Take an 11-minute break and view this Red Book Webinar that offers strategies and resources to increase the uptake of HPV vaccines and other recommended adolescent immunizations. Presenter Janet Siddiqui, MD, MBA, FAAP, ABIHM, also shares tips to help adolescents catch up with vaccines they may have missed due to the pandemic and reviews vaccine recommendations, coverage rates and barriers to vaccination.
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Human Papillomavirus Vaccines - Immunizations - American Academy of Pediatrics
Navigating school-based mental health services can be difficult for a child with mental health issues, their family, and at times, for the pediatrician.
James Wallace, MD, associate professor, Department of Psychiatry and Pediatrics, University of Rochester Medical Center, Child and Adolescent Psychiatry Faculty Trainer,The REACH Institute, explained how to traverse the crossover landscape between the pediatrician and school, in this Q+A interview with Contemporary Pediatrics.
Contemporary Pediatrics:
What is the pediatricians role when it comes school-based mental health services?
James Wallace, MD:
The single most important thing pediatricians can do is to consider the school as a natural and important ally and partner for managing pediatric behavioral health issues. Collaboration can help us make more accurate diagnoses, develop more effective multimodal treatment plans, and monitor progress in many areas. Without collaboration and communication, there are always missing pieces.
Contemporary Pediatrics:
How can schools and pediatricians work better together, or what are the missing links?
Wallace:
Medicine and education have different ways to think about children and teens. Each uses different language, follows different laws and regulations, and uses different strategies to intervene. Therefore, collaboration requires that both parties work hard to understand each other.
Simple routine communication procedures like sending the pediatrician a copy of every Individualized Education Plan (IEP) and 504 Accommodation Plan can help. Pediatric offices could develop a liaison for schools, [such as] clerical, medical assistant, nurse, and schools could develop a liaison for medical offices, [such as] clerical, teacher on special assignment, school nurse, counselor, or administrator.
To follow confidentiality laws (HIPPA, FERPA), having convenient releases of information (ROI) and making routine communication an expectation are huge steps in the right direction.1
Contemporary Pediatrics:
When is a good time to refer a patient to a mental health professional, perhaps going from a school therapist or counselor to something more?
Wallace:
When children and teens need evidence-based care that the school cannot provide, referring to community resources for that care is critical. Both schools and PCPs should keep a list of providers in the community with whom they have had good experiences and share that resource list.
Many states have Child Psychiatric Access Programs2 where primary care providers can call to get a list of appropriate referrals. But it is not an either/or. Students often continue with their school-based counseling as they enter community-based services. Collaboration between these 2 providers using the same language and skill-building can boost the impact of interventions and help generalize changes to more settings.
Contemporary Pediatrics:
What are schools and pediatricians lacking when it comes to providing resources to children with mental health concerns?
Wallace:
A school and pediatrician team can effectively assess and manage many, perhaps most, mental health concerns in children and teens, especially if the pediatric provider had intensive training in the assessment and management of mental health problems like the Patient-centered Mental Health in Pediatric Primary Care (PPP4) course offered through the REACH Institute.3
Primary care providers can also learn time-limited evidence-based Cognitive Behavior Therapy, Parent Training and Trauma interventions that they can provide themselves for milder cases or for when access to community therapy resources is delayed or unavailable.
Children with complex symptoms and impairment often need services and expertise beyond this core team. They often need a more specialized clinical therapist in the community. Some need consultation and treatment with a child and adolescent psychiatrist or psychiatric nurse practitioner.
Others need care management, in-home services, crisis services and acute care services beyond the resources of schools and primary care providers. These services are in addition to the school-pediatrician team, not instead of.
As the complexity and impairment expands, the village of collaborating providers needed to support the family and child should grow to meet the need. Call Access Programs can be a great resource for primary care providers to learn how to use the complex and often unique network of available local services.2
Contemporary Pediatrics:
Who are the students who are most vulnerable to mental health issues?
Wallace:
Children and teens who have suffered significant trauma are a very vulnerable group who are often in need of mental health service. Behavioral health problems have genetic and environmental components (nature and nurture), so they tend to run in families, especially when the whole family is struggling.
