Established Evidence Results

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)

Intervention Description: To increase primary care providers' use of validated tools for developmental, social/emotional, maternal depression, and domestic violence screening and to increase early awareness of autism symptoms during pediatric well-child visits in children aged 0 to 3 years.

Intervention Results: Percentage of sites screening 85% of children by 12-month well-child visit increased from 0% at baseline to 68.8% at follow-up. Sites not reaching 85% screening screened 48-83% of children at follow-up. Percentage of sites conducting social/emotional screening for 85% of children by 18-month well-child visit increased from 6% at baseline to 46.7% at follow-up. Sites not reaching 85% screening screened 5-81% of children at follow-up. Percentage of sites screening 85% of children by 24-month well-child visit increased from 0% at baseline to 68.8% at follow-up. Sites not reaching 85% screening screened 18-84% of children at follow-up.

Conclusion: The Enhancing Developmentally Oriented Primary Care (EDOPC) project enhanced confidence and intent to screen among a large group of Illinois primary health care providers. Among a sample of primary care sites at which chart reviews were conducted, the EDOPC project increased developmental screening rates to the target of 85% of patients at most sites and increased social/emotional screening rates to the same target rate in nearly half of the participating practices.

Study Design: QE: pretest-posttest

Setting: Primary care medical homes (federally qualified health centers, residency training programs, private practices) primarily in Chicago, Illinois, metropolitan area

Population of Focus: Children ages 4 to 24 months

Data Source: Child medical record

Sample Size: Chart audits at 16 sites (n=25 per site)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Outreach (School Staff), Educational Material (Provider), Patient Navigation,

Intervention Description: The intervention in the study is described as a school-based outreach pilot program aimed at increasing access and participation in State-subsidized health insurance. The specific activities of the intervention include including State-subsidized insurance marketing material in the student registration packet and providing outreach material to develop sustainable strategies for identifying uninsured children and systematically incorporating child health outreach into routine school district operations

Intervention Results: The study's results indicate that the school-based outreach program was effective in identifying uninsured children and facilitating their enrollment in State-subsidized health insurance programs. The outreach efforts resulted in a significant response rate, with a notable number of children enrolled in the program as a result of the intervention. These findings suggest that incorporating health insurance outreach into routine school district operations can be a successful strategy for reaching uninsured children and increasing their access to State-subsidized health insurance

Conclusion: The conclusion of the study suggests that integrating the collection of health insurance status into routine school communication channels is an effective way to identify uninsured children who may be eligible for State subsidized benefits. The research, conducted in Van Buren County, MI, estimates that 70% of the 1,211 uninsured children are eligible for State subsidized health insurance. A survey distributed with free and reduced lunch applications and school registration identified 156 uninsured children, raising questions about the external validity of the research. The study proposes the extrapolation of results to the entire county or even the state, emphasizing the simplicity of the survey and the statewide management of the Free and Reduced Lunch Program. The approach, already successful in several states, could provide a sustainable and everyday method for effective outreach to identify uninsured children. Additionally, the study rejects Ho2, stating there is a statistical difference in the number of applications received from a school-based outreach program during the pilot period. The analysis of application data shows a positive relationship between time and the number of applications received, with a predicted increase of 5.6593 applications in each subsequent period. The model's strength is supported by a relatively strong R² of 77.58%. However, the study acknowledges that 23% of the error remains unexplained, possibly due to factors such as the pilot outreach intervention. The actual number of applications in May 2013 exceeded the predicted range, suggesting factors not accounted for in the model.

Study Design: The study is described as a cross-sectional pilot study designed to employ a school-based outreach effort utilizing existing school communications to identify children who are currently uninsured and may be eligible for State subsidized health insurance.

Setting: State of Michigan schools

Population of Focus: The target audience for the study includes K-12 students and their families, particularly those who are currently uninsured and may be eligible for State subsidized health insurance.

Sample Size: The study identifies 156 children as not having health insurance, representing more than 44% of the 358 children who are eligible for State subsidized health insurance in the participating school districts

Age Range: The age range of the children involved in the study is K-12, which typically includes children between the ages of 5 and 18 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Educational Material (Provider)

Intervention Description: Increasing women's access to nonmedical interventions during labor, such as continuous labor support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation also can contribute to the safe lowering of the primary cesarean delivery rate.

Intervention Results: Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia.

Conclusion: Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane metaanalysis of 12 trials and >15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery.111 Given that there are no associated measurable harms, this resource is probably underutilized.

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): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider)

Intervention Description: We modified the Enhancing Developmentally Oriented Primary Care (EDOPC) program to provide a formal curriculum to pediatric residents serving children in distressed neighborhoods.

Intervention Results: Percentage of ASQ screening at 12-month well-child visits increased from 11% at baseline to 100% at follow-up. Percentage of ASQ:SE screening at 18-month well-child visits increased from 0% at baseline to 95% in June 2008 and declined to 58% at last follow-up in Jan 2009. Percentage of ASQ screening at 24-month well-child visits increased from 0% at baseline to 88% at follow-up.

Conclusion: Chart audits 1 year after the intervention demonstrated increased use of screening tools and more referrals to community services. This article will discuss lessons about facilitators and barriers to teaching residents about vulnerable preschool children.

Study Design: QE: pretest-posttest

Setting: University of Chicago Pediatric Residency Program in Chicago, Illinois

Population of Focus: Children ages 6 to 24 months

Data Source: Child medical record

Sample Size: Chart audits - Baseline (n=27 of 50 selected) - Follow-up 1: (n=61 of 100 selected) - Follow-up 2: (n=82 of 100 selected) - Follow-up 3: (n=94 of 100 selected) - Follow-up 4: (n=74 of 100 selected)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Educational Material (Provider), Residents/Medical Students,

Intervention Description: The intervention described by the article to increase postpartum screening was a 15-minute slide presentation with essential topics, including content on antepartum and postpartum depression focusing on signs, symptoms, screening, and treatment as well as antepartum maternal depression education highlighting the importance of understanding health literacy

Intervention Results: The results of the study showed that there was an increase in mean change over time for knowledge, self-efficacy, and motivation among medical and nurse practitioner students. The second null hypothesis was rejected, indicating that there was a significant increase in motivation levels from before to after the intervention. However, there was no significant difference between medical and nurse practitioner students, and student profession did not moderate the outcome effect

Conclusion: An intervention to influence health care students' knowledge, self-efficacy, and motivation for antepartum depression screening can be included in medical and nursing curricula and can also be used with currently practicing health care providers. Doing so could possibly benefit pregnant women by enhancing the antepartum care that they receive.

