The TREE Program: Promoting Positive Early Childhood Experiences During Well-Child Visits.

This feasibility study evaluated the developmental coaching TREE (Talk Read Engage Encourage) program for historically marginalized children ages 0 to 2 years, embedded within pediatric visits, examining if TREE could enhance caregiver-child interactions and increase pediatric resident report of competency and self-efficacy in coaching caregivers. Using a quasi-experimental design, a convenience sample (n = 167 families) was recruited (79 intervention; 88 control). Follow-up data were obtained from 45% of families (38 intervention; 38 control), impacted by COVID-19 attendance. Analyses demonstrated significant increases in self-reported Parent Verbal Responsivity (d = 0.68; 95% confidence interval [CI] = 0.17 to 1.18; P = .009) by intervention group caregivers. Intervention pediatric residents reported significant increases in promoting positive caregiver-child interactions and confidence in conveying child development (d = -.73; 95% CI = -1.21 to -0.22; P = .003). The TREE program is a promising practice that operationalizes promotion of relational health and positive early childhood experiences within pediatric primary care.

Understanding Pediatric Residents' Communication Decisions Regarding Anticipatory Guidance About Firearms.

In 2014, guns were the second leading cause of death among children and teens in the U.S. and it was previously found that approximately 33% of children live in homes with a firearm (Schuster et al., 2000). Currently, the AAP recommends pediatricians address firearms and firearm safety with patients; however, available research regarding the methods pediatricians use to communicate with patients regarding firearms and the influences on decision making is mixed and in need of more studies. Utilizing concepts from the theory of planned behavior and the health belief model, this paper presents findings from an online survey of medical doctors in several pediatric residency programs and seeks to identify the influences on prioritization of firearm safety in one's anticipatory guidance. Findings indicate that many residents do not counsel on firearm safety during well child visits. Further, prioritization is influenced by comfort, training, and confidence. Gender differences were also found, wherein women are more likely to indicate that firearm safety is as important as other anticipatory guidance messages, but also indicate less confidence in abilities to counsel. Theoretical and practical implications, including possibilities for future research and interventions, are discussed.

Assessment of Pediatric Residents' Attitudes toward Anticipatory Counseling on Gun Safety.

INTRODUCTION: Guns remain a major cause of injury and death among children. We determined pediatric residents' familiarity with gun safety campaigns and their gun safety counseling practices. We determined pediatric residents' comfort with the Asking Saves Kids (ASK) campaign, which recommends that parents ask about gun safety and storage where their children play. METHODS: Cross-sectional 27-item electronic survey was distributed to three pediatric residency programs in Baltimore, Maryland, USA. Residents were asked to respond to statements using a seven-point Likert scale on familiarity with three gun safety campaigns and their attitudes toward gun safety counseling. RESULTS: 82% of respondents were not familiar with gun safety programs. 23% reported not counseling. 87% believed it is a good idea to ask about guns in a home but only 64% were comfortable recommending their patients' parents to ask about guns. 59% were personally comfortable asking about guns in the home. 15% believed their patients' parents would be comfortable asking about guns in the homes of friends and families. CONCLUSIONS: The residents in this survey supported the idea of gun safety anticipatory guidance but discussing firearms can be problematic. Educational programs and strategies are needed to support physicians' counselling on gun safety.

Strengthening legal frameworks for vaccination: The experiences of Armenia, Georgia, and Moldova.

BACKGROUND: Gavi, the Vaccine Alliance, delivers life-saving vaccines to children in the world's poorest countries and encourages countries to assume increasing ownership of their immunization programs as their economies grow. Vaccination legislation may promote country ownership and immunization program sustainability. However, despite establishment of vaccination laws as an indicator of national commitment to immunization through the Global Vaccine Action Plan, little is known about the content of vaccination legislation in low- and middle-income countries and the processes by which countries strengthen their legal frameworks. We describe the experiences of three countries supported by Gavi through its partnership with the Sabin Vaccine Institute- Armenia, Georgia, and Moldova-in strengthening their legal frameworks for vaccination as they transition from Gavi support. METHODS: Information presented comes from national legal documents and the 2017 European Regional Workshop on Immunization Legislation, in which legislators and health officials from Armenia, Georgia, and Moldova shared approaches to making immunization a national priority by strengthening legal frameworks. We outline each country's legislative framework, describe progress in modifying vaccination legislation, and present strategies developed by countries to continue strengthening the legal basis of their immunization programs. RESULTS: Armenia, Georgia, and Moldova have legal frameworks that guarantee immunization as a public good, define immunization calendars, and establish regulations for vaccine procurement and administration. Legislative priorities include modifications of regulations to optimize procurement (Armenia and Moldova), potential provisions to increase vaccination through incentives (Georgia) or requirements (Moldova, possibly Armenia), and new mechanisms to finance routine program costs (all three countries). Each country is employing a distinct approach to strengthen its legal framework. CONCLUSION: These country experiences suggest that while legal approaches can promote country ownership, there is no standardized approach to vaccination legislation. A better understanding of the complex legal frameworks and their impact on supporting and sustaining progress in vaccination is needed.

Routes Countries Can Take To Achieve Full Ownership Of Immunization Programs.

A goal of the Global Vaccine Action Plan, led by the World Health Organization, is country ownership by 2020, defined here as the point when a country fully finances its routine immunization program with domestic resources. This article reports the progress made toward country ownership in twenty-two lower- and lower-middle-income countries engaged in the Sabin Vaccine Institute's Sustainable Immunization Financing Program. We focus on new practices developed in the key public institutions concerned with immunization financing, budget and resource tracking, and legislation, using case studies as examples. Our analysis found that many countries are undertaking new funding mechanisms to reach financing goals. However, budget transparency remains a problem, as only eleven of the twenty-two countries have performed sequential analyses of their immunization program budgets. Promisingly, six countries (Cameroon, the Republic of the Congo, Nepal, Nigeria, Senegal, and Uganda) are creating new national immunization funding sources that are backed by legislation. Seven countries already have laws regarding immunization, and new immunization legislative projects are under way in thirteen others.