Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Consensus Guideline Implementation, Referrals,

Intervention Description: The article describes the development and implementation of a concussion care pathway, which includes the integration of the Cleveland Clinic Concussion (C3) app to guide clinical decision-making throughout the injury recovery process. The intervention involves the use of the C3 app to provide standardized, biomechanical outcomes that serve as qualifiers to monitor recovery patterns in patients, identify individuals at risk for protracted recovery, and drive referral for specialty services for those not recovering in a timely manner. The C3 app includes assessment modules to measure important aspects of cognitive and motor function, as well as a return to play module to systematically document the six phases of post-injury rehabilitation. The intervention also involves the use of detailed injury documentation to better understand circumstances surrounding concussive injuries with the aim of mitigating risk and improving outcomes. Therefore, the intervention description includes the use of the C3 app for standardized assessment and monitoring of recovery patterns, as well as the documentation of injury details to facilitate understanding and mitigation of risk associated with concussive injuries.

Intervention Results: Overall, the carepath coupled with the C3 app functioned in unison to facilitate communication among the interdisciplinary team, prevent stagnant care, and drive patients to the right provider at the right time for efficient and effective clinical management.

Conclusion: The article reports statistically significant findings related to the performance of student-athletes on the C3 app modules at baseline and during each post-injury phase of recovery. Specifically, the article reports that Welch's two-sample t-tests revealed a significant difference between student-athletes who recovered within three weeks of injury and those who were still symptomatic three weeks after injury for the following C3 app modules: simple reaction time, choice reaction time, Trail Making Test B, and for two of the six BESS stances quantifying postural sway (double limb stance on foam, tandem stance on foam). These results suggest that athletes who remained symptomatic performed significantly worse on C3 modules measuring information processing, executive function, set switching, and postural stability. However, the article notes that the sensitivity and specificity of these modules with the current data set cannot be determined, as only injured athletes are represented. Therefore, while the article reports statistically significant findings related to the performance of student-athletes on the C3 app modules, the sensitivity and specificity of these modules require further investigation.

Study Design: The study described in the article is a descriptive study that outlines the development and implementation of a concussion care pathway and the integration of technology in the form of a mobile application to enable the care pathway and guide clinical decision-making. The article presents data on the utility of the Cleveland Clinic Concussion (C3) app in facilitating decision-making throughout the injury recovery process, but it does not report on the results of a specific research study. The article describes the process of developing and implementing the concussion care pathway, including the involvement of an interdisciplinary team of experts in concussion care, the use of evidence-based best practices, and the validation and deployment of the C3 app. Therefore, the study design/type is a descriptive study of the development and implementation of a concussion care pathway and the integration of technology to support clinical decision-making.

Setting: The setting for the study described in the article is the Cleveland Clinic. The development and implementation of the concussion care pathway, as well as the validation and deployment of the Cleveland Clinic Concussion (C3) app, were carried out within the Cleveland Clinic enterprise. The interdisciplinary team involved in the development of the care pathway included providers from various departments within the Cleveland Clinic, such as sports medicine, neurology, neurosurgery, rehabilitation medicine, neuroradiology, emergency medicine, primary care, pediatrics, and family medicine, as well as athletic trainers, physical therapists, speech therapists, occupational therapists, nurses, and neuropsychologists. Therefore, the study was conducted within the clinical and research environment of the Cleveland Clinic.

Population of Focus: The target audience for the study described in the article is likely to be healthcare providers involved in the management of concussion, including physicians, athletic trainers, physical therapists, speech therapists, occupational therapists, nurses, and neuropsychologists. The article provides a detailed description of the development and implementation of a concussion care pathway and the integration of technology in the form of a mobile application to enable the care pathway and guide clinical decision-making. The study also presents data on the utility of the C3 app in facilitating decision-making throughout the injury recovery process. Therefore, the article is likely to be of interest to healthcare providers who are involved in the care of patients with concussion and who are interested in evidence-based best practices and technology-enhanced approaches to concussion management.

Sample Size: The article does not provide a specific sample size for the study. The study described in the article involves the development and implementation of a concussion care pathway and the validation and deployment of the Cleveland Clinic Concussion (C3) app. The article presents data on the utility of the C3 app in facilitating decision-making throughout the injury recovery process, but it does not provide information on the number of patients or participants involved in the study. Therefore, the sample size for the study is not reported in the article.

Age Range: The age group discussed in the article is primarily focused on student-athletes, as indicated in the representative results section. The study involved 181 student-athletes who were diagnosed with concussion during the 2013-2014 athletic seasons. The age range of the student-athletes is not explicitly mentioned, but it is noted that the mean age of the athletes was 17 years for those who recovered within three weeks of injury and 18 years for those who experienced prolonged recovery. Therefore, the age group of the student-athletes in the study is likely to be in the range of late adolescence to early adulthood.

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

Intervention Description: The intervention involved two referral mechanisms: warm handoff and electronic referral. A warm handoff was defined as a referral practice conducted in person between the primary care provider (PCP) and the licensed master social worker (LMSW) with the patient and family, if present. The LMSW performed a brief triage and connected patients to psychiatric resources, referred them to crisis intervention, or scheduled an appointment for psychotherapy. In the electronic referral group, the PCP placed an electronic referral to the LMSW in the patient’s electronic medical record, and the LMSW contacted the patient by telephone to schedule an appointment. The study also considered the time between the referral and first contact with the LMSW as part of the intervention description.

Intervention Results: The WH group was more likely to engage with mental health services compared to the EF group (odds ratio = 3.301, 95% confidence interval = 1.850-5.902, p = .002) while age, gender, race/ethnicity, and primary language had no correlation. Within the EF group, those who were contacted by the LMSW within 3 days (1-3 days group) were more likely to attend appointments (odds ratio = 2.680, 95% confidence interval = 0.414-8.219, p = .040). There was no difference in attendance in the WH group and the 1-3 days group (p = .913) DISCUSSION: A warm handoff between primary care providers and behavioral health clinicians is significantly correlated with engagement with behavioral health services for adolescents who screen positive for depression or anxiety. Contact with the family within 3 days of referral is significantly correlated with engagement compared to a longer duration between referral and family contact.

Conclusion: Yes, the study found statistically significant results related to engagement with services. Patients who received a warm handoff were three times more likely to engage with services, and those in the e-referral group who had first contact with the licensed master social worker (LMSW) within 3 days were nearly three times more likely to engage with services. Additionally, there was no statistically significant difference in engagement between the warm handoff group and the e-referral group with early contact within 3 days.

Study Design: The study design was a retrospective cohort study conducted in an inner-city pediatric primary care clinic.

Setting: The study was conducted in an urban inner-city pediatric clinic of a large publicly funded hospital in Brooklyn, New York.

Population of Focus: The target audience for the study includes healthcare providers, particularly those working in pediatric primary care settings, as well as researchers and policymakers interested in integrated mental health care for adolescents.

Sample Size: The study included a total of 305 patients, with 132 receiving a warm handoff and 173 receiving an electronic referral.

Age Range: The study included adolescent patients with a median age of 16 years, ranging from 12 to 21 years.

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

Intervention Description: Due to the pervasive shortage of behavioral health (BH) specialists, collaborative partnerships between pediatric primary care practitioners (PPCPs) and BH specialists can enhance provision of BH services by PPCPs. We aimed to create a new model of collaborative care that was mostly virtual, affordable, and scalable. The pilot program was implemented in 18 practices (48 PPCPs serving approximately 150 000 patients) in 2 consecutive cohorts. Outcomes were assessed by administering pre-program and post-program surveys.

Intervention Results: Across the 18 practices, PPCPs reported significantly increased confidence in their BH knowledge and skills, and significantly increased their provision of target BH services. Barriers to BH service provision (resources, time, and staff) were unchanged.