Study Design: The study design/type is a quasi-experimental study design

Setting: University of South Florida, College of Nursing and College of Medicine

Population of Focus: he target audience for the study was medical and nurse practitioner students who had completed the women's health/obstetric course within the curriculum, had self-identified ability to use the online technology platform/intervention, had access to an Internet-enabled device capable of accessing the online intervention, and were fluent in the English language

Sample Size: The sample size of this study was 71 participants, including 19 medical students and 52 nurse practitioner students

Age Range: The age group of the participants is not explicitly mentioned in the given texts. However, it is stated that medical students tended to be younger than nurse practitioner students

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Home Visit (caregiver), Educational Material (caregiver), Oral Health Product, Patient Navigation (Assistance), PROVIDER/PRACTICE, Outreach (Provider), Education/Training (caregiver)

Intervention Description: The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group.

Intervention Results: Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail.

Conclusion: The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.

Study Design: RCT

Setting: Jefferson County in Louisville, KY

Population of Focus: Children aged 4-15 years who currently or for 2 years prior had Medicaid insurance but have not had Medicaid dental claims filed for the previous 2 years

Data Source: Medicaid claims

Sample Size: Intervention (n=68) Control (n=68)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Nurse/Nurse Practitioner, PROFESSIONAL_CAREGIVER, Patient Navigation (Assistance), Care Coordination, STATE, Multicomponent Approach

Intervention Description: The Healthy Beginnings system of care in Atlanta, GA connects children and their families to health insurance and a medical home model of care to support children’s health and development. The main components are care management + education and parent engagement + collaborative partnerships. A registered nurse, known as the health navigator, supports parents and helps them learn how to work with health care professionals on behalf of their children; they also connect parents to the Center for Working Families to ensure that they receive public benefits for which they are eligible.

Intervention Results: Healthy Beginnings coordinated care approach has ensured that participating children and families have health insurance (97%) and receive regular immunizations (92%), ongoing health care from a primary care physician and dental health provider, and regular developmental screenings (98%) and follow-up care. Healthy Beginnings has dramatically increased children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Conclusion: By building upon the partnerships formed through the foundation’s community change effort, Healthy Beginnings has dramatically increased neighborhood children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Study Design: Program evaluation

Setting: Community (Community-based organizations in Atlanta, Georgia)

Population of Focus: Low-income young children and families

Data Source: Questionnaire data

Sample Size: 279 children

Age Range: 0-10 years

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Educational Material (Provider),

Intervention Description: Training health professionals for the skills and capacity to respond adequately to children and adults who have been exposed to adverse childhood experiences is recognized as an essential need in health care. Accessible opportunities to educate physicians and physician-trainees are limited. Four computer-based e-modules were created focusing on addressing childhood adversity and implementing trauma-informed care in the pediatric primary care setting. These childhood adversity and trauma-informed care (CA-TIC) e-modules were designed as an individualized, self-directed experience to allow for distance learning with flexibility to be embedded into existing coursework. To foster an engaging learning environment, we narrated the modules, prioritized images, and included the opportunity for participant interaction via multiple-choice and short-answer questions. Twenty-eight pediatric residents, two medical students, four attending physicians, and one fellow at Children's National Hospital completed the e-modules.

Intervention Results: Overall, participants rated the CA-TIC e-modules 4.6 (SD = 0.5) out of 5 for design and quality. Using paired t tests and Wilcoxon signed rank tests, we found statistically significant score increases from presession to postsession for participants' knowledge, attitudes, practice, and confidence related to CA-TIC. The most commonly cited learning points and practice changes included asking about trauma in practice and the seven C's of resilience.

Conclusion: A trauma-informed, strengths-based approach to care can assist health care providers in mitigating the link between adversity and related poor health outcomes. The CA-TIC e-modules provide an opportunity to train health professionals using an innovative, self-directed, and low-resource mechanism.

Study Design: Pre-post study

Setting: Pediatric primary care practices in connection with Children’s National Hospital

Population of Focus: Pediatric health care providers (pediatric residents, medical students, attending physicians, and fellows)

Sample Size: 35 pediatric health care providers 28 pediatric residents, 2 medical students, 4 attending physicians, and 1 fellow

Age Range: Adults who take care of pediatric populations

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Continuing Education of Hospital Providers, Policy/Guideline (Hospital), Educational Material (Provider), Guideline Change and Implementation

Intervention Description: We hypothesized that a pragmatic, multilevel treatment model including (ask, advise, refer [AAR]) coupled with individualized, telephone-based behavioral counseling promoting child tobacco smoke exposure (TSE) reduction would demonstrate greater child TSE reduction than would standard AAR.

Intervention Results: Complete case analysis demonstrated that compared with control parents (29.9%), significantly more parents in the experimental condition (45.8%) eliminated their children’s exposure to all sources of tobacco smoke both inside and outside their homes at 3-month follow-up. In addition, more parents in AAR/counseling than in AAR/attention control eliminated all sources of TSE (45.8% vs. 29.9%) and quit smoking (28.2% vs. 8.2%).

Conclusion: The results indicate that the integration of clinic- and individual-level smoking interventions produces improved TSE and cessation outcomes relative to standalone clinic AAR intervention. Moreover, this study was among the first in which researchers demonstrated success in embedding AAR decision aids into electronic health records and seamlessly facilitated TSE intervention into routine clinic practice.

Study Design: RCT

Setting: Community (home)

Population of Focus: Tobacco-smoking parents living in low-income, urban communities with children <11 years old exposed daily to tobacco smoke in the home. Additional inclusion criteria: daily smoker, >17 years old, and speaking English

Data Source: Structured telephone interviews for baseline data collection and 3-month follow-up.

Sample Size: 334 providers. 327 participants (n=163 AAR and counseling, n=164 AAR and control)

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, 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): HEALTH_CARE_PROVIDER_PRACTICE, Training/Education, Educational Material (provider), Audit/Attestation (provider), PROFESSIONAL_CAREGIVER, Education/Training (caregiver), HOSPITAL, Quality Improvement, Crib Card

Intervention Description: This quality improvement project used an interprofessional, multimodal approach to improve sleep safety for hospitalized infants. The working group for this project included the Director of Quality Improvement for the Department of Pediatrics, a Pediatric Hospitalist, a Senior Advanced Practice Nurse in Pediatrics, Senior Associate Counsel for the Office of Counsel, and a medical student with a background in social work. The interdisciplinary group met to review and discuss improvements to communication and facilitated the development of five family interventions: a designated safe sleep web page, a clear bedside guide to safe sleep, additional training for nursing staff in motivational interviewing, a card audit system, and electronic health record smart phrases. A short survey was conducted to assess how the safe sleep toolkit has been useful to care providers in the Children’s Hospital. 

Intervention Results: With the initial pilot implementation of the K-cards, staff reported increased ease of audits. Adherence to recommended safer sleep measures was a major barrier in previous attempts to improve institutional sleep safety (1). By making adherence easier, providers may be more likely to both participate in quality improvement tracking measures and follow-up with families directly.

