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Youth in residential treatment settings often present with a complex combination of mental and physical health problems. Despite an emerging literature documenting significant associations between mental health and physical health, the relationship between these two areas of functioning has not been systematically examined in youth presenting to residential treatment. This study examines the association between youth psychopathology and physical health problems in a sample of 606 youth entering a large residential treatment program between 2003 and 2010. As a part of the intake process, youth psychopathology symptoms were assessed using the parent-report form of the Child Behavior Checklist, and youth physical health problems were assessed in a medical evaluation by a licensed child health professional. Results indicated that higher levels of youth psychopathology, particularly internalizing problems, were associated with greater risk for physical health problems and more prescription medications. Psychopathology comorbidity was also associated with physical health problems. These findings suggest an interplay between physical and mental health among youth entering residential treatment, highlighting the need for integrated assessment and intervention services that address psychological and medical needs within this population. (Contains 5 tables.)

www.pediatrics.org/cgi/doi/10.1542/ peds.2006-0259 doi:10.1542/peds.2006-0259 Key Words community pediatrics, AS A YOUNG kid growing up in Nebraska, I could never have imagined having the honor of following such a distinguished American as Marian Wright Endelman, nor, I might add, [...]

Background. In 2001, the American Academy of Pediatrics (AAP) adopted a policy that all infants and young children should be screened for developmental delays at regular intervals. The policy statement promoted the use of valid reliable instruments. It is unknown, however, what proportion of pediatricians follow this recommendation and whether such a practice is associated with improved identification of children with developmental difficulties. Objectives. To describe the use of developmental screening tests among board-certified pediatricians practicing general pediatrics and to determine the association between standardized screening and the self-reported identification of children with developmental difficulties. Methods. We mailed a survey to a random sample of AAP members. We used multivariate logistic/linear-regression analyses to determine the association between standardized screening and the self-reported identification of children with developmental disabilities. Results. Of the 1617 surveys mailed, 894 were returned, for a response rate of 55%. Of the respondents, 646 practiced general pediatrics and were included in the analysis. Seventy-one percent of those pediatricians indicated that they almost always used clinical assessment without an accompanying screening instrument to identify children with developmental delays. Only 23% indicated that they used a standardized screening instrument. The most commonly used instrument was the Denver II. Logistic regression modeling demonstrated odds ratios between 1.71 and 1.90 for a >10% rate of identification of developmental problems among patients of pediatricians reporting standardized screening. Each adjusted odds ratio bordered on statistical significance. Linear-regression models estimating the difference in mean proportions of children identified with developmental problems across screening groups failed to show a statistically or clinically significant difference in physician-reported identification rates. Conclusions. Our findings indicate that, despite the AAP policy and national efforts to improve developmental screening in the primary care setting, few pediatricians use effective means to screen their patients for developmental problems. It is uncertain whether standardized screening, as it is practiced currently, is associated with an increase in the self-reported identification of children with developmental disabilities. Pediatrics 2005;116:174-179; developmental screening, early intervention, screening tests, developmental surveillance. ABBREVIATION. AAP, American Academy of Pediatrics., Children with developmental difficulties constitute between 12% and 16% of the general pediatric population.1 Early diagnosis of such children is important, because evidence has demonstrated the effectiveness of early intervention [...]

ABSTRACT. Objectives. 1) To develop and implement an innovative, interactive, and nontraditional continuing medical education (CME) curriculum to educate primary care physicians, pediatric office staff, child health advocates, allied health care professionals, and parents of children with special health care needs (CSHCN) about the medical home concept of care and 2) to identify key partners in communities to plan the CME program and ultimately plan for fostering medical homes at the community and state levels. Methods. Participant outcomes for the CME program and planning process include 1) explaining the elements of the medical home concept as applied to their practice environment or child's care; 2) understanding the concepts, skills, and information necessary to care successfully for CSHCN who are enrolled in managed care organizations; 3) accurately describing trends and developments in caring for CSHCN; 4) identifying programs in the community that serve CSHCN; and 5) assessing and, if necessary, improving pediatric office practices to ensure that they are sensitive to families of children and youths with special health care needs. Conclusion. A diverse national committee that included physicians, nonphysicians, and family members developed the Medical Home Training Program curriculum. The medical home curriculum was written to meet the needs of the local community. The training program can offer CME credit and use a direct, outcome-based adult learning technique (eg, determine short- and long-term goals). Furthermore, the program parallels and complements the Healthy People 2010 goals and objectives. Pediatrics 2004;113:1479-1484; children with special health care needs, training, curriculum, medical home, continuing medical education. ABBREVIATIONS. CSHCN, children with special health care needs; AAP, American Academy of Pediatrics; MCHB, Maternal and Child Health Bureau; MHTP, Medical Home Training Pro gram; CMF, continuing medical education., Fifteen to 18 million children in the United States are estimated to have chronic illness or disability. (1,2) In an effort to educate physicians, allied health care professionals, families, and [...]

