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Objective: To determine whether use of digital-based screening is a feasible approach to monitoring child development, it is necessary to assess young children's abilities to interface with touch screen technology. The primary objectives of this exploratory feasibility study with a randomized experimental design were to determine (1) whether young children respond differently to developmental tasks on paper versus tablet device and (2) whether responses to items presented digitally differed according to hours of weekly exposure to touch screen technology in the home. Methods: Eighty children attending 18-, 24-, 36-, or 48-month pediatrician well-child checks were randomly assigned to complete a series of 70 examiner-facilitated, developmental tasks across 7 domains (receptive language, expressive language, early literacy, early numeracy, social emotional, cognition, and fine motor) presented either digitally or on paper. Parents provided information about use of technology in the home. A series of t tests assessed for main effects of presentation modality (digital vs paper) on each of the domains. Results: Raw scores across the 7 domains did not differ by presentation modality. Hours of technology use per week was not related to raw scores among children in the digital condition. Conclusion: Young children do not respond differentially to items when presented in a digital format in comparison to a paper-based format. Use of manipulatives for assessing developmental skills may be needed for children 2 years and younger, as they displayed a limited range of responses to items in both conditions at these age groups.

Purpose:The Covid-19 pandemic contributed to adverse adolescent mental health outcomes globally. Adolescents with chronic conditions have four times the odds of self-harm than peers.Little evidence exists to guide pediatric nurses on how to engage this vulnerable population with mental health supports as the pandemic continues. In adults with chronic conditions, positive health assets (health access literacy, health self-efficacy, and emotional wellbeing) are directly related to improved patient engagement. The objective of this study was to gain a deeper understanding of engagement with mental health supports in adolescents with chronic conditions to inform practice. Design and Methods:Using mixed methods, we surveyed and interviewed adolescents with chronic conditions aged 10-20 years. Random sampling was applied to avoid bias. Valid and reliable scales were used to measure health access literacy, health self-efficacy and emotional wellbeing. Textual data was collected using a semi-structured interview guide. Integrated data analysis was conducted using structural equation models and interpretive phenomenology.Results: 154 participants provided numerical data and 17 participants provided textual data (mean age 15.5 years; 56% female, 5.8% agender; 56% white; 16.9% Black or African American, 4.5% Asian; 51.9% Hispanic or Latinx; 23.4% LGBTQ+). The structural model was an acceptable fit for the data (CFI = 0.97, TLI = 0.95). Participants reported higher levels of health access literacy (M=3.88, SD=0.848) than health self-efficacy (M=2.98, SD=.646), and engagement (M=1.78, SD=1.71). Health access literacy predicted emotional wellbeing (b = .33, p < .001, 95% CI [.20, .50]) and health self-efficacy (b = 0.52, p < .001, 95% CI [0.42, .062]).Emotional wellbeing positively predicted health self-efficacy (b = 0.21, p < .003, 90% CI [0.10, .033]). Health self-efficacy predicted engagement (b = 0.20, p < .01, 90% CI [0.07, .034]).Participants reported not engaging until "it was really, really bad" citing fear, stigma, and lack of connectedness with providers as barriers.Practice Implications: Regardless of health access literacy and health self-efficacy, adolescents with chronic conditions may not engage until crisis levels. Pediatric nurses can aim to engage with this vulnerable population proactively.

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