Conclusion: These coordinated interventions reflect advantages of an interprofessional and family-centered approach: building rapport and achieving improvements to infant sleep safety.

Setting: Golisano Children’s Hospital

Population of Focus: Hospital healthcare providers

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

Intervention Description: We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services.

Intervention Results: Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers.

Conclusion: The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.

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): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), PARENT_FAMILY, Training (Parent/Family), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Peer Counselor, Parent Mentors

Intervention Description: The aim of the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) study was to evaluate the effects of parent mentors – Latino parents with children covered by Medicaid or the Children’s Health Insurance Program (CHIP) – on insuring Latino children in a community-based trial of uninsured children from 2011-2015. Parent mentors were trained to assist families in getting insurance coverage, accessing health care, and addressing social determinants of health. The intervention group was assigned parent mentors – trained, fluently bilingual Latino parents who had at least one child insured by Medicaid or CHIP for at least one year. Parent mentors attended a two-day training and received training manuals in English and Spanish with 9 training topics and one on sharing experiences. Parents mentors provided 8 services to intervention children and families (e.g., teaching about types of insurance programs and application processes; helping parents complete and submit children’s insurance applications; acting as family advocates by liaising between families and Medicaid or CHIP agencies; and helping parents complete and submit applications for coverage renewal).

Intervention Results: The study found that parent mentors were more effective than traditional methods in insuring children (95% vs. 69%), achieving faster coverage and greater parental satisfaction, reducing unmet health care needs, providing children with primary care providers, and improving the quality of well-child and subspecialty care. Children in the parent-mentor group had higher quality of overall and specialty care, lower out-of-pocket spending, and higher rates of coverage two years after the end of the intervention (100% vs. 70%). Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities. Parent mentors, as a special category of community health workers, could be an excellent fit with and complement to current state community health worker models. This RCT documented that the Kids’ HELP intervention is significantly more efficacious than traditional Medicaid and CHIP methods of insuring Latino children. Kids’ HELP eliminates coverage disparities for Latino children, insures children more quickly and with greater parental satisfaction than among control parents, enhances health care access, reduces unmet needs, improves the quality of well-child and subspecialty care, reduces out-of-pocket spending and family financial burden, empowers parents, ad creates jobs.

Conclusion: Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Uninsured children 0-18 years old whose primary caregiver identified them as Latino and uninsured and reported meeting Medicaid/CHIP eligibility criteria for the child

Data Source: Kids’ HELP trial data; questionnaires

Sample Size: 155 subjects (children and parents); 75 in the control group and 80 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), PARENT_FAMILY, Training (Parent/Family), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Peer Counselor, Parent Mentors

Intervention Description: This study examined the effects of parent mentors on insuring minority children in the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) program. Parent mentors were experienced parents with ≥1 Medicaid/CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. Parent mentors received monthly stipends for each family mentored. Parents mentors and intervention participants were matched by race/ethnicity and zip code, whenever possible. Latino families were matched with fluently bilingual Latino parent mentors. Session content for the 2-day training was based on training provided to community case managers in the research team’s previous successful RCT and addressed 9 topics (e.g., why health insurance is so important; being a successful parent mentor; parent mentor responsibilities; Medicaid and CHIP programs and the application process; the importance of medical homes).

Intervention Results: In the Kids’ HELP trial, the intervention was more effective than traditional outreach/enrollment in insuring uninsured minority children, resulting in 95% of children obtaining insurance vs. 68% of controls. The intervention also insured children faster, and was more effective in renewing coverage, improving access to medical and dental care, reducing out-of-pocket costs, achieving parental satisfaction and quality of care, and sustaining insurance after intervention cessation. This is the first RCT to evaluate the effectiveness of parent mentors in insuring uninsured children. Kids’ HELP could possibly save $12.1 to $14.1 billion. Parent mentors were more effective in improving access to primary, dental, and specialty care; reducing unmet needs, achieving parental satisfaction with care, and sustaining long-term coverage. Parent mentors resulted in lower out-of-pocket costs for doctor and sick visits, higher well-child care quality ratings, and higher levels of parental satisfaction and respect from children’s physicians.

Conclusion: PMs are more effective than traditional Medicaid/CHIP methods in insuring uninsured minority children, improving health care access, and achieving parental satisfaction, but are inexpensive and highly cost-effective.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Primary caregiver had ≥1 child 0 to 18 years old who lacked health insurance but was Medicaid/CHIP eligible, and the primary caregiver self-identified the child as Latino/Hispanic or African-American

Data Source: Kids’ HELP trial data; questionnaires; national, state, and regional surveys

Sample Size: 237 participants; 114 in the control group and 123 in the intervention group

Age Range: 0-18 years

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): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider)

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. An algorithm detailing when to start safe sleep practices, a "Back to Sleep" crib card, educational programs for nurses and parents, a crib audit tool, and postdischarge telephone reminders were developed as quality improvement intervention strategies.

Intervention Results: NICU compliance with supine positioning increased from 39% to 83% (P < .001), provision of a firm sleeping surface increased from 5% to 96% (P < .001), and the removal of soft objects from the bed improved from 45% to 75% (P = .001). Through the use of a postdischarge telephone survey, parental compliance with safe sleep practices was noted to improve from 23% to 82% (P < .001).

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

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation Systems (Inter-Hospital Systems), Educational Material (Provider),

Intervention Description: The DC Mental Health Access in Pediatrics (DC MAP) program is a child psychiatry access program (CPAP) that provides telephonic consultation services to primary care providers (PCPs) in Washington, DC. The program aims to increase access to mental health services for children and adolescents by providing PCPs with real-time access to child psychiatry experts who can offer guidance on diagnosis, treatment, and care coordination. The program also provides PCPs with information about community resources and referral options available to their patients. The program is staffed by a team of child psychiatrists, psychologists, and social workers who provide consultation services to PCPs on a range of mental health concerns, including depression, anxiety, ADHD, and behavioral problems,.

Intervention Results: DC MAP consult volume increased 349.3% over the first 5 years. Services requested included care coordination (85.8%), psychiatric consultation (21.4%), and psychology/social work consultation (9.9%). Of psychiatry-involved consultations, PCPs managed patient medication care with DC MAP support 50.5% of the time. Most (94.1%) PCPs said they would recommend colleagues use DC MAP, and 29.6% reported diverting patients from the emergency departments using DC MAP.

Conclusion: Yes, the study reported statistically significant findings, including a significant increase in consultation volume over the first 5 years of the program, as well as a significant difference between baseline and 1 year of participation in PCPs' ability to receive more timely care coordination services for their patients with mental health needs,,. Additionally, paired t-tests were conducted to analyze self-report data about PCP beliefs related to mental health services collected at baseline and again 1 year later, indicating statistically significant changes in PCP beliefs over time.

