Explore the vast range of titles available.

Background Pediatric Support Services (PSS) is a Patient Navigation Program designed to address barriers from referral-to-service connection from primary care to health system and community-based services and resources. This study aimed to evaluate PSS’ implementation for mental health services along the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and identify factors throughout implementation to inform sustainability and delivery. Methods This study included descriptive analysis of all patients referred to PSS to assess reach, with a primary cohort analyses of a subset of patients referred specifically to mental health services. Data collection included triangulation of information extracted from electronic health records, direct contact with patients’ caregivers, and follow-up surveys completed by patients’ caregivers. Analyses were designed within each construct of the RE-AIM framework, and assessed for their tiered impact on the patient, provider, and system levels. Results From October 2019 to June 2023, 13,109 total referrals for 11,214 unique patients were triaged by PSS. The patient population overrepresented younger, Hispanic, female patients compared to the clinical population included in this health system’s service area. Of these patients, 3,929 were followed-up by trained navigators at two-weeks for mental health service connection, with 50.6% reported being connected to referred services and an additional 27.1% with pending appointments. There was a significant increase in referral connection rate as age increased and for Black patients, compared to other children. For patients considered connected to or pending services, a satisfaction survey found high satisfaction with PSS and the amount of navigator-patient contact (81.5 and 79.6%, respectively). Conclusion These findings highlight potential program modifications to optimize quality of care and health for children and families, while enhancing capacity among providers, navigators, and clinics. Further adaptations, including electronic health record integration, patient/family feedback, and automated navigation processes, are suggested next steps for comprehensive navigation. Trial registration This study was approved by the Institutional Review Board for Prisma Health, trial number 1,852,794, with the most recent approval for expanded evaluation received on June 15, 2022 (original application approved in 2016).

Background Children with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC). Methods This mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews ( N  = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews. Results Overall, 39.87% of CMC experienced  ≥  1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations , and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families. Conclusions Findings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers’ insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.

Background Managing Abstinence in Newborns (MAiN) is an evidence-based, cost-saving approach to caring for infants at risk of developing neonatal opioid withdrawal syndrome (NOWS). MAiN provides medication management in combination with education and is being implemented in hospitals across South Carolina (SC). This expansion of MAiN throughout the state includes educational training for providers on managing NOWS symptomology and evaluation support for data collection and analysis. This evaluation assessed the readiness of hospitals to implement MAiN by identifying potential barriers and facilitators to early program adoption. Methods We used the Consolidated Framework for Implementation Framework (CFIR) to guide the evaluation. As part of the ongoing evaluation of MAiN implementation, brief, structured interviews were conducted with healthcare providers ( n  = 82) at seven hospitals between 2019 and 2022 to learn more about perceived barriers and facilitators to implementation readiness. Two coders independently reviewed all transcripts and used deductive thematic analysis to code qualitative data using Atlas.ti Web using the established CFIR codebook. Results We identified barriers and facilitators to implementing MAiN in all five CFIR domains. Providers identified MAiN as an evidence-based, patient-centered model with the flexibility to adapt to patients’ complex needs. Specific champions, external support, alignment with providers’ personal motivation, and an adaptable implementation climate were identified as facilitators for implementation readiness. Barriers included a lack of consistent communication among hospital providers, minimal community resources to support patients and families after discharge, and a lack of provider buy-in early in implementation. Conclusions Key barriers and facilitators of MAiN implementation readiness were identified at seven participating hospitals throughout SC. Communication, staff and hospital culture and climate, and internal and external resource were all reported as essential to implementation. These findings could inform the MAiN program expansion in hospitals across SC.

Youth with autism spectrum disorder (ASD) are at nearly twice the risk of experiencing obesity, compared to youth without ASD. W ellness E ducation to C reate H ealthy habits and A ctions to T hrive ( WE CHAT ) is a novel chatbot that engages participants to enhance primary care delivery and associated care coordination services through mobile health (mHealth) technology focused on social determinants of health (SDOH) and social-emotional health. This study examines multiple perspectives regarding the development and implementation of innovative mHealth technology among youth with ASD. The phases of this study include (1) discussion among individuals and parents of children with ASD, (2) in-depth interviews with primary care providers (PCPs) who treat youth with ASD, and (3) in-depth interviews with interdisciplinary rehabilitation providers who treat youth with ASD. Phases 1 and 2 employed rapid qualitative analysis, and Phase 3 involved inductive thematic analysis to provide context to gaps identified in prior phases. Key themes across the three phases included the variability of symptoms among individuals with ASD , the differences in perceived value of mHealth technology , the importance of family-centered care , and the role of interdisciplinary support . Participants recommended the development of branching logic to increase the flexibility of mHealth technology designed for youth with ASD. This study gathered insight from multiple perspectives to identify opportunities for supporting independent participation in mHealth technology while reducing associated caregiver burden among youth with ASD. These findings may inform refinement and expansion of WE CHAT for patients with varying health needs.

