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Mindful education (ME) in schools can address student well-being and stressors, as well as improve the overall school environment. Implementing a whole-school mindfulness curriculum can be challenging, especially when serving students in both general education and emotional behavioral disorder (EBD) settings. We investigated the feasibility, implementation, and benefits of a whole-school mindfulness curriculum (MindUP) in an urban elementary school. This study is unique in that it investigated how to implement mindfulness curriculum within both general education and EBD student populations. Participants included 55 staff and 436 students. This study used a concurrent mixed methods design. The qualitative data included interviews, informal focus groups, and participant feedback, and the quantitative data included participant satisfaction surveys and teacher assessment of student behaviors before/after the curriculum. While implementing MindUP, teacher feedback was incorporated to adapt the program (e.g., decrease lesson length, provide supplemental child-friendly breathing activities). Qualitative data indicated the adapted MindUP program improved school climate and aided teachers with teaching coping skills, especially breathing techniques, to help their students self-regulate when stressed. Data indicated students in regular education improved in their aggression/disruptive behaviors, concentration/attention, and social/emotional competence, whereas students in the EBD program only improved in their aggression/disruptiveness (effect sizes 0.15 to 0.51). An adapted MindUP curriculum was accepted, implemented, effective, and sustainable in both the general education and EBD settings. The program helped students learn mindfulness-based coping strategies with breathing being the most beneficial mindfulness intervention for managing and reducing student stress and for creating a calmer school climate.

Purpose/Objective: There is a need for innovative methods to provide high-quality care to vulnerable populations in an effort to reduce disparities. This is particularly important for women facing a new breast cancer diagnosis. The purpose of the present research was to investigate what social determinants may play a role in the existing disparities impacting adherence to care recommendations in communities with poor access to primary care and higher rates of morbidity and mortality. This study characterized adherence with breast health follow-up care in a diverse population of patients where inequalities exist that may negatively impact adherence to treatment recommendations. The objective of the study was to characterize factors associated with adherence to treatment among women with newly diagnosed breast cancer. Materials/Methods: Women diagnosed with stage I through IV breast cancer treated at the University of Florida College of Medicine-Jacksonville between 01/01/2014 and 12/31/2019 were included in the sample. Patterns of adherence were categorized using machine learning methods with data derived from the electronic medical record and the UF Health Jacksonville Tumor registry. Age, race, and Area Deprivation Index (ADI) state rank in 2019 as a disparity proxy were used to build a machine learning model and classify compliance to treatment. Included patients had a diagnostic procedure that identified breast cancer. Compliance to treatment was fulfilled if the patient received surgery following diagnostic confirmation. A machine learning model was used to stratify patients by risk of non-adherence to treatment following a diagnostic procedure. The models were evaluated using their area under the curve (AUC). Results: A total of 6,951 women were included, 629 who were adherent and 6322 non-adherent patients with breast cancer. The average age of the participants was 61.4 years, (Standard Deviation = 12.8 years). The majority of patients were Black (48%) or Caucasian (45%), 2% were Asian, and 5% were Other races. Payer type at diagnosis showed 45% had Medicare, 30% had commercial insurance, 17% were covered by Medicaid, 7% were charity, and 1% had other sources of pay. Most women were diagnosed with stage III breast cancer. Of 346 patients who received surgery that data was available, 127 (36.7%) had surgery within 30 days of diagnosis, 102 (29.5%) between 31 and 60 days, and 37 (10.7%) between 61 and 90 days. Fifteen models were compared using the PyCaret Python library. The ADI appeared as the most important factor to predict adherence in the model, followed by race and characterized by an AUC of 0.63. Conclusion: Our clinic treats predominantly more women diagnosed with biologically aggressive and advanced breast cancer especially in young African American population. The role social conditions play that precipitate and perpetuate health care disparities were investigated to determine their impact on adherence to treatment. At our safety net hospital, over one third were able to undergo surgery within 30 days of diagnosis. The ADI appeared as the most important feature to predict adherence, followed by race. This demonstrated the necessity to better understand the relation between socio-economical determinants and care received by patients. A more detailed description of the patients’ circumstances, such as access to transport, proximity of the hospital, and insurance status may further improve the model. There is a need for innovative methods of providing quality health care to vulnerable populations. Machine learning models can be used to stratify patients by risk of non-adherence to diagnostic follow-up and treatment following a diagnosis of breast cancer. Future research needs to move from identification of non-adherence risk factors to implementation of interventions to improve breast cancer outcomes. Citation Format: Guillaume Labilloy, Brian Celso, Bharti Jasra, Leigh Neumayer, Erin Mobley, Carmen Smotherman, Jennifer Brailsford. Risk factors for lack of adherence with diagnostic follow-up care in breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-14-14.

