Using genograms to understand pediatric practices’ readiness for change to prevent abuse and neglect

Abatemarco, Diane J.; Kairys, Steven; Gubernick, Ruth S.; Hurley, Tammy Piazza

doi:10.1177/1367493511424888

Cited by 6 publications

(9 citation statements)

References 15 publications

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“…In this project, we demonstrated that the PS bundles of tools and processes have multi-level effects on pediatric practice. In our previous studies, we found that the intervention enabled practices to understand their organizational dynamics and how these dynamics effect care to begin to make practice change (Abatemarco et al ., 2008; 2012). The current findings extend this previous work by showing that the intervention was effective in promoting the use of all three bundles of tools and processes to assess/screen, provide anticipatory guidance and resources to parents/caregivers, make referrals to community resources, and document follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…Incorporating the IOM’s core health values, Practicing Safety ( PS ) is a pediatric intervention developed to promote routine and enhanced well care in the child’s medical home, that focuses on the primary prevention of child abuse and neglect by engaging all patient families and the community (Abatemarco et al ., 2008). Practicing Safety processes are based theoretically on participatory action research (Simons and MacDonald, 2006), reflective adaptive practice (Crabtree et al ., 2001), and complexity science (Stroebel et al ., 2005).…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Self Cite

View full text Add to dashboard Cite

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“…Major events such as deaths, divorces, accidents, mental disorders, violence, chemical and alcohol dependence, and sexual abuse are also shown in this graphic representation, in order to plan for the full family health care 11 12 The familiarization of the pediatrician with this instrument increases the resoluteness of the service provided for the child, and it can also help the family to understand its members in new ways, as well as promote means to become partners in its own therapeutic plan 13 …”

Section: Introductionmentioning

confidence: 99%

Degradação Do Vínculo Parental E Violência Contra a Criança: O Uso Do Genograma Familiar Na Prática Clínica Pediátrica

Leoncio

Souza

Machado

2017

Rev. paul. pediatr.

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Objective: To demonstrate the importance of using the family genogram in pediatric consultation, as an analysis tool to evaluate the degradation of parental bonding and also violence against children.Methods: A qualitative study was conducted in 2011 wherein 63 children, aged between 2 and 6 years, enrolled in a slum nursery, was studied. In order to construct the genogram, data were collected in four stages: pediatric evaluation at nursery; interview with caregivers; interview with teachers; and interview with the nursery coordinator. The data about the families were used to construct the genograms with the aid of GenoPro®-2016 software. In order to evaluate the quality of bonding, the following items were included in the genograms: violence against children, drug addiction, neglect, mental disorder, type of relationship among family members.Results: The evaluated children and their families generated 55 genograms. In 38 of them, functional family arrangements, and close or very close emotional ties were observed. In 17 cases, situations involving physical, emotional, or sexual violence against children were perceived. Among these, four represented extreme cases, with fraying parental bonding, and dysfunctional family arrangements. In these families, chemical addiction was prevalent among multiple members, as well as severe mental disorder, persistent physical and verbal abuse, and sexual abuse.Conclusions: The use of the genogram helps to identify at an early stage the degradation of parental bonding and violence against children, and when it is incorporated into the pediatric practice routine, it may contribute to the promotion of the comprehensive health care of the child, regardless of the presence of social vulnerability.

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“…Sustainable transformation relies on understanding practice culture and its effect on practice change, PCP perceptions and needs (Dempster et al , 2015), and the ‘buy-in’ of referring PCPs (Abatemarco et al , 2008; 2012). The present study aims to determine the referring PCPs’ most prevalent perceptions about the AP/Access Clinics as well as to characterize the influence of external factors.…”

Section: Introductionmentioning

confidence: 99%

Pediatrician preferences, local resources, and economic factors influence referral to a subspecialty access clinic

Guglielmo

Greenspan

Abatemarco

2016

Prim Health Care Res Dev

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Background Pediatric patients seek timely access to subspecialty care within a complex delivery system while facing barriers: distance, economics, and clinician shortages. Aim We examined stakeholder perceptions about solutions to the access challenge. We engaged over 300 referring primary care pediatricians in the evaluation of Access Clinics at an academic children’s hospital. Methods Using an anonymous online survey, we asked pediatricians about their and their patients’ experiences and analyzed factors that may influence referrals. Findings Referring pediatricians reported satisfaction; they provided feedback about their patients’ experiences, physician communication, and referral influences. Distance from the Access Clinic does not correlate with differences in referral volume; living in areas with higher child populations and higher median income is associated with more referrals. Referring pediatricians have strong opinions about referrals, are attuned to patient experiences, and desire bi-directional communication. Multiple factors influence referral to and acceptance of Access Clinics, but external influences have less impact than expected.

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Using genograms to understand pediatric practices’ readiness for change to prevent abuse and neglect

Cited by 6 publications

References 15 publications

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

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

Degradação Do Vínculo Parental E Violência Contra a Criança: O Uso Do Genograma Familiar Na Prática Clínica Pediátrica

Pediatrician preferences, local resources, and economic factors influence referral to a subspecialty access clinic

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