An Exploratory Study of Educators' Perspectives Towards Hospital School Program Support for Children with Special Health Care Needs After Hospitalization.

More than 14 million children in the United States are identified as children with special healthcare needs (CSHCN). Rates of hospitalization for CSHCN with chronic conditions as well as re-admissions have been increasing in recent years. For hospitalized children transitioning back to their school of record, a host of issues may arise such as socioemotional concerns, peer rejection, and being behind in academics. Hospital-based school programs (HBSPs) play an important role in the transition back to a child's school of record. Utilizing a database of inpatient CSHCN at a midwestern children's hospital's HBSP, private and public-school educators associated with the previously hospitalized CSHCN were asked to complete an online survey to gather their perspectives related to the child's transition back to the school of record upon hospital discharge. Overall, educators' perspectives of the HBSP were positive while perceptions related to communication provided by the HBSP were mixed. Educators surveyed reported a lack of training related to working with CSHCN. Finally, accommodations and services offered to students upon return to school focused mostly on academic performance and attendance. Study limitations and implications for practice in schools are discussed.

What Is Parent-Child Interaction Therapy?

This Patient Page describes what parent-child interaction therapy is and who can benefit from this type of therapy.

Acceptability and Access Metrics for Telehealth Consultation of Pediatric Neurodevelopmental Disabilities During COVID-19.

INTRODUCTION: We report caregiver agreement to attend telehealth neurodevelopmental consultation during COVID-19, demographic differences in agreement, reasons families declined, and clinical access metrics before and during COVID-19. METHOD: Data were gathered from telehealth referrals and consultations from April to July 2020. Schedulers documented agreement status and reasons for the decline. Wait time, lag time, and missed appointment rates were calculated to measure access. RESULTS: Ninety-one percent agreed to attend telehealth consultation; 55% of those who declined preferred in-person services. There were no demographic differences between those who accepted, declined, or did not respond. The median wait time from referral to appointment was 60 days. Missed appointment rates were consistent with prepandemic rates. DISCUSSION: Findings support literature suggesting patients are agreeable to telehealth. They diverged from evidence suggesting telehealth reduces missed appointments. Overall, results indicate telehealth is an acceptable alternative; however, further telehealth innovation is needed to address existing disparities.

INteractive Virtual Expert-Led Skills Training: A Multi-Modal Curriculum for Medical Trainees.

Background: Internationally, pediatric depression and suicide are significant issues. Additionally, in the context of the COVID-19 pandemic, pediatric mental health needs are rising astronomically. In light of Child & Adolescent Psychiatrist (CAP) subspecialist shortages in the United States (US), there is an increasing call for primary care physicians in Family Medicine and Pediatrics to address an increasingly broad variety of patient needs. Here we report on the development and preliminary evaluation of medical student and resident perceptions on the "INteractive Virtual Expert-led Skills Training" (INVEST) medical education curriculum, a virtual synchronous CAP curriculum employing active learning strategies, including expert-led discussion and video modeling, and discussion designed to meet those priorities. Methods: In a standardized 60-min training format, our curriculum leverages audience response system polling, video modeling of key clinical skills, and interactive discussion with an expert subspecialist, over a virtual video conferencing platform. The primary educational strategy relies on use of video modeling to demonstrate best practice with CAP led group discussion to solidify and explain important concepts. Five waves of medical students and residents (N = 149) participated in the INVEST curriculum and completed pre- and post-training surveys regarding knowledge and comfort in the management of pediatric patients with depression and suicidality. Results: Trainee participants reported significant positive gains in perceived likelihood of encountering pediatric suicidality as well as knowledge/comfort with depression screening and suicidality assessment in a primary care setting. Across some competency areas, there was an effect of medical learner level. Learners at lower levels generally reported the highest benefit. Medical students reported significant increases in their comfort interpreting and discussing positive depression screens and evidenced the greatest relative benefit in comfort with discussing suicidality. Conclusion: To our knowledge, INVEST is the first fully virtual, multimodal curriculum led by expert CAP subspecialists. Our findings suggest that INVEST shows promise for equipping medical learners with baseline knowledge for caring for patients with pediatric depression and suicidality. This synchronous, virtually delivered curriculum allows for critical training delivered to diverse medical learners regardless of geographic location, a particular benefit during the current COVID-19 pandemic.

Treatment of Typically Developing Toddlers with Hair-Pulling Behavior and Concurrent Poor Sleep Hygiene: A Case Series.

OBJECTIVE: Hair-pulling disorder is a rare condition with onset most commonly in adolescence and a well-documented association with comorbid psychiatric disorders. Minimal literature currently exists detailing the occurrence and treatment of this condition in young children, particularly less than 5 years old. METHOD: This case report describes 2 cases of children (<24 months old) with hair-pulling disorder and concurrent highly disrupted sleep. Treatment aimed at addressing sleep hygiene through parental psychoeducation and training, competing items, and faded naptime/bedtime. RESULTS: In both children, sleep hygiene intervention yielded significant improvement in sleep disruption patterns and hair-pulling behavior across approximately a 3-month period that maintained at 1- and 3-month follow-ups. CONCLUSION: Identifying factors that may be related or concurrent to hair pulling in young children is vital in ensuring that treatment is individualized and effective.

Addressing Academic Concerns: A Survey of Primary Care Providers.

Given new clinical recommendations, we sought to better understand the perspectives and practices of primary care providers (PCPs) around pediatric academic concerns. Practicing PCPs were recruited to complete an 8-item self-report survey; 163 PCPs were included in the final analysis. Results indicated that 84% of PCPs perceived their role in addressing patients' academic concerns as highly important; yet there was variability in the frequency with which PCPs reported engaging in activities around these educational needs. There was a significant positive relationship between perception of role importance and engagement in clinical supports. Some differences were present in responses across PCP specialty area. More information about practice differences between provider types, rural versus urban practices, and how perceptions/practices differ based on provider demographics are likely to be useful areas for future consideration. Our findings highlight the need to advance PCP instruction for practical implementation to increase rates of engagement in these activities.

Specific Learning Disabilities: The Family Physician's Role.

Academic underachievement, such as failing a class and the threat of being held back because of academic issues, is common. Family physicians can provide support and guidance for families as they approach their child's unique academic challenges. Specific learning disabilities are a group of learning disorders (e.g., dyscalculia, dysgraphia, dyslexia) that impede a child's ability to learn. Understanding standard educational terms; looking for medical, family, and social risk factors associated with academic underachievement; and investigating the medical differential for academic underachievement can help direct the family to appropriate care. The physician can provide medical documentation to support an individualized education program evaluation and address risk factors that schools may not be aware of or cannot assess. The family physician can support children and families by understanding the connection between risk factors, medical and educational evaluations, and educational resources.

Development of human patient simulation programs: achieving big results with a small budget.

The benefits of simulation in nursing education are well documented. Nursing students learn in a safe environment that enhances critical thinking and collaboration. Barriers to simulation include cost, resources, and fear of technology. This article describes how to design and implement a quality simulation program for less than $20,000.