Society for Developmental & Behavioral Pediatrics Position Statement on Telehealth.

ABSTRACT: Telehealth has long held promise as a way to increase access to subspecialty care for children and families, including in developmental and behavioral pediatrics (DBP). The coronavirus disease 2019 (COVID-19) pandemic necessitated rapid uptake of telehealth to continue care delivery that was facilitated by "temporary" policy changes related to the pandemic. As a result, the field of DBP has recognized telehealth as a potential model of care for performing home-based diagnostic assessments, providing medication management follow-up, and delivering therapeutic interventions for children with neurodevelopmental disorders. Telehealth has been helpful in mitigating barriers families often face when attending in-person visits (lack of transportation and child care, missed work hours, etc) but has also highlighted additional determinants of health that need to be addressed to provide equitable access to care (broadband connectivity, device access, digital literacy, access to interpretation and sign language services, etc). Anticipating the lifting of pandemic-related emergency declaration and expiration of temporary policies around telehealth, the ability to continue to deliver DBP care by telehealth is uncertain. The purpose of this policy statement is to advocate for legislation and policies that support ongoing, equitable, home-based telehealth care for patients seen by DBP providers while ensuring equitable access to DBP in general. In addition, there is a need to recognize the benefits and challenges of telehealth versus in-person care and to identify clinical scenarios that favor 1 model of care versus the other.

Sources of medical student stress.

BACKGROUND: Key elements in the clinical practice of prevention, health and wellness are best cultivated in medical professionals during undergraduate medical training. This study explores students' self-assessed stress relative to gender, academic expectations, and level of medical training to guide development of targeted wellness interventions. METHODS: In early 2012, undergraduate (M1-M4) students in four Southeastern U.S. allopathic medical schools were surveyed about health-related attitudes and behaviors. RESULTS: A total of 575 students returned completed questionnaires. Students in the preclinical years (M1-M2), especially females, reported significantly higher stress levels. Academic expectations and satisfaction were also significantly implicated. DISCUSSION: These findings highlight the general areas of potential concern regarding stressors associated with medical training. Future research should guide programmatic efforts to enhance students' overall health and wellness vis-à -vis curriculum, skills training, and support services.

Interprofessional education and practice in an Indian setting.

With current global healthcare trends, there is a growing need for interprofessional education (IPE) and interprofessional practice (IPP) in collaborative care of persons with chronic medical conditions. Tools and models for IPE and IPP are now available, but they are not yet in widespread use. Developmental-behavioural paediatrics is a medical discipline that is characterized by IPP with an encouraging emergence of this speciality in India and other developing countries. This article provides an overview of IPE and IPP, followed by a precise account of an Indian institution, which provides services to children suffering from neurodevelopmental disorders utilizing an IPP approach and implementing IPE to its trainees.

Social Behaviors and Active Videogame Play in Children with Autism Spectrum Disorder.

OBJECTIVE: Children with autism spectrum disorder (ASD) often display problematic and excessive videogame play. Using active videogames (AVGs) may have physical benefits, but its effects on socialization are unknown. MATERIALS AND METHODS: We conducted an A-B-A' experiment comparing sedentary videogames and AVGs for three dyads of a child with ASD and his sibling. An augmented reality (AR) game was used to introduce AVGs. Sessions were coded for communication, positive affect, and aggression. RESULTS: One dyad had increases in positive affect with AVGs. Otherwise, social behaviors were unchanged or worse. The AR game demonstrated consistent elevations in social behaviors. CONCLUSIONS: Use of AVGs has inconsistent effects on social behavior for children with ASD. Further research is needed to understand mediators of response to AVGs. AR games should be evaluated for potential benefits on socialization and positive affect.

Improving Developmental-Behavioral Pediatric care workflow.

: Experience and available research suggest that Developmental Behavioral Pediatric (DBP) practice is both complex and variable. Variability involves multiple aspects of DBP care, from activities before the visit (e.g. triage and collecting information) to activities during (e.g. history taking and testing) and after the visit (e.g. care coordination). Together these activities represent workflow, a series of clinical events by which health care is delivered. In complex systems, workflow variation often suggests the presence of inefficiency or inconsistent quality. Given the current environment of increasing health care costs and an increasing focus on quality, DBP practitioners must be mindful of these concepts for the field of DBP to remain viable. In order to characterize current DBP practice and identify common challenges, a workshop was developed with the ultimate goal of identifying potential solutions for improving both quality and efficiency. This paper summarizes the workshop findings and proposes future directions to foster improvements in DBP workflow.

The influence of Community Access to Child Health (CATCH) program on community pediatrics.

The CATCH (Community Access to Child Health) Program, which supports pediatricians who engage with the community to improve child health, increase access to health care, and promote advocacy through small seed grants, was last evaluated in 1998. The objective was to describe the characteristics of CATCH grant recipients and projects and assess the community impact of funded projects. Prospective data was collected from CATCH applications (grantee characteristics, topic area and target population for projects funded from 2006-2012) and post-project 2-year follow-up survey (project outcomes, sustainability, and impact for projects funded from 2008 through 2010). From 2006 through 2012, the CATCH Program awarded 401 projects to grantees working mostly in general pediatrics. Eighty-five percent of projects targeted children covered by Medicaid, 33% targeted uninsured children, and 75% involved a Latino population. Main topic areas addressed were nutrition, access to health care, and medical home. Sixty-nine percent of grantees from 2008 to 2010 responded to the follow-up survey. Ninety percent reported completing their projects, and 86% of those projects continued to exist in some form. Grantees reported the development of community partnerships (77%) and enhanced recognition of child health issues in the community (73%) as the most frequent changes due to the projects. The CATCH Program funds community-based projects led by pediatricians that address the medical home and access to care. A majority of these projects and community partnerships are sustained beyond their original CATCH funding and, in many cases, are leveraged into additional financial or other community support.

