Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Consultation (Parent/Family), Outreach (School Staff),

Intervention Description: The study examined the effectiveness of an ambulatory behavioral health urgent care pilot project, the Urgent Evaluation Service (UES), in reducing emergency department (ED) visits and improving collaborations with schools in the local community. The UES model involved same-day, ambulatory psychiatric evaluation and care coordination for school-aged children experiencing behavioral health crises.

Intervention Results: The UES model was effective in reducing preventable ED visits and meeting the mental health needs of students in crisis. The study found a decrease in the volume of school referrals to the ED during UES hours of operation, dropping from 80 to 45 pre- and post-pilot, a decrease of 44%. The admission rate of school referrals to the ED during the day shift increased from 4% in 2013 to 11% in 2014, suggesting an increase in the proportion of clinically appropriate ED referrals, with subacute referrals being diverted to the UES.

Conclusion: The study suggests that urgent psychiatric evaluation and care coordination may be an effective model for reducing preventable ED visits and meeting the mental health needs of students in crisis. The authors recommend further analysis of a more fully developed UES with attention to utilization, cost-effectiveness, and the experiences and outcomes for patients, families, and school personnel to justify the model.

Study Design: Observational

Setting: The study was conducted at a large urban hospital in Brooklyn, New York.

Population of Focus: The target audience for the study is mental health professionals, educators, and policymakers interested in improving access to mental health services for school-aged children.

Sample Size: The sample size for the study was 72 students referred to the Urgent Evaluation Service (UES) from January 1 to June 30, 2014.

Age Range: This article focuses on school-age children and adolescents who were referred for behavioral health evaluations and crisis management. This typically encompasses individuals between the ages of 5 to 18 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: This statement provides an algorithm as a strategy to support health care professionals in developing a pattern and practice for addressing developmental concerns in children from birth through 3 years of age.

Intervention Results: The authors recommend that developmental surveillance be incorporated at every well-child preventive care visit. Any concerns raised during surveillance should be promptly addressed with standardized developmental screening tests. In addition, screening tests should be administered regularly at the 9-, 18-, and 30-month visits. (Because the 30-month visit is not yet a part of the preventive care system and is often not reimbursable by third-party payers at this time, developmental screening can be performed at 24 months of age. In addition, because the frequency of regular pediatric visits decreases after 24 months of age, a pediatrician who expects that his or her patients will have difficulty attending a 30-month visit should conduct screening during the 24-month visit.) The early identification of developmental problems should lead to further developmental and medical evaluation, diagnosis, and treatment, including early developmental intervention. Children diagnosed with developmental disorders should be identified as children with special health care needs, and chronic-condition management should be initiated. Identification of a developmental disorder and its underlying etiology may also drive a range of treatment planning, from medical treatment of the child to family planning for his or her parents.

Conclusion: Developmental surveillance should be a component of every preventive care visit. Standardized developmental screening tools should be used when such surveillance identifies concerns about a child's development and for children who appear to be at low risk of a developmental disorder at the 9-, 18-, and 30-month* visits. When a child has a positive screening result for a developmental problem, developmental and medical evaluations to identify the specific developmental disorders and related medical problems are warranted. In addition, children who have positive screening results for developmental problems should be referred to early developmental intervention and early childhood services and scheduled for earlier return visits to increase developmental surveillance. Children diagnosed with developmental disorders should be identified as children with special health care needs; chronic-condition management for these children should be initiated.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: Children ages 0-3 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation Training, Assessment, Policy/Guideline (National)

Intervention Description: In an effort to document state and jurisdiction activity in National Performance Measure 6 (NPM 6), AMCHP conducted an environmental scan of Title V program developmental screening activities. AMCHP obtained information through the Title V Information System (TVIS) by filtering Title V programs that chose NPM 6 and reviewing the narrative and action plans to ascertain their NPM 6 strategies, their accompanying evidence-based/informed strategy measures (ESMs), and related challenges. Information included in this issue brief does not represent an exhaustive list of each state’s and jurisdiction’s developmental screening activity, nor is every state or jurisdiction that is implementing the strategies mentioned. However, the range of strategies presented and the states and jurisdictions referenced here provide a snapshot of Title V program approaches, strategies, and techniques being used to increase developmental screening rates.

Intervention Results: The environmental scan of TVIS revealed that 41 states and jurisdictions chose NPM 6. As previously mentioned, Title V programs also have the option to select a State Performance Measure (SPM) based on results from their state’s needs assessment. Ten of the 41 states and jurisdictions that chose NPM 6 also selected an SPM related to developmental screening. The scan also found four states that did not choose NPM 6, but did select an SPM related to developmental screening. The environmental scan revealed a wide range of NPM 6 strategies and activities, under the following categories: • Policy Research, Development and Implementation • Systems Coordination 3 • Data Collection, Measurement and Existing Landscape • Technical Assistance and Training • Education, Engagement and Resource Development • Other Title V Program Strategies

Conclusion: information on Title V program activities related to NPM 6. These data provide insight into identified needs in policy, systems coordination, training, data integration, as well as strategies to address these needs. The selected examples highlighted within each category may prove useful to other Title V programs as they implement developmental screening-related strategies and measures to build or improve systems of care for children. In coming years, NPM 6 data can be analyzed more in-depth to develop resources such as reports, toolkits, or guides to assist Title V programs with developmental screening and early identification system challenges. These data will also guide AMCHP’s efforts to create meaningful technical assistance opportunities including webinars, learning modules, conference sessions, and other in-person trainings, to help states in advancing NPM 6. These resources will expand the repository of promising policies and practices featured on the State Public Health Autism Resource Center website (http://www.amchp.org/SPHARC), which is accessible to all Title V programs and their state and national partners.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Expert Support (Provider), Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The Vermont Child Health Improvement Program (VCHIP) at the University of Vermont collaborated with state agencies and professional societies to conduct a survey of Vermont pediatric and family medicine practices regarding their developmental screening and autism screening processes, referral patterns, and barriers. The survey was administered in 2009 to 103 primary care practices, with a 65% response rate (89% for pediatric practices, 53% for family medicine practices).

Intervention Results: The survey results revealed that while 88% of practices have a specific approach to developmental surveillance and 87% perform developmental screening, only 1 in 4 use structured tools with good psychometric properties. Autism screening was performed by 59% of practices, with most using the M-CHAT or CHAT tool and screening most commonly at the 18-month visit. When concerns were identified, 72% referred to a developmental pediatrician and over 50% to early intervention. Key barriers to both developmental and autism screening were lack of time, staff, and training. Over 80% of practices used a note in the patient chart to track at-risk children, and most commonly referred to child development clinics, audiology, early intervention, and pediatric specialists.

Conclusion: The survey conducted by VCHIP revealed wide variation in developmental and autism screening practices among Vermont pediatric and family medicine practices. While most practices conduct some form of screening, there is room for improvement in the use of validated tools, adherence to recommended screening ages, and implementation of office systems for tracking at-risk children. The survey identified knowledge gaps and barriers that can be addressed through quality improvement initiatives, which most respondents expressed interest in participating in.

Study Design: QE: pretest-posttest

Setting: Pediatric and family medicine practices in Vermont

Population of Focus: Children up to age 3

Data Source: Child medical record; ProPHDS Survey

Sample Size: Chart audits at 37 baseline and 35 follow-up sites (n=30 per site) Baseline charts (n=1381) - Children 19-23 months (n=697) - Children 31-35 months (n=684) Follow-up charts (n=1301) - Children 19-23 months (n=646) - Children 31-35 months (n=655)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment,

Intervention Description: Enforcing mandatory vaccinations is one of the strategies adopted by some countries, like Italy and France, to increase coverage.

Intervention Results: Despite the good results, several EU countries are going through unprecedented outbreaks of vaccine-preventable diseases due to insufficient coverage. The increase of vaccine hesitancy has made it difficult to reach and maintain high rates of vaccination coverage. Enforcing mandatory vaccinations is one of the strategies adopted by some countries, like Italy and France, to increase coverage. However, each country should find the most suitable way to keep up with vaccination coverages according to own cultural and organizational background.

Conclusion: Enforcing mandatory vaccinations is one of the strategies adopted by some countries, like Italy and France, to increase coverage. However, each country should find the most suitable way to keep up with vaccination coverages according to own cultural and organizational background.

Study Design: assess vaccination coverage in childhood up to booster preschool age in order to update the analysis on European trends of immunization coverage in the last nine years

Setting: Childhood vaccination coverage in Europe

Population of Focus: Gov't leadership and policymakers

Age Range: childhood up to booster preschool age

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Quality Improvement/Practice-Wide Intervention, Provider Training/Education, Assessment (Provider)

Intervention Description: To evaluate the effectiveness of a complex intervention to improve referral and treatment of pregnant smokers in routine practice, and to assess the incremental costs to the National Health Service (NHS) per additional woman quitting smoking.

Intervention Results: After introduction of the intervention, the referral rate increased more than twofold (incidence rate ratio=2.47, 95% CI 2.16 to 2.81) and the probability of quitting by delivery increased (adjusted OR=1.81, 95% CI 1.54 to 2.12). The additional cost per delivery was £31 and the incremental cost per additional quit was £952; 31 pregnant women needed to be treated for each additional quitter.

Conclusion: The implementation of a system-wide complex healthcare intervention was associated with significant increase in rates of quitting by delivery.

Study Design: Quasi experimental Crosssectional and Cost-benefit analysis

Setting: National Health Service(NHS) antenatal clinics

Population of Focus: Health records of singleton births to mothers who smoked and did not smoke

Data Source: Electronic health records

Sample Size: 37726

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (Provider), Access, Care Coordination, Targeting Interventions to Focused Groups

Intervention Description: N/A

Intervention Results: Fifty-three percent (n = 107) of the children received care within a medical home. Low socioeconomic status (young caregiver: risk ratio [RR] = 0.73; 95% CI 0.55, 0.97; low education: RR= 0.69; 95% CI 0.49, 0.98) and delayed language (RR = 0.63; 95% CI 0.42, 0.95) were associated with a lower likelihood of receiving care within a medical home. Degree of prematurity and neonatal clinic follow-up participation were unrelated to receipt of care within a medical home.

Conclusion: Receipt of care within a medical home was lacking for nearly one-half of preterm toddlers, especially those with lower socioeconomic status and poorer developmental status. Discharge from a neonatal intensive care unit may be an optimal time to facilitate access to a primary care medical home and establish continuity of care.

Study Design: Participants were 202 caregivers of children born at <35 weeks of gestation. At 10-16 months of corrected age, caregivers completed the National Survey of Children's Health (2011/2012) medical home module and a sociodemographic profile. Care within a medical home comprised having a personal doctor/nurse, a usual place for care, effective care coordination, family-centered care, and getting referrals when needed. Gestational age and neonatal follow-up clinic attendance were abstracted from the medical record. The Bayley Scales of Infant and Toddler Development, Third Edition assessed developmental status. Log-binomial regression examined factors related to receiving care within a medical home.

Setting: NSCH Survey; United States

Population of Focus: Caregivers of children born pre-term

Sample Size: 202

Age Range: Caregivers vary in age. Babies born before 35 weeks.

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition, Assessment, Consultation (Parent/Family),

Intervention Description: "The whole health care model embedded monitoring of overall health and wellness education within the center’s outpatient mental and substance use disorder treatment services, and it improved care coordination with primary care providers."

Intervention Results: "For the first two-and-a-half years of the program, Medicare expenditures decreased by $266 per month on average for each enrolled beneficiary in the intervention group relative to the comparison group (p,.01). Intervention clients had .02 fewer hospitalizations, .03 fewer emergency department (ED) visits, and .13 fewer office visits per month relative to the comparison group (p,.05 for all estimates)."

Conclusion: "Overall, the whole health model reduced Medicare expenditures, ED visits, and hospitalization rates. These results may be due in part to the availability of more comprehensive medical data and staff’s improved awareness of client’s overall health needs."

Study Design: The study design was a difference-in-differences model using fee-for-service Medicare administrative claims and enrollment data.

Setting: The setting for the study was a community mental health center.

Population of Focus: The target audience for the study would include healthcare providers, mental health professionals, policymakers, and researchers interested in integrated care models and their impact on service utilization and expenditures.

Sample Size: he sample size for the intervention group was N=846, and the matched comparison group was N=2,643.

Age Range: The age range of the participants was not explicitly mentioned in the provided excerpts.

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, Teacher/Staff Training, Assessment,

Intervention Description: The core BRISC strategy is implemented in four sessions. In session 1, the SMHP engages the student, assesses current functioning using brief standardized assessment measures, and identifies “top problems” (Weisz et al., 2011). The student is asked to informally monitor a behavior related to one of their top problems (e.g., time spent with friends, days feeling “blue,” number of disputes with parents). In session 2, the SMHP introduces a structured problem-solving framework, and the student chooses a “top problem” to address. Using a structured approach, the student outlines a concrete goal, brainstorms possible steps toward this goal, identifies a specific step, and troubleshoots barriers (D'Zurilla & Nezu, 2010). In session 3, a set of evidence-based, skill-based elements (communication skills, stress and mood management, realistic thinking) are taught, if needed, to help modify the step tried or to identify and support the student’s next step(s). In session 4, the student and SMHP review progress and identify a “post-BRISC pathway”: (1) end treatment/problem resolved, (2) supportive monitoring by the SMHP or other school staff, (3) continued treatment from the SMHP, or (4) referral to more specialized or intensive services. SMHPs are also encouraged to refer students to supportive school-based services (e.g., tutoring, special education), if indicated. BRISC-assigned SMHPs attended a 1.5-day in-person training by two Ph.D.-level clinical psychologists that incorporated strategies (e.g., modeling, role play) found to facilitate uptake of new skills (Rakovshik & McManus, 2010). Although therapists in both conditions were already deployed full time by their agencies into the school setting, the training also reviewed how to manage the unique challenges of SBMH work as it applies to the BRISC framework (e.g., adjusting to school schedules, triaging to school and community supports). SMHPs received bi-weekly phone consultation/coaching from the trainers that included a review of adherence checklists completed by the clinician following each of their sessions, case presentations, and review of and feedback on their BRISC implementation.

