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OBJECTIVE: To implement comprehensive screening for child behavior and social determinants of health in an urban pediatric practice, and explore rates of referrals, and follow-up for positive screens. METHOD: Quality improvement (QI) methodology was used to implement routine screening using an adapted version of the Survey of Well Being of Young Children (SWYC), a child behavior and social screen, for all children ages 6 months to 10 years. Rates of screen administration and documentation were assessed for 18 months. Medical records of a convenience sample (N=349) were reviewed to track referrals and follow-up for positive screens. A secondary analysis explored associations between reported parental concern for their child’s behavior, and both child behavior symptoms and social stressors. RESULTS: Over 18 months, 2,028 screens were administered. Screening rates reached 90% after introducing a tablet for screening. Provider documentation of screens averaged 62%. In the convenience sample, 28% scored positive for a behavioral problem, and 25% reported at least one social stressor. Of those with positive child behavior or social stressor screens, approximately 80% followed up with their primary medical doctor, and approximately 50% completed referrals to the clinic social worker. Further analysis indicated that referral and follow up rates varied depending on whether the family identified child behavior or social issues. Logistic regression revealed that parental concern was independently associated with child behavior symptoms (p=0.001) and social stressors (p=0.002). CONCLUSION: Implementing a comprehensive psycho-social screen is feasible in pediatric primary care, and may help target referrals to address psycho-social health needs.

Schools experience barriers when implementing wellness policies, and there is a dearth of research detailing how district wellness policies are implemented at the school level. Wellness councils were established in 7 elementary schools in Harlem and Washington Heights, New York City (NYC), to help these schools implement the NYC district wellness policy. Data on 4 wellness council process indicators and wellness council self-evaluation scores were correlated with obesity prevention process outcomes using Kendall tau correlations. An average of 8.9 (standard deviation = 0.7) wellness council meetings were held per school throughout the 10-month academic year. The average attendance at each meeting ranged from 7.1 to 15.2 members. There was a positive relationship between wellness council attendance and the number of participant encounters at staff physical activity events ( r = .71, P = .02). Higher self-evaluation scores on staff wellness initiatives were associated with more student nutrition encounters ( r = .69, P = .04) and in-class student physical activity minutes ( r = .69, P = .04). The wellness councils served as a forum for regular interaction between health professionals and school staff and allowed for evidence-based interventions to be adapted to local school needs and culture. School staff engagement is important for successful obesity prevention initiatives and should be a goal of school-based wellness programs.

Many school-age children in the United States with social, emotional, and behavioral problems do not receive mental health services. These problems negatively affect their social and behavioral functioning and academic achievement. This is particularly a problem for Latino youths, who represent the largest ethnic minority group in the United States and the largest group with unmet need for mental health services. School-based mental health promotion and prevention programs (SBMH-PPs) can mitigate such problems. This article describes such a program, located in an underserved area of northern Manhattan, New York City. A study was conducted to examine the effects of this SBMH-PP, which served 174 predominantly Latino at-risk students from two urban elementary schools during the 2008-2009 school year. Pre and post teacher reports, attendance rates, and academic scores were used to analyze the effects of the SBMH-PP on these students. RESULTS demonstrated increased prosocial behavior and classroom compliance, as well as improved academic achievement. Improvement was also found in attendance when compared with a control group of similar students not served by the program. The outcomes of this study provide further evidence for the effectiveness of SBMH-PPs that serve minority youths in elementary schools. Language: en

BackgroundParents exert a significant effect on children's eating behaviors and physical activity levels, so it is imperative to find successful obesity prevention programs that target whole families in underserved communities.PurposeTo investigate the effects of a Coordinated School Health Program (CSHP) on parents in the program over a 2-year period.MethodsParents of kindergarteners (n = 277) in 7 schools participating in a CSHP that served an underserved, predominantly minority community were surveyed at 3 time points regarding their nutrition and physical activity knowledge, attitudes, and behaviors (KABs). Results after years 1 and 2 were compared with pre-intervention results using t tests. Effects of socioeconomic variables were investigated using multivariate linear regression.ResultsReported unhealthy behaviors were lower at the end of both year 1 (P = .03) and year 2 (P = .04). Numerous factors were associated with changes in KABs in the parents, including parental gender.DiscussionA CSHP may ha...

BACKGROUND Turn 2 Us (T2U) is an elementary school-based mental health promotion and prevention program in New York City. It targets fourth- and fifth-grade students at risk for social/emotional and behavioral problems and provides a range of services to students, staff, and parents. The purpose of this study is to determine if T2U decreases internalizing and externalizing behaviors in participating students. METHODS Teachers measured students' symptoms before and after participation using the strengths and difficulties questionnaire (SDQ). Change in the total SDQ score was analyzed using Wilcoxon rank-sum nonparametric testing. We assessed the effects of covariates on the score change with linear regression models. RESULTS The 185 unique students who participated in the intervention showed a significant improvement in total SDQ score (Z = -4.107, p

Background: Obesity is a public health concern that disproportionately affects underserved and minority communities. Purpose: To evaluate whether a comprehensive obesity prevention program that targets children and school staff in an underserved Hispanic community affects obesity related knowledge, attitudes, and behaviors among both students and staff. Methods: Using a longitudinal design over 2 years we administered surveys to fourth-grade students (N = 184) and school staff (N = 99) from 7 elementary schools involved in a comprehensive obesity prevention program. In year 2, a control group of students and staff from a neighboring school completed the same surveys for comparison. Results: Over 2 years, students and school staff participating in the program reported improved nutrition knowledge and behavior, and school staff reported improved self-efficacy for physical activity and a trend toward increased physical activity. In year 2 student nutrition behaviors improved preferentially for intervention v...

Objectives To explore caregiver perceptions of, and barriers and facilitators to, their involvement in school-based obesity prevention programs in underserved Latino immigrant communities. Methods Focus groups discussions were conducted with caregivers (n = 42) at 7 elementary schools with an academic partnership-based obesity prevention program. Thematic analysis was used to identify key findings in the data. Results Caregivers described their role as (1) learners of new and often complex health information using their children as primary messengers and (2) champions within their homes in which healthier choices are assimilated. Barriers to involvement included lack of time, financial pressures, unhealthy family practices, and concern that attempts to engage peers would be perceived as intrusive. Facilitators included assurance that stigmatizing health issues would be addressed with sensitivity. Conclusions and Implications Caregiver involvement in obesity prevention may be fostered by transmitting information through children, addressing cultural barriers, and avoiding potentially stigmatizing approaches to delivering health messages.