Literature suggests integrative pain management strategies reduce chronic pain and opioid use. However, many older adults are unaware of these options. The Aging and Integrative Pain Assessment and Management Initiative (AI-PAMI) launched in 2020, providing webinars and recorded presentations on integrative pain management for adults > age 50, caregivers and healthcare providers. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to evaluate AI-PAMI via the following measures: participant demographics, survey results, program elements and qualitative findings. Reach: There have been > 20,000 views of recorded content and 48% (885/1,859) of registrants attended a live webinar. Effectiveness: Survey results demonstrate 75% of providers and 73% of older adults/caregivers reported new knowledge gain; and 80% of providers and 60% of older adults/caregivers reported changing their pain management practice/routine. Adoption: Presentations were delivered by 33 multidisciplinary experts from 12 different institutions. Six regional stakeholders promoted AI-PAMI using their dissemination networks. Implementation: The COVID-19 pandemic changed program delivery from an in-person model to virtual. To date, AI-PAMI has delivered 17 live webinars and 25 recorded presentations. Live webinars are delivered with a didactic, Q&A discussion and follow-up email. To refine AI-PAMI, 11 healthcare providers and 16 older adults participated in focus groups or in-depth interviews. Maintenance: AI-PAMI is in its third year and will be maintained under a long-standing institution-wide program. Website content will be sustained and remain free access. AI-PAMI is a valuable educational resource for older adults, caregivers, and healthcare providers. Virtual delivery is accommodating for a post-COVID environment.

Monika Patel,1 Sophia Sheikh,2 Jennifer Brailsford3 1Department of Anesthesiology, Division of Pain Management, University of Florida College of Medicine, Jacksonville, FL, USA; 2Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA; 3Center for Data Solutions, University of Florida Health, Jacksonville, FL, USACorrespondence: Monika Patel, Department of Anesthesiology, Division of Pain Management, University of Florida College of Medicine, Pavilion, 2nd Floor, 555 W. 8th street, Jacksonville, FL, 32209, USA, Tel +1 904 383 1020, Fax +1 904 244 1740, Email monika.patel@jax.ufl.eduBackground: Socioeconomic deprivation is shown to be linked to chronic lower back pain. However, a comprehensive approach to identify key components contributing to pain outcomes using a biopsychosocial model incorporating social determinants of health is needed to develop and tailor successful strategies for mitigating chronic pain development and persistence. We aimed to develop and validate an instrument (the HELP survey) to assess themes characterized by a combination of social determinants of health and the biopsychosocial model in an underserved population. The HELP survey was developed as part of an observational study determining the influence of health disparities on chronic pain interference, The Neighborhood of Pain: Health Disparity Influence on Level of Chronic Pain Interference study (HELP).Methods: A multidisciplinary group of experts developed the 40-item, 5-domain HELP survey to address Pain Catastrophizing, Pain Motivation, Social Support, Health Care Access, and Physical Environment. After IRB approval, recruitment occurred at an academic pain clinic and emergency department. Survey validation included principal factor analysis, factor loadings of 0.40 or greater, and Cronbach’s alpha of 0.70 or greater.Results: Initial pilot testing occurred in 48 participants, followed by question revision and retesting in 57 patients. The average age was 57 years old. The majority were female (61.9%), self-reported black (55.2%), and had a high school health literacy level of 60.9%. Nearly half of participants (52.4%) lived in a neighborhood of extreme socioeconomic disadvantage and for 43.4% highest educational attainment was high school. Pilot testing resulted in 5 domains with Cronbach’s alphas: Pain Catastrophizing (0.82), Patient Motivation (0.80), Social Support (0.56), Health Care Access (0.75), and Physical Environment (0.81).Conclusion: Pilot study validation of the HELP survey demographic data indicated testing was performed in an underserved chronic pain population, and questions supported measurement of social determinants of health and the biopsychosocial model based on the five themes identified.Keywords: chronic pain, socioeconomic status, health disparity, survey validation