Study Design: The study design is a retrospective analysis of data collected from the DC Mental Health Access in Pediatrics program between May 2015 and May 2020. The study used a mixed-methods approach, including descriptive statistics and paired t-tests to analyze self-report data about PCP beliefs related to mental health services collected at baseline and again 1 year later.

Setting: The study was conducted in the primary care setting, specifically in pediatric primary care practices in Washington, D.C.. The DC Mental Health Access in Pediatrics program was designed to provide consultation services to primary care providers in order to enhance their ability to meet the mental health needs of their pediatric patients.

Population of Focus: The target audience for the study includes primary care providers (PCPs) who care for pediatric patients, as well as professionals involved in pediatric mental health care, such as child psychiatrists, psychologists, and other mental health specialists. The study aims to evaluate the effectiveness of the Child Psychiatry Access Program (CPAP) in supporting PCPs in addressing the mental health needs of children and adolescents in the primary care setting.

Sample Size: The study received 3,389 consultation requests from primary care providers (PCPs) between May 2015 and May 2020. This indicates a substantial sample size for evaluating the effectiveness of the Child Psychiatry Access Program (CPAP) in Washington, D.C.

Age Range: According to the PDF file, the DC Mental Health Access in Pediatrics program provides mental health consultation services for youth aged 0-21 years.

Intervention Components (click on component to see a list of all articles that use that intervention): Notification/Information Materials (Online Resources, Information Guide), Referrals, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: To improve Early Head Start/Head Start (EHS/HS) screening, referral, and enrollment for children from diverse, low-income communities.

Intervention Results: The preintervention group included 223 patients. The postintervention group included 235 patients. EHS/HS screening improved significantly after the intervention, rising from 8% in the preintervention period to 46% in the postintervention period (odds ratio [OR] 10.5, 95% confidence interval [CI] [5.9, 19.4]). EHS/HS documented referral rates increased from 1% in the preintervention period to 20% in the postintervention period (OR 18.3, 95% CI [5.7, 93.6]). Thirty-two of the 42 patients in the postintervention group referred to EHS/HS were reached to determine enrollment status. Six children (14%) had enrolled in EHS/HS.

Conclusion: With use of existing resources, a medical home–Head Start partnership can build an integrated system that significantly improves screening and referral rates to early learning programs.

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), PROFESSIONAL_CAREGIVER, Educational Material (caregiver), Patient Navigation (Assistance), Outreach (Provider), Enrollment Assistance

Intervention Description: Community Health Centers (CHCs) serving low-income populations are well-positioned to support patients navigating the complexities of the public health insurance application process and prevent lapses in coverage. Specialized staff, called enrollment assistants, can help to determine insurance eligibility and/or guide patients through application processes, including assistance with completing application forms, understanding requirements, and providing appropriate documentation.

Intervention Results: Enrollment assistants are valuable resources, and CHCs are effective at helping patients with public health insurance. The enrollment assistants helped families understand the process and avoid mistakes and delays while patients valued their advice and their pragmatic, hands-on application assistance.

Conclusion: Patients’ understanding of eligibility status, reapplication schedules, and how to apply, were major barriers to insurance enrollment. Clinic staff addressed these barriers by reminding patients when applications were due, assisting with applications as needed, and tracking submitted applications to ensure approval. Families trusted clinic staff with insurance enrollment support, and appreciated it. CHCs are effective at helping patients with public health insurance. Access to insurance expiration data, tools enabling enrollment activities, and compensation are needed to support enrollment services in CHCs.

Study Design: Observational cross-case comparison

Setting: Community (Community-health centers in Oregon)

Population of Focus: Practice members (e.g., managers, clinical and non-clinical staff, enrollment assistants) and families using community health centers

Data Source: Observations and interviews

Sample Size: 4 Community Health Centers (CHCs) in Oregon; 26 practice members; 18 adult family members who had at least one pediatric patient

Age Range: Parents and children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Adult-led Spport/Counseling/Remediation, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The purpose of this study is to conduct moderator analyses using pooled data from three randomized controlled trials of the intervention conducted in collaboration with 2-1-1 contact centers in Atlanta, North Carolina and Houston. 2-1-1 is a strategic partner for tobacco control as it connects over 15 million clients, largely socio-economically disadvantaged, to social and health resources each year.

Intervention Results: Intervention effectiveness was not moderated by race/ethnicity, education, income, children in the home or number of smokers in the home. Smoking status of the participant, however, did moderate program effectiveness, as did time to first cigarette. Number of cigarettes per day and daily versus nondaily smoking did not moderate intervention effectiveness.

Conclusion: The intervention was effective across socio-demographic groups and was effective without respect to daily versus nondaily smoking or number of cigarettes smoked per day, although smoking status and level of nicotine dependence did influence effectiveness.

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, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Screening Tool Implementation Training, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: To assess the degree to which a national sample of pediatric practices could implement American Academy of Pediatrics (AAP) recommendations for developmental screening and referrals, and to identify factors that contributed to the successes and shortcomings of these efforts.

Intervention Results: At the project's conclusion, practices reported screening more than 85% of patients presenting at recommended screening ages. They achieved this by dividing responsibilities among staff and actively monitoring implementation. Despite these efforts, many practices struggled during busy periods and times of staff turnover. Most practices were unable or unwilling to adhere to 3 specific AAP recommendations: to implement a 30-month visit; to administer a screen after surveillance suggested concern; and to submit simultaneous referrals both to medical subspecialists and local early-intervention programs. Overall, practices reported referring only 61% of children with failed screens. Many practices also struggled to track their referrals. Those that did found that many families did not follow through with recommended referrals.

Conclusion: A diverse sample of practices successfully implemented developmental screening as recommended by the AAP. Practices were less successful in placing referrals and tracking those referrals. More attention needs to be paid to the referral process, and many practices may require separate implementation systems for screening and referrals.

Study Design: QE: interrupted timeseries design

Setting: Sixteen pediatric primary care practices from 15 different states

Population of Focus: Children ages 8 to 36 months at wellchild visits

Data Source: Child medical record

Sample Size: Chart audits: - Baseline and Follow-Up: (n=30) per practice in July 2006 and March 2007; total charts audited (n= 960) - Intervention period: (n=10) per practice per month for 7 months; total charts audited (n=1,120)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Educational Material

Intervention Description: Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies.

Intervention Results: Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P<.001) and at 6 months (7.9% vs 0.6%; P =.01), and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28).

Conclusion: Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding.

Study Design: The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996-December 1997 with a 1-year follow-up.

Setting: Thirty-one maternity hospitals and polyclinics in the Republic of Belarus.