Those who have experienced adverse childhood events (ACES) are at risk, as are children who have been bullied, who are engaged in substance use, or who are in the LBGQT+ community. Non-English speakers, recent immigrants, people of color and other minority groups are at risk due to chronic stressors. They also face complex barriers to adequate health and mental health services, so they suffer doubly with greater needs and worse access.
Contemporary Pediatrics:
What signs should pediatricians and teachers/counselors look for in these patient populations?
Wallace:
Abrupt changes in mood, behavior, academic performance and/or relationships are worrisome signs. School refusal, self-injury or suicidal comments or behaviors, verbal or physical threats or aggression are red flags.
Subtle changes can signal a possible behavioral health problem early when the problems and impairment are milder and more amenable to change. School personnel and primary care providers have the advantage of knowing their students/patients over time so they can tell when a childs behavior changes. Familiar faces make it easier for students/patients and their families to disclose their concerns and seek help.
In medical settings, the United States Preventative Services Task Force (USPSTF) recommends universal screening for high frequency mental health problems like anxiety, depression, and suicidalityavailable on the ProjectTeachNY.org websitebecause some patients and families dont disclose their concerns unless asked.1,4
Some school districts have screening protocols for the same reason. We must all be on the lookout for significant changes in mood, anxiety, aggression, relationships, and academic performance so we can help these students/patients and all children and teens get the help they need.
References:
1. Families thrive with good mental health. Project Teach. Accessed February 9, 2024. https://projectteachny.org/
2. Integrating physical and behavioral health care for every child. National Network of Child Psychiatry Access Programs. Accessed February 9, 2024. https://www.nncpap.org/
3. REACH mental health training. The REACH Institute. Accessed February 28, 2024. https://thereachinstitute.org/training/#patient-centered-mental-health-in-pediatric-primary-care-ppp
4. Mental health conditions and substance abuse. US Preventive Services Task Force. Accessed February 9, 2024. https://www.uspreventiveservicestaskforce.org/uspstf/topic_search_results?category%5B%5D=20&searchterm=
Link:
The role of the pediatrician in school-based mental health services - Contemporary Pediatrics
Monday, March 4, 2024 12:00 pm 1:00 pm EST; 11:00 am 12:00 pm CST; 10:00 am 11:00 am MST; 9:00 am 10:00 am PST Register Here
Kara Monnin, PhD Kara Monnin, PhD, is a Clinical Assistant Professor of Pediatrics at Nationwide Childrens Hospital and Ohio State Universitys School of Medicine in Columbus, OH. Dr. Monnin provides clinical services across multiple inpatient units, including complex healthcare, inpatient physical medicine and rehabilitation, and acute care services (PICU, Trauma/Surgery/Neurosurgery), and operates on a consultative basis for Complex Care clinics. Dr. Monnin also serves as a member of the Advanced Illness Management/Palliative Care team at NCH and specializes in traumatic brain injury, rehabilitation populations, and children and adolescents with complex medical needs.
Kelsey E. Bakaletz, MSW, LISW Kelsey E. Bakaletz, MSW, LISW, is most importantly, a mother to 2-year-old Ellis. Kelsey is a clinical medical social worker in Developmental Behavioral Pediatrics at Nationwide Childrens Hospital in Columbus, OH. Kelsey received both undergraduate and graduate degrees from Ohio State University. Prior to working at NCH, Kelsey spent two years in rapid re-housing of homeless military veterans, and before that, she spent almost two years in therapeutic rehabilitation of adjudicated juvenile sex offenders. Kelsey is a member of the Trauma-Informed Care Work Group at Nationwide Childrens Hospital, working to provide and teach the best trauma-informed practices. Kelsey is passionate about treating every patient interaction as though the caregiver and child are part of our family, to lead with empathy, compassion, and determination that we resist re-traumatization.
Objectives: At the end of this session, the learner will:
Audience: This webinar is intended for all members of the rehabilitation team, including medical staff, nurses, physical therapists, occupational therapists, speech language pathologists, licensed psychologists, mental health professionals, and other interested professionals.
Level: Intermediate
Certificate of Attendance: Certificates of attendance are available for all attendees. No CEs are provided for this course.