Conclusion: This compact, mostly virtual model of BH collaboration appears to be beneficial to PPCPs while also offering convenience to patients and affordability and scalability to the practice network.

Study Design: Pre-post observational study

Setting: 18 clinical practices (48 PPCPs serving approximately 150000 patients) in CA.

Population of Focus: Pediatric primary care provicers in clinic-based practices. The eligible population comprises approximately 200 PPCPs in 65 practices in a pediatric network affiliated with an academic medical center in Southern California. This report presents the findings from the first 2 groups of practices to enroll (cohorts 1 [7 practices, 23 PPCPs] and 2 [11 practices, 25 PPCPs]).

Sample Size: 18 practices, 48 pediatric primary care providers

Age Range: Providers seeing pediatric patients 0-17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Educational Material, Referrals,

Intervention Description: To determine whether participation in a home visiting program increases and expedites utilization of early intervention services for suspected developmental delays. Methods Children participating in Every Child Succeeds (ECS), a large home visiting (HV) program serving greater Cincinnati, between 2006 and 2012, were propensity score matched to a sample of children identified from birth records who did not receive services from ECS. Data were linked to early intervention (EI) data acquired from the Ohio Department of Health.

Intervention Results: Among 3574 HV and 3574 comparison participants, there was no difference in the time to EI service utilization; however a higher percentage of HV participants accessed services. Overall, 6% of the HV group and 4.3% of the comparison group accessed services (p = 0.001). Modeling revealed an odd ratio = 1.43 [95% confidence interval (CI) 1.16-1.78, p value = 0.001] and hazard ratio = 1.42 [95% CI 1.15-1.75, p value = 0.001]. Differences in utilization were greatest directly after birth and between approximately 2 and 3 years.

Conclusion: Participation in home visiting was associated with greater utilization of EI services during two important developmental time points, demonstrating that home visiting may serve as an important resource for facilitating access to early intervention services.

Study Design: Retrospective Cohort Study

Setting: Every Child Succeeds (ECS) program in the Greater Cincinnati area in Ohio

Population of Focus: Children and families involved in the Every Child Succeeds (ECS) home visiting program in the Greater Cincinnati area between 2006 and 2012

Sample Size: Matched cohort of 7,148 families (3,574 families participating in the Every Child Succeeds (ECS) home visiting program in comparison with 3,574 families identified from birth records who did not receive services from ECS)

Age Range: Infants and children ages 0-3 years of age

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

Intervention Description: The intervention involved a quality improvement initiative aimed at addressing social drivers of health (SDoH), socioemotional development, and perinatal depression in pediatric practices through practice and system improvement. The Addressing Social Health and Early Childhood Wellness (ASHEW) project provided a framework for successful development and efficient integration of screening and referral processes into clinic workflow. It involved implementing Plan-Do-Study-Act cycles, monthly chart reviews, and collaborative meetings to facilitate increased documentation of screening, counseling, and referral for positive SDoH screens in participating practices. The project promoted a team-based approach that allowed individual practices to implement screening and referral practices using available staff and documentation and referral processes they had available.

Intervention Results: Measures showed significant improvements in SDoH screening and identified opportunities for improvement in the care continuum. SDoH screenings of eligible patients significantly increased from 21% to 62% on average ( p = 0.0002). Needed referrals fulfilled increased from 37% to 57% ( p = 0.003) on average. Interestingly, no significant improvement was seen in referring patients who screened positive (81% vs 89%, p = 0.0949).

Conclusion: Yes, the study reported statistically significant findings. The percentage of needed referrals fulfilled significantly increased over time for all practices involved in the study (37%–57%, p = 0.003). Additionally, SDoH screenings of eligible patients significantly increased from 21% to 62% on average (p = 0.0002). These findings indicate significant improvements in the screening and referral processes for social drivers of health in the participating pediatric practices.

Study Design: The study design/type is a quality improvement initiative. The Indiana Chapter of the American Academy of Pediatrics (INAAP) participated in a national quality improvement project led by the AAP called Addressing Social Health and Early Childhood Wellness (ASHEW), which sought to screen for and address social drivers of health (SDoH), socioemotional development, and perinatal depression in pediatric practices through practice and system improvement. The study evaluated the positive SDoH screenings and subsequent referrals from participating Indiana practices.

Setting: The setting for the study was pediatric practices in mid-central Indiana. Ten pediatric practices in this region participated in the collaboration between July 2020 and July 2021 as part of the quality improvement project led by the American Academy of Pediatrics (AAP).

Population of Focus: The target audience for the study includes healthcare professionals, pediatricians, and practitioners involved in pediatric care, as well as individuals and organizations interested in quality improvement initiatives related to addressing social drivers of health, socioemotional development, and perinatal depression in pediatric practices. Additionally, policymakers and researchers focusing on pediatric healthcare and social determinants of health may also find the study relevant.

Sample Size: The study involved ten pediatric practices in mid-central Indiana that participated in the collaboration between July 2020 and July 2021. Therefore, the sample size for the study was ten pediatric practices.

Age Range: The PDF file does not specify the age group of the patients who were screened for social drivers of health in the participating pediatric practices. However, it is mentioned that the project aimed to address social drivers of health, socioemotional development, and perinatal depression in pediatric practices. Therefore, it is likely that the age group includes infants, children, and adolescents.

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Expert Support (Provider), Enabling Services, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The purpose of this study was to pilot the feasibility of a CHW to support parental contraceptives needs within a pediatric setting serving a high number of Latino immigrant families. This article describes Mi Plan/My Plan, a CHW contraceptive counseling and resource navigation pilot program.

Intervention Results: All 311 individuals counseled were Latina mothers with median child age of 3 months. At baseline, 64.3% were using contraception and 76.5% desired to start or change their current method. Among those who desired a change, 47.9% (114/238) obtained their desired method within three months of initial counselor contact.

Conclusion: Bilingual CHW contraceptive counseling and care coordination is feasible and acceptable in a pediatric setting serving a high number of Latino immigrant families. CHWs in pediatric settings support health care access equity and are relevant to optimal maternal and child health.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Referrals

Intervention Description: To assess the impact of ‘opt-out’ referrals for pregnant smokers on SSS uptake and effectiveness, we conducted a ‘before–after’ service development evaluation.

Intervention Results: Approximately 2300 women attended antenatal care in each period. Before the implementation, 536 (23.4%) women reported smoking at ‘booking’ and 290 (12.7%) were referred to SSS. After the implementation, 524 (22.9%) women reported smoking at ‘booking’, an additional 156 smokers (6.8%) were identified via the ‘opt-out’ referrals and, in total, 421 (18.4%) were referred to SSS. Over twice as many women set a quit date with the SSS after ‘opt-out’ referrals were implemented (121 (5.3%, 95% CI 4.4% to 6.3%) compared to 57 (2.5%, 95% CI 1.9% to 3.2%) before implementation) and reported being abstinent 4 weeks later (93 (4.1%, 95% CI 3.3% to 4.9%) compared to 46 (2.0%, 1.5% to 2.7%) before implementation).

Conclusion: In a hospital with an ‘opt-in’ referral system, adding CO screening with ‘opt-out’ referrals as women attended ultrasound examinations doubled the numbers of pregnant smokers setting quit dates and reporting smoking cessation.

