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Objective To develop, implement, and assess implementation outcomes for a developmental monitoring and referral program for children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods Based on Centers for Disease Control and Prevention's Learn the Signs. Act Early. campaign, the program was developed and replicated in two phases at 20 demographically diverse WIC clinics in eastern Missouri. Parents were asked to complete developmental milestone checklists for their children, ages 2 months to 4 years, during WIC eligibility recertification visits; WIC staff referred children with potential concerns to their healthcare providers for developmental screening. WIC staff surveys and focus groups were used to assess initial implementation outcomes. Results In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most ([greater than or equal to] 80%) agreed that checklists fit easily into clinic workflow and required [less than or equal to] 5 min to complete. Staff ([greater than or equal to] 55%) indicated using checklists with [greater than or equal to] 75% of their clients. 92% or more reported referring one or more children with potential developmental concerns. According to 80% of staff, parents indicated checklists helped them learn about development and planned to share them with healthcare providers. During the second phase, 18 of 20 staff surveyed indicated the program helped them learn when to refer children and how to support parents, and 19 felt the program promoted healthy development. Focus groups supported survey findings, and all clinics planned to sustain the program. Conclusions Initial implementation outcomes supported this approach to developmental monitoring and referral in WIC. The program has potential to help low-income parents identify possible concerns and access support., Author(s): Janet E. Farmer [sup.1] [sup.5] , Lee Walker Falk [sup.2] [sup.6] , Mary J. Clark [sup.1] [sup.6] , Wayne A. Mayfield [sup.3] [sup.7] , Katie K. Green [sup.4] Author [...]

Children with autism spectrum disorders (ASD) experience difficulty accessing health care services. Using parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs, we examined whether having a medical home reduces unmet need for specialty care services for children with ASD (n = 3,055). Descriptive statistics and Chi square tests identified sample characteristics and examined the relationship between unmet needs and a standardized measure of medical home. Logistic regression models explored the individual impact of demographic, condition-specific and medical home variables on unmet need. Parents reported that nearly all children had a need for specialty services, 36% had an unmet need, and 23.9% had a medical home. Children who had fewer unmet needs were more likely to have received family-centered and coordinated care through a medical home, and this relationship remained significant even when demographic and condition-specific variables were taken into account. These findings suggest ways to improve access to care for children with ASD through enhanced family-centered and coordinated care within the medical home.

Patterns of current psychotropic medication use among 5,181 children with autism spectrum disorders (ASD) enrolled in a Web-based registry were examined. Overall, 35% used at least one psychotropic medication, most commonly stimulants, neuroleptics, and/or antidepressants. Those who were uninsured or exclusively privately insured were less likely to use greater than or equal to 3 medications than were those insured by Medicaid. Psychiatrists and neurologists prescribed the majority of psychotropic medications. In multivariate analysis, older age, presence of intellectual disability or psychiatric comorbidity, and residing in a poorer county or in the South or Midwest regions of the United States increased the odds of psychotropic medication use. Factors external to clinical presentation likely affect odds of psychotropic medication use among children with ASD.

Successful school reentry following traumatic brain injury (TBI) is critical to recovery. Physical, cognitive, behavioral, academic, and social problems can affect a child's school performance after a TBI. However, early intervention has the potential to improve child academic outcomes and promote effective coping with any persistent changes in functioning. The purpose of this article is to review the topic of school reentry after a childhood TBI. The authors describe 4 essential principles to planning a positive reentry to school: assessment, multidisciplinary teaming, facilitation of peer interactions, and planning for the provision and withdrawal of support. The authors delineate a sequence of steps for promoting school reentry and review existing school reentry programs. The authors also discuss barriers to the school reentry process and possible solutions. The article concludes with a case study that highlights some of the challenges of school reentry and the benefits of using interactive videoconferencing to link rehabilitation and community-based treatment teams during the reentry process.