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Neal dejong, MD, MPH, at the UNC School of Medicine, David Y. Ming, MD, at Duke University School of Medicine and Ryan Coller, MD, at University of Wisconsin School of Medicine and Public Health, received $5.5 million to study hospital-to-home transitions across settings for children and youth with special healthcare needs.
Nearly one in five children, almost 14 million in the United States, have a special healthcare need that may require hospitalization. After a childs hospital stay, the transition back home can be risky, particularly for children with chronic health issues and complex medical conditions. To understand how to best support children and youth with special healthcare needs (CYSHCN), researchers of the CYSHCN National Research Network (CYSHCNet) received $5.5 million for a multi-site studyfunded by the Patient-Centered Outcomes Research Institute (PCORI)to compare two types of hospital-to-home transitional care to optimize outcomes.
The CYSHCNet researchers are led by David Y. Ming, MD, principal investigator, associate professor of pediatrics at Duke University School of Medicine; Neal dejong, MD, MPH, associate professor of pediatrics and member of the UNC Childrens Research Institute at the UNC School of Medicine; and Ryan Coller, MD, associate professor of pediatrics at the University of Wisconsin School of Medicine and Public Health.
Over a one-month post-discharge period, researchers will compare the effectiveness of two transitional care approaches focused doseversusextended dose reducing return visits to the hospital or emergency department and increasing parent-reported confidence. They will also evaluate the impact of each type of hospital-to-home transitional care on specific CYSHCN patient groups, including those with highly complex clinical needs and those from racial/ethnic minority groups or living in rural areas. Lastly, researchers will investigate how and why each approach to hospital-to-home transitional care is effective and for whom they work best.
The study team includes multiple community partners, including parents and caregivers with lived experience, clinicians, policymakers, and health system leaders. A community advisory board, primarily composed of a diverse group of parents/caregivers of CYSHCN, will work closely with the research team throughout the study. This collaborative effort aims to contribute to the equitable improvement of overall care for all CYSHCN transitioning from hospital to home.
About CYSHCNet:
CYSHCNet brings academic researchers and lived experience partners together to study the health care system issues that matter most to CYSHCN and their families. We help CYSHCN and their families by advancing knowledge and implementation of optimal health systems through innovative, rigorous multi-site studies, far reaching dissemination of findings, meaningful partnerships with families, and strong training of emerging CYSHCN investigators. Learn more:https://cyshcnet.org/.
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Viewpoint: Journal Pediatrics reneges on its commitment to print response to botched article claiming GMOs are ... Genetic Literacy Project
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By Associated Press
Updated: 1 day ago Published: 1 day ago
The Albert Einstein College of Medicine in New York City. The school will be tuition-free for all students from now on thanks to a $1 billion donation from a former professor, the widow of a Wall Street investor. (Jason Torres/Albert Einstein College of Medicine via AP)
NEW YORK A New York City medical school will be tuition-free for all students from now on thanks to a $1 billion donation from a former professor, the widow of a Wall Street investor.
Ruth Gottesman announced the gift and its purpose to students and faculty at Albert Einstein College of Medicine Monday, bringing some in the audience to tears and others to their feet, cheering. Gottesman, 93, has been affiliated with the college for 55 years and is the chairperson of its board of trustees.
The gift is intended to attract a diverse pool of applicants who otherwise might not have the means to attend. It will also let students graduate without debt that can take decades to repay, college administrators said. Tuition at Einstein is $59,458 per year. The average medical school debt in the U.S. is $202,453, excluding undergraduate debt, according to the Education Data Initiative.
Each year, well over 100 students enter Albert Einstein College of Medicine in their quest for degrees in medicine and science, Gottesman said. They leave as superbly trained scientists and compassionate and knowledgeable physicians, with the expertise to find new ways to prevent diseases and provide the finest health care.
Gottesman credited her late husband, David Sandy Gottesman for leaving her with the financial means to make such a donation. David Gottesman built the Wall Street investment house, First Manhattan, and was on the board of Warren Buffetts Berkshire Hathaway. He died in 2022 at age 96.
l feel blessed to be given the great privilege of making this gift to such a worthy cause, Ruth Gottesman said.
The gift is believed to be the largest made to any medical school in the country, according to Montefiore Einstein, the umbrella organization for Albert Einstein College of Medicine and the Montefiore Health System.