Data Source: N/A

Sample Size: 17 046 mother-infant pairs 16491 (96.7%) of which completed the entire 12 months of follow-up

Age Range: mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed

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, Data Collection Training for Staff

Intervention Description: To explore rates of screening and identification and treatment for behavioral problems using billing data from Massachusetts Medicaid immediately following the start of the state's new court-ordered screening and intervention program.

Intervention Results: Major increase from 16.6% of all Medicaid well-child visits coded for behavioral screens in the first quarter of 2008 to 53.6% in the first quarter of 2009. Additionally, the children identified as at risk increased substantially from about 1600 in the first quarter of 2008 to nearly 5000 in quarter 1 of 2009. The children with mental health evaluations increased from an average of 4543 to 5715 per month over a 1-year period.

Conclusion: The data suggest payment and a supported mandate for use of a formal screening tool can substantially increase the identification of children at behavioral health risk. Findings suggest that increased screening may have the desired effect of increasing referrals for mental health services.

Study Design: Observational pretestposttest design

Setting: Massachusetts

Population of Focus: Children enrolled in Medicaid

Data Source: Medicaid data prepared for Rosie D. v Romney (Patrick) court case

Sample Size: Well-child visits - Baseline/first quarter 2008 (n=122,494)4 - Follow-up/first quarter 2009 (n=118,573)

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, 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): Provider Training/Education, Nurse/Nurse Practitioner, Educational Material (Provider),

Intervention Description: The intervention was an online educational program that included information on PD screening and treatment, interviewing skills, screening tools, and treatment options. The intervention was designed based on the Theory of Planned Behavior (TPB) constructs, which include attitudes toward behavior, perceived behavioral control, subjective norms, perceived behavioral intention, and behavioral outcome. The study analyzed the impact of this specific intervention on participants' PD-related perceptions and intentions. Therefore, the intervention described aligns with a discernable strategy based on the TPB constructs.

Intervention Results: The results of the study showed positive gains in several key areas related to perinatal depression (PD) screening and treatment. Specifically, the intervention resulted in positive gains in PD-related perceived behavioral control (PBC), attitudes, subjective norms, knowledge, intention to screen and treat PD, and perceived importance of screening and treating PD from pre- to post-intervention . The findings indicated improvements in PD-related attitudes, knowledge, and the perceived importance of PD screening and treatment after the intervention . Additionally, the Theory of Planned Behavior Scale (TPBS) scores showed significant improvements from pre- to post-intervention, indicating a positive impact of the educational intervention on participants' perceptions and intentions related to PD screening and treatment . Overall, the results suggested that the PD online educational intervention was effective in improving participants’ PD-related PBC, attitudes, subjective norms, knowledge, and intention to screen and treat PD

Conclusion: PBC demonstrated a small-to-moderate positive association with perceived importance of screening and treating PD at post-intervention. Results from the current study suggest that the PD online educational intervention is effective in improving participants’ PD-related PBC, attitudes, subjective norms, knowledge, and intention to screen and treat PD.

Study Design: The study utilized a quasi-experimental, repeated-measures design. The study included a single group of participants, and data were collected at two time points: pre-intervention and post-intervention. The pre-intervention assessments occurred online directly prior to the participants engaging in the training, while the post-intervention assessments occurred online directly after the participants engaged in the training . This design allowed for the evaluation of changes in participants' perceptions and intentions related to perinatal depression (PD) screening and treatment before and after the educational intervention. The use of pre-post measures enabled the researchers to assess the impact of the intervention on participants' PD-related knowledge, attitudes, and intention to screen and treat PD, as well as their perceived importance of screening and treating PD. While the study did not include a control group, the use of a repeated-measures design allowed for the evaluation of changes within the same group of participants, which can provide valuable information about the impact of the intervention on participants' perceptions and intentions related to PD screening and treatment.

Setting: The study setting was not explicitly mentioned in the provided excerpts. However, the study was conducted with graduate nursing students, and the intervention was implemented and assessed online via Qualtrics . Therefore, it can be inferred that the study setting for the educational intervention and data collection was an online platform, likely associated with the academic institution where the graduate nursing program was located.

Population of Focus: The target audience of the study was graduate nursing students. The researchers chose nursing students as the participant population for several reasons. First, educational interventions for healthcare profession students have been well received and effective in improving student comfort with addressing postpartum depression. Second, nursing is the largest of the healthcare professions, with almost 3 million nurses practicing in the United States, indicating their potential impact on patient care. Third, the nursing profession has shifted to providing evidence-based care to patients; as such, this study aimed to improve perinatal depression-related evidence-based care

Sample Size: The study included a sample of 59 graduate nursing students

Age Range: The study did not provide a specific age range for the participants. However, the study included graduate nursing students, and the average age of the participants was 33.83 years (SD = 7.35)

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, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Seven pediatric primary care practices participated in New Mexico's Developmental Screening Initiative in a year-long quality improvement project with the goal of implementing standardized developmental screening tools.

Intervention Results: At baseline, there were dramatic differences among the practices, with some not engaged in screening at all.

Conclusion: Overall, the use of standardized developmental screening increased from 27% at baseline to 92% at the end of the project.

Study Design: QE: pretest-posttest

Setting: Seven primary care practices in a large urban area and small regional community in New Mexico

Population of Focus: Children ages 1 through 60 months

Data Source: Child medical record

Sample Size: Total medical records reviewed at baseline and follow-up (n=1139)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material (Provider), Educational Material, Media Campaign (Print Materials, Public Address System, Social Media)

Intervention Description: HBWW is a multi-dimensional, community-based approach to preventing preventable preterm births. In HBWW sites, community health leaders, including hospitals, health departments and local March of Dimes staff partner to work together to implement multiple (bundled) interventions known to impact preterm birth; to improve systems of care in their community so that these interventions reach the patients who need them; and to promote awareness of preterm birth across all the community, including providers, patients and the public. The pilot/demonstration project was built on an innovative, ecological model designed to work in real world settings, where a multitude of factors—not a single intervention— influence outcomes. Like other public health problems, prematurity must be addressed in communities with broader approaches than just medical care. Working with providers, the goal of the project was to move research to practice quickly and effectively. With patients, the teams worked to improve networks of support services that addressed patient needs. For the public, the goal was that everyone, whether grandmothers, friends or business leaders, understood the impact of prematurity on families and the community.