Intervention Results: Services Received: Student Report - Results of analyses of longitudinal service receipt as assessed via the SACA are shown in Table 2 and Fig. 2 (model results with confidence intervals are available as online resource 3). There were no differences at baseline between conditions on the proportion of students receiving school-based mental health services. From baseline to 2 months, the proportion of students receiving SMH services, and the number of services received, increased for both conditions. From 2 to 6 months, the proportion of students receiving SMH and the number of SMH services decreased more for the BRISC condition. At 6 months, there were no significant differences between the groups on the proportion of students receiving SMH services, but the number of SMH services received was significantly less for BRISC. This demonstrates that BRISC was associated with increased SMH services between baseline to 2 months and decreased SMH services by 6 months. The proportion of BRISC students who used outpatient MH services significantly decreased across all time points, while the proportion of students in SAU receiving outpatient services decreased from baseline to 2 months and then increased. At 6 months, significantly fewer BRISC students received outpatient services. Clinician Report - Clinician report of client status after 4 sessions was limited to the 9 BRISC and 13 SAU SMHPs still participating in the study in the final year of the study (N=45 and N=65 students, respectively). As shown in Table 3, there was a significant difference after 4 sessions (χ2 = 18.9, p = .004), with adjusted standardized residuals indicating students in the BRISC condition were more likely than SAU to have concluded treatment with no further services planned (37.8% vs. 12.3%, RR = 3.07, RD = 0.25) and to be referred to outside MH services (15.6% vs 3.1%, RR = 5.06, RD = 0.12). SAU students were more likely to continue school-based treatment with no additional services planned (61.5% vs. 35.6%, RR = 0.58, RD =  −0.26).

Conclusion: This project evaluated the potential for improving the efficiency of SMH via a school-based assessment, brief intervention, and triage approach for students with socio-emotional concerns. BRISC provides a first-line intervention using consistent assessment to inform level and type of ongoing services needed in a prevention-oriented, multi-tiered delivery model. Research questions focused on feasibility, fidelity, student report of problems, and ability of BRISC to promote efficiency within SMH. We also measured a range of mental health outcomes over 6-month follow-up to evaluate whether this emphasis on efficiency compromised these outcomes compared to SMH “as usual.” SMHPs who participated in the study were predominantly outpatient clinic providers deployed to the school setting. Their training and established practice were geared to traditional, longer term supportive therapy. The structured, measurement-based, and goal-oriented BRISC approach represented a different way of practicing aligned with data-informed, multi-tiered frameworks used by schools. Despite the learning curve required and deviation from typical practice, SMHPs rated BRISC as feasible, acceptable, and appropriate. Importantly, the majority of SMHPs rated BRISC as easy to learn, “compatible with the school mission,” and “likely to improve students’ social, emotional, and academic success.” SMHPs delivered BRISC with fidelity; however, session 3 fidelity was lower than for other sessions. This was likely due to the complexity introduced by the option to use evidence-based treatment elements as needed. A second key finding was that SMHPs in the BRISC condition were significantly more likely (53% to 15%) to report that they had completed treatment after 4 sessions than SAU. BRISC-assigned SMHPs were also more likely to refer students to alternative and/or more intensive services. Students in the BRISC condition were also significantly more likely to report receipt of SMH at 2 months and less likely to report SMH services at 6 months. These results support the hypothesis that BRISC can promote SMH that is more efficient and better aligned with MTSS and public health frameworks. Finally, we asked whether SMHPs’ use of a brief strategy to achieve greater efficiency would compromise mental health outcomes. To the contrary, students served via BRISC showed significantly greater improvement on their self-rated top mental health problems at 2 and 6 months. Symptom and functioning measures showed significant improvement, but slopes did not differ by condition. Students served by BRISC SMHPs were less likely to receive outpatient care at 6 months. This finding could indicate that BRISC more effectively addressed students’ “top problems” to an extent that reduced their need for longer-term mental health services. Or, it could be that students in the BRISC condition felt more confident in their school-based provider to help them in the future, reducing the need for clinic-based services. Such questions will need to be examined in more in-depth research with longer follow-up.

Study Design: Cluster randomized controlled trial

Setting: 15 school districts in the United States (Maryland, Minnesota, Washington)

Population of Focus: High school students referred to/seeking school mental health services

Sample Size: 457 students

Age Range: 13-18 years old (High School students)

Intervention Components (click on component to see a list of all articles that use that intervention): Development/Improvement of Services, Needs Assessment, Consultation Systems (Hospital), HOSPITAL, Reorganization of Neonatal Services, NATIONAL

Intervention Description: The natural extension of inpatient-focused neonatal neurocritical care (NNCC) programs is the evaluation of long-term neurodevelopmental outcomes in the same patient population.

Intervention Results: To achieve this goal, we devised a two-clinic follow-up model at Children's Wisconsin: HOPE (Healthy Outcomes Post-ICU Engagement) and DREAM: Developmentally Ready: Engagement for Achievement of Milestones) clinics. Those infants with significant neurologic diagnoses attend DREAM clinic, while all other high-risk neonatal intensive care unit (NICU) infants are seen in the HOPE clinic.

Conclusion: These clinic models allow for a targeted approach to post-NICU care, which has improved family engagement and perceptions of value.

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: School-based surveys were administered to a census of 6th-12th graders in 16 school districts across a large metropolitan area in the United States (n = 79,492). A 2-factor scale assessed repeated experiences with bullying aggression and victimization.

Intervention Results: Both dimensions of bullying tended to be more common among younger, male, African American and Native American students. There were, however, several exceptions as well as considerable variation in the magnitude of demographic differences. Most youth involved with bullying were either perpetrators or victims, but not both. For example, only 7.4% of all youths were classified as bully/victims. Substance use was more strongly associated with aggression, whereas depressive affect was more strongly associated with victimization.

Conclusion: Researchers should distinguish different dimensions of bullying and consider how they vary by demographic characteristics. In particular, repeated aggression and victimization largely involve different students and may require distinct approaches to prevention.

Study Design: Survey

Setting: 16 school districts across a large metropolitan area in the United States

Data Source: School-based surveys data

Sample Size: n = 79,492

Age Range: 6th-12th graders

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: The CDC Worksite Health ScoreCard (HSC) is a tool designed to help employers assess and implement evidence-based health promotion interventions or strategies at their worksites to prevent heart disease, stroke, and related conditions. It covers 16 topic areas like organizational supports, tobacco control, nutrition, physical activity, weight management, screenings for health conditions, and emergency response. The HSC provides a framework for employers to identify gaps, prioritize strategies based on evidence ratings and potential impact, and develop an annual worksite health improvement plan and budget.

Intervention Results: The HSC was validated through pilot testing with 93 employers of varying sizes. On average, this sample had 20 of the 43 highest-rated "best practice" strategies in place related to areas like tobacco control, nutrition, physical activity, and disease screening. However, readiness varied, with larger employers tending to have more comprehensive programs. Additional modules on lactation support, occupational safety, vaccine-preventable diseases, and community resources were later tested with 102 employers in the CDC's National Healthy Worksite Program. The manual provides benchmarking data allowing employers to compare their scores to these pilot samples as they use the HSC to guide program enhancements.

Conclusion: Despite evidence that comprehensive worksite health promotion programs can improve employee health and save costs, only a small percentage of employers offer such programs. The HSC aims to facilitate employers' adoption of an evidence-based, comprehensive approach by guiding assessment, prioritization of high-impact strategies, and implementation planning tailored to their workforce needs and resources. By using the HSC to create a supportive environment and target key health areas, employers can foster a healthy workforce, increase productivity, and reduce healthcare costs associated with chronic diseases.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Comprehensive School-Based PA Program, Electronic PA, Assessment (patient/consumer),

Intervention Description: Participants in the BOXVR group engaged in exercise with a virtual reality game, while participants in the guided video group engaged in exercise with a guided workout video. Both interventions consisted of 5 exercise sessions per week, for a total of 15 exercise sessions over a 3-week period. Each exercise session was 10 minutes in length

Intervention Results: The BOXVR group showed a significant improvement in stress levels and performance on a cognitive task (TMT B) compared to the control and guided video groups. Adolescents who participated in BOXVR reported significantly higher levels of enjoyment than those who participated in traditional boxing with a guided video. The control group was the only group that showed a significant reduction in anxiety, but this could be interpreted as possible changes in behavior simply due to being enrolled in a research study and asked about anxiety status. The study suggests that engagement and enjoyment in a 'play' setting may contribute to mental aspects of health in the short-term more than the level of effort

Conclusion: The study suggests that chronic exercise with a VR game may be an effective tool for reducing stress and improving cognitive performance in adolescents. The findings also highlight the importance of engagement and enjoyment in exercise programs for mental health benefits. Future studies should investigate what aspects of gaming in VR contribute the most to stress reduction and cognitive performance

Study Design: The study design is a Pilot Randomized Controlled Trial

Setting: The setting for the study was a public high school in suburban New York, and the study was conducted during the summer of 2021

Population of Focus: The target audience for the study was healthy high school students between the ages of 14 and 18 who were able to participate in physical activity of at least moderate intensity

Sample Size: The sample size for the study was 42 participants, who were randomized into one of three cohorts: a BOXVR group, a guided video group, or a nonintervention control group

Age Range: The age range of the participants was between 14 and 18 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Sleep Environment Modification

Intervention Description: The objective of this study was to examine the association between the perceptions of inner city parents about teaching and modeling during the postpartum period of infant sleeping position, and their choice of sleeping position for their infants.

Intervention Results: Forty-two percent of parents reported that they usually placed their infants in the supine position for sleep; 26 percent placed their infants to sleep in the prone position at least some of the time. Parents who reported being told by a doctor or a nurse to have their infants sleep in the supine position were more likely to choose that position. Similarly, those who reported seeing their infants placed to sleep exclusively in the supine position in the hospital were also more likely usually to choose that position. Parents who reported that they both were told by a doctor or a nurse to put their infants to sleep in the supine position and reported seeing their infants exclusively placed that way in the nursery were the most likely usually to choose that position for their infants to sleep.

Conclusion: Perceptions by parents of instructions from a doctor or a nurse of the position in which the infants were placed in the nursery were associated with the position parents reported placing their infants to sleep at home. Efforts to promote the supine sleeping position in the inner-city setting should address both practices and education provided to parents in the nursery during the postpartum hospital stay and should be sufficiently powerful to align their perceptions of the postpartum experience with current American Academy of Pediatrics recommendations.

Study Design: Survey based on a convenience sample

Setting: Urban Primary Care Center

Data Source: A convenience sample of parents of 100 healthy infants who came for the 2-week well-child visit at an urban primary care center were invited to complete a questionnaire and to report on the position in which infants were placed for sleep.

Sample Size: 100 healthy infants

Age Range: Infants 2 weeks old

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Sleep Environment Modification

Intervention Description: SIDS remains the leading cause of postneonatal death in the US. To decrease risk, infants should be placed supine for sleep. Objective: Determine trends and factors associated with choice of infant sleeping position. Design: National Infant Sleep Position Study (NISP): Annual nationally representative telephone surveys. Setting: 48 contiguous states of the United States. Participants: Nighttime caregivers of infants born within the last 7

Intervention Results: For the 15-year period, supine sleep increased (p<0.0001) and prone sleep decreased (p<0.0001) for all infants with no significant difference in trend by race. Since 2001 a plateau has been reached for all races. Factors associated with increase supine sleep between 1993-2007 included: time, maternal race other than Black, higher maternal education, not living in Southern States, first-born infant, and full-term infant. Impact of these variables was reduced when variables related to maternal concerns about infant comfort, infant choking and advice received from doctors were taken into account. Between 2003 and 2007, choice of infant sleep position could be explained almost entirely by caregiver concern about comfort, choking and advice. Race no longer was a significant predictor of supine sleep.

Conclusion: Since 2001 supine sleep has reached a plateau, and there continue to be racial disparities in both sleep practice and death rates. There have been changes in factors associated with sleep position and maternal attitudes about issues such as comfort and choking concerns may account for much of the racial disparity in practice. To decrease SIDS, we must ensure that public health measures reach the populations at risk and include messages that address concerns about infant comfort or choking in the supine position.

Study Design: National Infant Sleep Position Study (NISP): Annual nationally representative telephone surveys.

Setting: 48 contiguous states of the United States.

Data Source: Interviews

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent Approach, Office Systems Assessments and Implementation Training, Data Collection Training for Staff,

Intervention Description: The intervention implemented in the study aimed to improve the process of referring patients to early intervention (EI) services. The multifaceted intervention included several components: 1. Patient and provider activation: The improvement team met with local EI staff to review eligibility criteria and best practices in motivating families to connect with EI. An EI brochure was developed to educate families on EI's services and evaluation process. 2. Centralizing and tracking referrals through an EI registry: The referral routes were streamlined by encouraging the use of an electronic order form within the electronic medical record (EMR) to direct the referral into the database after an intake visit had been scheduled. An EI registry was utilized to track referrals and facilitate follow-up for patients. 3. Plan-Do-Study-Act (PDSA) cycles: The team conducted a series of PDSA cycles regarding communication with EI sites to refine the intervention and address any identified barriers. The intervention was designed to address the identified drivers of successful EI referral and to streamline the referral process, ensuring that patients were connected with EI in a timely manner. The multifaceted approach aimed to improve the connection of patients to EI services and to track the effectiveness of the intervention.

Intervention Results: The percentage of patients evaluated by EI within 120 days increased from a baseline median of 50% to a median of 72% after implementation of the systems (N = 309). After implementation, the centralized referral system was used a median of 90% of the time. Tracking of referral outcomes revealed decreases in families refusing evaluations and improvements in exchange of information with EI.