I believe we can change health care history when we recognize that access is the path to excellence, said Dr. Philip Ozuah, president and chief executive of Montefiore Einstein.
Gottesman joined Einsteins Childrens Evaluation and Rehabilitation Center in 1968 and developed screening and treatments for learning problems. She started the first-of-its-kind Adult Literacy Program at the center in 1992, and in 1998 was named the founding director of the Emily Fisher Landau Center for the Treatment of Learning Disabilities at CERC. She is clinical professor emerita of pediatrics at Einstein.
Through their foundation, the Gottesman Fund, the family has supported charities in Israel and within the U.S. Jewish community, especially through gifts to schools, universities and New York Citys American Museum of Natural History.
Einstein becomes the second tuition-free medical school in New York. In 2018, New York University School of Medicine announced that it would cover the tuition of all its students.
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By HCO Staff
SPRINGFIELD, Ill.For many children, a trip to the doctor can be anxiety-inducing or even downright scary. Pediatricians offices have long tried to combat that fear by creating a softer and more child-friendly environment with toys, games and colorful dcor, but what if the building itself was designed from the ground-up to directly address and distract from childrens anxiety starting from the moment they pull into the parking lot?
This was the concept behind Lawrence Groups design of the new $23 million Springfield Clinic pediatric center in Springfield, Ill. a 41,500-square-foot facility consolidating multiple pediatric practices across Springfield under one roof, including general pediatrics, dermatology, lab and radiology services. The facility officially welcomed its first patients on Oct. 16, 2023. The general contractor on the project was OShea Builders of Springfield, Ill.
The project came to the design team through a longstanding relationship between one of Lawrence Groups business development professionals and the Vice President of Facilities, Real Estate and Construction at Springfield Clinic.
They were looking for something unique and different that still supported their brand but had a new approach, and it had to appeal to a wide range of ages from newborns to young adults in their early twenties, so thats where our expertise in ground-up construction and healthcare and hospitality design came into play, said Lawrence Group Director of Interiors Julie Steffens, NCIDQ.
The building was designed inside out with pediatric patients and their caregivers in mind, employing an on stage (patients) and off stage (staff and providers) model that provides complete separation between these two groups for a seamless patient experience.
Its a trend in healthcare design that a lot of organizations are moving to from that experiential standpoint, Steffens said.
The model was one that Springfield Clinic already had in the works at another facility under construction in Jackson, Ill. Clinic administrators wanted to bring that same methodology and branding to all its clinics. With four pediatric practices across Springfield merging into one space under this new concept, the biggest question was whether it would work for all of them.
From a culture standpoint and operational flow, theres a lot of change that they are going to be going through for the good of the organization itself as well as the patient experience, said Steffens.
Once there was buy-in from the various stakeholders, Lawrence Group proceeded to focus on creating a unique healthcare experience through interior and exterior design with a guiding principle of creating elements of distraction and discovery around every corner to reduce the stress of visiting patients.
The whole idea of this project is about a journey starting with that ride to the doctors office and that connection between a parent and child or a caregiver and a child, said Steffens. Those elements of distraction start when they arrive on site with strategically placed walking paths for safety that have these moments of discovery embedded with footprints and leaves, and exterior sculptures even before they get into the interior.
Lawrence Group Design Architect Kevin Le used multi-hued terracotta baguettes across the buildings faade, strategically placed to create an immediate visual impression as visitors pull up to and enter the building. The baguettes rise above the roofline on a slope, allowing the sky to peek through.
They wanted to be different and bring the future to this area as opposed to blending with what is there, furthering their mission and their brand identity, said Lawrence Group Architect and Project Manager Ganesh Sathyan. We wanted to continue that feeling going inside, one surprise after another.
Those surprises include large fish tanks, a slide that goes from the second floor to the first and a significant amount of artwork throughout the spaces, both on-stage and off-stage. Lawrence Group worked with St. Louis art consultancy TOC Artwork to curate a variety of both limited-edition and commissioned pieces, including two kinetic art sculptures installed on the exterior.
TOC really listened and tailored the artwork selections to the providers vision. Its pretty unique to Springfield and they did tap into some local artists in the community for a few pieces, said Steffens. The providers were so heavily invested in the art and that was the one piece where they could really personalize their spaces. Many of them use the artwork as a point of conversation to engage the patient and get them talking about something thats familiar to them.