Children with autism spectrum disorders (ASD) experience difficulty accessing health care services. Using parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs, we examined whether having a medical home reduces unmet need for specialty care services for children with ASD (n = 3,055). Descriptive statistics and Chi square tests identified sample characteristics and examined the relationship between unmet needs and a standardized measure of medical home. Logistic regression models explored the individual impact of demographic, condition-specific and medical home variables on unmet need. Parents reported that nearly all children had a need for specialty services, 36 % had an unmet need, and 23.9 % had a medical home. Children who had fewer unmet needs were more likely to have received family-centered and coordinated care through a medical home, and this relationship remained significant even when demographic and condition-specific variables were taken into account. These findings suggest ways to improve access to care for children with ASD through enhanced family-centered and coordinated care within the medical home., Author(s): Nancy C. Cheak-Zamora[sup.1] [sup.2] , Janet E. Farmer[sup.3] Author Affiliations: (1) Department of Health Sciences, University of Missouri, 510 Clark Hall, Columbia, MO, USA (2) Public Health Program, University [...]

The purpose of this study was to examine the relationship between having access to a medical home and unmet needs for specialty care services for children with autism spectrum disorders (ASD). Parents of children enrolled in a national autism registry were invited to complete an online Access to Care Questionnaire. The resulting sample consisted of 371 parents-child dyads. Bivariate and hierarchical regression analyses were conducted to determine whether having a medical home was associated with the number of unmet needs for specialty care. Less than one in five children with ASD had a medical home (18.9%). Nearly all parents reported that their child had a personal doctor or nurse as well as a usual source of care, but less than one-third received coordinated care (29.9%) and less than one-half received family-centered care (47.1%). Many children had unmet needs (63%), and the highest unmet need was for behavioral therapy. Having a medical home was associated with fewer unmet specialty care needs, even after demographic, child and family characteristics were taken into account. Children with ASD who have a medical home are more likely to have adequate access to needed services. Unfortunately, relatively few children have a medical home that includes family-centered and coordinated care. Enhancements in the delivery of primary care for children with ASD may make a real difference in access to needed specialty care services, potentially improving child and family outcomes. Keywords Autistic disorder * Delivery of health care * Health services * Medical home * Patient-centered care, Introduction Children with autism spectrum disorders (ASD) require early and intensive interventions from a myriad of health and educational specialists [1-3]. These children typically need more medical services, rehabilitation therapies, [...]

Evaluating children with traumatic brain injury (TBI) in order to facilitate their transition to school is reviewed. A process-oriented approach to assessing TBI children during rehabilitation is suggested. The major areas of functioning important to school reentry are discussed. The need for families and professionals to communicate about the child's reentry is emphasized. (CR)

Reviews physical, cognitive, and behavioral characteristics of traumatic brain injury (TBI) that can place a child at risk for poor school adjustment. Proposes an ecological approach to school-based assessment and interventions that considers developmental factors and quality of the school environment. Discusses key issues for school success including early identification of children with TBI. (Author/JDM)

Objective. Most research on comprehensive primary care interventions for children with chronic health conditions has been conducted in large urban areas, where child health and related services are readily available. The purpose of this study was to evaluate the feasibility and impact of a medical home demonstration project in a more rural part of the country. Methods. Fifty-one parents of children with special health care needs participated in a pre-/posttreatment assessment of a program designed to enhance comprehensive and coordinated care. Participants were recruited from 3 primary care practices in a central Midwest state and remained in the program for ~12 months. Results. Parents reported significant increases in satisfaction with care coordination and access to mental health services after the intervention. They also noted decreases in family needs, caregiver strain, parents' missed work days, children's school absences, and utilization of ambulatory services. Satisfaction with primary care declined slightly but remained in the "very good" range. Families of children with more complex conditions were more likely to report a decrease in needs after intervention, but other factors, such as geographic location or socioeconomic status, were not related to key outcome variables. Conclusions. Comprehensive care has a positive effect on children with chronic health conditions and their families, including those who live in more rural areas. Additional study is needed to learn more about rural service delivery strategies that promote implementation of this approach in general practice. Pediatrics 2005;116: 649--656; medical home, children with special health care needs, rural health services., ABBREVIATIONS. CSHCN, children with special health care needs; SES, socioeconomic status; NP, nurse practitioner. Children with special health care needs (CSHCN) rely on a complex and fragmented system of care [...]