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Psychoeducation, where clinicians teach problem-solving skills in a supportive environment, can help address families' social vulnerabilities and promote well-being. Group well-child care (GWCC) may provide unique opportunities for pediatric residents to improve their skills in psychoeducation. Our aim was to characterize pediatric residents' perspectives and experiences of communication while conducting both individual well-child care and GWCC. We used a longitudinal qualitative study design to conduct 15 semistructured interviews with five pediatric residents who facilitated GWCC. Using the constant comparative method, we characterized pediatric residents' perspectives and experiences of communication while conducting both individual well-child care and GWCC. Four themes emerged. Residents perceived that GWCC (i) enabled families to honestly share their knowledge and parenting practices, (ii) allowed time and a space for families to share personal stories and scenarios, (iii) facilitated discussions of maternal health and psychosocial matters, toward which residents felt ambivalence, and (iv) fostered skills in psychoeducation that transferred to the rest of their clinical practice. When pediatric residents lead GWCC, they perceive that they can facilitate key aspects of psychoeducation, enabling them to assist families in meeting complex social needs. Residents describe that they transfer psychoeducation skills learned in GWCC to the rest of their practice.

Parents of children with autism spectrum disorder (ASD) show increased levels of parenting stress, but only one study has examined this association before a diagnostic evaluation. We conducted a cross-sectional study of parenting stress in 317 low SES parents with children at-risk for ASD before a diagnostic evaluation. Multiple regression modeling evaluated the associations between parenting stress and parent and child factors. Parenting stress was negatively associated with social support and positively associated with active avoidance coping and parental worry. However, parenting stress was not associated with the child's ASD symptom severity or adaptive functioning, except for self-direction. Findings suggest parenting stress among parents of children at risk of ASD should be assessed prior to diagnosis. [This study was conducted in collaboration with the Developmental and Behavioral Pediatrics Research Network (DBPNet).]

Medical-legal partnerships (MLPs) support patients and clinicians by streamlining legal and medical care and helping identify and address a subset of social drivers of health (SDOH). Less is known on the effect of MLPs on the competency of residents regarding SDOH. The aim of this study was to identify how integration of an MLP into a pediatric residency training program affected residents' experience understanding and addressing SDOH. [ABSTRACT FROM AUTHOR]

Objective Alternative primary care structures such as group well-child care (GWCC) may enhance care for families, particularly those subject to structural vulnerabilities such as poverty or restrictive immigration policies. The purpose of this study was to characterize how group dynamics in GWCC impact the perceptions of low-income, immigrant, and/or Spanish-speaking parents of health services. Methods Using Spanish and English interview guides that were conceptually identical, we conducted semi-structured interviews with parents who elected to participate in GWCC at an urban academic center. We drew from directed content analysis, grounded theoretically in the Andersen model of health services utilization. Modeling a bilingual, multicultural analytic strategy, we preserved the narrative of participants in the source language through all stages of analysis. Results From March through August 2017, we interviewed 22 caregivers in their preferred language. Most (82%) were mothers and half spoke Spanish only. Three themes emerged: participants perceived that (1) GWCC facilitates their and their peers' discovery of inherent expertise, which moderates parents' use of health services, (2) GWCC encourages rearrangements of hierarchies of knowledge, professional roles and genders; and (3) in the context of structural vulnerabilities, relationships formed in GWCC facilitate collective efficacy. Conclusions for Practice By considering the self and peer as sources of health-related expertise, GWCC may extend current theoretical models of health services utilization. GWCC provides opportunities to impact health services utilization among families subject to structural vulnerabilities., Author(s): Benjamin J. Oldfield [sup.1] [sup.2] [sup.3] [sup.4] , Patricia F. Nogelo [sup.5] [sup.6] , Marietta Vázquez [sup.1] , Kimberly Ona Ayala [sup.1] , Ada M. Fenick [sup.1] , Marjorie [...]

Developmental screens are often used in nonstandardized conditions, such as pediatric waiting rooms, despite validation under standardized conditions. We examined the reproducibility of the Ages and Stages Questionnaire (ASQ), a developmental screening instrument commonly used in pediatric practices, under standardized versus nonstandardized conditions in an underserved population. English- or Spanish-speaking parents of 18- or 30-month-old children completed the ASQ in the waiting room and then were randomized to repeat the ASQ in waiting room (W-W) or standardized (W-S) conditions. We calculated ASQ fail rates and intraclass correlation coefficient, a measure of reliability, for each of the 5 domains of the ASQ. We hypothesized that intraclass correlation coefficients in the W-W condition would demonstrate greater reliability than in the W-S condition. A total of 131 parents were randomized (66 W-W, 65 W-S). Parents were mostly minority. Of the entire sample, 25.8% failed the first ASQ screen completed in the waiting room before randomization. There was no statistically significant difference in fail rates between study arms on the first or second screen. Intraclass correlation coefficient for W-W in the 5 domains ranged from 0.66 to 0.95, and for W-S from 0.73 to 0.92. There were no statistically significant differences between intraclass correlation coefficients in W-W versus W-S in any domain. In an underserved population, 25.8% of children failed the ASQ. The ASQ, when completed in the waiting room, is reliable compared with standardized conditions, indicating that the ASQ can be used to screen children for developmental delay in the waiting room of pediatric practices.