Conclusion: Yes, the study reported statistically significant findings related to the evaluation of patients referred to early intervention (EI) services. The study found that the percentage of patients evaluated by EI within 120 days of referral increased from a baseline median of 50% to a median of 72% after the implementation of the new referral process. Additionally, the study identified demographic and clinical predictors of successful evaluation, with insurance status and specific diagnoses being statistically significant factors associated with timely evaluation. Furthermore, the study used t tests, χ2 testing, and multivariate logistic regression to identify these predictors and assess the statistical significance of the findings. The results of the study demonstrated the effectiveness of the intervention in improving the timely connection of patients to EI services.,

Study Design: The study design used in this research is a quality improvement (QI) initiative. The authors engaged in a quality improvement study to redesign the early intervention (EI) referral process with the goal of ensuring that 70% of patients referred to EI were evaluated by the program. The QI initiative involved implementing a multifaceted referral process, including a centralized electronic referral system used by providers, patient navigators responsible for processing all EI referrals, and a tracking system post-referral to facilitate identification of patients failing to connect with EI. The study utilized a QI approach to address the issue of timely connection to early intervention for young children with developmental delays.,

Setting: The quality improvement initiative was implemented at an academic hospital-based primary care clinic that cares for approximately 16,000 patients, with 17% of them being under 3 years of age and potentially eligible for early intervention services. The families primarily reside in urban neighborhoods, and 68% of them are Medicaid insured. The pediatric provider team consists of attending physicians, nurse practitioners, and resident physicians. The clinic serves a low-income population, and 20% of well-child visits are billed as having a developmental-behavioral concern. The study was conducted in this setting to improve the connection of patients to early intervention services.

Population of Focus: The target audience for the study includes healthcare professionals, particularly those involved in pediatric primary care, early intervention programs, and quality improvement initiatives. Additionally, policymakers and researchers interested in early childhood development, developmental services, and interventions for children with developmental delays would also find the study relevant. The findings and recommendations from the study are likely to be of interest to professionals and organizations involved in improving the coordination of early intervention referrals and services for young children with developmental delays.

Sample Size: The sample size for the study was 309 patients who were referred to early intervention services from the academic primary care clinic. Of these patients, 219 were evaluated within 120 days of referral. The study analyzed the demographic and diagnostic characteristics of the patients and their associations with timely referral to early intervention services.

Age Range: The article discusses early intervention for children under the age of 3 years who are experiencing or at risk for developmental delays.

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Assessment (caregiver), PROFESSIONAL_CAREGIVER, PARENT_FAMILY, Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: To evaluate formative evaluation, a pedagogic method that sensitizes mothers to sudden infant death syndrome (SIDS), as a new way to improve prevention of SIDS.

Intervention Results: At follow-up, 91.9% and 86.8% of the mothers reported practicing supine sleep position in the intervention and control group respectively (p=0.16; OR=1.7, 95% CI: 0.7-4.0).

Conclusion: Formative evaluation using an educative questionnaire could improve maternal awareness on SIDS risk factors and their compliance with recommendations about SIDS prevention.

Study Design: RCT

Setting: Maternity department of the Rennes University Hospital

Population of Focus: Mothers hospitalized during the immediate postpartum period between Jun 19 and Aug 28, 2005 who were not hospitalized for abnormal or high-risk pregnancies and did not have newborns hospitalized in neonatology

Data Source: Mother report

Sample Size: Baseline (n=320) Follow-up (n=292)  Intervention (n=148)  Control (n=144)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, CAREGIVER, Motivational Interviewing/Counseling, Assessment (caregiver), PATIENT/CONSUMER, Educational Material, Online Material/Education/Blogging, Motivational Interviewing, PARENT/FAMILY, Consultation (Parent/Family), Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: A study was undertaken to determine the effectiveness of two brief multi-strategic child health nurse delivered interventions in: decreasing the prevalence of infants exposed to SHS; decreasing the prevalence of smoking amongst parent/carers of infants and increasing the prevalence of household smoking bans.

Intervention Results: When compared to the Control group at 12 months, no significant differences in the prevalence of infant exposure to SHS were detected from baseline to follow-up for Treatment condition 1 or Treatment condition 2. Similarly, no significant differences were detected in the proportion of parent/care givers who reported that they were smokers, or in the proportion of households reported to have a complete smoking ban.

Conclusion: Further research is required to identify effective interventions that can be consistently provided by child health nurses if the potential of such settings to contribute to reductions in child SHS exposure is to be realised.

Study Design: Cluster randomized controlled trial

Setting: Community well-child health clinics

Population of Focus: s Infants exposed to second hand smoke

Data Source: Data was collected via computer during the visit, child health clinic records

Sample Size: 1424 parents of children aged 0 to 4 years attending well-child health checks

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Assessment, YOUTH, PATIENT_CONSUMER, Feedback, PARENT_FAMILY, Text Messaging

Intervention Description: This study evaluates a novel air quality feedback intervention using remote air quality monitoring with SMS and email messaging to promote smoke-free homes among families from deprived areas.

Intervention Results: Of 86 homes that completed the intervention study, 57 (66%) experienced pre-post reductions in measured PM2.5. The median reduction experienced was 4.1 µg/m3 (a reduction of 19% from baseline, p = 0.008). Eight homes where concentrations were higher than the WHO guideline limit at baseline fell below that level at follow-up. In follow-up interviews, participants expressed positive views on the usefulness of air quality feedback.

Conclusion: Household air quality monitoring with SMS and email feedback can lead to behaviour change and consequent reductions in SHS in homes, but within the context of our study few homes became totally smoke-free.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Quality Improvement/Practice-Wide Intervention, Designated Clinic/Extended Hours, Female Provider, Needs Assessment, PATIENT_CONSUMER, HOSPITAL

Intervention Description: Translational research (TR) and continuous quality improvement (CQI) processes used to identify and address barriers and facilitators to Pap smear screening within an urban Aboriginal Community Controlled Health Service (ACCHS).

Intervention Results: There was a statistically significant increase in Pap smear numbers during Plan-Do-Study-Act (PDSA) cycles, continuing at 10 months follow up.

Conclusion: he use of TR with CQI appears to be an effective and acceptable way to affect Pap smear screening. This model is transferrable to other settings and other health issues.

Study Design: QE: pretest-posttest

Setting: An urban Aboriginal Community Controlled Health Service (ACCHS)

Population of Focus: All women within eligible age range

Data Source: Electronic medical records

Sample Size: Total (N=213)

Age Range: 18-70

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Early identification of children with developmental and behavioral delays is important in primary care practice, and well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process and flow is necessary for making screening a routine and consistent part of primary care practice.

Intervention Results: In the North Carolina Assuring Better Child Health and Development Project, careful attention to and training for office process has resulted in a significant increase in screening rates to >70% of the designated well-child visits. The data from the project prompted a change in Medicaid policy, and screening is now statewide in primary practices that perform Early Periodic Screening, Diagnosis, and Treatment examinations.

Conclusion: Although there are features of the project that are unique to North Carolina, there are also elements that are transferable to any practice or state interested in integrating child development services into the medical home.

Study Design: QE: pretest-posttest

Setting: Partnership for Health Management, a network within Community Care of North Carolina

Population of Focus: Children ages 6 to 60 months receiving Early Periodic Screening, Diagnosis, and Treatment services

Data Source: Child medical record

Sample Size: Unknown number of charts – screening rates tracked in 2 counties (>20,000 screens by 2004)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Assessment (PATIENT_CONSUMER), Professional Support, HEALTH_CARE_PROVIDER_PRACTICE, Other (Provider Practice), COMMUNITY, Social Supports, Individual Supports,

Intervention Description: In 2014, the New York State WIC program launched the You Can Do it (YCDI) initiative in 12 WIC clinics. This multicomponent intevention, which was originally developed by the Vermont WIC program, was designed to improve participants' knowledge, attitudes, confidence, and social support to breastfeed exclusively through a screening and tailored counseling protocol combined with peer counselor and professional support spanning the prenatal and early postpartum periods. This multicomponent intervention paired with a yearlong learning community in the 12 clinics.

Intervention Results: Prevalence of exclusive BF at 7 and 30 days was significantly higher among BAPT women compared with non-BAPT or baseline cohorts. Non-Hispanic black and Hispanic women in the BAPT cohort achieved significantly higher exclusive BF rates at 30 and 60 days compared with those in non-BAPT and baseline cohorts.

Conclusion: The initiative seems to be effective at increasing exclusive BF, particularly among non-Hispanic black and Hispanic women in the New York State WIC program.

Study Design: Quasi-experimental study

Setting: 12 WIC clinics in New York State

Population of Focus: Prenatal women enrolled in WIC during the first trimester of pregnancy who intended to breastfeed or were undecided

Sample Size: Baseline cohort of 688 mother-infant dyads and two intervention cohorts: Breastfeeding Attrition Prediction Tool (BAPT) (n=362 monther-infant dyads) and non-BAPT (n=347 mother-infant dyads); 12 WIC clinics; 47 WIC staff members

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, CAREGIVER, Outreach (caregiver), Assessment, SCHOOL, Reporting & Response System

Intervention Description: The goals of this study were to determine the self-reported environmental tobacco smoke exposure status (ETS) of primary school students in grades 3 to 5, to verify self-reported exposure levels with data provided from a biomarker of exposure, and to develop methods for preventing school children from passive smoking.

Intervention Results: According to questionnaire data, 59.9% of the study group (208 of 347) were exposed to ETS. Urinary cotinine measurements of children were highly consistent with the self-reported exposure levels (P < 0.001). Two different intervention methods were applied to parents of the exposed children. Control tests suggested a remarkable reduction in the proportion of those children demonstrating a recent exposure to ETS in both groups. Proportions of children with urinary cotinine concentrations 10 ng/ml or lower were 79.5% in Group I and 74.2% in Group II (P > 0.05).

Conclusion: Self-reported ETS exposure was found to be pretty accurate in the 9–11 age group when checked with urinary cotinine tests. Only informing parents that their childrens' ETS exposure were confirmed by a laboratory test seems to be very promising in preventing children from ETS.

Study Design: Comparison of two groups with different interventions

Setting: Private school primary grades 3-5

Population of Focus: Primary school students

Data Source: Data collected by project staff

Sample Size: 347 students

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material, CAREGIVER, Educational Material (caregiver), Assessment (caregiver)

Intervention Description: An information programme on measures to prevent passive smoking by children, designed for use during well-child visits, was tested

Intervention Results: There was no significant difference between the groups with respect to change in smoking behavior. None of the families had contacted the smoking cessation resources provided to the intervention group.

Conclusion: We found no significant differences between the groups with respect to change in smoking behaviour.

Study Design: Randomized, parallel group, clinical trial

Setting: Clinic based well-child intervention

Population of Focus: Families bringing their children to the participating health centers for 6-week, 2 or 4 year well-child visits

Data Source: Self-report by parents

Sample Size: 443 families initially, 80 families dropped out

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Referrals, YOUTH, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: 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).

Intervention Results: In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most (≥ 80%) agreed that checklists fit easily into clinic workflow and required ≤ 5 min to complete. Staff (≥ 55%) indicated using checklists with ≥ 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.

Conclusion: 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.

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (patient/consumer), Assessment (Provider), Education on Disease/Condition,

Intervention Description: The study evaluated the impact of a community-based mobile crisis service intervention in Connecticut, which provides crisis stabilization and support, screening and assessment, suicide assessment and prevention, brief, solution-focused interventions, and referral and linkage to ongoing care.

Intervention Results: Youths who received mobile crisis services had a significant reduction in odds of a subsequent behavioral health ED visit compared with those who did not receive mobile crisis services.

Conclusion: The study provides evidence suggesting that community-based mobile crisis services, such as Mobile Crisis, reduce ED use among youths with behavioral health service needs.

Study Design: Quasi-experimental study

Setting: Connecticut, United States

Population of Focus: Healthcare providers, policymakers, and researchers interested in improving behavioral health services for youths.

Sample Size: Not specified

Age Range: Youths who were age 18 and younger, as well as older youths who were still attending high school.

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Office Systems Assessments And Implementation Training, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider), Data Collection Training for Staff , Provider Training/Education

Intervention Description: This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes.

Intervention Results: Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening.

Conclusion: Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.

Setting: Pediatric primary care practices

Population of Focus: Physician leader, staff and parent partner

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Home Visits, CAREGIVER, Home Visit (caregiver), Education/Training (caregiver), Educational Material (caregiver), Assessment (caregiver), Motivational Interviewing/Counseling, Motivational Interviewing

Intervention Description: The aim of this study is to evaluate effects of the counseling method “Smoke-free children” that focuses on protection of infants.

Intervention Results: Forty-one mothers participated in the study, 26 in the intervention group and 15 in the control group. Cotinine was collected from 22 subjects in the intervention and 8 in the control group. Before the intervention, the mean cotinine level was 185 ng/mL in the intervention group and 245 ng/mL in the control group. After the intervention, cotinine levels were reduced in the intervention group (165 ng/mL) and increased in the control group (346 ng/mL). Yet, after the intervention, the mothers themselves reported more smoking in the intervention group than in the control group. Only weak correlations were found between self-reported smoking and cotinine.

Conclusion: The statistical analysis supports the view that a client-centered intervention, aimed at increasing self-efficacy, exerts a positive effect on maternal smoking in the prevention of infant exposure to ETS, when applied in a routine clinical setting.

Study Design: RCT

Setting: Child health centers

Population of Focus: Swedish mothers who had given birth to a healthy child

Data Source: Self-reporting of smoking; cotinine levels of mothers’ saliva

Sample Size: 26 mothers in the intervention group and 15 in the control group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Lactation Consultant, Educational Material, Assessment (PATIENT_CONSUMER)

Intervention Description: Primary prevention utilizing consistent visits with lactation professionals with a group of new mothers may efficiently address a care gap to meet breastfeeding goals. Mother-infant dyads attending a newborn care clinic for 6 weeks received feeding assessment and standard-of-care guidance from an Internationally Board-Certified Lactation Consultant (IBCLC). This study is an evaluation of a cost-effective easy-to-deliver strategy provided to an at-risk population attending a primary care clinic in the normal course of postnatal care.

