Expanding the Pediatrician’s Black Bag: A Psychosocial Care Improvement Model to Address the “New Morbidities”

Abatemarco, Diane J.; Kairys, Steven; Gubernick, Ruth S.; Kairys, Jo Ann

doi:10.1016/s1553-7250(08)34013-6

Cited by 13 publications

(15 citation statements)

References 34 publications

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“…Earlier studies focused on clinical variables such as the Glasgow Coma Scale (GCS) score and pupillary reflexes to predict outcome [1,2,3,4,5], while more recent studies have focused on the use of radiologic variables, particularly magnetic resonance imaging, to predict outcome [6,7,8,9]. Similar studies in children with acute hypoxic ischemic encephalopathy (HIE) have demonstrated that specific abnormalities in pupil reactivity, somatosensory evoked potentials, electroencephalogram and magnetic resonance imaging predict poor outcome when performed at least 24 h, and ideally 48–72 h, after injury [10,11]. In both TBI and HIE, combining multiple modalities results in the most accurate prediction of outcome.…”

Section: Introductionmentioning

confidence: 99%

Trajectory Analysis of Serum Biomarker Concentrations Facilitates Outcome Prediction after Pediatric Traumatic and Hypoxemic Brain Injury

Berger

Bazaco

Wagner³

et al. 2010

Dev Neurosci

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Traumatic brain injury (TBI) and hypoxic ischemic encephalopathy (HIE) are leading causes of morbidity and mortality in children. Several studies over the past several years have evaluated the use of serum biomarkers to predict outcome after pediatric brain injury. These studies have all used simple point estimates such as initial and peak biomarker concentrations to predict outcome. However, this approach does not recognize patterns of change over time. Trajectory analysis is a type of analysis which can capture variance in biomarker concentrations over time and has been used with success in the social sciences. We used trajectory analysis to evaluate the ability of the serum concentrations of 3 brain-specific biomarkers – S100B, neuron-specific enolase (NSE) and myelin basic protein (MBP) – to predict poor outcome (Glasgow Outcome Scale scores 3–5) after pediatric TBI and HIE. Clinical and biomarker data from 100 children with TBI or HIE were evaluated. For each biomarker, we validated 2-, 3- and 4-group models for outcome prediction, using sensitivity and specificity. For S100B, the 3-group model predicted poor outcome with a sensitivity of 59% and specificity of 100%. For NSE, the 3-group model predicted poor outcome with a sensitivity of 48% and specificity of 98%. For MBP, the 3-group model predicted poor outcome with a sensitivity of 73% and specificity of 61%. Thus, when the models predicted a poor outcome, there was a very high probability of a poor outcome. In contrast, 17% of subjects with a poor outcome were predicted to have a good outcome by all 3 biomarker trajectories. These data suggest that trajectory analysis of biomarker data may provide a useful approach for predicting outcome after pediatric brain injury.

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Section: Introductionmentioning

confidence: 99%

Trajectory Analysis of Serum Biomarker Concentrations Facilitates Outcome Prediction after Pediatric Traumatic and Hypoxemic Brain Injury

Berger

Bazaco

Wagner³

et al. 2010

Dev Neurosci

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“…Our previous findings indicated that practice change can be intuitive if teams are reflective (Abatemarco et al, 2008). However, in this study we also found that practice change is enhanced by the use of brief easy to use tools when the tools are bundled and specific to maternal, infant, and toddler issues.…”

Section: Discussionmentioning

confidence: 42%

“…Finally, child maltreatment assessment and safety prevention are often provided to families inconsistently or not at all depending on their personal characteristics (eg, race/ethnicity, socio-economic status). Use of universal and standardized screening/assessment, anticipatory guidance, referral, and follow-up tracking are strategies to provide equitable care to all patient populations (Schuster et al, 2000;Abatemarco et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Practicing safety: a quality improvement intervention to test tools to enhance pediatric psychosocial care for children 0–3 years

Abatemarco

Gubernick²,

LaNoue

et al. 2017

Prim Health Care Res Dev

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BackgroundChild maltreatment is a significant public health issue in the United States. Yet, fewer than half of pediatricians discuss behavioral, developmental, or parenting issues with parents.ObjectiveThis paper describes the testing of bundles of tools and processes, part of a larger intervention, Practicing Safety, targeted at changing physician and staff behavior to identify families at risk for child maltreatment, provide anticipatory guidance, refer to community resources, and follow-up and track at-risk families. The intervention was implemented with 14 pediatric primary care practices throughout the United States; the study was completed in 2011.MethodsA within-subjects repeated measures pre-post follow-up design was used to evaluate the intervention. Baseline and repeated measurements of pediatric practices’ processes were collected using qualitative and quantitative methods. In total, 14 core improvement teams from across the country tested three bundles of tools (maternal, infant, toddler) within a quality improvement framework over seven months.ResultsQuantitative results showed statistically significant adoption of tools and processes and enhancement of practice behaviors and office environmental supports. The increase in tool use was immediate and was sustained for six months after implementation. Qualitative data provided insight as to how meaningful the intervention was to the core improvement teams, especially with more complicated behaviors (eg, engaging social workers or community agencies for referrals). Barriers included lack of community resources. Findings showed unanticipated outcomes such as helping practices to become medical homes.ConclusionLessons learned included that practices appreciate and can adopt brief interventions that have meaningful and useful tools and process to enhance psychosocial care for children 0–3 and that do not place a burden on pediatric practice. An innovative, quality improvement strategy, intuitive to pediatricians, with a brief intervention may help prevent child maltreatment.

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“…Schools are a major gateway for mental health referral of crime victims, 70 so HCPs may be able to partner with school officials or teachers to facilitate access to care. 126 In this report, a combination of organizational change approaches and specialized assessment procedures was used to facilitate practice innovation and implementation of the program. 125 CACs offer a multidisciplinary approach to investigation, management, treatment, and prosecution of child abuse cases, and are a helpful resource to the HCP for information and medical collaboration.…”

Section: Strength Of the Evidencementioning

confidence: 99%

Psychological Impact and Treatment of Physical Abuse of Children

Kolko¹,

Kolko²

2011

Child Abuse and Neglect

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Expanding the Pediatrician’s Black Bag: A Psychosocial Care Improvement Model to Address the “New Morbidities”

Cited by 13 publications

References 34 publications

Trajectory Analysis of Serum Biomarker Concentrations Facilitates Outcome Prediction after Pediatric Traumatic and Hypoxemic Brain Injury

Trajectory Analysis of Serum Biomarker Concentrations Facilitates Outcome Prediction after Pediatric Traumatic and Hypoxemic Brain Injury

Practicing safety: a quality improvement intervention to test tools to enhance pediatric psychosocial care for children 0–3 years

Psychological Impact and Treatment of Physical Abuse of Children

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