The artwork was carefully selected to tie into the color story created by the interior design team, with six colors used as a means of wayfinding. Each clinic corridor is identified by a unique color, thoughtfully applied so as to not be overwhelming when entering the space. More neutral fixed elements are brightened with pops of color in the artwork, furniture and accents. The design concept also had to support Springfield Clinics brand, so the interior design team worked closely with the clinics marketing and brand experience team to ensure proper execution.
No project is without its challenges, and the biggest one for Springfield Clinic was its mid-pandemic timeline. With work starting early in 2020, the subsequent shutdowns caused substantial schedule shifts. Delays and shortages of materials also required advanced planning. The projects general contractor guided the Lawrence Group team on acquiring certain materials, like metal decking, long before they were needed in order to ensure procurement. Other materials had to be fully substituted due to extensive delays.
The pandemic taught us a lot and we experienced a lot of circumstances that forced us to think differently about how a project gets put together and gets built, Sathyan said. In healthcare, very little for us has been cookie cutter. Every client is different and every solution is different. What we pride ourselves on is the fact that were able to translate the dreams of our clients into reality. The client came to us with a vision to be a premier pediatric facility, and this is the end product.
Throughout the entire design/build process, the Lawrence Group team kept the patient experience as its guiding principles for all decisions and solutions, knowing the profound impact the completed facility would have on the communitys youngest members.
From the beginning, the entire team from the design team to the client side really came together and worked transparently and creatively. The final product is the result of trust, respect and team collaboration, said Steffens.
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Even with teen opioid overdose deaths soaring, a new study finds most pediatricians aren't prepared to treat young patients struggling with addiction. The nationwide survey was conducted by researchers at Mass General for Children and Yale School of Medicine. Of those pediatricians surveyed, 48% said they felt prepared to counsel teen patients struggling with opioid use. That's despite the fact nearly all of those surveyed believe it's their responsibility to do so. And, even though 24% said they'd diagnosed Opioid Use Disorder in a young patient, just 5% said they had prescribed any medication considered the standard of care for the disorder. Dr. Scott Hadland, an addiction specialist at Mass General for Children and the lead author on the study, said increasing training is critical when it comes to bridging this gap. That includes starting opioid use education in medical school and continuing it throughout a pediatrician's career, he said. Hadland also stressed that correcting the situation is vital to protect our kids. "It's so important because sometimes the hook, the thing that makes a teenager want to come back and talk to you more is not actually about their drug use; it's about something else," he said. "For example, I might be caring for a teenager who's struggling with acne and also struggling with opioids and they may not be ready to talk to me about their opioid use, but I can help address their acne and that gives me an opportunity to continuously engage them and work at that substance use with them."The survey is published in JAMA Pediatrics.
Even with teen opioid overdose deaths soaring, a new study finds most pediatricians aren't prepared to treat young patients struggling with addiction.
The nationwide survey was conducted by researchers at Mass General for Children and Yale School of Medicine.
Of those pediatricians surveyed, 48% said they felt prepared to counsel teen patients struggling with opioid use. That's despite the fact nearly all of those surveyed believe it's their responsibility to do so.
And, even though 24% said they'd diagnosed Opioid Use Disorder in a young patient, just 5% said they had prescribed any medication considered the standard of care for the disorder.
Dr. Scott Hadland, an addiction specialist at Mass General for Children and the lead author on the study, said increasing training is critical when it comes to bridging this gap. That includes starting opioid use education in medical school and continuing it throughout a pediatrician's career, he said.
Hadland also stressed that correcting the situation is vital to protect our kids.
"It's so important because sometimes the hook, the thing that makes a teenager want to come back and talk to you more is not actually about their drug use; it's about something else," he said. "For example, I might be caring for a teenager who's struggling with acne and also struggling with opioids and they may not be ready to talk to me about their opioid use, but I can help address their acne and that gives me an opportunity to continuously engage them and work at that substance use with them."
The survey is published in JAMA Pediatrics.
