Clinical Topic Review 2013 - Behavioral Health Screening Among MassHealth Children and Adolescents

Results from the 2013 evaluation suggest that the Children’s Behavioral Health Initiative had a large impact on formal behavioral health screening and treatment utilization among children and adolescents enrolled in MassHealth

Improving the Lives of Young Children: Opportunities for Care Coordination and Case Management for Children Receiving Services for Developmental Delay

Summarizes new opportunities for states to develop a coordinated system of care for children receiving early childhood intervention and services and how providers can support effective care coordination and case management policies

Development of a Primary Care Clinician Intervention in the Management of Overweight and Obesity in Children and Adolescent: A Pound of Cure

Poster Division: Arts, Humanities, and Social Sciences: 2nd Place (The Ohio State University Edward F. Hayes Graduate Research Forum)Primary care clinicians, despite regular access to young families, lack a cohesive model for approaching office visits regarding excess weight. Using the 2007 Expert Committee’s Recommendations, a set of clinician guidelines on the standard of care for managing childhood obesity, we developed high quality intervention tools for clinician use to direct behavior modification in families with school-age children. We have developed “A Pound of Cure” (POC), a counseling process and educational materials founded on the ECRs, to provide clinicians with the necessary skill set to approach excess weight in children. POC modular counseling sessions and resources were piloted among physicians in a primary care network. Families and physicians were interviewed on the modular counseling sessions and resources. The feedback obtained guided development of office visit modules and materials. On average, motivated families that returned to the clinic needed to complete only 3 to 4 modules, setting 3 goals per visit, to successfully incorporate the recommendations into the child’s daily life. Of families that returned for follow up visits 38.5%, 47.3%, 8.7%, 5.2%, and 1.7% of families completed two, three, four, five or six office visit modules, respectively. Weight maintenance or weight loss occurred in 57% of patients, with an average weight loss of 1.0 kg.A three-year embargo was granted for this item

Bolstering Confidence in Obesity Prevention and Treatment Counseling for Resident and Community Pediatricians

Objective- To assess whether equipping resident pediatricians and community pediatricians with both training and practical tools improves their perceived confidence, ease, and frequency of obesity related counseling to patients. Methods- In 2005-2006, resident pediatricians (n = 49) and community pediatricians (n=18) received training regarding three evidence-based obesity prevention/treatment tools and responded to pre-and post-intervention questionnaires. We analyzed changes in reported mean confidence, ease, and frequency of dietary, physical activity, and weight status counseling. Results- Baseline scores of confidence, ease, and frequency of counseling were higher in community pediatricians than residents. Mean scores increased significantly in the combined group, among residents only, and trended towards improvement in the community pediatricians following the intervention. Means for "control" questions were unchanged. Conclusion- Training and tools for residents and community pediatricians improved their confidence, ease, and frequency of obesity-related counseling. Practice Implications- This study demonstrates that when feasible and appropriate tools and training were provided through a simple intervention, physicians gained confidence and ease and increased their counseling frequency. The results here suggest that widespread implementation of such educational interventions for community practitioners and practitioners in training could change the way physicians counsel patients to prevent the often frustrating problem of childhood obesity. Originally published Patient Education and Counseling, Vol. 73, No. 2, Nov 200

Partner randomized controlled trial: study protocol and coaching intervention

<p>Abstract</p> <p>Background</p> <p>Many children with asthma live with frequent symptoms and activity limitations, and visits for urgent care are common. Many pediatricians do not regularly meet with families to monitor asthma control, identify concerns or problems with management, or provide self-management education. Effective interventions to improve asthma care such as small group training and care redesign have been difficult to disseminate into office practice.</p> <p>Methods and design</p> <p>This paper describes the protocol for a randomized controlled trial (RCT) to evaluate a 12-month telephone-coaching program designed to support primary care management of children with persistent asthma and subsequently to improve asthma control and disease-related quality of life and reduce urgent care events for asthma care. Randomization occurred at the practice level with eligible families within a practice having access to the coaching program or to usual care. The coaching intervention was based on the transtheoretical model of behavior change. Targeted behaviors included 1) effective use of controller medications, 2) effective use of rescue medications and 3) monitoring to ensure optimal control. Trained lay coaches provided parents with education and support for asthma care, tailoring the information provided and frequency of contact to the parent's readiness to change their child's day-to-day asthma management. Coaching calls varied in frequency from weekly to monthly. For each participating family, follow-up measurements were obtained at 12- and 24-months after enrollment in the study during a telephone interview.</p> <p>The primary outcomes were the mean change in 1) the child's asthma control score, 2) the parent's quality of life score, and 3) the number of urgent care events assessed at 12 and 24 months. Secondary outcomes reflected adherence to guideline recommendations by the primary care pediatricians and included the proportion of children prescribed controller medications, having maintenance care visits at least twice a year, and an asthma action plan. Cost-effectiveness of the intervention was also measured.</p> <p>Discussion</p> <p>Twenty-two practices (66 physicians) were randomized (11 per treatment group), and 950 families with a child 3-12 years old with persistent asthma were enrolled. A description of the coaching intervention is presented.</p> <p>Trial registration</p> <p>ClinicalTrials.gov identifier <a href="http://www.clinicaltrials.gov/ct2/show/NCT00860834">NCT00860834</a>.</p

Factors for improving short- and long-term health outcomes for children who have experienced adversity and trauma

This thesis is comprised of a comprehensive literature review focused on identifying factors that protect children from early adversity and a proposed intervention and accompanying program evaluation intended to improve health outcomes for traumatized children. The literature review summarizes the impact and prevalence of adverse childhood experiences and provides evidence for a hypothesized mechanism by which ACEs damage health: ACEs induce neuroendocrine changes while simultaneously predisposing children to engage in health risk behaviors. This literature review identifies and documents evidence for five modifiable resilience factors to improve the long- and short-term health outcomes for children who have experienced early adversity. They include improving parenting, enhancing social support, supporting maternal mental health, teaching self-care skills, and fostering understanding of trauma. The thesis proposes a pilot trauma-informed medical home (TIMH) designed to leverage the identified modifiable resilience factors for a group of pediatric patients in CPS custody at a large urban pediatric practice. The thesis includes an evaluation plan to formatively and summatively gain insight into TIMH’s effectiveness and enable program improvement

Moving Ahead Amid Fiscal Challenges: A Look at Medicaid Spending, Coverage and Policy Trends

Examines fiscal year 2011 trends in state efforts to control Medicaid spending, reform payment and delivery systems, and prepare for healthcare reform implementation, as well as projections in spending and enrollment growth for fiscal year 2012

Building Medical Homes in State Medicaid and CHIP Programs

Presents strategies, best practices, and lessons learned from ten states' efforts to advance the medical home model of comprehensive and coordinated care in Medicaid and Children's Health Insurance Programs in order to improve quality and contain costs