Intervention Results: The number and timing of IBCLC visits was correlated with EDB at 6 weeks PP. Maternal/infant dyads seen at day 3 had 2.5 times higher odds of EDB at 6 weeks than those not receiving IBCLC standard-of-care feeding assessment. Dyads seen at days 3 and 14 had 3.4 times higher odds of EDB than those with less follow-up. Bottle use correlated with decreased odds of AB at 6 weeks PP; similarly, dyads seen only at day 14 PP had decreased odds of EDB. When looking at timing of the first involvement, dyads seen at 3 days had higher odds of EDB than dyads first seen at day 14 PP.

Conclusion: This primary prevention strategy of early minimal intervention using an IBCLC increased the odds of EDB and AB at 6 weeks PP. These data support the conclusion that early feeding assessment the first 2 weeks PP with an IBCLC may increase breastfeeding at 6 weeks PP.

Study Design: Retrospective comparison cohort study

Setting: Hospital-affiliated primary care clinic serving the underinsured and uninsured in the community

Population of Focus: Mother-infant dyads attending a newborn care clinic

Sample Size: 640 mother-infant dyads

Age Range: Infants at 6 weeks postpartum

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Motivational Interviewing, PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Telephone Support, CAREGIVER, Home Visit (caregiver), Assessment (caregiver), Attestation (caregiver), Motivational Interviewing/Counseling

Intervention Description: This pilot study evaluated the effectiveness of a nurse-delivered home-visiting program during the postpartum period that included a low-intensity smoking relapse-prevention intervention.

Intervention Results: Although both groups showed significant relapse from being smoke free, the intervention group was twice as likely to be smoke free at 3 and 6 months, and three times as likely to be smoke free at both times. The cotinine verification revealed a misclassification rate of 37% at the 6-month follow-up (i.e., participants self-reported as abstinent but shown by cotinine not to be abstinent).

Conclusion: The effectiveness of this brief, low-cost, and potentially replicable intervention in improving the rate of persistent postpartum smoke-free status for women who quit smoking during pregnancy is encouraging. A randomized trial of the approach is warranted.

Study Design: Pilot study; Prospective two-group design

Setting: Birthing hospital plus home visit

Population of Focus: English-speaking women who delivered healthy babies, resided in Franklin County, Ohio, and reported quitting smoking during pregnancy and at least 7 days before delivery

Data Source: Questionnaire that included smoking history and attitudes and intent to stay smoke free administered at baseline. Saliva sample for maternal cotinine analysis collected at baseline and 3 and 6 months for all participants who self-reported abstinence (defined as no smoking for the previous 7 days)

Sample Size: 97 in the baseline group and 122 in the intervention group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, Assessment (Provider), HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, CAREGIVER, Education/Training (caregiver), Assessment (caregiver), Educational Material (caregiver)

Intervention Description: The aims of this project were to increase the percentage of infants following safe sleep practices in the NICU before discharge and to determine if improving compliance with these practices would influence parent behavior at home.

Intervention Results: Audit data showed that there was a significant increase in the rate of supine positioning from 39% at baseline to 83% at follow-up (p<0.001). Parental surveys showed that there was a significant increase in the rate of supine position from 73% at baseline to 93% at follow-up (p<0.05).

Conclusion: Multifactorial interventions improved compliance with safe sleep practices in the NICU and at home.

Study Design: QE: pretest-posttest

Setting: Children’s Memorial Hermann Hospital NICU in Houston, TX

Population of Focus: Infants in open cribs eligible for safe sleep practices; Parents of infants after discharge

Data Source: Crib audit/infant observation; Parent report

Sample Size: Baseline (n=62) Follow-up (n=79); Baseline (n=66) Follow-up (n=98)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: To determine the prevalence of bullying during elementary school and its association with school attendance, academic achievement, disciplinary actions, and self-reported feelings of sadness, safety, and belonging.

Intervention Results: Twenty-two percent of children surveyed were involved in bullying either as a victim, bully, or both. Victims and bully-victims were more likely to have low achievement than bystanders (odds ratios [ORs], 0.8 [95% confidence interval (CI), 0.7-0.9] and 0.8 [95% CI, 0.6-1.0], respectively). All 3 bullying-involved groups were significantly more likely than bystanders to feel unsafe at school (victims, OR, 2.1 [95% CI, 1.1-4.2]; bullies, OR, 2.5 [95% CI, 1.5-4.1]; bully-victims, OR, 5.0 [95% CI, 1.9-13.6]). Victims and bully-victims were more likely to report feeling that they don't belong at school (ORs, 4.1 [95% CI, 2.6-6.5] and 3.1 [95% CI, 1.3-7.2], respectively). Bullies and victims were more likely than bystanders to feel sad most days (ORs 1.5 [95% CI, 1.2-1.9] and 1.8 [95% CI, 1.2-2.8], respectively). Bullies and bully-victims were more likely to be male (ORs, 1.5 [95% CI, 1.2-1.9] and 3.0 [95% CI, 1.3-7.0], respectively).

Conclusion: The prevalence of frequent bullying among elementary school children is substantial. Associations between bullying involvement and school problems indicate this is a serious issue for elementary schools. The research presented herein demonstrates the need for evidence-based antibullying curricula in the elementary grades.

Study Design: Cross-sectional study using 2001-2002 school data

Setting: Urban, West Coast public school district.

Data Source: 2001-2002 school data

Sample Size: Three thousand five hundred thirty (91.4%) third, fourth, and fifth grade students.

Age Range: third, fourth, and fifth grade students

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Expert Support (Provider), Modified Billing Practices, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: This report evaluates the impact of Phase II of Maine's First STEPS initiative

Intervention Results: Average percentage of documented use of a developmental screening tool increased substantially from baseline to followup for all three age groups (46% to 97% for children under one; 22% to 71% for children 18-23 months; and 22% to 58% for children 24-35 months). Rate of developmental screening based on MaineCare claims increased from the year prior to intervention implementation to the year after implementation for all three age groups (5.3% to 17.1% for children age one; 1.5% to 13.3% for children age two; and 1.2% to 3.3% for children age 3).

Conclusion: The authors summarize lessons learned in implementing changes in practices and challenges in using CHIPRA and IHOC developmental, autism, and lead screening measures at the practice-level to inform quality improvement.

Study Design: QE: pretest-posttest

Setting: Pediatric and family practices serving children with MaineCoverage

Population of Focus: Children ages 6 to 35 months

Data Source: Child medical record; MaineCare paid claims

Sample Size: Unknown number of chart reviews from 9 practice sites completing follow-up

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Continuing Education of Hospital Providers, Assessment,

Intervention Description: To evaluate the effectiveness of a bespoke short training programme, which incorporated interactive and didactic teaching with printed and electronic resources.

Intervention Results: Training was associated with significant improvements in the specificity of depression judgements (52.0% for the intervention group and 47.2% for the control group, P = 0.039), and there was a non-significant increase in sensitivity (64.5% compared to 61.5% P = 0.25). Nurses’ knowledge about depression improved (standardised mean difference = 0.97 [95% CI 0.58 to 1.35], P < 0.001); and confidence about their professional role in relation to depression increased.

Conclusion: This school nurse development programme, designed to convey best practice for the identification and care of depression, delivered significant improvements in some aspects of depression recognition and understanding, and was associated with increased confidence in working with young people experiencing mental health problems.

Study Design: Cluster randomized controlled trial

Setting: School nurse services from 13 Primary Care Trusts in London

Population of Focus: School nurses

Sample Size: 146 school nurses

Age Range: School pupils (aligns with ages 12-17)

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Assessment, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: This study aimed to evaluate the effectiveness of systematic assessment of asthma-like symptoms and environmental tobacco smoke (ETS) exposure during regular preventive well-child visits between age 1 and 4 years by well-child professionals.

Intervention Results: No differences were found in asthma, wheezing and other measures between intervention and control group. Children whose parents received the intervention had a decreased risk of ETS at home ever at age 2 and 3 years, but not at age 6.

Conclusion: Systematic assessment and counselling of asthma-like symptoms and ETS exposure in early childhood by well-child care professionals using a brief assessment form was not effective in reducing the prevalence of physician-diagnosed asthma ever and wheezing, and did not improve FeNO, Rint or HRQOL at age 6 years. Our results hold some promise for interviewing parents and using information leaflets at well-child centres to reduce ETS exposure at home in preschool children.

Study Design: RCT

Setting: Well-child care centers in Rotterdam

Population of Focus: Children born between April 2002 and January 2006 attending wellcare visits at 16 well-care centers. The centers were randomized into 8 intervention and 8 control centers

Data Source: Parent self-report

Sample Size: 7775 children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, STATE, Funding Support, Perinatal Committees/Councils

Intervention Description: A major objective was to develop and maintain a regionalized system of care. Such a system has been developed but differed from traditional systems by using regional level II centers. Iowa's low population density necessitated this modification.

Intervention Results: Level I hospitals currently manage low-risk patients and report very low mortality rates. Level II facilities receive high-risk referrals, but selective referral occurs since the tertiary center accounts for a disproportionate number of fetal and neonatal deaths, and births weighting less than 1500 g.

Conclusion: Other regions may benefit from similar approaches to development of regionalized systems of care and evaluation of the same.

Study Design: QE: pretest-posttest

Setting: All Iowa hospitals Pretest: 129 level I, 11 level II, and one level III hospital Posttest: 118 level I, 11 level II, and one level III hospital

Population of Focus: All infants born at ≥20 weeks GA and ≤1500 gm

Data Source: Data from Iowa State Health Department matched birth and infant death certificates.

Sample Size: Pretest (n= 432) Posttest (n= 343)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment, POPULATION-BASED SYSTEMS, INTER-HOSPITAL SYSTEMS, Maternal/In-Utero Transport Systems, Agreement for Level III Hospital to Accept All Patients, Perinatal Committees/Councils, STATE

Intervention Description: A voluntary system of regionalized perinatal health care was developed in Iowa to provide accessible services for a rural population.

Intervention Results: The intervention in Iowa focused on increasing both level III and level II VLBW births due to population density concerns in Iowa. Among all VLBW infants, there were changes in the birth location distribution. Of these infants, there was a statistically significant increase in percentage born in level III hospitals from 6.7% to 22.6% (p<0.05)1 and an increase in births in level II hospitals from 26.9% to 35.6%. The percentage born in level I centers decreased from 68.2% to 41.8%.

Conclusion: The concept of a mortality risk ratio (neonatal deaths/<1,500 gm live births) is suggested as a method of reviewing mortality data from the perspective of risks inherent in the population served.

Study Design: QE: pretest-posttest

Setting: All Iowa hospitals Pretest: 130 level I, 10 level II, and one level III hospital Posttest: 122 level I, 10 level II, and one level III hospital

Population of Focus: All live births <1500 gm

Data Source: Data from Iowa State Health Department matched birth and infant death certificates.

Sample Size: Pretest (n= 440) Posttest (n= 402)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (patient/consumer)

Intervention Description: This study explored the victimization experiences of urban elementary school students to determine whether subsets of youth emerged with similar victimization profiles (e.g., no victimization, multiple types of victimization). It also evaluated whether multiple victimization was associated with greater psychological distress and lower academic performance.

Intervention Results: Cluster analysis suggested the existence of three distinct youth profiles: those with minimal victimization, those victimized primarily by their peers, and those with multiple types of victimizations. As hypothesized, youth with multiple victimizations experienced more psychological distress and earned lower grades than their peers.

Conclusion: Findings highlight the heterogeneity of youth victimization experiences and their relations to functioning, and have implications for treatment planning among practitioners working with youth.

Study Design: N/A

Setting: an urban, ethnically diverse school district in the Northeast

Data Source: Self-report

Sample Size: 689

Age Range: fifth grade students

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Quality Improvement/Practice-Wide Intervention, Sleep Environment Modification

Intervention Description: (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2-6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination.

Intervention Results: Mothers had the greatest trust in doctors for advice on all infant care practices (56-89 %), while trust was lowest for friends (13-22 %) and the media (10-14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources.

Conclusion: for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices.

Study Design: Survey

Setting: Maternity Hospitals

Data Source: Recruited Mothers from Maternity Hospitals

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: The committee met five times within six months. The committee held three open information-gathering sessions at which the members heard from a diverse group of stakeholders, researchers, members of advocacy organizations, and the public. Box S-2 provides the committee definition of preventive health services. The committee’s methodology to identify preventive services necessary for women’s health and well-being and to identify specific services that could supplement the current list of recommended preventive services for women under the ACA follows. The committee’s first step was to review and reach an understanding of existing guidelines. The second step was to assemble and assess additional evidence, including reviews of the literature, federal health priority goals and objectives, federal reimbursement policies, and the clinical guidelines of health care professional organizations. The committee also considered the public comments that it received. Finally, the committee formulated a list of recommendations to be considered by the Secretary of HHS in developing a comprehensive package of preventive services for women to be included under the ACA.

Intervention Results: The committee recommends for consideration as a preventive service for women: screening for gestational diabetes in pregnant women between 24 and 28 weeks of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes. The committee recommends for consideration as a preventive service for women: the addition of high-risk human papillomavirus DNA testing in addition to cytology testing in women with normal cytology results. Screening should begin at 30 years of age and should occur no more frequently than every 3 years. The committee recommends for consideration as a preventive service for women: annual counseling on sexually transmitted infections for sexually active women. The committee recommends for consideration as a preventive service for women: counseling and screening for human immunodeficiency virus infection on an annual basis for sexually active women. The committee recommends for consideration as a preventive service for women: the full range of Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling for women with reproductive capacity. The committee recommends for consideration as a preventive service for women: comprehensive lactation support and counseling and costs of renting breastfeeding equipment. A trained provider should provide counseling services to all pregnant women and to those in the postpartum period to ensure the successful initiation and duration of breastfeeding. (The ACA ensures that breastfeeding counseling is covered; however, the committee recognizes that interpretation of this varies.) The committee recommends for consideration as a preventive service for women: screening and counseling for interpersonal and domestic violence. Screening and counseling involve elicitation of information from women and adolescents about current and past violence and abuse in a culturally sensitive and supportive manner to address current health concerns about safety and other current or future health problems. The committee recommends for consideration as a preventive service for women: at least one well-woman preventive care visit annually for adult women to obtain the recommended preventive services, including preconception and prenatal care. The committee also recognizes that several visits may be needed to obtain all necessary recommended preventive services, depending on a woman’s health status, health needs, and other risk factors.