ABBREVIATIONS. AAP, American Academy of Pediatrics; CSHCN, children with special health care needs; COPP, Council on Pediatric Practice; BOD, Board of Directors; MCHB, Maternal and Child Health Bureau; SPRANS, Special Projects of Regional and National Significance; CATCH, Community Access to Child Health., "Every child deserves a medical home" is one of the American Academy of Pediatrics' (AAP) essential child health outcomes for the 21st century. With increasing health care costs, technology, survivorship, [...]

The test of the morality of a society is what it does for its children. Dietrich Bonhoeffer (1) Pediatrics is a contextual specialty concerned about children, their families, and the [...]

Background. As outlined in the Newborn Screening Task Force report published in August 2000, the newborn screening system is more than just testing, but also involves follow-up, diagnosis, treatment, and evaluation. As such, multiple professional and public partners need to be adequately involved in the system to help ensure success. In addition, newborn screening programs are state-based; therefore, policies and procedures vary from state to state. Historically, there has been little uniformity between state newborn screening programs. Objective. To examine the communication practices of state newborn screening programs in the United States, particularly in relation to the medical home. Methods. A facsimile survey of program staff in all US newborn screening programs. Survey data were collected in August 2000. Results. All 51 programs participated. States were questioned about whether or not they had a procedure to identify the infant's medical home before the child's birth. Twelve states (24%) indicated that there was a procedure in place, whereas 39 states (76%) indicated that either no procedure existed or that they were unsure. In contrast, all state programs (except 1) indicated they notified the primary care physician about abnormal results and the need for follow-up. In addition, state programs reported that primary care physicians have responsibilities within the newborn screening system, particularly related to communicating with parents about screen-positive results and coordinating the collection of a second specimen. Thirty states reported that they directly notified parents of screen-positive infants of results and the need for follow-up as well. In regard to informing parents about newborn screening, 45% of states indicated that primary care physicians had some responsibility in informing parents about newborn screening. Most often, parents were informed about newborn screening just before specimen collection, and the most commonly used techniques to educate parents were informational brochures and conversation. Thirty-five states reported that they engaged in long-term tracking of infants after diagnosis confirmation. Only about half of these states provided long-term tracking of all of the conditions included in their state's newborn screening test panel. Of these 35 states that engaged in long-term tracking, 25 reported that they requested patient information from the primary care physician and/or subspecialist about ongoing treatment and follow-up. Conclusions. Newborn screening roles and responsibilities vary tremendously between states. Improvements in communication and better-defined protocols are needed, particularly between state newborn screening programs and the medical home. Many states identified the medical home as having significant responsibilities related to the short-term follow-up of screen-positive infants. Identification of the correct medical home before testing would help to reduce unnecessary time and frustration for state newborn screening programs, especially in the follow-up of infants that are difficult to locate. In addition, primary care physicians (ie, the medical home) need to have appropriate and ongoing involvement, including a mechanism to provide feedback to their state newborn screening program. This is particularly important given the adoption of tandem mass spectrometry by an increasing number of states, and the likely expansion of newborn screening in the future. Recommendations include the following: * Primary care physicians should have appropriate and ongoing involvement in the newborn screening system and should be appropriately represented on state newborn screening advisory committees, * States should develop protocols to identify the medical home before heelstick screening, * States should work with families, primary care physicians, and prenatal health care professionals to develop well-defined systems for pretesting education of parents, * All newborn screening results (both positive and negative) should be sent to the infant's medical home. If results are not received by the medical home, efforts should be made to obtain results, * Medical homes and subspecialists should submit follow-up information on screen-positive infants and infants with confirmed diagnoses to the state newborn screening program, regardless of the existence of state requirements to do so, and * Efforts to build enhanced direct communication systems, linking state newborn screening programs to community-based medical homes, should continue. Pediatrics 2003;111:e120-e126. URL: http://www. pediatrics.org/cgi/content/full/111/2/e120; medical home, newborn screening, public health, communication.

In 2002, the American Academy of Pediatrics released a statement calling for a medical home for all children with special health care needs. (1) This statement came in recognition that [...]

Youth in residential treatment settings often present with a complex combination of mental and physical health problems. Despite an emerging literature documenting significant associations between mental health and physical health, the relationship between these two areas of functioning has not been systematically examined in youth presenting to residential treatment. This study examines the association between youth psychopathology and physical health problems in a sample of 606 youth entering a large residential treatment program between 2003 and 2010. As a part of the intake process, youth psychopathology symptoms were assessed using the parent-report form of the Child Behavior Checklist, and youth physical health problems were assessed in a medical evaluation by a licensed child health professional. Results indicated that higher levels of youth psychopathology, particularly internalizing problems, were associated with greater risk for physical health problems and more prescription medications. Psychopathology comorbidity was also associated with physical health problems. These findings suggest an interplay between physical and mental health among youth entering residential treatment, highlighting the need for integrated assessment and intervention services that address psychological and medical needs within this population. [ABSTRACT FROM AUTHOR]