Search

Financial stress is the root cause of many adverse health outcomes among poor and low-income children and their families, yet few clinical interventions have been developed to improve health by directly addressing patient and family finances. Medical-Financial Partnerships (MFPs) are novel cross-sector collaborations in which health care systems and financial service organizations work collaboratively to improve health by reducing patient financial stress, primarily in low-income communities. Financial services provided by MFPs include individually tailored financial coaching, free tax preparation, budgeting, debt reduction, savings support, and job assistance, among others. MFPs have been shown to improve finances and, in the few existing studies available, health outcomes. We describe the rationale for MFPs and examine 8 established MFPs providing financial services under 1 of 3 models: full-scope on-site service partnerships; targeted on-site service partnerships; and partnerships facilitating referral to off-site financial services. The services MFPs provide complement clinical social risk screening and navigation programs by preventing or repairing common financial problems that would otherwise lead to poverty-related social needs, such as food and housing insecurity. We identify common themes, as well as unique strengths and solutions to a variety of implementation challenges MFPs commonly encounter. Given that the financial circumstances and health outcomes of socially marginalized patients and families are closely linked, MFPs represent a promising and feasible cross-sector service delivery approach and a new model for upstream health care to promote synergistic financial well-being and health improvement.

ObjectiveTo compare asthma treatment decisions by pediatric residents to current asthma guidelines and to learn whether treatment decisions vary by postgraduate year in training.MethodsWe conducted a Web-based survey of residents from 10 training programs through the Continuity Research Network of the Academic Pediatric Association (CORNET). Surveys included 6 vignettes of patients receiving low-dose inhaled steroids with guideline- and non-guideline-based indicators of asthma status and 1 stable patient on high-intensity medication.ResultsThere were 369 resident respondents (65% response rate), 26% postgraduate year (PGY) 1, 38% PGY2, and 36% PGY3+. Seventy-five percent of each resident group reported seeing fewer than 1 asthma patient per continuity clinic session. A majority of residents made appropriate treatment recommendations in 2 of 4 vignettes of guideline-based indicators of asthma status: first, 97% overall stepping up treatment for mild persistent asthma; and second, 52% overall stepping down treatment for a patient with well-controlled asthma on high-intensity medications. Inconsistent with guideline recommendations, 82% of residents overall did not step down treatment for a patient with well-controlled asthma receiving low-intensity therapy; 75% of residents did not step up treatment for a patient with a recent hospitalization for asthma. Of the 3 vignettes evaluating non-guideline-based indicators of asthma status, a majority of residents (60%) stepped up treatment for parental reports of worse asthma, while a minority did so for a parental report of being bothered by their child's asthma (27%) or when wheezing was reported at physical examination (43%). There were no statistically significant differences for any of the comparisons by year in training.ConclusionsPediatric residents' management of asthma is consistent with national guidelines in some cases but not in others. There were no differences in the outpatient asthma management decisions between residents by years in training. Educational efforts should be focused on strategies to facilitate pediatric resident adherence to national asthma guideline recommendations for outpatient asthma management.

Background and objectivePediatricians are encouraged to engage in community child health activities, yet practice constraints and personal factors may limit involvement. The objective was to compare community involvement in 2004 and 2010 and factors associated with participation in the past year.MethodsAnalysis of 2 national mailed surveys of pediatricians (2004: n = 881; response rate of 58%; 2010: n = 820; response rate of 60%). Respondents reported personal characteristics (age, gender, marital status, child ≤5 years old, underrepresented in medicine), practice characteristics (type, setting, full-time status, time spent in general pediatrics), formal community pediatrics training, and community pediatrics involvement and related perspectives. We used χ2 statistics to measure associations of personal and practice characteristics, previous training, and perspectives with involvement in the past 12 months. Logistic regression assessed independent contributions.ResultsFewer pediatricians were involved in community child health in 2010 (45.1% in 2004 vs. 39.9% in 2010) with a higher percentage participating as volunteers (79.5% vs. 85.8%; both P = .03). In 2010, fewer reported formal training at any time (56.1% vs. 42.9%), although more reported training specifically in residency (22.0% vs. 28.4%; both P < .05). Factors associated with participation in 2010 included older age, not having children ≤5 years old, practice in rural settings, practice type, training, and feeling moderately/very responsible for child health. In adjusted models, older age, practice setting and type, feeling responsible, and training were associated with involvement (P < .05).ConclusionsFormal training is associated with community child health involvement. Efforts are needed to understand how content, delivery, and timing of training influence involvement.