Asthma health disparities are widely recognized, with worse outcomes in children from low income families. In a Medical-Legal Partnership (MLP), an attorney is embedded in a healthcare setting to address social determinants of health. We studied whether an MLP could impact asthma exacerbation rates in a vulnerable urban population at an academic children's hospital. The study population comprised children with asthma who were referred to the MLP between 2013 and 2017. We compared healthcare utilization for asthma exacerbations managed in primary care, emergency department and inpatient settings in the year before and year after MLP intervention. 98 children with asthma were included in the study. The mean total encounters per person per year decreased from 1.16 to 0.66 (relative reduction 44.2%, p < 0.01). The largest effect was on hospitalizations, with a reduction from 0.33 to 0.10 hospitalizations per patient per year (relative reduction 69.7%, p < 0.01). Encounters for asthma exacerbations in the primary care office and emergency department also decreased but these changes did not meet statistical significance. In a pediatric population with asthma, an MLP intervention was associated with a significant reduction in asthma exacerbation encounters and hospitalizations comparing the year before and after MLP intervention. Further studies are needed to better understand which interventions are most effective, and for which patient groups MLP referral would be particularly useful. MLPs may be an important way to reduce health disparities in patients with asthma and other chronic illnesses. Management/control; pediatrics [ABSTRACT FROM AUTHOR]

Background: Physician burnout impacts all levels of medical education and has a relatively unknown impact on those responsible for medical student education, particularly in paediatrics. This study examines the prevalence of burnout among paediatric undergraduate medical educators and explores the impact of roles in medical education on medical educator burnout. Methods: This cross‐sectional mixed‐methods study utilised a binational survey of paediatricians involved in undergraduate medical education. Respondents answered demographics, standardised questions about burnout and attitudes towards students, and an open‐ended probe about interactions between medical student education and wellness. Findings: Of 445 possible, 120 (26.9%) responded to demographic and burnout questions. Of these, 23.3% endorsed burnout, 21.7% high emotional exhaustion (EE) and 10.8% high depersonalisation (DP). High levels of student‐related burnout symptoms were reported by fewer than 5% of respondents and were correlated with overall EE and DP. Content analysis revealed four emergent themes: positive effect of student‐related role, need to balance medical education and clinical roles, impact of protected time and medical education‐related autonomy on educator well‐being, and the burden of the administrative portion of educational roles. Discussion Participating paediatric educators had low rates of burnout compared with paediatricians as a whole in prior studies. The vast majority found working with students rewarding and described the overall positive impact of their medical education role on wellness. Conclusion: Physician involvement in rewarding non‐clinical activities may improve their overall well‐being. Providing dedicated time for these activities may ameliorate the difficulty that many medical educators described in balancing their clinical and educational roles. Future studies should continue to explore how we can better support medical educators and the impact of this support on burnout. [ABSTRACT FROM AUTHOR]

Background: Public health crises in primary care and psychiatry have prompted development of innovative, integrated care models, yet undergraduate medical education is not currently designed to prepare future physicians to work within such systems.Aim: To implement an integrated primary care-psychiatry clerkship for third-year medical students.Setting: Undergraduate medical education, amid institutional curriculum reform.Participants: Two hundred thirty-seven medical students participated in the clerkship in academic years 2015-2017.Program Description: Educators in psychiatry, internal medicine, and pediatrics developed a 12-week integrated Biopsychosocial Approach to Health (BAH)/Primary Care-Psychiatry Clerkship. The clerkship provides students clinical experience in primary care, psychiatry, and integrated care settings, and a longitudinal, integrated didactic series covering key areas of interface between the two disciplines.Program Evaluation: Students reported satisfaction with the clerkship overall, rating it 3.9-4.3 on a 1-5 Likert scale, but many found its clinical curriculum and administrative organization disorienting. Students appreciated the conceptual rationale integrating primary care and psychiatry more in the classroom setting than in the clinical setting.Conclusions: While preliminary clerkship outcomes are promising, further optimization and evaluation of clinical and classroom curricula are ongoing. This novel educational paradigm is one model for preparing students for the integrated healthcare system of the twenty-first century. [ABSTRACT FROM AUTHOR]

Objectives:  The lack of feasible and meaningful measures of clinicians' behavior hinders efforts to assess and improve obesity management in pediatric primary care. In this study, we examined the external validity of a novel algorithm, previously validated in a single geographic region, using structured electronic health record (EHR) data to identify phenotypes of clinicians' attention to elevated body mass index (BMI) and weight-related comorbidities., Methods:  We extracted structured EHR data for 300 randomly selected 6- to 12-year-old children with elevated BMI seen for well-child visits from June 2018 to May 2019 at pediatric primary care practices affiliated with Yale. Using diagnosis codes, laboratory orders, referrals, and medications adapted from the original algorithm, we categorized encounters as having evidence of attention to BMI only, weight-related comorbidities only, or both BMI and comorbidities. We evaluated the algorithm's sensitivity and specificity for detecting any attention to BMI and/or comorbidities using chart review as the reference standard., Results:  The adapted algorithm yielded a sensitivity of 79.2% and specificity of 94.0% for identifying any attention to high BMI/comorbidities in clinical documentation. Of 86 encounters labeled as "no attention" by the algorithm, 83% had evidence of attention in free-text components of the progress note. The likelihood of classification as "any attention" by both chart review and the algorithm varied by BMI category and by clinician type ( p  < 0.001)., Conclusion:  The electronic phenotyping algorithm had high specificity for detecting attention to high BMI and/or comorbidities in structured EHR inputs. The algorithm's performance may be improved by incorporating unstructured data from clinical notes., Competing Interests: None declared., (Thieme. All rights reserved.)