Family-based behavioral interventions are efficacious and effective in preventing drug use and sexual risk behaviors; unfortunately, they have not been evaluated and disseminated in pediatric primary care practice, where they can have a significant impact. There is an increased focus on integrating parenting interventions into primary care to reduce health disparities among ethnic minorities such as Hispanics. Although Hispanic youth demonstrate higher levels of drug use and sexual risk behaviors than their non-Hispanic counterparts, few parenting interventions are available for Hispanic youth, and none have been delivered specifically to Hispanic adolescents in primary care. Therefore, this manuscript describes the rationale and design of an Internet-based, family-centered, Hispanic-specific, evidence-based prevention intervention, eHealth Familias Unidas Primary Care. Hispanic adolescents (n = 456) and their care givers will be recruited from pediatric primary care clinics in South Florida and randomized to: eHealth Familias Unidas Primary Care or prevention as usual. The intervention will be delivered by trained interns, clinic volunteers, social workers, mental health counselors, students, and nurses. Outcomes will be measured at baseline and 6, 12, 24, and 36 months post-baseline. This study will determine whether the intervention, compared to prevention as usual, is effective in reducing drug use, unprotected sex, and STI incidence in Hispanic youth through the improvement of family functioning. Additionally, we will determine the cost effectiveness of delivering eHealth Familias Unidas within primary care settings. The effectiveness of eHealth Familias Unidas Primary Care will further inform the need to integrate effective behavioral health interventions into primary care settings.

As the number of living pediatric solid organ transplant (SOT) recipients continues to grow, there is an increased likelihood that primary care providers (PCPs) will encounter pediatric SOT recipients in their practices. In addition, as end-stage organ failure is replaced with chronic medical conditions in transplant recipients, there is a need for a comprehensive approach to their management. PCPs can significantly enhance the care of immunosuppressed hosts by advising parents of safety considerations and avoiding adverse drug interactions. Together with subspecialty providers, PCPs are responsible for ensuring that appropriate vaccinations are given and can play an important role in the diagnosis of infections. Through early recognition of rejection and posttransplant complications, PCPs can minimize morbidity. Growth and development can be optimized through frequent assessments and timely referrals. Adherence to immunosuppressive regimens can be greatly improved through reinforcement at every encounter, particularly among adolescents. PCPs can also improve long-term outcomes by easing the transition of pediatric SOT recipients to adult providers. Although guidelines exist for the primary care management of adult SOT recipients, comprehensive guidance is lacking for pediatric providers. In this evidence-based overview, we outline the main issues affecting pediatric SOT recipients and provide guidance for PCPs regarding their management from the first encounter after the transplant to the main challenges that arise in childhood and adolescence. Overall, PCPs can and should use their expertise and serve as an additional layer of support in conjunction with the transplant center for families that are caring for a pediatric SOT recipient.

This article focuses on the rationale, design and methods of an effectiveness-implementation hybrid type I randomized trial of eHealth Familias Unidas Mental Health, a family-based, online delivered intervention for Hispanic families to prevent/reduce depressive and anxious symptoms, suicide ideation/behaviors, and drug use in Hispanic youth. Utilizing a rollout design with 18 pediatric primary care clinics and 468 families, this study addresses intervention effectiveness, implementation research questions, and intervention sustainment, to begin bridging the gap between research and practice in eliminating mental health and drug use disparities among Hispanic youth. Further, we will examine whether intervention effects are partially mediated by improved family communication and reduced externalizing behaviors, including drug use, and moderated by parental depression. Finally, we will explore whether the intervention’s impact on mental health and drug use, as well as sustainment of the intervention in clinics, varies by quality of implementation at clinic and clinician levels. Trail registration: ClinicalTrials.gov Identifier: NCT05426057, First posted June 21, 2022.

The pictures were a stark reminder of what might have been. There she was: radiant with long, dark hair artfully coiffed. Her torso, cinched at the waist, gave way to cascading yards of white, glimmering fabric. It seemed to billow like clouds. Her eyes sparkled, as did her tiara. It was a far cry from reality: sallow, a short cropped haircut, and a drab hospital gown.The din of the monitor was in the background, and many times, its sound faded away with all the other beeps, whistles, and whispers of the machines in the pediatric intensive care unit. Tonight, it alerted us that her body was withering. She had hypotension, and the purported miracle drug would not be so miraculous after all. I was struck by how peaceful it all seemed. Three days prior, it was nothing but peaceful. Three days ago, we were denying what her parents believed would save her life.The miracle drug was astralagus membranaceous. Her parents had purchased it from an herbalist. Her immune system, ravaged by chemotherapy, needed this boost. Its contents could promote recovery. Early one morning, they brought it to me, the resident, so I could administer it."Señora, eso no es así. Ma'am, it doesn't work that way. We can't just give her something you bought. It's not an approved drug. We have no proof that it will work. It could even harm her," I said.Her mother responded, "But the herbalist says it will cure her. We bought 6 vials. He gave us the directions."On rounds, frustration mounted. "Why can't we give her this medicine? It's right here." Again, she pulled out the package, showing my attending physician this time. I had spoken with the patient's family several times a day since the start of her intensive care unit stay 3 weeks ago. I knew her well from when her leukemia was in remission. But it was a nasty malignancy, with meningeal involvement and the prognosis had always been poor. To me, the end was obvious; for her parents, the prospect of the end was not an option."Mamá, no seria ético darle una droga que no está aprobado." It wouldn't be ethical to give an unapproved drug.She replied, "It would be unethical not to try and everyone will know that you withheld lifesaving treatment."I could not find my attending physician fast enough.