the medical services system. Practical implications -- F2Fs can increase use of their centres by African American and Hispanic families through provider referrals by: promoting specific services and supports they offer families, rather than describing their programmes; promoting how they can help providers with the care coordination functions that are time consuming; offering providers training opportunities; and developing processes for referrals that include feedback to providers. Originality/value -- There are no studies that currently address strengthening the collaboration between medical homes and F2F centres to improve care coordination, access to information and receiving needed services for Hispanic and African American CSHCN and their families. Understanding how healthcare providers serving Hispanic and African American CSHCN perceive F2Fs and currently work with them will enhance this collaboration. [ABSTRACT FROM AUTHOR]

Background: A decline in cognitive test scores in elderly persons can signal the beginning of a descent into dementia or may indicate only a short-term cognitive disturbance. It would be clinically useful to distinguish between the two outcomes and to identify characteristics of each., Methods: Four hundred thirty-seven community-dwelling elderly persons were given the Mini-Mental State Examination (MMSE) annually for an average of 7 years. A low score between baseline and final MMSE was identified. A low score 3 or more points lower than baseline score indicated cognitive decline. This decline was called persistent if the final MMSE score was also at least 3 points lower than baseline MMSE score; otherwise, the decline was considered transient., Results: Twenty participants (4.6%) experienced a persistent cognitive decline, 67 participants (15.3%) experienced a transient cognitive decline. Presence of the apolipoprotein epsilon4 allele was significantly associated with persistent cognitive decline (age-adjusted odd ratio [OR] = 11.46, p < .0001) but not with transient cognitive decline (age-adjusted OR = 1.53, p = .219). Incorrect answers on the orientation part of the MMSE at the time of cognitive decline was associated with persistent decline compared to transient decline (age-adjusted OR = 3.58, p = .058)., Conclusions: Persistent cognitive decline is an infrequent occurrence in community-dwelling elderly persons. Presence of the epsilon4 allele and errors made by the subject on questions of orientation may be useful in determining whether a cognitive decline is likely to be persistent.