Study Design: Quasi experimental cross sectional

Setting: Antenatal clinics

Population of Focus: Data on Pregnant women who smoke receiving National Health Services (NHS) obstetric services

Data Source: UK National Health Service database

Sample Size: 2287 women who received care before initiation of CO breath test intervention, 2293 after

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Administration/Practice Management, Quality Improvement, HOSPITAL, PATIENT_CONSUMER, Patient Reminder/Invitation, HEALTH_CARE_PROVIDER_PRACTICE, EMR Reminder

Intervention Description: Researchers implemented process changes in 3 phases: phase 1, changing the screening instrument and adding decision support; phase 2, adding automatic reminders; and phase 3, adding a referral option for autism evaluations in primary care. We analyzed the proportion of visits with autism screening at 2 intervention clinics before and after implementation of process changes versus 27 community clinics (which received only automatic reminders in phase 2) with χ2 test and interrupted time series.

Intervention Results: In 12 233 visits over 2 years (baseline and phased improvements), autism screening increased by 52% in intervention clinics (58.6%-88.8%; P < .001) and 21% in community clinics (43.4%-52.4%; P < .001). In phase 1, interrupted time series trend for screening in intervention clinics increased by 2% per week (95% confidence interval [CI]: 1.1% to 2.9%) and did not increase in community clinics. In phase 2, screening in the community clinics increased by 0.46% per week (95% CI: 0.03% to 0.89%). In phase 3, the intervention clinic providers referred patients for diagnostic evaluation 3.4 times more frequently (95% CI: 2.0 to 5.8) than at baseline.

Conclusion: We improved autism screening and referrals by changing the screening instrument, adding decision support, using automatic reminders, and offering autism evaluation in primary care in intervention clinics. Automatic reminders alone improved screening in community clinics.

Setting: Pediatric and community clinics

Population of Focus: Pediatricians and staff

Intervention Components (click on component to see a list of all articles that use that intervention): Psychoeducation, Referrals, Presentation/Meeting/Information Session/Event,

Intervention Description: The intervention was a transdiagnostic mental health center offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long-term physical conditions. The intervention included a suite of empirically grounded interventions, including single sessions, signposting or referral to appropriate services, a comprehensive diagnostic and/or supplementary neurodevelopmental assessment, and brief modular transdiagnostic psychological treatment delivered in the form of guided self-help.

Intervention Results: The results showed that the intervention was feasible and acceptable, with high levels of retention and satisfaction reported by participants. Changes in SDQ scores demonstrated statistical significance, but the effect size was small and does not equate to clinically significant change.

Conclusion: The conclusion from the study was that it is possible to deliver brief transdiagnostic psychological interventions to patients in a pediatric hospital who are experiencing mental health needs alongside long-term physical conditions, as part of a stepped-care pediatric psychology health service. The study provides evidence that such interventions could have an important role in reducing symptoms and improving quality of life.

Study Design: The study design/type was an uncontrolled trial.

Setting: The setting for the study was a national pediatric hospital.

Population of Focus: The target audience for the study was children and young people with mental health needs in the context of long-term physical conditions, as well as their families and caregivers.

Sample Size: The sample size was 186 consented participants.

Age Range: The age range of the participants was not specified in the article.

Intervention Components (click on component to see a list of all articles that use that intervention): , Referrals, Expanded Insurance Coverage; Medicaid, Enrollment Assistance, PATIENT_CONSUMER, STATE, PAYER, Expanded Insurance Coverage, Medicaid

Intervention Description: The ACA Medicaid expansion is one of the most significant recent public investments in health insurance. The ACA was designed as a comprehensive reform of health care in the U.S., and one of its priorities was to reduce uninsurance. An important question in an evaluation of the Medicaid expansion is whether it had effects on health or well-being through enrollment in other social safety net prorams. This study investigates Medicaid expansion’s potential spillover participation in the Supplemental Nutrition Assistance Program (SNAP; formerly the Food Stamp Program). In addition to providing public insurance, the policy connects individuals to SNAP, affecting social determinants of health such as hunger. We use difference-in-differences regression to estimate the effect of the Medicaid expansion on SNAP participation among approximately 414,000 individuals from across the U.S. Not all states participated in the ACA Medicaid expansion, and there was inconsistent timing among those who did. This state-time variation in implementation provides a natural experiment for investigating the relationship between the two programs. Our study contributes new evidence on an important policy topic.

Intervention Results: SNAP, by addressing nutritional needs, can improve social determinants of health. We find support for our first hypothesis that Medicaid expansion leads to greater SNAP participation. We find that the ACA Medicaid expansion connects vulnerable individuals to SNAP, the primary nutritional safety net program in the country. The increase is likely a combination of new enrollments and continued participation among individuals who otherwise would have been disenrolled. The spillover affects children, who are not the target of the expansion, and produces large effects for very-low-income adults, many of whom were not connected to SNAP despite their limited resources. More specifically, there is a 2.4 percentage point increase in the average rates of participation in Medicaid and SNAP for households with children implying that some low-income children benefit indirectly through more access to SNAP. Furthermore, the increase in SNAP in very low-income households is likely to provide substantial improvements in access to food. Joint processing of Medicaid and SNAP appears to facilitate the spillover effect, suggesting that reducing administrative burden would be helpful for improving access to multiple safety net programs.

Conclusion: We find that the ACA Medicaid expansion connects vulnerable individuals to SNAP, the primary nutritional safety net program in the country. This main finding is consistent with the Oregon Health Insurance Experiment, as well as the handful of ACA Medicaid expansion studies in this area of research. The spillover affects children, who are not the target of the expansion, and produces large effects for very-low-income adults, many of whom were not connected to SNAP despite their limited resources. Joint processing of Medicaid and SNAP appears to facilitate the spillover effect, suggesting that reducing administrative burden would be helpful for improving access to multiple safety net programs. Although SNAP is a federal program and Medicaid is a state-federal program, states can streamline applications, recertifications, and other hurdles to accessing and staying enrolled in these programs. We find no spillover effect for ABAWDs, however, who are a vulnerable group of adults that need additional outreach and support to access programs for which they may be eligible. Our findings contribute to a body of evidence that the Medicaid expansion does more than improve access to health care; it connects eligible low-income individuals to multiple supports. Enrolling in SNAP increases access to food, an important social determinant of health, and an investment in population health for states.

Study Design: Quasi-experimental difference-in-difference

Setting: Policy (States with Medicaid Expansion and SNAP)

Population of Focus: Adults/families under 138 percent of the federal poverty level on Medicaid

Sample Size: 414,000 individuals

Age Range: N/A

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

Intervention Description: The intervention in this study was a telehealth-enhanced referral process designed to improve access to community mental health clinics (CMHCs) for children referred from primary care. The intervention process was developed using a community-partnered approach and involved the following steps: 1. Parents received a CMHC referral from their primary care clinician at the federally qualified health center (FQHC). 2. Parents watched a 5-minute video introduction to the referred CMHC or received a text message link to watch the video at a later time. 3. Parents scheduled a return visit to the FQHC for a telehealth eligibility screening visit with the FQHC’s telehealth care coordinator. These visits were available to be scheduled on one selected day per week at each clinical site. 4. Upon return, parents met with the FQHC telehealth care coordinator, who connected via videoconference to the screening department at the CMHC. 5. A case manager from the CMHC screening department conducted the eligibility screening process via a live videoconference visit with the parents and FQHC telehealth coordinator (located at the FQHC site). The parents answered a series of questions regarding insurance coverage, their child’s mental health concerns, and other issues to determine eligibility. The intervention did not involve any changes to the actual services that parents and children received, organizational structure and staffing (except for the telehealth care coordinator), or billing arrangements. The study found that this telehealth-enhanced referral process significantly improved initial access to CMHCs for children referred from primary care.