Intervention Results: (In the pilot study in Kentucky) Real world implementation of HBWW in Kentucky provided potential for “contamination” due to a high likelihood that comparison sites were exposed to HBWW and other prematurity prevention messages due to overall state and national publicity regarding the HBWW program. Such contamination is an important consideration when interpreting HBWW evaluation results. Additionally, comparison site knowledge that its performance was being scrutinized (the Hawthorne Effect [Landsberger, 1958]) may have influenced its activities and outcomes. Population Objective Patients Create positive changes in knowledge, attitudes and behavior regarding preterm birth circumstances and modifiable risk factors, with a focus on late preterm birth. Perinatal providers Bring the latest research to everyday practice, particularly regarding late preterm infants; create positive changes in knowledge, attitudes and behaviors regarding adherence to professional guidelines on preterm birth prevention (especially late preterm birth) and elective inductions and cesareans. Public (community) Increase awareness of the importance of preventing preterm birth and the risks associated with late preterm birth. Chapter 3: The HBWW Initiative marchofdimes.com 21 The HBWW evaluation used an ecological design. This design means that the unit of analysis was the aggregated results of the intervention and comparison groups rather than individual hospitals, patients or providers. The HBWW Evaluation Team (including an independent program evaluator hired for the project and March of Dimes and Kentucky Department for Public Health staff) used data collected from the state vital records system prior to project implementation and at follow-up. They compared data over time and between intervention and comparison sites. March of Dimes staff tracked process data, and the program evaluator gathered additional data via surveys and interviews. Outcome data was collected through two methods: 1) consumer and perinatal provider surveys on knowledge, attitudes and behaviors related to preterm birth, and 2) analyses of extant vital records and birth certificate data (on preterm birth rates and other outcomes) provided by the Kentucky Department for Public Health. The HBWW logic model in Figure 3.4 has more information on inputs (resources), principle strategies, outputs, and intended behavioral, policy, health status and cost outcomes of the project. Before the HBWW initiative, Kentucky had increasing preterm birth rates. A year after HBWW implementation, Kentucky had the largest drop in preterm birth rates of any of its contiguous states. There were no other major, new initiatives addressing preterm birth in the state during this time. Both survey and birth outcome data provide exciting evidence about the success of the HBWW Kentucky pilot. Some of the most compelling outcomes are anecdotes from women and perinatal providers. HBWW successfully built relationships, partnerships and collaborations that resulted in enhancement of services and patient care. Many of these anecdotes are shared throughout this manual.

Conclusion: A lesson learned through the HBWW Kentucky pilot is that data has the power to influence behavior and, therefore, directly affect program success. For example, KDMC staff recognized a problem—a substantial number of pregnant women had substance abuse problems, illustrated by the number of newborns with positive toxicology screens. To address this issue, KDMC staff developed a “plan” to appoint a perinatal social worker to address prenatal substance abuse. The site applied for a March of Dimes community chapter grant and received funding for the perinatal social worker position. The social worker’s objectives (the “do” step) included screening women for tobacco, alcohol and drug use during pregnancy; providing appropriate referrals; and providing continuity of care for high-risk prenatal patients by improving communication between the social services department and private physician practices at the hospital. Staff examined toxicology screens at a woman’s entry into prenatal care and at delivery. Once the social worker was established at the site, women with positive toxicology screens at prenatal care enrollment were less likely to deliver infants with positive toxicology screens than prior to the social worker being available. These findings (“study”) and supporting anecdotal evidence encouraged the hospital system to continue funding the social work position beyond the grant funding period. In addition, the social worker was validated and felt empowered to continue work to reduce substance use during pregnancy. Both of these results are part of the “act” stage in PDSA. As new HBWW programs move forward, program staff should share stories and data with partners to celebrate program success. Outcome measurement and process tracking provide program staff with information on accomplishments. Defining measurable objectives for each HBWW core component in a project’s implementation workplan offers opportunities to track success. Although barriers and roadblocks may exist, small and large wins along the way provide reasons to acknowledge and celebrate project successes. Program staff can share these successes with partners, collaborators and the community and thank them for their support through media efforts and during community outreach activities. Each person working on prematurity prevention makes life better for children, their families and the communities in which they live.

Study Design: Ecological Design Study

Setting: Pilot Study based in Kentucky.

Data Source: data collected from the state vital records system prior to project implementation and at follow-up

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, PROVIDER/PRACTICE, Educational Material (Provider), Online Material/Education/Blogging

Intervention Description: This study examined the degree to which the pregnant or postpartum women, in the process of quitting smoking, felt that writing in a blog about their smoking cessation journeys helped them in their efforts to become or remain smoke free.

Intervention Results: Participants were asked to complete an online survey, which had closed-ended questions regarding their sociodemographic and smoking characteristics. Once they completed the survey, semistructured qualitative interviews were conducted over the phone. Findings suggest that blogging might combine several evidence-based behavioral strategies for tobacco cessation, such as journaling and getting support from others who use tobacco.

Conclusion: Being part of a blogging community of women who have experienced or are experiencing similar challenges can be therapeutic and help women gain confidence in their ability to quit smoking. In conclusion, blogging may help pregnant and postpartum women quit smoking by increasing their social support and promoting self-reflection.

Study Design: Quasi experimental cross sectional - survey

Setting: Online forum for pregnant women

Population of Focus: Pregnant women in an online forum

Data Source: Survey, phone interview

Sample Size: 5

Age Range: Not specified

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): Educational Material (Provider), Consultation (Parent/Family), Education on Disease/Condition,

Intervention Description: The intervention consisted of a five-component toolkit aimed at improving healthcare providers' communication skills about HPV vaccination. The components included: (1) making presumptive and strong recommendations, (2) using motivational interviewing techniques, (3) providing a fact sheet, (4) showing disease images, and (5) using a website.

Intervention Results: - Providers in the intervention group reported higher use of the intervention components, including making presumptive and strong recommendations and using motivational interviewing techniques. - Use of the fact sheet was significantly correlated with high parental acceptance of the HPV vaccine. - Providers in the intervention group did not report spending more time discussing the vaccine with hesitant parents than control providers. - Providers in the intervention group reported greater improvement in parental HPV vaccine acceptance than control providers. The study found that the intervention resulted in substantial improved HPV vaccine series initiation and completion among adolescents in the intervention arm compared to controls. Providers in the intervention group reported greater improvement in parental HPV vaccine acceptance than control providers. However, the change in parental vaccine acceptance over time was not statistically significant between groups.

Conclusion: Communication-based interventions, such as the five-component toolkit used in this study, have the potential to increase HPV vaccination rates among adolescents. - Future research should examine the effectiveness of a streamlined version of the intervention, focusing on communication skills training and fact sheets.

Study Design: The study used a randomized controlled trial design.

Setting: The study was conducted in a central Colorado practice-based research network.

Population of Focus: Healthcare providers who work with adolescent patients.

Sample Size: The study included 187 providers from 16 practices (8 intervention, 8 control).

