Prev Chronic Dis

IntroductionDespite epidemic increases in childhood obesity rates, many providers fail to diagnose obesity. Body mass index (BMI)-for-age percentiles are the recommended screening test. We evaluated whether mailing a toolkit to physicians would increase use of sex-specific BMI-for-age percentiles to screen for childhood obesity.MethodsWe assigned a random sample of family physicians and pediatricians from New York State\ue2\u20ac\u2122s medical licensing database to either intervention or control groups in the summer of 2004. At baseline and at follow-up, we sent physicians a survey that asked how often they used various screening methods to identify childhood obesity. Between the surveys, we sent physicians in the intervention group a toolkit that consisted of professional guidelines for childhood obesity screening, a tool for calculating BMI, BMI-for-age growth charts, and educational information.ResultsAt follow-up, more physicians in the intervention group than in the control group reported using BMI percentiles to screen for childhood obesity. Compared with physicians in the control group, physicians in the intervention group had a larger increase in their routine use of BMI percentiles to screen children aged 2 to 5, 6 to 11, and 12 to 20 years, although the differences in the older 2 groups did not attain statistical significance.ConclusionDirectly mailing an educational toolkit to physicians can have a small but positive effect on clinical practice

Increasing Permanent Home Placements for Children With Diagnosed Disabilities in Foster Care

In the United States, 397,000 children received foster care services in 2012. Some states successfully achieved permanent homes for children with diagnosed disabilities who exited care while others were less successful. Using change theory and social ecological theory as the foundations, the purpose of this study was to determine the impact that diagnosed disabilities had on permanent home placements among Pennsylvania\u27s foster care children who were discharged and were between ages of 0 to 6 years in 2012. Hernandez\u27s and Hodges\u27s theory of change was used to evaluate the 1982 standards that license foster care agencies, while Stokol\u27s ecological theory provided the framework to assess whether there were measurable increases in child welfare outcomes for permanent placements among children with diagnosed disabilities. Following a retrospective, nonexperimental, quantitative design, data were acquired from a purposive sample of 344 archived foster care files across the state. These data were analyzed using bivariate correlation procedures to evaluate the strength of the relationship between medically diagnosed conditions and permanent placement. The findings indicated a statistically significant association between medically diagnosed conditions and permanent placements (p=0.01). Additionally, length of stay in care was also found to be statistically associated with permanent placement (p=0.019). The theoretical constructs evaluation with a theory of change found the 1982 standards were outdated to authorize the licensing of foster care agencies; the social ecological theory identified evidence for change to achieve the intended goal. Findings of this study may provide guidance to policymakers in term of improving standards related to oversight and licensing foster care agencies in order to better support permanent placement of children with disabilities

International Board Certified Lactation Consultants: Current Reimbursement Practices in the United States

Objectives: To explore International Board Certified Lactation Consultants (IBCLCs) reimbursement strategies and success rates for third party reimbursement. Methods: All United States IBCLCs (10,495) with email received the survey. Results were descriptively analyzed. Results: Response rate was 29% (n=2637). Thirty percent did not know about reimbursement strategies. Twenty-five percent do not file encounters for reimbursement. Thirty-four percent use their IBCLC credentials as a billing source for third party reimbursement. The success of this strategy is high for 5% of encounters. Conclusions: Lactation management by IBCLCs is not consistently reimbursed by third party payers. The credentials used as a billing source are important to successful reimbursement. Many IBCLCs are not familiar with reimbursement strategies or do not submit to insurance.Master of Public Healt