Intervention Results: A total of 342 children ages 5 to 12 were enrolled; 86.5% were Latino, 61.7% were boys, and the mean age at enrollment was 8.6 years. Children using the telehealth-enabled referral process had 3 times the odds of completing the initial CMHC screening visit compared with children who were referred by using usual care procedures (80.49% vs 64.04%; adjusted odds ratio 3.02 [95% confidence interval 1.47 to 6.22]). Among children who completed the CMHC screening visit, intervention participants took 6.6 days longer to achieve it but also reported greater satisfaction with the referral system compared with controls. Once this initial access point in referral was completed, >80% of eligible intervention and control participants (174 of 213) went on to an MH visit.

Conclusion: Yes, the study reported statistically significant findings related to the effectiveness of the telehealth-enhanced referral process in improving access to mental health services for children referred from pediatric primary care to community mental health clinics. The study found that children using the telehealth-enabled referral process had three times the odds of completing the initial CMHC screening visit compared with children who were referred using usual care procedures (80.49% vs 64.04%; adjusted odds ratio 3.02 [95% confidence interval 1.47 to 6.22]). Additionally, in the adjusted analysis, children in the intervention group remained more likely to complete the initial-access screening visit compared with control children (adjusted odds ratio 3.17 [95% confidence interval 1.46 to 6.91]). Furthermore, parents in the intervention group reported higher satisfaction with the referral system and with care overall, indicating a positive impact of the telehealth-enhanced referral process on the experiences of families accessing mental health services for their children. These statistically significant findings support the effectiveness of the telehealth-enhanced referral process in improving access to mental health services and enhancing the overall satisfaction of families with the referral system and care received.

Study Design: The study design used in this research is a cluster randomized trial. The six federally qualified health center clinics were randomly assigned to either the intervention or control group using computer-generated random allocation. The intervention group implemented a newly developed telehealth-enhanced referral process for all mental health referrals, while the control group used the usual referral process. The study's primary outcome was completion of the initial access point for referral (CMHC screening visit), and the study used multivariate logistic and linear regression to examine the intervention's impact on this outcome. To accommodate the cluster design, the study used mixed-effect regression models. Overall, the cluster randomized trial design allowed for the evaluation of the effectiveness of the telehealth-enhanced referral process in improving access to mental health services for children referred from pediatric primary care to community mental health clinics.

Setting: The study was conducted in a multisite Federally Qualified Health Center (FQHC) with six clinics and two Community Mental Health Centers (CMHCs) that serve a large population of publicly insured children in the geographical areas served by the FQHC's clinical sites. This setting allowed for the implementation and evaluation of the telehealth-enhanced referral process within the context of pediatric primary care and community mental health services.

Population of Focus: The target audience for the study is healthcare providers, policymakers, and researchers who are interested in improving access to mental health services for children referred from pediatric primary care to community mental health clinics (CMHCs). The study provides evidence-based recommendations for a telehealth-enhanced referral process that can improve initial access to CMHCs for children referred from primary care. The findings of the study may be of particular interest to healthcare providers who work with children and families, as well as policymakers who are interested in improving access to mental health services for underserved populations. The study's methodology and results may also be of interest to researchers who are interested in evaluating the effectiveness of interventions aimed at improving access to mental health services for children in need. Overall, the study's target audience includes individuals and organizations who are invested in improving the mental health referral process for children referred from primary care to CMHCs.

Sample Size: The sample size for the study was 342 children ages 5 to 12 who were referred from pediatric primary care to community mental health clinics (CMHCs) in Los Angeles County. Of these children, 164 were enrolled in the intervention group, and 178 were enrolled in the control group. The study used a cluster randomized trial design, with six federally qualified health center clinics randomly assigned to the intervention or control group. The study's sample size was determined by a priori power analysis, which required an analytic N of 320 for a minimum detectable effect size of 0.518 with 80% power, a = .05 (2-sided) with 6 clusters and a 1:1 randomization, and intraclass correlation coefficient of 0.01. Therefore, the sample size was sufficient to detect the study's primary outcome of initial access to a screening visit.

Age Range: The age group of the children involved in the study was not explicitly mentioned in the provided excerpts. However, the study enrolled parents of children who were referred to the CMHCs, and the mean child age at enrollment was 8.6 years. This suggests that the study focused on children in the pediatric age range, typically defined as individuals from birth to 18 years of age.

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

Intervention Description: To test the efficacy of Babies Living Safe and Smokefree (BLiSS), a multilevel intervention initiated in a citywide safety net health system to improve low-income maternal smokers' abstinence and reduce child tobacco smoke exposure.

Intervention Results: AAR + MBI mothers had significantly higher 12-month bioverified abstinence rates than did AAR + control mothers (odds ratio [OR] = 9.55; 95% confidence interval [CI] = 1.54, 59.30; P = .015). There were significant effects of time (b = -0.15; SE = 0.04; P < .001) and condition by time (b = -0.19; SE = 0.06; P < .001) on reported child exposure favoring AAR + MBI, but no group difference in child cotinine. Presence of other residential smokers was related to higher exposure. Higher baseline nicotine dependence was related to higher child exposure and lower abstinence likelihood at follow-up.

Conclusion: The multilevel BLiSS intervention was acceptable and efficacious in a population that experiences elevated challenges with cessation. Public Health Implications. BLiSS is a translatable intervention model that can successfully improve efforts to address the persistent tobacco-related burdens in low-income communities.

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing, Pharmacotherapy (Nicotine), Referrals, PATIENT_CONSUMER

Intervention Description: The current randomized controlled trial (RCT) study aimed to evaluate the effectiveness of a multi-component smoking reduction intervention in parental smoking reduction and children's environmental tobacco smoke exposure reduction in clinical settings.

Intervention Results: Smoking parents in the intervention group had significantly more biochemically validated ≥50% smoking reduction than the control: 27.1 vs. 10.0% (OR = 3.34, 95% CI: 1.16-9.62, P = 0.02). The rate of self-reported ≥50% smoking reduction was also significantly higher in the intervention group than the control: 51.9 vs. 20.2% (OR = 4.40, 95% CI: 2.38-8.12, P < 0.001). For secondary outcomes, the rate of parental self-reported smoking cessation was higher in the intervention arm: 10.5 vs. 1.0% (OR = 12.17, 95% CI: 1.54-96.07, P < 0.001), however, no differences were detected in biochemically validated cessation and changes in children's passive smoke exposure between the groups.

Conclusion: Monthly smoking reduction counseling together with nicotine replacement therapy is more effective than simple verbal cessation advice in the smoking reduction for parents of pediatric patients. However, this study did not demonstrate differences in smoking cessation or reduction in children's passive smoke exposure with a 6-month follow-up. Achievement of a smoke-free environment remains challenging.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Midwife, Referrals

Intervention Description: This was a demonstration project designed to assess whether frequency of midwives’ smoking cessation advice within the home environment had an impact on smoking rates for the women and their wider household contacts over a 15 month period.

Intervention Results: Young and Māori women within this project were more likely to become smoke-free than others. A significant number of the women lived in households with other smokers, which may have made it more difficult for them to become smoke-free. The midwives provided smoking cessation interventions using the ABC to the women with varying frequency; however, the frequency of these interventions did not appear to be related to the likelihood of the women becoming smoke-free. The midwives did not provide ABC at every single visit for every woman; however, for some women it was provided more often than for others.

Conclusion: Although midwifery care is provided within, and acknowledges the woman’s context, the majority of women in this project faced considerable day-to-day challenges to becoming smoke- free, as they lived in households with others who also smoked. Broad strategies are needed to reduce smoking, that reach beyond the realm of midwifery practice and the health care sector, such as wider tobacco control policies, public health campaigns and smoke-free environments.