Objectives To evaluate the implementation and sustainability of the effect of a 1-year Leadership in Education for Neurodevelopmental and related Disabilities (LEND) program in a southeastern state, and to examine its impact on advancing the Maternal Child Health Bureau’s (MCHB) Blueprint for Change —a national agenda for pediatric healthcare reform. Methods This study applies the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to rigorously evaluate LEND implementation and impact between 2018 and 2022. In-depth interviews ( N  = 24) were conducted among long-term (1-year) LEND trainees, via Zoom, in a southeastern state. A hybrid approach of deductive and inductive thematic analysis was conducted to identify emergent patterns and themes from trainees’ experiences, related to the EPIS constructs and national priorities. Results Exploration and Preparation. Trainees identified insights from multidisciplinary discussions and family panels as key facilitators to their development. Implementation. Trainees reported growth in confidence and communication and improving their service delivery, including implementation of a collaborative approach to patient care, family-centered care, and occasionally facilitating their obtainment of leadership positions. Trainees also reported systemic barriers to implementation, including time and financial constraints. Sustainability. Trainees identify their experienced shift in mindset and statewide connections as drivers for sustained change, with suggestions for follow-up events and networking opportunities to enhance the effect of LEND training. Conclusions for Practice These results may inform LEND objectives to enhance the statewide network and to advance a national framework for prioritizing family well-being and quality of life and access to services. Significance Leadership in Education for Neurodevelopmental and Related Disabilities (LEND) is a graduate-level, interdisciplinary training program, with 60 sites funded by the Maternal Child Health Bureau nationwide. LEND is well-positioned to advance the Blueprint for Change , a national agenda for pediatric healthcare reform among children with special healthcare needs. This study’s LEND program has not been rigorously evaluated since its inception in 2011. This study seeks to evaluate the perceived sustainability of the effect of LEND training and examine its congruence with the priority areas of the Blueprint for Change , within the Exploration, Preparation, Implementation, and Sustainment framework.

In 2021, national leaders in the United States declared a “national youth mental health crisis.” Still, only 1-in-4 children receive adequate mental healthcare access. Patient Navigator Programs (PNPs) can improve children’s referral-to-connection to mental health services. We examined patient- and community-level factors associated with pediatric mental healthcare access. Pediatric Support Services (PSS) is a PNP that triages mental and behavioral health referrals within a large health system in a southeastern state. This study analyzes PSS data from September 2017-March 2023 and Child Opportunity Index 2.0 state-normed zip-code level data to assess social drivers of health estimates. Structural equation modeling was conducted between patient- and community-level factors and connection to mental health services. Overall, 62.7% of children connected to mental health services since PSS’ inception. Regardless of SDOH, as children get older, they are more likely to connect with mental health services (β = .053, SE  = .010, p  < .001). Children with greater number of referral needs are more likely to connect with mental health services (β = .034, SE  = .011, p  = .002). Further, children who live in communities with higher opportunity levels are more likely to connect with mental health services (β = .016, SE  = .008, p  = .040), suggesting that children who live in low-income communities experience more barriers to mental healthcare. Social drivers may inform referral practices and tiered navigation support for optimal mental healthcare access among children. Further research should demonstrate the effectiveness of PNPs integrated within healthcare and community-based settings.

Within the first couple of years after release from prison in the United States, recidivism rates are highest. Lack of or limited education levels, access to mental health services or substance abuse treatment, and the environment post release are well-documented reasons for recidivism. A grant-funded community-based multidisciplinary post-incarceration pilot program in Southwest Michigan began to assist the returning ex-offenders overcome reintegration barriers to ensure a successful transition to community living. The program design provided wrap around services that included access to counseling, social work navigator services, mentoring, tutoring, and occupational therapy life skills training to selected ex-offenders who chose to enroll. The program provided services for one year. The conclusion of the program occurred at the end of the grant funded period, when at the same time, the COVID-19 pandemic occurred in March 2020, and coincidentally, at the same time the team adjourned due to internal consequences. There are lessons learned in this experience that worked to reduce recidivism and re-incarceration in prison for a one-year period to effectively zero. Programmatically and organizationally, there are also important lessons to share for practice that are universal.

Many individuals make financial, health and food related trade-offs to cope with the challenges of food insecurity and to meet their household needs for healthy, affordable food. A survey (n = 652) was conducted in nine rural counties in South Carolina, USA, during the COVID-19 pandemic from August 2020 to July 2021. We examine if level of food insecurity predicts hunger-coping trade-offs, and whether this relationship is moderated by easiness in food access and dependence on different food source types. Nearly one-third of the respondents experienced food insecurity. Making trade-offs between paying for food and other household expenses was common among the rural residents as on average they made nearly one type of trade-off in the past three months. The number of trade-offs was the highest among highly food insecure respondents (mean = 2.64), followed by moderately food insecure respondents (mean = 1.66); low food insecure respondents had the lowest number of trade-offs (mean = 0.39). The moderating effects of easiness in food access and dependence on food sources varied by level of food insecurity. The results show that individuals at different levels of food insecurity use different strategies to fulfill their food needs and social programs are more often utilized than personal food sources. We conclude with implications for addressing food insecurity in order to reduce the possibility of making trade-offs.