Conclusion: Bringing clinical preventive services into rational alignment with the coverage for other health care services under the ACA will be a major task. The committee notes that many of the individual components for review of the evidence are already managed within HHS but currently lack effective coordination for the purposes outlined in the ACA and that some functions are entirely new. The structure might be effectively built over time by using some current bodies and adding new ones as resources permit. The committee does not believe that it has enough information to recommend which unit in HHS should implement the recommendations. Figure S-1 illustrates the committee’s suggested structure. In view of the critical importance of community-based preventive services in achieving clinical aims, the committee encourages the Secretary to consider widening the scope of authority to include public health efforts to more comprehensively address prevention. It will be critical for a preventive services coverage commission to coordinate with the new and existing committees that are charged with overseeing other elements of the ACA. Finally, the committee notes that it would make the most sense to consider preventive services for women, men, children, and adolescents in the same way. Thus, although the committee’s recommendations address women’s preventive services, a parallel approach could be equally useful for determining covered preventive services for men, children, and male adolescents.

Study Design: N/A

Setting: N/A

Data Source: Existing Guidelines

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Policy/Guideline (Hospital), Assessment (patient/consumer), Screening in Nontraditional Settings

Intervention Description: The intervention described by the article to increase postpartum depression (PPD) screening is the implementation of a PPD screening program in a Pediatric Emergency Department (PED) setting . The study found that PED-based screening had a positive impact through PPD screening, education, and resources, and helped to identify PPD in mothers who had not been screened previously.

Intervention Results: The results found that 27% of mothers (n=209) screened positive for PPD, with 7% reporting suicidal thoughts . Additionally, 47% of mothers had never previously been screened for PPD, including 58% of PPD screen-positive mothers . The study also assessed maternal attitudes toward screening and found that PED-based screening had a positive impact through PPD screening, education, and resources, and helped to identify PPD in mothers who had not been screened previously

Conclusion: Approximately 1 in 4 mothers screened positive for PPD in a PED, with almost 1 in 10 reporting suicidal thoughts. The majority of PPD screen–positive mothers had not been screened previously. Our study helps to inform future efforts for interventions to support mothers of young infants who use the PED for care.

Study Design: To answer your question, the study design/type is a pilot cohort study of a convenience sample of mothers of infant patients

Setting: The study was conducted in a Pediatric Emergency Department (PED)

Population of Focus: The target audience for the study is healthcare providers, particularly those who work in pediatric emergency departments and are involved in the care of mothers and infants

Sample Size: The sample size for the study was 209 mothers of infant patients who presented to a PED from June 2015 to January 2016

Age Range: The study included mothers of infant patients 6 months or younger presenting to a Pediatric Emergency Department

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Assessment, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Educational Material (caregiver), Counseling (Parent/Family)

Intervention Description: To investigate whether a biomarker screening approach for tobacco smoke exposure (TSE) conducted concurrently with lead screening at well-child visits would increase parental smoking cessation and implementation of home smoking restrictions.

Intervention Results: Eighty-four percent of eligible parents agreed to have their child tested for TSE along with lead testing. Measurable cotinine was identified in 93% of children. More parents in the intervention group received tobacco treatment than in the comparison group (74% vs. 0%) and more parents reported 7-day point-prevalent abstinence from smoking at 8 weeks (29% vs. 3%).

Conclusion: These data demonstrate the feasibility of adding cotinine measurement to routine well-child lead screening to document TSE in small children. Data suggest providing this information to parents increases engagement in tobacco treatment and prompts smoking cessation.

Study Design: Observational, quasiexperimental

Setting: Pediatric clinic in Minneapolis, Minnesota

Population of Focus: Parents who smoked and their children presenting for well-child visits

Data Source: Parental self-report and child cotinine level.

Sample Size: 80 parents

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: The goal of the study was to examine whether bullying experiences are associated with lower academic performance across middle school among urban students.

Intervention Results: Results of multilevel models (MLMs) showed that grade point averages and teacher-rated academic engagement were each predicted by both self-perceptions of victimization and peer nominations of victim reputation, controlling for demographic and school-level differences as well as overall declines in academic performance over time. Further MLM analyses suggested that most of the victimization effect was due to between-subject differences, as opposed to within-subject fluctuations, in victimization over time.

Conclusion: The results of the study suggest that peer victimization cannot be ignored when trying to improve educational outcomes in urban middle schools.

Study Design: Longitudinal Study

Setting: Public Middle School

Data Source: a longitudinal study of 2,300 sixth graders

Sample Size: 2300

Age Range: sixth graders

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Assessment, Group Education,

Intervention Description: The Mindlink center providing screening, counseling, case management, therapy groups, family interventions, etc. for youth mental health.

Intervention Results: A community‐based early‐intervention service for youth was first introduced in 2012, when a special team was formed in a community mental health centre of Korea. As the numbers of young clients increased, a youth‐friendly, early‐intervention centre called Mindlink was opened in 2016. Mindlink targets those aged 15–30 years with mental illness less than 5 years in duration. Its goal is to detect mental illness in young people early and provide comprehensive multidisciplinary interventions. It provides intensive case management and group programmes including cognitive‐behavioural therapy, family intervention, psychoeducation, behavioural activation and physical health promotion. The Korean government has officially announced that the Mindlink model is effective and is currently in the process of scaling it up on a national level.

Conclusion: Our community‐based early intervention for youth mental health gradually evolved from a special team to the Mindlink centre and is ready for expansion to other areas. We are currently collecting more systematic evidence and hope to open hundreds of early‐intervention centres for Korean youth. Many young people with distressing mental illnesses, and their family members, now voluntarily visit Mindlink for help. They are seeking early psychiatric treatment despite the major associated stigma. Although stigma is problematic, low investment in effective mental health services may be of greater concern. Our experience with the Mindlink model suggests that investments in youth mental health and good service delivery can overcome stigma and other barriers to early access to mental health services.

Study Design: Quantitative analysis of an early intervention program

Setting: Community mental health center and separate Mindlink early intervention center in Gwangju, South Korea

Population of Focus: Community mental health center and separate Mindlink early intervention center in Gwangju, South Korea

Sample Size: 206 young people registered for services in 2019

Age Range: 15-30 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: To review the research addressing the association of suicide and bullying, from childhood to young adulthood, including cross-sectional and longitudinal research findings. Relevant publications were identified via electronic searches of PsycNet and MEDLINE without date specification, in addition to perusing the reference lists of relevant articles.

Intervention Results: Cross-sectional findings indicate that there is an increased risk of suicidal ideation and (or) suicide attempts associated with bullying behaviour and cyberbullying. The few longitudinal findings available indicate that bullying and peer victimization lead to suicidality but that this association varies by sex. Discrepancies between the studies available may be due to differences in the studies' participants and methods.

Conclusion: Bullying and peer victimization constitute more than correlates of suicidality. Future research with long-term follow-up should continue to identify specific causal paths between bullying and suicide.

Study Design: N/A

Setting: N/A

Data Source: PsycNet and MEDLINE databases as well as references lists

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (Provider), Referrals, Food Programs

Intervention Description: This study evaluated the efficacy of screening and referral through process evaluation, key informant interviews, and focus groups with 19 caregivers and 11 clinic staff. Three pediatric clinics implemented a two-question food insecurity screening of 7,284 families with children younger than five years.

Intervention Results: Using grounded theory, transcript themes were coded into facilitators and barriers of screening and referral. Facilitators included trust between caregivers and staff, choice of screening methods, and assistance navigating benefits application. Barriers included complex administration of referral, privacy and stigma concerns, and caregivers' current benefit enrollment or ineligibility.

Conclusion: Results demonstrate importance of integrated screening and referral consent processes, strong communication, and convenient outreach for families.

Study Design: Process evaluation, key informant interviews, and focus groups

Setting: Pediatric clinic

Population of Focus: Familes

Sample Size: 7284

Age Range: n/a

Intervention Components (click on component to see a list of all articles that use that intervention): Peer-led Mentoring/Support Counseling, Education on Disease/Condition, Assessment,

Intervention Description: The intervention evaluated in the study "Improving Care Linkage for Racial-Ethnic Minority Youths Receiving Emergency Department Treatment for Suicidality: SAFETY-A" is the SAFETY-A program. This program is a brief strengths-based, cognitive-behavioral family intervention aimed at enhancing care continuity and mental health equity for racial-ethnic minority youths at risk for suicide. The study involved a randomized controlled trial comparing the effects of SAFETY-A versus enhanced usual care on care linkage and treatment outcomes for racial-ethnic minority youths receiving emergency department treatment for suicidal episodes

Intervention Results: Racial-ethnic minority youths who received SAFETY-A had higher treatment linkage rates than those receiving usual care. Adequate treatment dose rates did not differ by group.

Conclusion: "SAFETY-A is a promising approach to enhance care continuity and mental health equity for racial-ethnic minority youths at risk for suicide."

Study Design: Randomized controlled trial

Setting: Emergency Department

Population of Focus: Racial-ethnic minority youths at risk for suicide

Sample Size: 105 racial-ethnic minority youths

Age Range: Ages 10–18 years

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (patient/consumer)

Intervention Description: We examined the effects on infant growth and health of 3 compared with 6 mo of exclusive breastfeeding.

Intervention Results: From 3 to 6 mo, weight gain was slightly greater in the 3-mo group [difference: 29 g/mo (95% CI: 13, 45 g/mo)], as was length gain [difference: 1.1 mm (0.5, 1.6 mm)], but the 6-mo group had a faster length gain from 9 to 12 mo [difference: 0.9 mm/mo (0.3, 1.5 mm/mo)] and a larger head circumference at 12 mo [difference: 0.19 cm (0.07, 0.31 cm)]. A significant reduction in the incidence density of gastrointestinal infection was observed during the period from 3 to 6 mo in the 6-mo group [adjusted incidence density ratio: 0.35 (0.13, 0.96)], but no significant differences in risk of respiratory infectious outcomes or atopic eczema were apparent.

Conclusion: Exclusive breastfeeding for 6 mo is associated with a lower risk of gastrointestinal infection and no demonstrable adverse health effects in the first year of life.

Study Design: observational cohort study nested within a large randomized trial

Setting: Belarus

Data Source: N/A

Sample Size: 3483 infants

Age Range: Infants under 1 year

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, POPULATION-BASED SYSTEMS, STATE, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The objectives of this study were to assess the feasibility of implementing a bundle of strategies to facilitate the use of Bright Futures recommendations and to evaluate the effectiveness of a modified learning collaborative in improving preventive and developmental care.

Intervention Results: Office system changes most frequently adopted were use of recall/reminder systems (87%), a checklist to link to community resources (80%), and systematic identification of children with special health care needs (80%). From baseline to follow-up, increases were observed in the use of recall/reminder systems, the proportion of children's charts that had a preventive services prompting system, and the families who were asked about special health care needs. Of 21 possible office system components, the median number used increased from 10 to 15. Comparing scores between baseline and follow-up for each practice site, the change was significant. Teams reported that the implementation of office systems was facilitated by the perception that a component could be applied quickly and/or easily. Barriers to implementation included costs, the time required, and lack of agreement with the recommendations.

Conclusion: This project demonstrated the feasibility of implementing specific strategies for improving preventive and developmental care for young children in a wide variety of practices. It also confirmed the usefulness of a modified learning collaborative in achieving these results. This model may be useful for disseminating office system improvements to other settings that provide care for young children.

Study Design: QE: pretest-posttest

Setting: Primary care practices (15 at baseline, 8 at follow- up) throughout the US (9 states total), with most in the Midwest

Population of Focus: Children from birth through 21 years of age

Data Source: Child medical record

Sample Size: Unknown number of chart audits from 8 practice sites completing follow-up

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: Prevention programs target children at high risk and focus on removing external risk factors, providing enriching environments, training parents on responsiveness and skill-building to encourage optimal development. Remediation programs are for children diagnosed with developmental disturbances. They attempt to maximize developmental competence and minimize delays. Compensation services target children with established disorders like cerebral palsy or Down syndrome that cannot be substantially changed. The aim is maximizing overall functioning, often through aids and behavioral techniques.

Intervention Results: Intervention programs have been shown to have a positive moderate effect on developmental attainment, improving intellectual abilities, academic achievement, and scores on developmental measures. Prevention services have demonstrated significant lasting effects into adulthood, with participants less likely to fail grades, require special education, more likely to graduate high school, pursue higher education, and have higher earnings. For biologically at-risk children, interventions facilitated short-term gains in growth, development, and improved parenting skills.

Conclusion: While more methodologically rigorous longitudinal studies are needed, the available evidence suggests early intervention programs can benefit children with or at risk of developmental delays. It proposes that for intervention to be effective, programs should be structured, intense, involve family support, and begin as early as possible in the child's life. Developmental screening is crucial for early identification to provide appropriate interventions and maximize developmental potential.

Study Design: report

Setting: N/A

Data Source: NCES Crime and Safety Surveys portal, 2010–11 Common Core of Data (CCD) and the 2011–12 Private School Universe Survey (PSS)

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Assessment, YOUTH, HEALTH_CARE_PROVIDER_PRACTICE, EMR Reminder

Intervention Description: This study aimed to assess the feasibility of a CDSS to address caregivers' tobacco use and child tobacco smoke exposure (TSE).

Intervention Results: We screened 185 caregivers whose children were exposed to TSE for study inclusion; 155 (84%) met the eligibility criteria, and 149 (80.5%) were included in the study. Study nurses advised 35.2% of the caregivers to quit, assessed 35.9% for readiness to quit, and assisted 32.4%. Of the 149 participants, 83.1% were female; 47.0% were white and 45.6% African American; 84.6% had public insurance or were self-pay; 71.1% were highly nicotine dependent; 50.0% and 50.7% allowed smoking in the home and car, respectively; and 81.3% of children were biochemically confirmed to be exposed to tobacco smoke. At follow-up (86.6% retention), 58.9% reported quit attempts at 3 months. There was a significant decrease in nicotine dependence and a significant increase in motivation to quit. Self-reported quit rate was 7.8% at 3 months.