WHO growth chart awareness among clinicians in Kentucky.

OBJECTIVES: To examine children's growth chart use among clinicians and explore awareness of the Centers for Disease Control and Prevention's (CDC) recommendations for the use of World Health Organization (WHO) growth charts. METHODS: A cross-sectional survey of pediatricians and family practitioners in Kentucky. RESULTS: Only 29% of clinicians reported using WHO growth charts, with board-certified urban pediatricians more likely to be aware of the WHO growth charts and to recognize that CDC growth charts led them to overdiagnose infants as being underweight. Approximately one-fourth of respondents did not know the source of growth charts for their practice. Only 13% of clinicians discussed body mass index and other vital parameters with parents and provided copies of growth charts at the end of patient visits. Clinicians who provided copies of growth charts to parents were more likely to be nonacademic, board-certified pediatricians in urban areas with more than 10 years' experience. CONCLUSIONS: More than 6 months after the CDC's recommendation to use WHO growth charts for children younger than 2 years old, few clinicians were familiar with and used the WHO charts. Increased awareness and training, increased availability of WHO growth charts, and adherence to the recommendations will result in more accurate growth calculations and avoid underidentification of infants at risk for overweight and obesity.

Geomapping telehealth access to developmental-behavioral pediatrics.

BACKGROUND: Geographic information systems (GIS) mapping is fairly novel in describing utilization of health services. Our study is the first to use GIS to demonstrate that telehealth pediatric specialty service access would create substantial savings in travel time and distance compared with accessing a tertiary-care center for similar service. MATERIALS AND METHODS: A retrospective chart review of telehealth encounters and geocoding of patients' address were done with actual travel along road calculations to estimate travel time and distance for a visit, compared with a hypothetical visit to the nearest tertiary-care site for the similar service. RESULTS: Over a 2-year period, 255 telehealth visits by 171 patients with a variety of developmental and behavioral diagnoses were made to five telehealth sites. The median travel time and distance saved by accessing a telehealth site were 66.9 min and 63.8 miles, respectively. Of these patients, 12.3% had a median negative estimated savings of 52.7 min and 39.0 miles, which was associated with longer travel burden. Using the straight-line method underestimated the total time and distance traveled by approximately one-quarter of the actual distance (median distance of 20.5 miles underestimate relative to the median distance of 100.7 miles). CONCLUSIONS: Telehealth patients experienced significant reduction in travel times and distances. Patients/families would accept an increased burden of spatial accessibility in exchange for reduced burdens in other aspects of access, such as accommodation or acceptability when engaging telehealth services. Using a road network-based method is more accurate than previously used straight-line methods in calculating distance impedance.

Navigating ethical issues with electronic health records in developmental-behavioral pediatric practice.

The increasing use of electronic health records (EHRs) allows for sharing of information across clinicians, quick access to laboratory results, and supports for documentation. However, this environment raises new issues of ethics and privacy, and it magnifies other issues that existed with paper records. In developmental-behavioral pediatrics (DBP) practice, which relies heavily on a team approach to blend pediatrics, mental health, and allied health, these issues are even more complicated. In this review, we highlight the ethical and privacy issues in DBP practice related to EHR use. Case examples illustrate the potential risks related to EHR access, confidentiality, and interprofessional collaboration. Suggestions to mitigate some of the ethical and privacy issues associated with EHRs at both an administrative level and a clinician level are included. With the expected increase in the adoption of EHRs by DBP clinicians in the near future, professional standards will need to be defined, and novel technological solutions may offer additional safeguards. Until then, professionals and organizations are responsible to uphold the standards of ethical practice while promoting effective information exchange to facilitate clinical care.

Telehealth in developmental-behavioral pediatrics.

Developmental-behavioral pediatrics (DBP) is recognized as one of the fields with the greatest shortages of pediatric subspecialists. Families who access care often must travel great distances to tertiary academic medical centers or endure long waiting lists. While the shortages are likely to persist due to limited provider availability and an increasing number of children with developmental and behavioral disorders being identified, our field must look to innovative ways to reduce the barriers to access. One such way is telehealth, the use of videoconferencing to deliver DBP services to underserved populations. We aim to describe the practical uses of telehealth for the delivery of diagnostic and management clinical services in a variety of settings and for the additional educational and research benefits of the modality. We will highlight the obstacles to setting up a successful DBP telehealth practice and direct readers to resources to address these in their communities. Most of all, we will demonstrate the benefit to families and children, practitioners, and health care systems of supplementing traditional in-person DBP services with telehealth modalities to enhance outreach and engagement with communities.

Office screening and early identification of children with autism.

Autism spectrum disorders (ASDs), also called pervasive developmental disorders in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revised), constitute a group of neurodevelopmental disorders that coalesce around a common theme of impairments in social functioning, communication abilities, and repetitive or rigid behaviors. The ASDs considered here include autism/autistic disorder, Asperger disorder/Asperger syndrome (AS), and pervasive developmental disorder not otherwise specified. This article focuses on autism/autistic disorder screening and its early identification, with a brief mention for AS screening, as there are limited tools and no recommendation for universal screening for AS.