Child maltreatment is an important public health problem with serious consequences. Even in the face of increased research and enhanced public awareness over the last decade, the rate of child fatalities due to reported child maltreatment has increased.This study describes pediatric emergency medicine (PEM) physicians' knowledge, training, confidence, and barriers in recognition and reporting suspected child maltreatment.A nationally representative sample of PEM physician members of Pediatric Emergency Medicine Collaborative Research Committee (PEM CRC) participated.A cross-sectional 36-item survey study of PEM physicians with content domains including provider knowledge, preparedness, confidence, and barriers to identifying and reporting child maltreatment was conducted and distributed.113 of 486 members completed the survey. Confidence with recognizing and reporting child abuse (95%) was greater than in child neglect (88%). Knowledge in child maltreatment recognition and reporting was significantly correlated with confidence in reporting and recognition (p 0.001). There was a significant relationship between knowledge and confidence for respondents from states with training in child maltreatment recognition and reporting requirement as a condition of licensure and re-licensure compared to states without the requirement (p 0.01). Qualitative responses revealed insightful themes to improve child maltreatment training, recognition and reporting.Our national survey study demonstrates that PEM-trained physicians have high confidence and knowledge with the management of child maltreatment, and that inclusion of mandated child maltreatment training in residency/fellowship and mandated training for medical licensure in all states could improve child maltreatment recognition and reporting.

Successful health outcomes in older patients are linked to the quality of the patient-provider relationship. Our study objective was to further understand the role of this relationship specific to pain management through perspectives from older adults and healthcare providers. Semi-structured interviews and focus groups were conducted with 9 older adults and 11 multidisciplinary healthcare providers. Transcripts were analyzed using a thematic analysis. Three main concepts emerged: (1) defining pain management goals — differences in providers and patients’ goals for pain and function, with sub-themes of realistic goal setting and a shift in pain treatment to minimize opioids as a first-line medication; (2) communication — perceived gap in providers communicating and coordinating across disciplines and with patients, with sub-themes of improving positive communication and inconsistent messaging among providers; and (3) therapeutic alliance — all parties feel that developing a relationship is built on consistent trust and open dialogue. Although providers and older adults often expressed similar perspectives, there were several areas of misalignment identified within each concept, representing areas of disconnect within the patient-provider pain management relationship. Our findings indicate providers could benefit from education on improving communication around realistic goals and patient-centered outcomes and incorporation of more holistic pain management approaches when working with older adult patients. Further study should focus on developing educational interventions to address the identified shortcomings.

Background Pediatric asthma exacerbations are a frequent reason for emergency care. Early administration of oral systemic corticosteroids (OCS) in the emergency department (ED) decreases hospitalization rates and ED length-of-stay (LOS). However, it is unknown whether even earlier OCS administration by emergency medical services (EMS) in the prehospital setting further improves outcomes. Purpose To describe the background and methods of a type 1 hybrid effectiveness-implementation trial of EMS-administered OCS for pediatric asthma patients incorporating a stepped wedge design and the RE-AIM framework. Methods The study employs a non-randomized stepped wedge design where multiple EMS agencies adopt OCS as a treatment for pediatric asthma exacerbations at varying times. This design accommodates ethical considerations of studying pediatric subjects in the prehospital setting where informed consent is not feasible. We will compare hospitalization rates, ED LOS, and short-term healthcare costs between pediatric asthma patients who do and do not receive OCS from EMS. Using geographic information systems (GIS), we will measure how differences in outcomes scale with increasing EMS transport time. We will use the RE-AIM framework to guide a mixed methods analysis of barriers and enablers to EMS administration of OCS for pediatric asthma patients, including quantitative measures of adoption and uptake and qualitative EMS provider focus group data. Conclusion This trial will determine if earlier EMS administration of OCS to pediatric asthma patients decreases hospitalizations, ED LOS, and short-term healthcare costs, and if those outcomes scale with longer EMS transport times. We will identify barriers and enablers to implementing EMS-administered OCS for pediatric asthma patients.