Little is known about parents' perceptions and prevention strategies regarding childhood falls. In this qualitative study using semi-structured interviews, we sought to describe parental reports of child fall experiences, concerns, and prevention strategies in the home. Sixteen parents with at least one child younger than 18 months were asked about their awareness of fall risks, falls experienced by the child, fall concerns, prevention strategies, and where in the home the child spends time throughout the day. Seven themes emerged: (1) "falls are unexpected," (2) "role of the physical environment," (3) "children's temperament and developmental stage," (4) "physical barriers and baby products," (5) "addressing walking surfaces," (6) "modifying the height of a fall," and (7) "supervision." Parents are aware of in-home fall hazards and actively use strategies to lessen fall risk. Anticipatory guidance should promote evidence-based and evidence-informed prevention strategies and augment effective strategies some parents use to lower fall risk. [ABSTRACT FROM AUTHOR]

There is limited understanding of risk and protective factors associated with depression among African American adolescents living in impoverished, urban settings. A cross-sectional study was conducted to identify a range of risk and protective factors associated with depressive symptoms among low-income urban African American adolescents. The sample (n = 467) comprised African American adolescents from three high-poverty urban neighborhoods in Baltimore, Maryland. A self-administered read aloud survey completed by adolescents assessed depressive symptoms as well as various individual- and environmental-level risk and protective factors. Multivariate analyses indicated that female gender, living with an adult with a substance abuse problem, greater exposure to physical violence, and greater peer delinquency were associated with higher depressive symptoms. Greater home assets and self-awareness were associated with lower depressive symptoms. Future interventions to prevent and treat depression among urban African American adolescents should focus on minimizing their risk factors while enhancing those factors found to be protective. (Contains 2 tables.)

Certain parenting behaviors have been linked with youth aggression and violence, but less is known about whether parents' attitudes toward fighting are a risk factor for children's aggressive behavior problems and future injury risk. Social cognitive theory suggests that parents' beliefs about fighting and retaliation may influence their children's attitudes toward fighting and aggression. The authors examined the associations among parental and youth attitudes toward fighting, parent-child relationships, and youth aggressive behavior in adolescents at great risk for future interpersonal violence. Data came from 72 parents and their adolescents (aged 12 to 17 years, 89% African American), who presented to an emergency department for youth's assault-related injuries. Analyses revealed an association between parents' and youth's attitudes toward fighting. Youth's and parents' attitudes were positively correlated with aggressive behavior, fighting, and school suspension. Parents' attitudes predicted youth's aggressive behavior, even after controlling for youth's attitudes. The findings suggest that interventions for high-risk youth should target the fighting-related attitudes of both parents and youth. (Contains 4 tables and 2 figures.)

Life Course Theory (LCT) is a framework that explains health and disease across populations and over time and in a powerful way, conceptualizes health and health disparities to guide improvements. It suggests a need to change priorities and paradigms in our healthcare delivery system. In 'Rethinking Maternal and Child Health: The Life Course Model as an Organizing Framework,' Fine and Kotelchuck identify three areas of rethinking that have relevance to clinical care: (1) recognition of context and the 'whole-person, whole-family, whole-community systems approach;' (2) longitudinal approach with 'greater emphasis on early ('upstream') determinants of health'; and (3) need for integration and 'developing integrated, multi-sector service systems that become lifelong 'pipelines' for healthy development'. This paper discusses promising clinical practice innovations in these three areas: addressing social influences on health in clinical practice, longitudinal and vertical integration of clinical services and horizontal integration with community services and resources. In addition, barriers and facilitators to implementation are reviewed. Keywords Life course theory * Health disparities * Health care delivery * Maternal child * Health * Family health * Clinical care, Introduction Life Course Theory (LCT) is a framework that explains health and disease across populations and over time [1, 2]. It is a powerful way to conceptualize health and health [...]