Study Design: Cohort /Prospective observational study

Setting: Home-based midwife services

Population of Focus: Pregnant women who smoked receiving midwife care in New Zealand

Data Source: Standard point of care data form

Sample Size: 6 midwives, 101 women

Age Range: Not specified

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

Intervention Description: The intervention involves providing a self-screening tool and referral pathway pamphlet to expectant mothers and fathers. The intervention aims to assist new parents in detecting and seeking help for early symptoms of distress related to postnatal depression. The intervention described in the PDF file aligns with a discernable strategy of routine screening for distress or depressive symptoms in the perinatal period for both mothers and fathers. The authors suggest that the use of the Edinburgh Postnatal Depression Scale (EPDS) for screening of distress and depression in men needs to be linked to guidelines related to perinatal care, which currently focuses on the mothers.

Intervention Results: The gender differences in the EPDS, Kessler-10 and MSSS scales are represented by differences of 1.0 points on EPDS, 1.0 points on Kessler-10, fathers were reporting less psychological distress than mothers in all cases. No difference was observed in perceived social support. The attrition between time-points was mostly men. Cultural and socio-demographic factors may affect generalisability of the findings. The self-screening tool and referral pathway pamphlet provided to dyads may have some benefit in assisting couples in the perinatal period to detect and seek help for early symptoms of distress.

Conclusion: Cultural and socio-demographic factors may affect generalisability of the findings. The self-screening tool and referral pathway pamphlet provided to dyads may have some benefit in assisting couples in the perinatal period to detect and seek help for early symptoms of distress.

Study Design: The study design/type is a longitudinal intervention study. It involved collecting data at baseline (antenatally) and at 12 months postnatally to evaluate the effectiveness of a self-screening and referral pathway pamphlet given to dyads of expectant mothers and fathers. The study aimed to assess the primary hypothesis that scores on the depression scales are different in those dyads who received the intervention. The data collection involved a large private hospital in Melbourne, Australia, and the participants were followed up at 12 months by a researcher who was blinded to the dyad allocation. Ethical approval was received, and informed consent was obtained from all participants before data collection. The study design also included multivariate analyses, univariate analyses, repeated measures doubly multivariate analysis of variance, and multivariate analysis of covariance to investigate the effectiveness of the intervention

Setting: The study was conducted at a large private hospital in Melbourne, Australia, which has up to 2400 deliveries per year. Data collection took place between April 2014 and February 2015, and participants were followed up at 12 months by a researcher who was blinded to the dyad allocation. All follow-up data was collected by March 2016. The hospital setting provided the opportunity to recruit expectant mothers and fathers from a diverse demographic background, allowing for a broad representation of the target population.

Population of Focus: The target audience for the study appears to be expectant mothers and fathers, as the research aimed to evaluate the effectiveness of a self-screening and referral pathway pamphlet given to dyads of expectant mothers and fathers. The study collected data at a large private hospital in Melbourne, Australia, and the participants were followed up at 12 months postnatally. The demographic variables recorded at baseline included age range, marital status, number of children, country of origin, living arrangements, highest level of education, employment status, level of support, and whether or not the participant had been previously diagnosed with a mood disorder. Therefore, the target audience for the study was expectant mothers and fathers in the perinatal period.

Sample Size: The sample size of the study was 140 participants, comprising 70 dyads (35 dyads in the control and 35 dyads in the intervention). High attrition occurred with 43.5% of participants (mostly males) lost to follow-up at 12 months. There were 56.5% of the participants who provided usable data at baseline remaining in the study by 12 months. The sample is further summarized descriptively across treatment groups in Table 3 for the 78 participants who provided valid data at follow-up. This comprised of 30 dyads (60 individuals), plus 18 individuals (17 females and 1 male) who completed the follow-up questionnaires without their partner.

Age Range: The age range of the participants in the study was not explicitly mentioned in the provided excerpts. However, the study did include demographic variables such as age range, marital status, number of children, country of origin, living arrangements, highest level of education, employment status, level of support, and whether or not the participant had been previously diagnosed with a mood disorder. The age range of the participants was likely captured within the demographic data collected at baseline.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Navigation, Other Person-to-Person Education, Referrals

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.

Study Design: Quasi experimental cross sectional -pilot

Setting: University obstetric and gynecology clinics

Population of Focus: Pregnant women over 18, smoked and expressed interest in quitting

Data Source: Expired air carbon monoxide (EACO), self-report, standardized scales

Sample Size: 50

Age Range: Not specified

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): Referrals, STATE, WIC Food Package Change, PATIENT_CONSUMER

Intervention Description: Based on Centers for Disease Control and Prevention’s Learn the Signs. Act Early. campaign, the program was developed and replicated in two phases at 20 demographically diverse WIC clinics in eastern Missouri. Parents were asked to complete developmental milestone checklists for their children, ages 2 months to 4 years, during WIC eligibility recertifcation visits; WIC staf referred children with potential concerns to their healthcare providers for developmental screening. WIC staf surveys and focus groups were used to assess initial implementation outcomes.

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.

Setting: WIC clinics

Population of Focus: WIC clinic staff

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): 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): Collaboration with Local Agencies (State), Referrals, Education/Training (caregiver), STATE, PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER

Intervention Description: We aimed to identify and describe the contextual factors that influence implementation of PNCC.

Intervention Results: Our findings support the need to study the implementation of perinatal public and community health interventions and consider “health in all policies.” Several changes would maximize PNCC's impact on maternal health: increased collaboration among policy stakeholders would reduce barriers; increased reimbursement would enable PNCC providers to better meet the complex needs of clients; and expansions in postpartum Medicaid coverage would extend the PNCC eligibility period.

Conclusion: Nurses who provide PNCC have unique insights that should be leveraged to inform maternal–child health policy.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Motivational Interviewing, Referrals, Educational Material

Intervention Description: Home visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied.

Intervention Results: A program effect was seen for smoking cessation such that clients who smoked less than ten cigarettes per day and those who smoked 20 or more cigarettes per day during the first trimester were more likely to achieve third trimester cessation than comparison women (p <0.01 and p = 0.01, respectively). Only for heavy smokers (20 or more cigarettes during the first trimester) was there a significant reduction in number of cigarettes smoked by the third trimester versus comparison women (p = 0.01). Clients expressed the difficulty of cessation, but addressed several harm-reduction strategies including reducing smoking in the house and wearing a smoking jacket. Clients also described smoking education that empowered them to ask others to not smoke or adopt other harm reducing behaviors when around their children.

Conclusion: While a significant impact on smoking cessation was seen, this study finds a less-clear impact on smoking reduction among women in home visiting programs. As home visiting programs continue to expand, it will be important to best identify effective ways to support tobacco-related harm reduction within vulnerable families.

Study Design: Cohort - Mixed methods using a retrospective cohort of propensity score

Setting: Home visiting programs

Population of Focus: English or Spanish speaking mothers who smoked during pregnancy who currently participated in a home visiting program and received welfare benefits

Data Source: Enrollment data, in-person or telephone interviews, birth certificate data

Sample Size: 10,296 women: 2595 study participants and 7701 controls

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Referrals, Enabling Services, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: To measure pediatric preventive counseling at patient-centered medical homes (PCMHs) compared with practices that reported undertaking some or no quality-related activities.

Intervention Results: Compared with other practices, PCMHs were generally associated with greater likelihood of receiving preventive counseling. Estimates varied with the quality-related activities of the comparison practices. Counseling against smoking in the home was 10.4 to 18.7 percentage points (both P < .01) more likely for PCMHs. More associations were statistically significant for PCMHs compared with practices that undertook 1 of 2 quality-related activities examined. Among children ages 2 to 5, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on 3 of 5 topics. Among adolescents, compared with practices undertaking both quality-related activities, those with PCMHs were more likely to receive counseling on smoking, exercise, and eating healthy.

