A Multisystem Approach to Improving Autism Care.

Children with autism face significant barriers to accessing evaluations and intervention services often because of confusing referral processes, lack of centralized coordination across organizations serving children with autism, insurance coverage gaps, multiyear waitlists for diagnostic services, and limited provider knowledge about autism. Racism and systemic inequities exist and persist in autism care across the United States. This article reviews targeted initiatives implemented by a multidisciplinary team to advocate for, and address barriers faced, by autistic children and their families in Washington, DC. We describe initiatives across multiple levels of the health care system including: 1. infrastructure-building initiatives (eg, coalition-building, policy, and advocacy); 2. enabling services (eg, population- and community-level supports that increase provider capacity to serve children's and families' needs); and 3. direct services (eg, innovative, gap-filling programs that directly serve children and families). We review outcomes and describe lessons learned.

Factors Associated With Psychiatric Readmission of Youths in a Racially Diverse and Urban Hospital Setting.

OBJECTIVE: This study examined predictors of readmission to a psychiatric inpatient unit of an urban children's hospital within 1 year of discharge among a racially diverse sample of youths. METHODS: The authors retrospectively analyzed 2 years of electronic health record data of inpatient psychiatric unit admissions (N=1,604). Multivariate logistic regression and random-effects multinomial logistic regression were used for analyses. RESULTS: The estimated odds ratios for any readmission within 1 year of discharge were significantly higher for Black youths, youths insured by Medicaid, and youths with a length of stay longer than 7 days. Factors remained strongly predictive when examining multiple readmissions versus no readmissions. CONCLUSIONS: Black youths, youths insured by Medicaid, and youths with longer stays were more likely than other youths to be readmitted. Findings suggest the need for interventions such as care coordination to target predictors of readmission and the need to examine inequities in the health care system.

Substance Use Among Adolescents and Young Adults With Type 1 Diabetes: Discussions in Routine Diabetes Care.

Pediatric health care providers are in a unique position to discuss the health implications of alcohol, tobacco, and drug use with adolescents and young adults (AYAs) with type 1 diabetes (T1D). This study evaluated the frequency of self-reported substance use and associated demographic and clinical characteristics in a sample of AYAs with T1D and patient-provider discussions of substance use in T1D care. Sixty-four AYAs completed questions about substance use from the Youth Risk Behavior Survey (YRBS). Corresponding diabetes clinic visits were audio-recorded, transcribed, and reviewed to examine substance use discussions. A total of 56.3% of AYAs reported ever engaging in substance use; 40.6% reported substance use within the past 30 days. Five AYAs had discussions about substance use during their most recent diabetes clinic visit. Substance use should be proactively addressed by pediatric health care providers and AYAs should be encouraged to raise questions related to substance use during clinic visits.

Discouraging partnerships? Teachers' perspectives on immigration-related barriers to family-school collaboration.

This study investigates barriers to facilitating family-school partnerships with immigrant families as identified by teachers in an urban school district with high rates of immigration. Participants consisted of 18 elementary teachers who identified predominantly as Hispanic (38.9%) or non-Hispanic White (33.3%), were frequently bilingual (55.6%), and were mostly female (94.4%) with an average age of 36.5 years. Participants engaged in focus group interviews that were transcribed and open-coded. Barriers to engagement for immigrant families fell into 3 broad areas: language and culture, family resources, and families' undocumented status. Many teachers attributed the barriers preventing parental collaboration to school policies (94.4%) and ineffective communication strategies (83.3%). Teachers also identified barriers as emanating from the families themselves, including families not attending school functions (88.9%) and being unresponsive to school-initiated communication (72.2%). Teachers noted that many families lacked resources necessary for school engagement (88.9%) and were hesitant to become engaged with schools due to required screening procedures (55.6%). Overall, numerous barriers to effective family engagement were identified, several of which are directly related to immigration and residency status. Given the strong evidence suggesting that family engagement in education mediates risk for children of recent immigrants, strategies to foster meaningful engagement for all families are desperately needed (Naughton, 2004). Roles for school psychologists to facilitate effective family-school partnerships are discussed. (PsycINFO Database Record