Conclusion: An electronic health record-embedded CDSS was feasible to incorporate into busy UC nurses' workloads and was associated with encouraging changes in the smoking behavior of caregivers. More research on the use of CDSS to screen and counsel caregivers who smoke in the UC and other acute care settings is warranted.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Expert Support (Provider), Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Office Systems Assessments and Implementation Training

Intervention Description: The aim of this study was to use family-centered measures to estimate the effect of a collaborative quality improvement program designed to help practices implement systems to promote early childhood development services.

Intervention Results: The number of care delivery systems increased from a mean of 12.9 to 19.4 of 27 in collaborative practices and remained the same in comparison practices (P=.0002). The proportion of children with documented developmental and psychosocial screening among intervention practices increased from 78% to 88% (P<.001) and from 22% to 29% (P=.002), respectively. Compared with control practices, there was a trend toward improvement in the proportion of parents who reported receiving at least 3 of 4 areas of care.

Conclusion: The learning collaborative was associated with an increase in the number of practice-based systems and tools designed to elicit and address parents' concerns about their child's behavior and development and a modest improvement in parent-reported measures of the quality of care.

Study Design: QE: pretest-posttest nonequivalent control group

Setting: Pediatric and family primary care practices (17 collaborative education, 18 comparison practices) in Vermont and North Carolina

Population of Focus: Children ages 0-48 months receiving well-child visits

Data Source: Child medical record

Sample Size: Unknown number of chart audits

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (Provider), Motivational Interviewing/Counseling,

Intervention Description: Screening, Brief Intervention, and Referral to Treatment (SBIRT) delivered either electronically or by a clinician.

Intervention Results: The study found that Screening, Brief Intervention, and Referral to Treatment (SBIRT) significantly decreased the number of days of primary substance use, including alcohol consumption, among women in reproductive healthcare centers. Pregnant women reported substance use, on average, about 17% fewer days per month than did non-pregnant women.

Conclusion: Screening, Brief Intervention, and Referral to Treatment (SBIRT) significantly reduced the number of days of primary substance use among women in reproductive healthcare centers. Both the electronic and clinician-delivered interventions were more effective in reducing substance use compared to enhanced usual care. However, there was no significant difference in treatment utilization between the intervention groups and the enhanced usual care group.

Study Design: Randomized controlled trial

Setting: Two urban academic hospital based clinics

Population of Focus: Nonpreganant and pregnant women who screened positive for substance use

Sample Size: 439 women

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Data Collection Training for Staff

Intervention Description: To determine the impact of the Healthy Steps for Young Children Program on quality of early childhood health care and parenting practices.

Intervention Results: Percentage of children with developmental assessments was 83.1% for intervention and 41.4% for control group (OR=8.00; 95% CI=6.69, 9.56; P<.001)

Conclusion: Universal, practice-based interventions can enhance quality of care for families of young children and can improve selected parenting practices.

Study Design: RCT and QE: nonequivalent control group

Setting: Pediatric practices in 14 states (6 randomization sites: San Diego, CA; Iowa City, IA; Allentown, PA; Pittsburgh, PA; Florence, SC; Amarillo, TX. 9 QE sites: Birmingham, AL/Chapel Hill, NC; Grand Junction, CO/Montrose, CO; Chicago, IL; Kansas City, KS; Boston, MA; Detroit, MI; Kansas City, MO; New York, NY; Houston, TX/Richmond, TX)

Population of Focus: Children ages 0-36 months

Data Source: Child medical record

Sample Size: Randomization Sites: - Intervention (n=832) - Control (n=761) - Total (n=1593) Quasi-Experimental Sites: - Intervention (n=1189) - Control (n=955) - Total (n=2144) Total: - All families (n=3737) - Intervention: (n=2021) - Control (n=1716)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: We analyzed pooled data from the 2009 and 2011 Youth Risk Behavior Surveys (n = 75 344) to assess race/ethnicity, gender, and sexual orientation variation in being bullied and suicide ideation.

Intervention Results: White and Hispanic gay and bisexual males, White lesbian and bisexual females, and Hispanic bisexual females were more likely to be bullied than were White heterosexual adolescents. Black lesbian, gay, and bisexual youths' vulnerability to being bullied was not significantly different from that of White heterosexual youths. Black and Hispanic heterosexual youths were less likely to be bullied than were White heterosexual youths. Despite differences in the likelihood of being bullied, sexual minority youths were more likely to report suicide ideation, regardless of their race/ethnicity, their gender, or whether they have been bullied.

Conclusion: Future research should examine how adolescents' intersecting identities shape their experience of victimization and suicidality. School personnel should develop antibullying and antihomophobia policies in response to the disproportionate risk of being bullied and reporting suicidality among sexual minority youths.

Study Design: N/A

Setting: N/A

Data Source: pooled data from the 2009 and 2011 Youth Risk Behavior Surveys

Sample Size: 75 344

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Development/Improvement of Services, Continuing Education of Hospital Providers, Needs Assessment

Intervention Description: This was a prospective population-based cohort study of perinatal outcomes before and after 1 full year of implementation of the preterm birth prevention program.

Intervention Results: In the state overall, the rate of singleton preterm birth was reduced by 7.6% and was lower than in any of the preceding 6 years. This reduction amounted to 196 cases relative to the year before the introduction of the initiative and the effect extended from the 28-31 week gestational age group onward. Within the tertiary level center, the rate of preterm birth in 2015 was also significantly lower than in the preceding years.

Conclusion: A comprehensive and multifaceted preterm birth prevention program aimed at both health care practitioners and the general public, operating within the environment of a government-funded universal health care system can significantly lower the rate of early birth. Further research is now required to increase the effect and to determine the relative contributions of each of the interventions.

Setting: Hospitals in Western Australia

Population of Focus: Pregnant women in Western Australia

Intervention Components (click on component to see a list of all articles that use that intervention): Office Systems Assessments and Implementation Training, Referrals,

Intervention Description: The intervention involved implementing electronically transmitted referrals for pediatric subspecialty care. The intervention included three main changes: 1. Redesigning the EMR referral order to transmit electronically to CHP sub-specialty schedulers through a shared electronic health platform for referrals specific to CHP specialists. 2. For referrals electronically transmitted to CHP, schedulers then called families up to 3 times. These two steps bypassed many steps and decisions that the family would otherwise need to navigate (i.e., understanding the need for referral, deciding to schedule the referral, actually calling the scheduler, and navigating the phone tree). 3. To improve PCP’s ability to track referrals, subspecialty schedulers sent electronic notifications to PCPs regarding the final scheduling outcome: appointment scheduled, family not reached, or family declined.

Intervention Results: From April 2015 through September 2016 there were 33,485 referral orders across all practices (7770 before the pilot, 11,776 during the pilot, 13,939 after full implementation). At pilot practices, there was a significant and sustained improvement in subspecialty visits attended within 4 weeks of referral (10.9% to 20.0%; P < .001). Relative to control practices, pilot practices experienced an 8.6% improvement (P = .001). After implementation at control practices, rates of visits attended also improved but to a smaller degree: 11.8% to 14.7% (P < .001). In survey responses, referring pediatricians noted improved scheduling processes but had continued concerns with appointment availability and referral tracking.

Conclusion: Yes, the study reports statistically significant findings. The study found that the percentage of referrals with a visit attended within 4 weeks increased significantly from 11.8% before the pilot to 21.1% after the pilot (P < .001). The percentage of referrals from control practices with a visit attended within 4 weeks also increased significantly, but more modestly, from 11.8% to 14.7% (P < .001). The interrupted time-series analysis confirmed a statistically significant change in the percentage of visits attended within 4 weeks of referral (P < .001).

Study Design: The study design is a quality improvement evaluation that uses an interrupted time-series analysis to evaluate the impact of implementing electronically transmitted referrals on pediatric subspecialty visit attendance. The study uses administrative data from referring practices and subspecialty services to examine appointment scheduling and attendance. The study also includes a survey of referring pediatricians to assess their perceptions of care processes before and after the intervention.

Setting: The setting for the study was the Children's Hospital of Pittsburgh (CHP) of University of Pittsburgh Medical Center (UPMC) in southwestern Pennsylvania. The hospital is a freestanding academic 315-bed children’s hospital with over 240,000 outpatient subspecialty visits occurring in 2015 at the main hospital and 9 satellite sites.

Population of Focus: The target audience for the study is likely healthcare providers, hospital administrators, and researchers interested in improving access to pediatric subspecialty care. The study evaluates the impact of implementing electronically transmitted referrals on pediatric subspecialty visit attendance and provides insights into the potential benefits and challenges of this intervention. The study may be of interest to those working in pediatric healthcare settings, as well as those interested in healthcare quality improvement and patient access to care.

Sample Size: The sample size for the study involved 39 community general pediatric practices affiliated with the Children's Hospital of Pittsburgh (CHP).

Age Range: The age group of the patients referred for pediatric subspecialty care is not specified in the abstract. However, Table 2 on shows the distribution of referrals by patient age, with categories of 0-2 years, 3-5 years, 6-11 years, 12-17 years, and 18+ years.

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Assessment, PARENT/FAMILY, Counseling (Parent/Family), PATIENT/CONSUMER, Motivational Interviewing, CAREGIVER, Motivational Interviewing/Counseling

Intervention Description: Tobacco smoke exposure (TSE) harms children, who are often “captive smokers” in their own homes. Project Zero Exposure is a parent-oriented, theory-based intervention designed to reduce child TSE. This paper reports on findings from the pilot study, which was conducted in Israel from 2013 to 2014

Intervention Results: Twenty-six of the 29 recruited families completed the study. The intervention was feasible to implement and acceptable to participants. Among the 17 children with reliable hair samples at baseline and follow-up, log hair nicotine dropped significantly after the intervention (P = .04), hair nicotine levels decreased in 64.7% of children, and reductions to levels of nonexposed children were observed in 35.3% of children. The number of cigarettes smoked by parents (P = .001) and parent-reported child TSE declined (P = .01). Logistical issues arose with measurement of all objective measures, including air nicotine, which did not decline; home air particulate matter; and hair nicotine.

Conclusion: A program based on motivational interviewing and demonstrating TSE and contamination to parents in a concrete and easily understandable way is a promising approach to protect children from TSE. Further research is needed to enhance current methods of measurement and assess promising interventions.

Study Design: Single group pre- and post-test design

Setting: Home-based with child biomarker and home air quality feedback

Population of Focus: Parents from families in which smoking occurred were recruited from areas adjacent to NA’AMAT child day care centers by using the snowball technique

Data Source: Baseline questionnaire (reported exposure, child health, demographics). Objective assessments of child TSE via biomarkers (hair nicotine) and measurement of home air quality (air nicotine, particulate matter). Motivational interviewing action plan. Follow-up questionnaire (reported exposure).

Sample Size: 26 of the 29 recruited families completed the study

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Educational Material (Provider), Screening Tool Implementation Training

Intervention Description: Prevention programs serve those at high risk by removing external risk factors, providing enriching environments, training parents on responsiveness and positive redirection to build skills for optimal development. Remediation programs are for children diagnosed with developmental disturbances, attempting to maximize competence and minimize delays. Compensation services target established disorders like cerebral palsy or Down syndrome, aiming to maximize overall functioning through aids and behavioral techniques. This article states that intervention programs tend to have a positive moderate effect on developmental attainment, with structured, intense programs providing family support being more effective. Earlier intervention in infancy may lead to better outcomes, though evidence is unclear. Appropriate early intervention services can help optimize development for delayed children.

Intervention Results: The resource presents several key results related to intervention programs for children with developmental delays. It states that intervention programs have been shown to have a positive moderate effect on eventual developmental attainment, improving intellectual, academic achievement, and scores on developmental outcomes measures. Prevention services specifically have been found to have significant lasting effects into adulthood, with children who participated being less likely to fail grades, be assigned to special programs, have higher achievement scores, be more likely to graduate high school and seek higher education, and have higher earning wages as adults. The Ypsilanti Perry Preschool Project calculated savings to society of $100,000 per child who participated. For biologically at-risk populations, intervention facilitated short-term gains in growth, development, and improved parenting skills.

Conclusion: This resource concludes that while more methodologically sound longitudinal studies are needed, the available evidence suggests that early intervention programs can benefit children with or at risk of developmental delays. It proposes that for intervention to be effective, programs should be structured, intense, involve family support services, and begin as early as possible in a child's life. The passage endorses developmental screening as a crucial step to identify delayed children early so they can receive appropriate intervention services to maximize their developmental potential.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Assessment (Provider), Provider Training/Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Crib Card, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital)

Intervention Description: This was a pre/post quality improvement study conducted at a single quaternary care medical center from 2015 to 2019. Infants <12 months were observed in their sleeping environment pre- and post-implementation of multiple hospital-wide interventions to improve the sleep safety of hospitalized infants. Following baseline data collection, a multidisciplinary team reviewed the hospital’s infant sleep practices and developed and implemented a care bundle that included the following: A new safe sleep hospital policy; online-learning modules for all hospital staff who interact with infants; educational updates to physicians; an educational handout for volunteers; infant safe sleep education in the nursing admission and/or discharge education for infants; infant safe sleep education in the electronic health record; and various forms of education for families/caregivers in English and Spanish. The primary outcome measure was adherence to the ABCs of safe sleep (Alone in the sleep environment, on their Back on a firm sleep surface, and in an empty Crib).

Intervention Results: Only 1.3% of 221 infants observed preintervention met all ABCs of safe sleep; 10.6% of 237 infants met the ABCs of safe sleep postintervention. Significant improvements in the post-intervention cohort included sleeping in a crib (94% versus 80% preintervention; P < 0.001), avoidance of co-sleeping (3% versus 15% preintervention; P < 0.001), absence of supplies in the crib (58% versus 15% preintervention; P < 0.001), and presence of an empty crib (13% versus 2% preintervention; P < 0.001).