Age Range: The study focused on adolescent patients who were eligible for HPV vaccination.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), HOSPITAL, Crib Card, Visual Display (Hospital), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: To determine the impact, at 60 days of life, of an educational intervention conducted in maternity centers aimed at improving adherence to the recommendations on safe infant sleep.

Intervention Results: After the intervention, a 35% increase in the supine sleeping position (p < 0.0001) was observed; exclusive breastfeeding increased by 11% (p= 0.01); and co-sleeping decreased from 31% to 18% (p< 0.0005).

Conclusion: The educational intervention was useful to improve adherence to the recommendations on safe sleep at 60 days of life: using the supine position and breastfeeding improved, and the rate of co-sleeping decreased. No changes were observed in the number of household members who smoke, bedroom sharing, and pacifier use.

Study Design: QE: pretest-posttest

Setting: Hospital Municipal Comodoro Meisner and Hospital Universitario Austral

Population of Focus: Live newborns with >36 gestation weeks born in two hospitals whose mothers lived in the District of Pilar without major congenital malformations and/or hospitalization in the NICU for more than 10 days

Data Source: Caregiver report

Sample Size: Baseline (n=251) Follow-up (n=248)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE, Educational Material (Provider), Peer Counselor

Intervention Description: To evaluate changes in referrals to Women, Infants, and Children’s Supplemental Nutrition Program peer counselors, reported prenatal provider education and support, and breastfeeding outcomes (intention, initiation, 1-month duration of any and exclusive breastfeeding) after a prenatal breastfeeding promotion intervention.

Intervention Results: Pre-intervention (n = 71) and post-intervention (n = 70) participants were 49% Black, 61% publicly insured, and 16% uninsured. More post-intervention participants had > 1 Toolkit use (76%), peer counselor program referrals (60.0% post vs. 36.6% pre, p < .01), reported any breastfeeding intention (89% vs. 72%, p = .013), and intended to breastfeed for > 1 year (31% vs. 14%, p = .014). Post-intervention breastfeeding initiation and exclusivity were higher, but not significantly different. Post-intervention participants reported better prenatal breastfeeding supp

Conclusion: Implementing a prenatal Breastfeeding Toolkit, including facilitating peer counselor referral, was associated with increases in provider counseling, participants’ breastfeeding intentions, and uptake of peer counselors. Replicating this approach may reinforce efforts to support breastfeeding in similar practices serving women with lower incomes.

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): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Screening Tool Implementation Training

Intervention Description: The purpose of this study was to examine the feasibility and effectiveness of implementation of validated developmental screening by using the Parents' Evaluation of Developmental Status in 2 urban pediatric practices.

Intervention Results: Providers found routine screening easier than expected and feasible to conduct in a busy primary care setting. The practice change resulted in screening of 61.6% of eligible children. Compared with same-aged children before screening, after screening was implemented more behavioral concerns were detected in the 2-year-old group, and more children with developmental concerns were identified in the 3-year-old group. Referral rates for additional evaluation increased only for 3-year-olds, although the types of referrals (ie, audiology and early intervention) were consistent as those found before screening started.

Conclusion: Implementation of validated screening by using the Parents' Evaluation of Developmental Status was feasible in large, urban settings. Effectiveness was demonstrated via chart review documenting an increased rate of identification of developmental and behavioral concerns. Perceived obstacles, such as the time requirement, should not prevent widespread adoption of screening.

Study Design: QE: pretest-posttest

Setting: Boston Children’s Hospital Primary Care Center (CHPCC) and Joseph Smith Community Health Center in Massachusetts

Population of Focus: Children ages 2-3 years (20-40 months) receiving well-child visits

Data Source: Child medical record

Sample Size: Medical charts reviewed6 : - Baseline (n=338) o Children aged 2 years (n=169) o Children aged 3 years (n=169) - Follow-up (n=278) o Children aged 2 years (n=127) o Children aged 3 years (n=151) - Total charts (n=616)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROFESSIONAL_CAREGIVER, Educational Material (caregiver), Provision of Safe Sleep Item, HOSPITAL, Quality Improvement, Crib Card, Policy/Guideline (Hospital), HEALTH_CARE_PROVIDER_PRACTICE, Educational Material (Provider), Nurse/Nurse Practitioner, Audit/Attestation, Audit/Attestation (Provider)

Intervention Description: This hospital quality improvement initiative performed a series of Plan-Do-Study-Act cycles designed to increase the proportion of infants placed in a “perfect sleep” environment that met all of the American Academy of Pediatrics’ infant safe sleep guidelines. The initiative took place while the hospital was preparing for Baby Friendly certification, with increased emphasis on rooming in and skin to skin at the same time. Initial cycles targeted nurse and parental education, while later cycles focused on providing sleep sacks/wearable blankets for the infants. The goal was to achieve 70% “perfect sleep” compliance among infants cared for in the hospital.

Intervention Results: While we did not meet our goal, the percentage of infants with 'perfect sleep' increased from a baseline of 41.9% to 67.3%, and we also saw improvement in each of the individual components that contribute to this composite measure. Improvements were sustained over 12 months later, suggesting that QI interventions targeting infant safe sleep in this inpatient setting can have long-lasting results.

Conclusion: This project also suggests that infant safe sleep QI initiatives and preparation towards Baby Friendly Hospital Certification can be complementary.

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Educational Material (Provider), Nurse/Nurse Practitioner,

Intervention Description: The article describes an evidence-based educational intervention aimed at increasing the screening of immigrant mothers for postpartum depression in the Baby Well Clinic. The intervention consisted of a 2-hour educational session for Child Health Services (CHS) nurses, which included information on postpartum depression, screening tools, and cultural aspects of depression in immigrant mothers. The nurses were also provided with a screening tool and a guideline for screening and referral. The intervention was followed by a 6-month implementation period during which the nurses were expected to screen all immigrant mothers attending the Baby Well Clinic for postpartum depression.

Intervention Results: The study found that the educational intervention was feasible and acceptable to CHS nurses. The nurses reported increased knowledge and confidence in screening for postpartum depression, and the majority of them (97%) stated that the training had a positive impact on their ability to screen immigrant mothers for postpartum depression. However, the study also found that the implementation of the intervention was challenging due to factors such as language barriers, limited time, and competing demands. The study suggests that further research is needed to evaluate the effectiveness and cost-effectiveness of the intervention

Conclusion: The intervention was found feasible but require adjustment in the design of the practical training sessions. The use of the provided material, a comic strip on parental support and interpreter information needs further evaluation.