Conclusion: PCMHs were associated with substantially greater receipt of pediatric preventive counseling. Evaluations of PCMHs need to account for the quality-related activities of comparison practices.

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Nurse/Nurse Practitioner, Multicomponent Approach,

Intervention Description: The intervention described in the article is an innovative program for the care of children with incontinence and dysfunctional elimination. This program is unique in that it combines subspecialty services (urology, gastroenterology, and psychiatry) in a single point of care for this population. It is also the first reported independent nurse practitioner (NP)-run specialty referral practice in a free-standing pediatric ambulatory subspecialty setting. The program involves the operation of a Continence Clinic, staffed by nurse practitioners, registered nurses, and medical assistants, and equipped with specialized clinical space and testing capabilities, including urodynamics and uroflow systems, anorectal manometry systems, and innovative treatment options such as animated pelvic floor biofeedback using a pediatric pelvic floor biofeedback system. The intervention aims to provide comprehensive care for children with incontinence and dysfunctional elimination, with the goal of achieving continence and improving the overall health and well-being of the affected children. The program also seeks to address the fragmentation of care that currently exists across traditional subspecialties and to demonstrate the effectiveness of non-physician provider reconfiguration of health care delivery in subspecialty practice. Overall, the intervention involves a multidisciplinary approach to the assessment, diagnosis, and management of incontinence and dysfunctional elimination in children, with a focus on integrating subspecialty services and utilizing nurse practitioners to deliver care in a specialized clinic setting.

Intervention Results: Analysis indicates that this model is fiscally sound, has similar or higher patient satisfaction scores when measured against physician-run subspecialty clinics, and has an extensive geographic referral base in the absence of marketing.

Conclusion: The article does not explicitly mention statistically significant findings in the context of hypothesis testing or inferential statistics. However, it reports on various outcome measures such as financial performance, patient/family satisfaction, and geographic referral base data. The study primarily utilizes descriptive statistics to measure and compare these outcomes. While the article provides data on revenue generation, cost per relative value unit, patient satisfaction scores, and geographic referral patterns, it does not explicitly state whether these findings were analyzed for statistical significance. Therefore, the presence of statistically significant findings is not clearly indicated in the article.

Study Design: The study design used in the article is not explicitly stated. However, the article mentions that retrospective data on financial, patient satisfaction, and patient referral base were compiled to assess the program. Additionally, the article discusses the use of descriptive statistics to measure and compare patient/family satisfaction and geographic referral base data. Furthermore, the article refers to the use of a Logic Model, which provides a pictorial representation of how a program is expected to achieve its results and corresponding process and outcome measures for determining the extent to which the intervention was implemented as planned. This suggests that the study may have utilized a program evaluation design based on a Logic Model, which is often used to evaluate the effectiveness and efficiency of unique programs.

Setting: The setting for the study was Nemours Children’s Specialty Care, an outpatient clinic in Jacksonville, Florida. The NP-run Continence Clinic is an independent program within Nemours, which offers 17 pediatric subspecialty services staffed by approximately 100 physicians and 20 NPs. The Continence Clinic is not embedded in any other division and is treated no differently from the physician-run divisions within the organization. It shares the same operations infrastructure as the rest of the subspecialty clinics, including the EPIC electronic medical record with associated registration, scheduling, and billing functions. Corporate services furnish materials and supplies, maintenance, housekeeping, legal, and risk management services.

Population of Focus: The target audience for the study includes healthcare professionals, administrators, and policymakers involved in pediatric subspecialty care, particularly those with an interest in innovative models of care delivery and workforce configurations. Additionally, the study may be of interest to nurse practitioners, as the program described in the article is nurse practitioner-run and represents a novel approach to subspecialty care. Furthermore, the findings of the study may be relevant to researchers and professionals interested in pediatric incontinence and dysfunctional elimination, as well as those focused on improving access to care and patient/family satisfaction in pediatric subspecialty settings.

Sample Size: The article does not explicitly mention the sample size for the study. However, it describes the program as the first reported independent nurse practitioner–run specialty referral practice in a free-standing pediatric ambulatory subspecialty setting. The study reports retrospective data on financial, patient satisfaction, and patient referral base to assess the program. Therefore, the sample size may be related to the patient population served by the NP-run Continence Clinic at Nemours Children’s Specialty Care in Jacksonville, Florida.

Age Range: The age range of the study is not explicitly mentioned in the provided document. However, since the program focuses on providing care for children with incontinence and dysfunctional elimination, it can be inferred that the study likely includes pediatric patients, encompassing a wide age range from infancy to adolescence. For specific details on the age range of the study, it may be necessary to refer to additional sources or contact the authors of the study directly.

Intervention Components (click on component to see a list of all articles that use that intervention): Pharmacotherapy (Nicotine), Referrals, Other Person-to-Person Education, PATIENT_CONSUMER, Incentives

Intervention Description: Monthly variability in smoking behaviors in caregivers of pediatric asthmatics yields questions of how much and when does smoking reduction result in improved environmental and clinical outcomes.

Intervention Results: Caregivers with 3 months of ≥25% decrease in cotinine levels had a significantly greater mean change in child cotinine levels (p = 0.018). “Low” caregiver cotinine levels did not significantly improve pediatric asthma control (OR 2.12 (95% CI: 0.62–7.25)). Caregiver anxiety and depression outcomes, measured by Patient Health Questionnaire (PHQ)-4 scores, was not significantly different based on cotinine categorization (p = 0.079);

Conclusion: Reduced pediatric cotinine levels were seen in caregivers who reduced their smoking for at least 3 months, but clinical outcome measures remained unchanged.

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

Intervention Description: The primary aim was to evaluate the efficacy of financial incentives for reducing paediatric tobacco smoke exposures (TSEs) through motivating cigarette usage reduction among low-income maternal caregivers and members of their social network.

Intervention Results: The mean change in monthly child cotinine values was not significantly different in the intervention cohort over the 6-month follow-up period, compared with the control group (p=0.098, CI −0.16 to 1.89). Trends in child cotinine could not be ascribed to caregivers or social network members. Despite decreasing mean monthly cotinine values, neither the intervention cohort’s caregivers (difference in slope (control–intervention)=3.30 ng/mL/month, CI −7.72 to 1.13, p=0.144) or paired social network members (difference in slope (control–intervention)=−1.59 ng/mL/month, CI −3.57 to 6.74, p=0.546) had significantly different cotinine levels than counterparts in the control group.

Conclusion: Financial incentives directed at adult contributors to paediatric TSE did not decrease child cotinine levels.

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Access to Provider through Hotline, Consultation (Parent/Family), PARENT_FAMILY, PATIENT_CONSUMER

Intervention Description: This study compared enrollment of parents who smoke in the quitline using electronic referral with that using manual referral.

Intervention Results: During the study period, in the eReferral group, 10.3% (24 of 233) of parents who smoked and were interested in quitting enrolled in the quitline, whereas only 2.0% (5 of 251) of them in the control group enrolled in the quitline-a difference of 8.3% (95% CI=4.0, 12.6). Parents aged ≥50 years enrolled in the quitline more frequently. Although more parents in the eReferral group connected to the quitline, among parents who had at least one quitline contact, there was no significant difference in the mean number of quitline contacts between eReferral and control groups (mean, 2.04 vs 2.40 calls; difference, 0.36 [95% CI=0.35, 1.06]).

Conclusion: Smoking parent eReferral from pediatric primary care may increase quitline enrollment and could be adopted by practices interested in increasing rates of parent treatment.