Conclusion: Most infants hospitalized at our institution do not sleep in a safe environment. However, the implementation of a care bundle led to improvements in the sleep environment in the hospital. Further research is necessary to continue improving in-hospital safe sleep and to assess whether these practices impact the home sleep environment.

Setting: A single quaternary care medical center

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): Enforcement of School Rules, School Rules, Assessment,

Intervention Description: the study compares the proportions of provisional enrollment, medical and non-medical exemptions, and required vaccine receipt before and after the new regulations were implemented. Moving the vaccination requirement from 8 months to 5 days.

Intervention Results: The study found that after the reduced provisional period was introduced at the beginning of the 2017/18 school year, the statewide rate of provisional enrollment at kindergarten and seventh grade immediately decreased from 11.1% to 2.5% (a 77% relative decrease) 6 [Page 6]. The study also found that the percent of students entering kindergarten and seventh grade not up-to-date on vaccination decreased from 14.1% in 2016/17 to 6.1% in 2017/18 6 [Page 6]. Among kindergartners, following the provisional period reduction, there were increases in uptake of ≥2 doses of MMR (measles-mumps-rubella) vaccine and 2 doses of the Varicella vaccine. Among 7th graders, the largest improvements were seen for the first MCV (meningococcal vaccine) dose and first Tdap/TD (Tetanus and diphtheria) vaccine dose 6 [Page 6]. The study also found that the new regulations in Pennsylvania are accomplishing the goal of increasing the proportion of students who are up-to-date or in compliance with requirements for vaccines at the beginning of the school year without a significant increase in exemption rates 9 [Page 9].

Conclusion: The study concludes that the new regulations in Pennsylvania are accomplishing the goal of increasing the proportion of students who are up-to-date or in compliance with requirements for vaccines at the beginning of the school year without a significant increase in exemption rates 6 [Page 9]. The study also suggests that vaccination policies/regulations that focus on children who have started, but not completed, required vaccine series have shown to be an effective approach to increase vaccination rates at school entry 9 [Page 9]. However, the persistence of high provisional enrollment in some counties points to additional barriers to this goal in some schools and regions

Study Design: retrospective analysis of vaccination data collected from school districts in Pennsylvania from the 2014/15 school year through the 2017/18 school year for kindergartners and 7th graders

Setting: The study was conducted in Pennsylvania, United States.

Population of Focus: Researchers, scholars, healthcare professionals, and individuals with an interest in biomedical and health-related topics.

Sample Size: The study analyzed vaccination data reported to the Pennsylvania Department of Health for all students in kindergarten and seventh grade in the state during the 2016/17 and 2017/18 school years.

Age Range: 5/13/2024

Intervention Components (click on component to see a list of all articles that use that intervention): Communication Tools, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool,

Intervention Description: The intervention description in the study "Increasing Warm Handoffs: Optimizing Community Based Referrals in Primary Care Using QI Methodology" included several key components aimed at improving the warm handoff process and referral workflow. Some of the interventions implemented during the study period are as follows: 1. Dedicating CHW Space: The study involved dedicating space near providers for Community Health Workers (CHWs) and creating electronic CHW schedules and warm handoff blocks. 2. Improving Communication: Efforts were made to improve communication with providers using email and huddle reminders, as well as posting informative signs in exam rooms to facilitate the warm handoff process. 3. Workflow Enhancements: Workflow enhancements were implemented, including the creation of warm handoff blocks in the electronic medical record (EMR) and the CHW's schedule, as well as the co-location of CHWs with pediatricians for a specified period each week. 4. Regular Updates and Reminders: Monthly update emails were sent to the entire clinic staff, providing program data, workflow reminders, and success stories of patients who were referred to community resources. Additionally, workflow reminders were placed in exam rooms to prompt and enable providers to conduct warm handoffs. 5. Leadership Engagement: Leadership buy-in to the workflow changes was emphasized, and monthly emails were used to keep providers and staff updated on the screening and referral workflow and improvement initiatives. Success stories of patients who connected with a referral resource were shared to positively reinforce referral behavior. These interventions were part of the Plan-Do-Study-Act (PDSA) cycles performed during the study and were aimed at optimizing the warm handoff process and increasing the effectiveness of referrals for patients with unmet social needs.

Intervention Results: Using quality improvement (QI) methods our pediatric clinic worked to increase the warm handoff rate between Community Health Workers (CHWs) and patients with unmet social needs. CHW warm handoff rates increased two-fold over the intervention period. Our results illustrate that QI methods can be used to optimize workflows to increase warm handoffs with CHWs.

Conclusion: Yes, the study reported statistically significant findings related to the impact of the interventions on increasing warm handoffs with Community Health Workers (CHWs) and improving the referral process for patients with unmet social needs. Specifically, the study found the following statistically significant results: 1. CHW Referral Rate: The study reported a significantly higher referral rate in the intervention period compared to the baseline period (P = 0.03). 2. Warm Handoff Rate: The study found a statistically significant increase in the warm handoff rate between families requesting assistance with unmet social needs and CHWs over the intervention period compared to the baseline period (P < 0.001). These statistically significant findings indicate that the quality improvement (QI) interventions implemented during the study had a significant impact on increasing the warm handoff rate and improving the referral process for patients with unmet social needs.

Study Design: The study design used in the research article is a quality improvement (QI) project. The study aimed to optimize community-based referrals in primary care using QI methodology. The authors used Plan-Do-Study-Act (PDSA) cycles to test and implement interventions aimed at increasing the warm handoff rate between patients with unmet social needs requesting assistance and Community Health Workers (CHWs). The study used a pre-post design, comparing the baseline period to the intervention period, to evaluate the effectiveness of the interventions. The study did not use a randomized controlled trial (RCT) design, which is commonly used in clinical research to evaluate the effectiveness of interventions.

Setting: The setting for the study was a pediatric clinic affiliated with the Albert Einstein College of Medicine and Montefiore Medical Group in Bronx, NY, USA. The study took place at an academic-affiliated Federally Qualified Health Center (FQHC) where providers and residents are accustomed to partaking in Quality Improvement (QI) and research projects. The clinic served underserved communities and aimed to optimize community-based referrals in primary care using QI methodology.

Population of Focus: The target audience for the study includes healthcare professionals, particularly those working in pediatric primary care settings, as well as professionals involved in community health and social services. Additionally, individuals and organizations involved in quality improvement initiatives within healthcare settings may also find the study relevant. The findings and recommendations of the study are likely to be of interest to practitioners, researchers, and policymakers seeking to improve social needs screening and referral programs, especially in underserved communities.

Sample Size: The sample size for the study was not explicitly mentioned in the provided excerpts. However, the study reported that a total of 3100 patients were screened for social needs in the baseline period, and 6278 patients were screened in the intervention period. Additionally, the study mentioned that 527 patients (8.4%) were referred to a Community Health Worker (CHW) in the intervention period. While the specific sample size for the intervention group was not provided, the study's findings were based on the outcomes observed during the intervention period involving the referred patients.

Age Range: The provided excerpts from the study "Increasing Warm Handoffs: Optimizing Community Based Referrals in Primary Care Using QI Methodology" did not explicitly mention the specific age range of the study participants. However, based on the context of the study, which focused on pediatric care and addressing the social needs of families, it can be inferred that the study likely involved children and their families. The study primarily focused on the impact of warm handoffs and referrals in a pediatric clinic, indicating that the age range of the study participants likely encompassed children and possibly their caregivers or family members.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Education on Disease/Condition, Assessment (patient/consumer),

Intervention Description: Youth account for half of new sexually transmitted infections (STIs) in the United States annually. Barriers to STI prevention include a lack of accurate sexual and reproductive health (SRH) education and low STI testing. We sought to obtain youth feedback on a digital health platform prototype designed to address these barriers. The platform prototype included SRH content, free STI testing and treatment, and anonymous question submission. Five focus group discussions, each lasting 45-60 minutes with 5-6 youth living in a high-prevalence STI region (Baltimore, Maryland), were conducted. Thematic analysis was conducted.

Intervention Results: There were 28 participants with a mean age of 15.9 years (range 14-19), among whom 89% self-identified as female, 57% Black/African American, 29% Asian American, 14% White, and 7% Hispanic/Latino. Youth felt that the prototype platform was comprehensive and understandable. They suggested adding peer reviews to increase trustworthiness.

Conclusion: Youth reported that the platform (violetproject.org) was an acceptable tool for SRH education and STI testing. Participants expressed enthusiasm and willingness to use the platform as a reliable SRH educational tool to combat medical misinformation on the Internet and a non-clinic-based source of STI testing. This platform could fill gaps in access to SRH care and education for youth.

Study Design: Qualitative study

Setting: Public high schools and community colleges in Baltimore, Maryland

Population of Focus: Adolescents and young adults living in Baltimore, Maryland

Sample Size: 28 adolescents and youth

Age Range: Adolescents and youth 14-19 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation Systems (Hospital), Assessment,

Intervention Description: The intervention in the study involved embedded child psychiatry consultation in primary care for an urban, largely Latino population. This model aimed to provide timely access to child psychiatry expertise within the primary care setting. The consultation psychiatrist worked collaboratively with pediatricians to address diagnostic or treatment questions, provide recommendations for management, and facilitate the transition of care back to the primary care setting. The intervention was designed to be a short-term intervention with planned transition back to primary care and ongoing collaboration as needed. The study assessed the feasibility and effectiveness of this intervention in improving access to mental health care for the target population.,

Intervention Results: Seventy-four percent of patients completed an evaluation. Younger children (p=.0397) and those with a history of therapy (p=.0077) were more likely to make initial contact. The markers of clinical need included PSC-35 Global Scores (p=.0027) and number of psychiatric diagnoses (p=.0178) predicted number of visits.

Conclusion: Yes, the study found several statistically significant findings. The Poisson regression analysis showed that patients' PSC Global Scores, positive PSC Global Score, number of PSC subscale elevations, and number of diagnoses significantly predicted the number of visits with the embedded child psychiatrist. Patients with higher PSC Global Scores, positive PSC Global Scores, more PSC subscale elevations, and more psychiatric diagnoses had a higher rate of follow-up visits with the embedded child psychiatrist. Additionally, the study found that almost 75% of referred children were seen for an evaluation, which is higher than published estimates of initial connection to subspecialty mental health in similar populations.,

Study Design: The study design was a retrospective chart review, which involved analyzing data from electronic medical records to assess the utilization of child psychiatry consultation embedded in primary care for an urban, Latino population. This type of study design is commonly used to examine healthcare utilization and outcomes based on existing patient records.

Setting: The study was conducted at the MGH Chelsea HealthCare Center, which is a community health center serving an urban, disadvantaged, Latino population.

Population of Focus: The target audience for the study includes healthcare professionals, researchers, and policymakers interested in improving access to mental health services for urban, Latino populations, particularly for children and adolescents.

Sample Size: The sample size for the study was fairly large, with 211 patients included in the analysis. This allowed for a robust examination of the utilization of child psychiatry consultation embedded in primary care for the urban, largely Latino and non-English speaking population.

Age Range: The age group of the patients in this study is 3-18 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Assessment (patient/consumer), Expert Support (Provider),

Intervention Description: ChilledOut Online is a treatment program based on the Cool Kids and Chilled anxiety management program developed at Macquarie University, Sydney, Australia [52]. The program teaches CBT strategies for adolescents through eight online modules of approximately 30 minutes, with a focus on psychoeducation, cognitive restructuring and graded exposure. To allow for flexibility and personal learning preferences, adolescents were able to access all modules at treatment start. To guide progress through the program, adolescents were however encouraged to complete all eight modules (and module content) in the order they appeared within the 14-week intervention period, after which they would have access to the web site for another three months. Program content such as goal setting, realistic thinking, problem solving, and assertiveness, is presented through a combination of multimedia formats, i.e. text, audio, illustrations, cartoons, worksheets, and video vignettes.

Intervention Results: Lending support to our main hypothesis, participants receiving ICBT demonstrated significant improvements at post-treatment compared to participants in the WL condition across all raters on diagnostic severity and level of anxiety symptoms (CSR and SCAS). The between-group ES’s found for CSRprim and CSRall in the present study (d = 0.65 and d = 0.83, respectively) are in the lower end of those found in other similar WL controlled studies.

Conclusion: This study demonstrated the Danish version of ChilledOut Online to be efficacious and feasible in relieving symptoms of anxiety in adolescents. As such, the study supports previous findings of similar guided ICBT interventions and helps build a strong foundation for future research in and implementation of ICBT in mental health services for adolescents with anxiety disorders.

Study Design: Randomized controlled trial

Setting: Online

Population of Focus: Adolescents with anxiety disorders

Sample Size: 70

Age Range: 13-17 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: To measure the impact of the New York State (NYS) SCHIP on access, utilization, and quality of health services for enrolled children.

Intervention Results: Of the 2644 study-group children who completed the initial interview, 2290 (87%) completed the follow-up interview. Key measures for the pre-SCHIP period and short-term "postenrollment" measures for the study group were not statistically different from measures for the comparison group, suggesting no major secular trends. Participants were non-Hispanic white (25%), non-Hispanic black (31%), and Hispanic (45%). Fifty-one percent of the parents were single, and 61% had a high school education or less; 81% of families had income <160% of the federal poverty level. Sixty-two percent of the children were uninsured > or = 12 months before the NYS SCHIP; of those insured, 43% previously had Medicaid. The proportion of children who had a USC increased after enrollment in the NYS SCHIP (86% to 97%). Two measures of accessibility (difficulty getting a medical person by telephone and difficulty getting an appointment) improved after enrollment in SCHIP. The proportion of children with any unmet health care needs decreased (31% to 19%). Specific types of unmet need also were reduced after enrollment; for example, among SCHIP enrollees who had a need for specific type of care, unmet needs wds were significantly lower postenrollment versus pre-SCHIP for specialty care (-15.5% in unmet need), acute care (-10.1%), preventive care (-9.6%), dental care (-13.0%%), and vision care (-13.2%). Emergency and total ambulatory visits did not change, but the proportion of children with a preventive care visit increased (74% to 82%). The proportion of children who used their USC for most or all visits increased (47% to 89%), demonstrating increased continuity of care. Several indicators of health care quality improved, including an overall rating of quality, the 4 indicators of physician-patient interaction used by the Consumer Assessment of Health Plans Survey, and a measure of parental worry about their child's health. Improvements were noted among major subgroups of children, with the greatest improvements for those with the lowest baseline levels. For example, at baseline, a lower percentage of children living at <160% of the federal poverty level had a presence of a USC or continuity with their USC than children living in families at >160% of the federal poverty level, and these poorer children experienced the greatest gains in having a USC or having continuity with their USC after enrollment in SCHIP.