Study Design: The study design used in this research is a feasibility study with a one-group pretest-posttest experimental design

Setting: However, it is mentioned that the study was conducted by researchers from Lund University in Sweden . The study focused on screening immigrant mothers for postpartum depression in the context of the Baby Well Clinic, which is a primary healthcare center that provides care for families with children aged 0-6 years

Population of Focus: The target audience for this study is Child Health Services (CHS) nurses who work with non-native-speaking immigrant mothers in the Baby Well Clinic in Sweden . The aim of the study was to test the feasibility of an evidence-based educational intervention for CHS nurses in screening non-native-speaking immigrant mothers for postpartum depression

Sample Size: The sample size for this study was 34 Child Health Services (CHS) nurses representing 17 clinics

Age Range: However, the study focused on screening immigrant mothers for postpartum depression in the context of the Baby Well Clinic, which is a primary healthcare center that provides care for families with children aged 0-6 years . Therefore, it can be inferred that the age group of the participants is mothers with newborns and infants aged 0-6 years.

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider/Patient Communication Portal, Educational Material (Provider),

Intervention Description: Although patient-provider continuity improves care delivery and satisfaction, poor continuity with primary care providers (PCP) often exists in academic centers. We aimed to increase patient empanelment from 0% to 90% and then increase the percent of well-child care (WCC) visits scheduled with the PCP from 25.6% to 50%, without decreasing timely access that might result if patients waited for PCP availability. Nationwide Children's Hospital Primary Care Network cares for >120,000 mostly Medicaid-enrolled patients across 13 offices. Before 2017, patients were empaneled to an office, not individual PCPs. We empaneled patients to PCPs, reduced provider floating, implemented continuity-promoting scheduling guidelines, scheduled future WCC visits for patients ≤15 months during check-in for their current one, and encouraged online scheduling. We tracked the percentage of all WCC visits that were scheduled with the patient's PCP and the percentage of subsequent WCC visits for patients ≤15 months that were scheduled during the current visit, and provided feedback to schedulers. We followed emergency department (ED) utilization and visit show rates. WCC visit completion rates were tracked using HEDIS metrics.

Intervention Results: Patient empanelment increased from 0% to >90% (P < .001). Patient-provider WCC continuity increased from 25.6% to 54.7% (P < .001). A 20.5% decrease in ED utilization rate was associated with continuity project initiation. Empaneled patients demonstrated higher show rates (76.9%) versus unempaneled patients (71.4%; P < .001). WCC completion rates increased from 52.6% to 60.7%.

Conclusion: WCC continuity more than doubled after interventions and was associated with decreased ED utilization, higher show rates, and increased timely WCC completion.

Study Design: Program evaluation

Setting: Nationwide Children's Hospital (NCH) Primary Care Network (PCN) with a group of 13 urban offices in Columbus, Ohio

Population of Focus: Patients of the Nationwide Children's Hospital (NCH) Primary Care Network (PCN) in Columbus, Ohio serving a diverse population of over 120,000 patients, most of whom are Medicaid-enrolled.

Sample Size: 13 primary care offices

Age Range: Pediatric practices serving children 0-17 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Educational Material (Provider), Collaboration with Local Agencies (Health Care Provider/Practice),

Intervention Description: The study used quality improvement (QI) as part of a collaborative learning system approach to improve access and flow within Child and Adolescent Mental Health Services (CAMHS). Seven separate teams across five CAMHS services in the trust identified a local issue related to flow in their system and developed QI projects to tackle these. Each team developed a family of measures containing outcome, process, and balancing measures.

Intervention Results: Improvements in outcome measures were seen by three teams; City and Hackney ADHD, Tower Hamlets Triage, and Luton Emotional and Behavioural Team. Improvements in process measures were seen by two teams. One team did not see an improvement in outcome or process measures.

Conclusion: The study shows that the use of quality improvement (QI) as part of a collaborative learning system approach can lead to improvements in access and flow within Child and Adolescent Mental Health Services (CAMHS).

Study Design: Quality improvement (QI) as part of a collaborative learning system approach.

Setting: Child and Adolescent Mental Health Services (CAMHS) in East London NHS Foundation Trust (ELFT), England

Population of Focus: Mental health professionals, healthcare providers, policymakers, and researchers interested in improving access and flow within CAMHS.

Sample Size: Seven separate teams across five CAMHS services in the trust participated in the study.

Age Range: The study focused on Child and Adolescent Mental Health Services (CAMHS), which serves individuals up to the age of 18.

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

Intervention Description: To determine whether an intervention addressing both logistical and knowledge barriers to early screening for autism spectrum disorder (ASD) increases evidence-based screening during 18-month well-child visits and primary care providers' (PCPs') perceived self-efficacy in caring for children with ASD.

Intervention Results: At follow-up, 8 of the 10 practices were using the webM-CHAT-R/F routinely at 18-month visits. The proportion of PCPs reporting routine M-CHAT screening increased from 82% at baseline to 98% at follow-up (16% increase, 95% confidence interval [CI] 3%-28%; McNemar exact P = .02). The proportion using the M-CHAT-R/F follow-up interview questions increased from 33% to 82% (49% increase, 95% CI 30%-68%, exact McNemar test, P < .001). Significant increases in self-efficacy were found for all seven areas assessed (Ps ≤ .008).

Conclusion: This brief intervention increased PCPs' self-reported valid use of the M-CHAT-R/F at 18 months and their self-efficacy regarding ASD care. Combining educational information with a web-based ASD screen incorporating the M-CHAT-R/F follow-up questions may increase universal ASD screening with improved fidelity.

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), PROVIDER/PRACTICE, Patient-Centered Medical Home, Educational Material (Provider), Continuity of Care (Caseload), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), PATIENT/CONSUMER, Referrals, Other Education

Intervention Description: This study examines the effect of a provider alliance on service utilization, satisfaction , self efficacy, and attachment to a regular source of care for participating low income urban children and their families.

Intervention Results: The use of Physician Assistants and community health workers to expand community outreach, primary care services, pediatric sub-specialty care, and service coordination within and between care settings improved health services utilization, satisfaction with health services, parental self efficacy in navigating the health care system for their children, and service convenience for an at-risk population. Also, the use of Physician Assistants to provide pediatric sub-specialty services did not have a negative effect on parental satisfaction with a child's care.

Conclusion: Parents were slightly more satisfied with services received from a Physician Assistant in comparison with the physician sub- specialists in cardiology and nephrology clinics.

Study Design: Prospective quasiexperimental; Survey

Setting: South Central Los Angeles primary and specialty care clinics

Population of Focus: Children between the ages of 0-18 (“or are adolescents”) who reside within the geographic area of South Los Angeles

Data Source: A 30 item parent survey to assess parents’ perceived difficulty in accessing services and their satisfaction with the services received • Patient database was used to collect service utilization and financial data from operational and administrative tracking instruments and reports at both the primary and specialty care sites

Sample Size: Estimated 727,000 children in the service area; n=11,533 children reach during outreach events; n=80,000 (10% of children in service area) children attached to a medical home; n=8545 children enrolled in available payer sources

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, 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