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Most pediatricians aren't prepared to handle teen opioid use, study says - WCVB Boston
Appointment cancellations and financial distress have become a constant at Bethesda Pediatrics, a nonprofit medical clinic in East Texas that is heavily dependent on Medicaid, the health insurance program for the poor.
On a recent Monday, the mother of a toddler who had a primary care appointment broke down in tears after learning the child had just lost Medicaid coverage, wondering how she could pay the bill.
Another mother told Dr. Danny Price, the clinics lead pediatrician, that she was afraid to get her child a flu shot because of the $8 fee she would have to pay now that the child had been dropped from Medicaid.
A child with depression did not show up, most likely, Dr. Price presumed, because of having lost Medicaid coverage.
The uncertainty and panic at the clinic, tucked inconspicuously in a poor residential pocket of Tyler, Texas, highlight a little-examined consequence of the vast trimming of the Medicaid rolls since a policy that barred states from kicking anyone out of the program during the pandemic ended last spring. The loss of coverage has not only affected families, but is also threatening the financial stability of vital components of the American safety net.
Medicaid payments are the lifeblood of our health centers and their ability to serve, said Dr. Kyu Rhee, the president and chief executive of the National Association of Community Health Centers, which treat roughly one in 11 people in the United States and rely on Medicaid and federal grants to provide a financial cushion for the uncompensated care they give uninsured patients.
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As Medicaid Shrinks, Clinics for the Poor Are Trying to Survive - The New York Times
A new study by the Kennedy Krieger Institute in Baltimore and 11 other medical sites found that up to a third of children who were hospitalized because of COVID-19 experienced persistent symptoms one to two years after they were released.
The research, published earlier this month in Frontiers in Pediatrics, analyzed the post-hospital quality of life for children previously diagnosed with COVID-19 or multisystem inflammatory syndrome in children a rare condition associated with COVID where body parts like the heart, lungs, kidneys, brain, skin and eyes become inflamed.
Researchers found that 30% of the families participating in the study reported that their child had not fully recovered from COVID or the syndrome also known by its initials as MIS-C.
Of the children who hadnt recovered following their hospital discharge, the majority 87% had neurological symptoms, Kennedy Krieger said in a news release this week. About three in five children continued to struggle with headaches and just under half experienced weakness.
These numbers speak volumes about the lasting effects that COVID has on some children, said Dr. Beth Slomine, co-director at Kennedy Kriegers Brain Injury Clinical Research Center and one of the studys co-authors.
Our findings highlight the urgent need for better monitoring systems and care strategies to address the long-term effects that the pandemic made on pediatric health, said Slomine, who is also Kennedy Kriegers assistant vice president of psychology.
The study included 79 children from 12 medical centers across the country and lasted from January 2020 to July 2021 during the coronavirus pandemic. It is part of a global research effort to better understand how often people hospitalized with COVID experience neurological problems once they are released.
Other important findings from the study included that of the children who had not recovered from COVID, 40% had at least one return emergency visit and 24% were readmitted to the hospital. These children also had increased signs of inflammation when they were admitted to the hospital, compared to those whose parents reported them being recovered.
Researchers also noted that children in the not recovered category were more likely to be from families who had reported changes in their routines, stress, food access and access to mental health treatment during the pandemic.
More research is needed to better understand the relationship between pandemic-related social stress and prolonged symptoms, Slomine said in the news release.
Also in the news release, Dr. Ericka Fink lead author of the study and a critical care pediatrician at the UPMC Childrens Hospital of Pittsburgh said the next step for researchers is to dig deeper into understanding factors that could help predict which patients are at risk for persistent symptoms.
In the future, she said, scientists may be able to develop a screening tool to help doctors identify those children more likely to require longitudinal, multidisciplinary care.
Most children diagnosed with COVID and long COVID a collection of ongoing, returning or new symptoms experienced after an initial COVID infection dont require hospitalization, according to Kennedy Kriegers news release. However, Slomine emphasized the importance of equipping families with information about the risks associated with the illness so they can make the best decisions for their children.
As we continue to learn about COVID-19, education and awareness remains at the forefront at Kennedy Krieger and around the world, Dr. Slomine said. Collaborative endeavors such as these are pivotal in guiding our research and ensuring the best care possible for children affected by the virus.
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Many children hospitalized with COVID continue to face challenges. - Baltimore Sun