Intervention Components (click on component to see a list of all articles that use that intervention): Referrals, Provider Training/Education, Outreach (caregiver), PATIENT_CONSUMER, PROFESSIONAL_CAREGIVER, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This invited article is one of several comprising part of a special issue of Child Abuse and Neglect focused on child trafficking and health. The purpose of each invited article is to describe a specific program serving trafficked children.

Intervention Results: Serving 62 youth during its first year, the medical home has begun to improve access to high-quality healthcare to a very vulnerable population.

Conclusion: Featuring these programs is intended to raise awareness of innovative counter-trafficking strategies emerging worldwide and facilitate collaboration on program development and outcomes research.

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

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

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

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

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

Setting: Pediatric clinic

Population of Focus: Familes

Sample Size: 7284

Age Range: n/a

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

Intervention Description: This study investigated the effects of a multi-level smoking intervention on mediators of long-term abstinence in parental smokers, including smoking cessation self-efficacy, smoking urge coping, and perceived support to quit smoking.

Intervention Results: Relative to AAR + control, AAR + counseling was associated with higher self-efficacy, urge coping, and perceived support to quit (all p's<.001). Self-efficacy, but no other mediators, had a significant positive effect on 12-month bioverified smoking abstinence (p < .001). The indirect effect of intervention on 12-month abstinence via self-efficacy suggested mediation via this pathway (p = .002).

Conclusion: Results suggest that all putative treatment pathways were improved more by the multi-level AAR + counseling than the clinic-level AAR + control intervention. Further, self-efficacy at end-of-treatment prospectively predicted long-term cessation, suggesting that building of self-efficacy through treatment may be key to sustained cessation.

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Referrals, School-Based Health Centers,

Intervention Description: The ProfScreen intervention involved a two-stage screening process. In the first stage, students completed a self-report questionnaire on mental health problems and risk behaviors. In the second stage, students considered at-risk based on the screening were invited for a clinical interview with a mental health professional and, if necessary, referred for subsequent treatment.

Intervention Results: Of the total N = 12,395 SEYLE study participants, 3070 were randomised to the ProfScreen and 3257 to the control group. Of those, 4172 (65.9%) completed the 12 month follow-up, were not emergency cases, and had complete data. Among those complete cases, 2583 (61.9%) students were considered at-risk for mental problems or risk behaviour at baseline; comprising 1314 (50.9%) students of the ProfScreen and 1269 (49.1%) of the control group. 535 (40.7%) students of the ProfScreen group attended the clinical interview and 149 (27.9%) of these were referred to subsequent treatment (Fig. 1). Subsequent data analyses refer to the 2583 students that were at-risk for mental health problems or risk behaviour at baseline. Compared to the control group, students of the ProfScreen group screened more often positive for suicidal tendencies and problems in social relationships at baseline (Table 1). The effect sizes of these differences were small. Sex, age, and all other baseline screening parameters did not differ between the ProfScreen and control group (Table 1).Effects of the ProfScreen intervention Of the total 2583 students at-risk for mental health problems or risk behaviour, 93 (3.6%) engaged in professional treatment within one year after the baseline assessment; 53 (4.1%) of the ProfScreen and 40 (3.1%) of the control group. Most of these students engaged in professional one-to-one therapy, followed by medication (see Online Resource 3). Neither follow-up service use (Table 2, unadjusted models in Online Resource 4) nor follow-up at-risk state (Table 3, unadjusted models in Online Resource 5) differed significantly between the ProfScreen and the control group, revealing no overall effects of the ProfScreen intervention.Post-hoc investigations for complete ProfScreen participation Within the ProfScreen intervention group, 40.7% participants took part in the interview offered (stage two of the intervention), referred to as ‘ProfScreen completers’. Post-hoc analyses of possible differences between ProfScreen completers and non-completers revealed that ProfScreen completers were younger (t(2581) = 5.22, p < 0.001). Looking only at the n = 535 ProfScreen completers, 29 (5.4%) engaged in professional treatment. Compared to the control group, ProfScreen completers had higher odds of engaging in service use with a professional, within one year after the intervention (OR = 1.78) (Table 4, unadjusted models in Online Resource 4). Regarding follow-up at-risk state, there were no differences between ProfScreen completers and participants of the control group (Table 5, unadjusted models in Online Resource 5).

Conclusion: Assignment to the ProfScreen intervention as implemented within the school-based SEYLE study had no effect on professional service use nor at-risk state compared to participation in the control group. The two-stage ProfScreen intervention suffered from low participation rates in the second part, the interview for clinical evaluation by professionals. Complete participation was positively associated with follow-up service use for young people at-risk for mental problems and risk behaviours, but the intervention was only able to reach 41% of eligible students for full participation. Overall, the present study highlighted two major difficulties in school-based screenings: less than half of the sample accepted the invitation for a clinical interview, and subsequently, only few students engaged in professional treatment. Thus, prior to the implementation of large-scale school-based screening programs as a regular tool to address young people’s mental health, further evidence and improvement of interview attendance rates as well as particular interventions targeting barriers to professional help are necessary.

Study Design: The study was a randomized controlled trial (RCT).

Setting: The study was conducted in 11 European countries as part of the SEYLE project.

Population of Focus: The target audience includes adolescents in school settings who were at risk for mental health problems and risk behaviors.

Sample Size: The total sample size was 4,172 students.

Age Range: The students were aged 15 ± 0.9 years.

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

Intervention Description: The intervention in the study was a vision referral program that included phone calls to families to identify and overcome barriers to obtaining vision care. The program aimed to increase follow-up vision care of school-aged children after a failed vision screening by 40% above baseline. The program involved mailing referral letters to families of school-aged children who failed vision screening, followed by phone calls to identify and overcome barriers to obtaining vision care. The barriers identified with the target population included disbelief of vision results, lack of knowledge about vision health, and financial cost. The program aimed to increase the rate of follow-up vision care obtained by school-aged children.

Intervention Results: Results indicated an increase of vision care rates during the 2017-2018 academic year by 60% above baseline rates from the previous academic year.

Conclusion: Yes, there were statistically significant findings in the study. The study found that there was an increase in the percentage of children who received follow-up vision care with the use of a vision referral program compared to baseline of 11% in the previous academic year (p ≤ .05).

Study Design: The study design/type is a quality improvement program aimed at increasing follow-up vision care of school-aged children after a failed vision screening.

Setting: The setting for the study was an elementary school located in a small community east of Cleveland, Ohio. The school had a population of 685 students, and the study participants included 100 kindergarten, 128 first-grade, 92 third-grade, and 136 fifth-grade students during the 2017-2018 academic year for a total of 456 students.

Population of Focus: The target audience for the study includes school nurses, healthcare providers, educators, and policymakers involved in children's vision health and school-based vision screening programs. Additionally, parents and guardians of school-aged children may also benefit from the findings and implications of the study.

Sample Size: The sample size for the study was 456 school-aged children from kindergarten to fifth grade during the 2017-2018 academic year.

Age Range: The age group involved in the study on the vision referral program included kindergarten, first-grade, third-grade, and fifth-grade students.

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Pharmacotherapy (Nicotine), Referrals, YOUTH, PATIENT_CONSUMER

Intervention Description: To determine if the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention can be implemented and sustained in pediatric practices and test whether implementing CEASE led to changes in practice-level prevalence of smoking among parents over 2 years.