Conclusion: Enrollment in the NYS SCHIP was associated with 1) improved access, continuity, and quality of care and 2) a change in the pattern of health care, with a greater proportion of care taking place within the usual source of primary care.

Study Design: For the study group, the design used pre/poststudy telephone interviews of parents of children enrolling in the NYS SCHIP, with baseline interviews soon after enrollment and follow-up interviews 1 year after enrollment. Baseline interviews reflected the child's experience during the 1-year period before enrollment in SCHIP. The follow-up interviews reflected the 1-year period after enrollment in SCHIP. For the comparison group, the design used baseline interviews of a comparison group enrolled 1 year after the study group to test for secular trends; these interviews reflected the 1-year period before enrollment in SCHIP.

Setting: NYS, stratified into 4 regions. The NYS SCHIP is modeled on commercial insurance (32 managed care plans) and at the time of the study had 18% of SCHIP enrollees nationwide.

Data Source: N/A

Sample Size: 2644

Age Range: Children (n = 2644) 0 to 18 years of age who enrolled in the NYS SCHIP for the first time (November 2000 to March 2001), stratified by age (0-5, 6-11, and 12-18 years), race/ethnicity (white non-Hispanic, black non-Hispanic, and Hispanic; others excluded), and region of NYS. The comparison group consisted of 400 children. Telephone interviews were conducted in English or Spanish throughout the day and evening, 7 days per week, to obtain measures.

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Assessment (provider), Provider Training/Education, Nurse/Nurse Practitioner, PARENT/FAMILY, Education/Training (caregiver), Provision of Safe Sleep Item, HOSPITAL, Quality Improvement

Intervention Description: The purpose of our safe sleep initiative was to improve parental and staff knowledge of safe sleep practices and to achieve increased compliance with infant safe sleep in the hospital setting. A multidisciplinary team of health professionals was created to address poor compliance with safe sleep guidelines, investigate barriers, and identify primary drivers for improvement. Subsequent interventions included parent education, staff education, and improvements in system processes. Members of the hospitals nurse residency program conducted multidisciplinary surveys before and after the quality improvement initiative to assess staff knowledge of safe sleep practices. The data were collected prospectively.

Intervention Results: Compliance with safe sleep improved to >80% in both units. Tracking of process measures revealed NICU parents received safe sleep education 98-100% of the time. No change was observed in the balancing measures. Transfers from the NN to the NICU for temperature instability did not increase. Parent satisfaction with discharge preparedness did not change (98.2% prior to and 99.6% after).

Conclusion: We achieved improved compliance with safe sleep practices in our NN and NICU through education of staff and parents and improved system processes. We believe this will translate to improved safe sleep practices used by parents at home.

Setting: Truman Medical Center in Kansas City

Population of Focus: Infants admitted to newborn nursery and NICU

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Assessment (Provider), HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Sleep Environment Modification

Intervention Description: The dual aims of this project were to develop a safe sleep educational model for our neonatal intensive care unit (NICU), and to increase the percentage of eligible infants in a safe sleep environment.

Intervention Results: At baseline, 21% of eligible infants were in a safe sleep environment. After education and reported observation, safe sleep compliance increased to 88%.

Conclusion: With formal staff and family education, optional wearable blanket, and data sharing, safe sleep compliance increased and patient safety improved.

Study Design: QE: pretest-posttest

Setting: The Children’s Mercy Hospital NICU in MO

Population of Focus: Safe sleep eligible infants (medically stable and transitioned to open cribs)

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=28) Follow-up (n=26)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Peer-led Mentoring/Support Counseling, Assessment, Education on Disease/Condition,

Intervention Description: Project Amp, a four-session one-on-one manualized intervention delivered by young adults with lived experience of substance use recovery (mentors or peers) to enhance SBIRT for moderate-risk youth

Intervention Results: 71 practitioners completed training in SBIRT, 30 mentors were hired and trained for the study, and 20 completed sessions with adolescent participants. Of the 1192 adolescents screened, 139 were eligible, and 51 eligible youth enrolled in the study, and 28 enrolled youth completed the intervention. Five of the six sites were successfully able to integrate the SBIRT-based Project Amp model into their workflow.

Conclusion: The Project Amp intervention can be conducted successfully in school and healthcare settings in conjunction with SBIRT, adding capacity to expand access to screening and early intervention in a developmentally appropriate way. However, the study yielded insights into adaptations for future implementation, such as a more streamlined model and centralized staff roles such as integrated roles for young peer mentors.

Study Design: Project Amp, a four-session one-on-one manualized intervention delivered by young adults with lived experience of substance use recovery (mentors or peers) to enhance SBIRT for moderate-risk youth

Setting: Three school-based programs and three health clinics

Population of Focus: Adolescents ages 13-17 who are at moderate risk for substance use disorder

Sample Size: 51 eligible youth enrolled in the study, and 28 enrolled youth completed the intervention

Age Range: 13-17 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Office Systems Assessments and Implementation Training,

Intervention Description: The intervention in the study involved the use of a natural language processing (NLP)-based clinical decision support system embedded in the electronic health record (EHR) to identify potential surgical candidates among children with epilepsy. Patients identified as potential surgical candidates by the NLP were then randomized for their provider to receive an alert or no reminder prior to the patient's visit. The alerts were delivered through two modalities: half of the alerts were sent via email, and the other half were in-basket messages that appeared in the EHR. The primary aim of the intervention was to assess whether these automated alerts increased referrals for epilepsy surgery evaluations.

Intervention Results: Between April 2017 and April 2019, at total of 4858 children were screened by the system, and 284 (5.8%) were identified as potential surgical candidates. Two hundred four patients received an alert, and 96 patients received standard care. Median follow-up time was 24 months (range: 12-36 months). Compared to the control group, patients whose provider received an alert were more likely to be referred for a presurgical evaluation (3.1% vs 9.8%; adjusted hazard ratio [HR] = 3.21, 95% confidence interval [CI]: 0.95-10.8; one-sided p = .03). Nine patients (4.4%) in the alert group underwent epilepsy surgery, compared to none (0%) in the control group (one-sided p = .03).

Conclusion: Yes, the study reported statistically significant findings related to the impact of automated alerts on the referral patterns for epilepsy surgery evaluations. Specifically, the study found that providers were more likely to refer patients with epilepsy for a presurgical evaluation after receiving an automated alert. Furthermore, the study results indicated that the alerts significantly increased the likelihood of referral for presurgical evaluations, as evidenced by the statistical analysis using a Cox proportional hazards model to estimate the hazard ratio (HR) of referrals after receiving an alert and Wald's test to estimate the corresponding p-value. Additionally, the study reported statistically significant differences in the proportion of patients referred for presurgical evaluations and surgeries between the group that received alerts and the control group that did not receive alerts.

Study Design: The study design was a prospective, randomized controlled trial. The trial evaluated the effectiveness of a natural language processing (NLP)-based clinical decision support system embedded in the electronic health record (EHR) to increase referrals for epilepsy surgery evaluations. The study randomly assigned potential surgical candidates to either receive an automated alert or standard of care (no alert) prior to their scheduled visit. The primary outcome was referral for a neurosurgical evaluation, and the likelihood of referral was estimated using a Cox proportional hazards regression model. The study was conducted over a 2-year period, from April 16, 2017, to April 15, 2019.

Setting: The study was conducted at a large pediatric epilepsy center in Cincinnati, OH, USA, specifically at the Cincinnati Children's Hospital Medical Center (CCHMC). The providers involved in the study were attending neurologists and nurse practitioners from this center. The research was carried out at 14 pediatric neurology outpatient clinic sites affiliated with the hospital.

Population of Focus: The target audience for this study includes healthcare providers, particularly neurologists and nurse practitioners involved in the care of children with epilepsy. Additionally, researchers and professionals in the fields of medical informatics, natural language processing, and clinical decision support systems may also find this study relevant and valuable. Furthermore, healthcare administrators and policymakers interested in improving the utilization of referrals for epilepsy surgery evaluations, as well as those involved in the implementation of technology-based interventions in clinical practice, would benefit from the findings of this research.

Sample Size: The study included a total of 284 children with epilepsy who were identified as potential surgical candidates by the natural language processing (NLP) algorithm and were randomized 2:1 for their provider to receive an alert or standard of care (no alert). Of these, 96 patients were assigned to the control group, 93 whose treating provider received an email, and 95 whose treating provider received an EHR alert. The study was conducted over a 2-year period, from April 16, 2017, to April 15, 2019.

Age Range: The study does not focus on a specific age group. However, the patients included in the study were children with epilepsy who were being treated at Cincinnati Children's Hospital Medical Center. The age range of the patients is not specified in the article.

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (Provider), Motivational Interviewing/Counseling,

Intervention Description: Electronically delivered screening, brief intervention, and referral to treatment (e-SBIRT); clinician delivered SBIRT, and enhanced usual care

Intervention Results: Both clinician-delivered SBIRT and electronically-delivered SBIRT produced modest and statistically significant effects in promoting abstinence from substances.

Conclusion: The study concluded that both clinician-delivered SBIRT and electronically-delivered SBIRT interventions were effective in promoting abstinence from substances among women in reproductive health settings. While abstinence from the primary substance was a rare outcome in the sample, both interventions showed modest and statistically significant effects. The ease of implementation and relatively low cost of the e-SBIRT intervention suggest its practicality for implementing brief interventions at scale for at-risk women. Further optimization efforts and large-scale implementations could be facilitated by the ease with which electronic interventions can be modified and disseminated.

Study Design: 3-group randomized controlled trial

Setting: Urban academic healthcare settings with a predominantly minority population

Population of Focus: Pregnant and nonpregnant women seeking reproductive health services who may be abusing substances

Sample Size: 439 women

Age Range: Mean age of 34.2 years

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment

Intervention Description: This report provides the latest prevalence estimates for diagnosed autism spectrum disorder, intellectual disability, and other developmental delay among children aged 3–17 years from the 2014–2016 National Health Interview Survey (NHIS).

Intervention Results: ● During 2014–2016, the prevalence of children aged 3–17 years who had ever been diagnosed with a developmental disability increased from 5.76% to 6.99%. ● During this same time, the prevalence of diagnosed autism spectrum disorder and intellectual disability did not change significantly. ● The prevalence of autism spectrum disorder, intellectual disability, other developmental delay, and any developmental disability was higher among boys compared with girls. ● The prevalence of any developmental disability was lower among Hispanic children compared with children in all other race and ethnicity groups.

Conclusion: During 2014–2016, there was a significant increase in the prevalence of children who had ever been diagnosed with any developmental disability. This increase was largely the result of an increase in the prevalence of children diagnosed with a developmental delay other than autism spectrum disorder or intellectual disability. There was not a significant change in the prevalence of diagnosed autism spectrum disorder or intellectual disability over the same time period. The prevalence of developmental disabilities described in this report is lower than findings described in previous reports using NHIS data (1). This report uses a more restrictive definition for a developmental disability that does not include conditions such as attention-deficit/ hyperactivity disorder or learning disabilities, which may account for differences in estimates. A similar definition was used in a 2015 National Health Statistics Report (2). For each condition examined, the prevalence was significantly higher among boys than girls, a finding common among children diagnosed with a developmental disability (1,3). The prevalence of any developmental disability diagnosis was lowest among Hispanic children compared with all other race and ethnicity groups; racial and ethnic disparities in the prevalence of developmental disabilities are findings commonly reported in the scientific literature (1,4). Prevalence among age groups varied by condition, which may reflect recent improvements in awareness and screening for developmental delay, resulting in younger cohorts having a higher diagnosed prevalence (4). However, for some children with less severe impairment, developmental disabilities, such as autism spectrum disorder and intellectual disability, may not be diagnosed until the child enters school and is observed by trained teachers (5).

Study Design: Report

Setting: Data from NHIS collected in respondent's home or in some cases via telephone

Data Source: Data from the 2014–2016 NHIS

Sample Size: N/A

Age Range: Children ages 3-17 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Screening Tool Implementation Training

Intervention Description: The article reviews literature on screening tools and strategies for early detection of autism spectrum disorder (ASD) in children aged 24 months and younger. It recommends that all children receive ASD-specific screening at 18 and 24 months using tools like the Modified Checklist for Autism in Toddlers (M-CHAT). It also suggests using broadband developmental screeners like the Communication and Symbolic Behavior Scales to assist ASD detection before age 2. Siblings of children with ASD should receive intensified developmental surveillance.

Intervention Results: Several ASD screening tools showed good sensitivity and specificity for detecting ASD risk around 18-24 months, including the M-CHAT, STAT, and FYI. The M-CHAT had a positive predictive value up to 0.65 in low-risk samples when combined with follow-up interviews. Studies indicate diagnoses of ASD around 24 months tend to be stable over time. However, challenges remain in implementing widespread ASD screening in pediatric practice due to time constraints, lack of reimbursement, logistical issues, and limited access to diagnostic and treatment resources.

Conclusion: The authors conclude that evidence supports the usefulness of ASD screening at 18-24 months using available tools, as recommended by the AAP. They call for further methodologically rigorous research on screening in representative samples, using meaningful long-term outcomes, and addressing barriers to widespread implementation in the healthcare system. Priorities include examining how to optimize screening strategies, such as combining broadband and ASD-specific tools, and considering use of biomarkers.

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Data Source: peer-reviewed articles published to December 2013

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