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An autism module was added to an existing computer decision support system (CDSS) to facilitate adherence to recommended guidelines for screening for autism spectrum disorders in primary care pediatric clinics. User satisfaction was assessed by survey and informal feedback at monthly meetings between clinical staff and the software team. To assess outcomes, such as changes in identification and referrals, we reviewed data captured from the CDSS. Between November 15, 2010 and July 26, 2012, 857 patients were eligible for screening. Of these, 66% (567/857) were screened as determined by the number of forms scanned into the system, of which 30% (171/567) had concerning Modified Checklist for Autism in Toddlers. However, pediatricians failed to respond to alerts for 73 children. Of the remaining 98 children, pediatricians felt 50 (68%) did not have an Autism spectrum disorder, 23 (32%) were referred for autism evaluation, eight (11%) were suspected but not referred and two (3%) were referred for audiology. Seventy percent of all users agreed that automation of the screening process helped them to adhere to recommended guidelines. Automating autism care into a CDSS resulted in moderate adherence to guidelines. Health information technology can facilitate the implementation of autism guidelines in busy pediatric clinics.

Clinical conversations between health professionals and parents can be frustrating for both parties when the topic is childhood immunization. Parents bring to the table personal models of decision making and experiences of risk that may differ from those of their health care providers. They may also feel confused by an explosion of information available through the popular media, Internet Web sites, public health agencies, and medical professional organizations. In this article, it is argued that parents' trust toward health care providers is a key to addressing parent worries about vaccines. Suggestions for understanding the bases of parent concerns and supporting parents' decision making are provided.

This article describes innovative service delivery models and clinical strategies that support the social-emotional development of young children and their families in the pediatric primary care setting. By understanding the trends affecting well-child care, early childhood providers will be better equipped to partner with their pediatric counterparts on behalf of the families both serve. First, the authors describe an emerging model in behavioral health care that provides the backdrop to current efforts to integrate social-emotional developmental services into primary care: the integrated behavioral health care model of care. Two programs highlighted in a recent Substance Abuse and Mental Health Services Administration study of pediatric primary care sites serving young children demonstrate how they have integrated behavioral health services in their programs. The article also describes clinical approaches for infusing social-emotional supports into primary care and provides a snapshot of promising applications of computer technology for psychosocial screening in primary care.

The author presents an overview of basic concepts of early childhood temperament and argues that child behavior is the result of the interplay between nature and culture. Due to inconsistencies in the field, temperament research and clinical application can be challenging for early childhood practitioners to interpret and apply to their daily work. By using multiple methods to clinically assess temperament, practitioners can acknowledge that infant/toddler behavior may vary across both setting and social partner. When considering a child's behavior, clinicians should offer the temperament explanation as only one of many hypotheses. Clinicians can use the concept of temperament to show parents how not to take the child's difficulties so personally, thus reducing blame on both child and parent.

Several vaccines for sexually transmitted infections (STI) are presently in development and the eventual availability of such vaccines is expected to result in the prevention of a significant number of burdensome conditions. Young adolescents are presumed to be likely targets for these vaccines since adolescents' risk for STI increases as they age and become sexually active. It is unclear, however, to what extent parents will agree to having adolescents receive STI vaccines. Inasmuch as acceptance is the foundation for effective immunization programs, an understanding of parental perspectives about this issue is required to inform future STI vaccine program strategies. This paper presents findings from a qualitative study that used in-depth interviews to elicit attitudes from 34 parents about accepting vaccines for genital herpes, human immunodeficiency virus, human papillomavirus and gonorrhea for their children (aged 8-17). Data were collected from parents bringing their children for care at an urban clinic and a suburban private office. Content analysis of the responses revealed that most parents (>70%) approved the administration of all four of the STI vaccines proposed. Parents' reasons for acceptance included wanting to protect their children, being concerned about specific disease characteristics, and previous experience with the infections. Parents who declined the vaccines did so primarily because they perceived their children to be at low risk for the infections or they had low concern about features of the diseases. Most parents thought they should be the decisionmaker regarding children receiving an STI vaccine. Results from this study will be used to plan subsequent investigations of the determinants of STI vaccine acceptance by parents. Keywords: Sexually Transmitted Infections; Health beliefs; Immunization Vaccination Adolescents; Parents: USA

Psychologists who are infant specialists play important roles in clinical assessment, intervention, and research with infants who have developmental disabilities and their families. Specific training experiences helpful to professional development are reviewed and their implications for training programs are discussed. (Author/DB)