Intervention Results: Of the 8184 parents screened after their child's visit 2 weeks after intervention implementation, 961 (27.1%) were identified as currently smoking in intervention practices; 1103 parents (23.9%) were currently smoking in control practices. Among the 822 and 701 eligible parents who completed the survey in intervention and control practices, respectively 364 in the intervention practices (44.3%) vs 1 in a control practice (0.1%) received meaningful treatment at that visit (risk difference, 44.0% [95% CI, 9.8%-84.8%]). Two years later, of the 9794 parents screened, 1261 (24.4%) in intervention practices and 1149 (25.0%) in control practices were identified as currently smoking. Among the 804 and 727 eligible parents completing the survey in intervention and control practices, respectively, 113 in the intervention practices (14.1%) vs 2 in the control practices (0.3%) received meaningful treatment at that visit (risk difference, 12.8% [95% CI, 3.3%-37.8%]). Change in smoking prevalence over the 2 years of intervention implementation favored the intervention (-2.7% vs 1.1%; difference -3.7% [95% CI, -6.3% to -1.2%]), as did the cotinine-confirmed quit rate (2.4% vs -3.2%; difference, 5.5% [95% CI, 1.4%-9.6%]).

Conclusion: In this trial, integrating screening and treatment for parental tobacco use in pediatric practices showed both immediate and long-term increases in treatment delivery, a decline in practice-level parental smoking prevalence, and an increase in cotinine-confirmed cessation, compared with usual care.

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Referrals, Educational Material, YOUTH, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE, Screening Tool Implementation

Intervention Description: The obective of this study was to describe innovations added to the CEASE intervention and to track 2 year post-intervention implementation data on families who were screened for tobacco use.

Intervention Results: Electronic screening was used to routinely identify tobacco users, leading to increased potential for offering cessation assistance to all household members who smoke.

Conclusion: Improved delivery of smoking cessation services to families may be achieved by integrating technological innovations into routine pediatric practice.

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Referrals, HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER, Telephone Support

Intervention Description: Children ages 12 to 42 months old who receive well-child care at a community health center serving predominantly Hispanic families were recruited and randomly assigned to intervention and control groups. Families in the intervention group were connected with 2-1-1, in which a trained care coordinator conducted developmental screening over the phone using the Parental Evaluation of Development Status Online system and made referrals to intervention services on the basis of developmental risk. The 2-1-1 care coordinator then followed-up with families to assist with connections to evaluations and services.

Intervention Results: One hundred and fifty-two children were randomly assigned to intervention (n = 77) and control (n = 75) groups. On the basis of intention-to-treat analyses, significantly more children assigned to the intervention group were referred (32% vs 9%; P = .001) and were receiving services (16% vs 1%; P = .002) within 6 months compared with children assigned to usual care alone.

Conclusion: Telephone-based developmental screening and care coordination through 2-1-1 appears to be an effective approach for increasing the numbers of young children referred to, and receiving, intervention services for developmental delays.

Setting: Community-based

Population of Focus: Children and families

Intervention Components (click on component to see a list of all articles that use that intervention): School-Based Health Centers, Screening Tool Implementation, Referrals,

Intervention Description: The Rhode Island Suicide Prevention Initiative (SPI) which links schools to mental health services through a coordinated screening, referral and follow-up system.

Intervention Results: Over 3 years, 328 students were referred by schools to mental health services, with 258 completing the referral (78.7% referral rate). Most parents consented to share info and participate in follow-up.

Conclusion: SPI links schools with mental health services to increase students receiving needed treatment. Evaluations of similar programs are limited. SPI reached multiple districts and age groups, with wrap-around follow-up services. This serves as a model for expanding school-based suicide screening and mental health referrals.

Study Design: Pre-post analysis of referral program data

Setting: Public schools in Rhode Island

Population of Focus: Students at risk for suicide, schools, mental health agencies

Sample Size: 328 students referred over 3 years

Age Range: 5-19 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Patient Navigation, Referrals,

Intervention Description: The first key MHQI strategy was a mental health–social work (MH-SW) electronic referral (Fig 1) through the shared EHR, implemented in September 2014. The electronic referral allows medical providers to make a direct referral to on-site mental health or social work services. The second significant MHQI strategy was a social work follow-up protocol, first implemented in December 2014, which has iteratively evolved over time (Fig 2). This begins with either a warm referral or through accessing the weekly electronic referral report. Then, the social worker communicates with each patient and offers options on the basis of the patient’s needs, which may include referrals to outside resources, care coordination, or brief counseling or therapy within the clinic and assistance with appointment scheduling.

Intervention Results: Rates of patients scheduling first appointments remained steady. First appointment show rates improved from 51% to 78%. Overall use of mental health appointments increased initially then lowered when emphasis shifted to treatment readiness before scheduling. Overall show rates for mental health appointments improved from 67% to 77%.

Conclusion: The electronic referral and social work protocol, along with other collaborative strategies, helped facilitate improved uptake and use of mental health services within an integrated care setting.

Study Design: Quantitative analysis of quality improvement data over 26 months Intervention: Implementation of 1) an electronic referral to mental health and social work services integrated into the electronic medical record; and 2) a social work follow-up protocol to coordinate referrals and assist patients in accessing treatment.

Setting: Adolescent primary care clinic at an academic medical center

Population of Focus: Adolescent patients ages 12-17

Sample Size: Referral and appointment data, sample size not reported

Age Range: 12-17 years old

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Collaboration with Local Agencies (State), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Referrals, STATE, Mini Grants, Public Insurance (State)

Intervention Description: Small grants to community-based organizations have been shown to be effective in garnering the involvement of the local community in health promotion efforts. The Georgia Utilization Mini-grant Program leveraged modest funding and resources to promote community involvement to improve enrollment and utilization of Medicaid and CHIP services for children. It demonstrates how a state Medicaid agency can step outside its usual administrative role to play an important part in supporting local outreach and marketing efforts to promote Medicaid/CHIP enrollment and utilization.

Intervention Results: Funded community-based organizations improved utilization of children’s health services by developing innovative staffing patterns, creating new data systems for scheduling appointments and maintaining records, and forging new collaborative relationships to leverage financial support. Responses suggest that the program improved levels of enrollment, appointment-setting and referrals for social and other services. Common facilitators and barriers to success and ways to address them were also identified.

Conclusion: Elaboration on each of the facilitators of success led to the development of several recommendations as guidance for future outreach funding programs such as: staffing, data systems, collaboration and how to address incentives and barriers.

Study Design: Participatory approach

Setting: Community (Community-based organizations)

Population of Focus: Children enrolled in Medicaid and PeachCare

Data Source: Questionnaires, telephone interviews, one-on-one counseling, application assistance, home visits

Sample Size: 6 organizations

Age Range: Children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Other Education, Referrals, PATIENT_CONSUMER

Intervention Description: Our nationally recognised enriched medical home intervention (EMHI) utilised community health worker home visitation to improve health outcomes of children by engaging the entire family and removing barriers to care-seeking.

Intervention Results: The EMHI participants were primarily families with infants <24 months old, Medicaid-insured and Latino. In the multivariable logistic regression model, EMHI program factors as well as community factors independently predicted program continuation and retention. Specifically, families learning about newborn care or with preferred spoken language Spanish were more likely to complete the program. Participants reporting neighbourhood distrust had a greater likelihood of non-completion than others. Results underscore the importance of cultural competency and community involvement in program design and dissemination.

Conclusion: Our findings are applicable to other home-based interventions with the goal of supporting underserved families in following recommended clinical care.

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

Intervention Description: We sought to evaluate the efficacy of a brief intervention with smoking parents on smoking cessation rates after child hospitalization with a randomized, controlled trial.

Intervention Results: Sixty smoking parents participated in the study. The majority of study participants were uninsured women under age 30 who smoked approximately half of a pack per day. There were no statistically significant differences between control and intervention groups for our outcomes. However, 45% (CI: 33–57%) of all participants reported at least one quit attempt during the 2-month study period and 18% (CI: 10–30%) of participants were quit at study conclusion.

Conclusion: Willingness to quit smoking was much higher than expected in this population of parenting smokers.

Study Design: RCT

Setting: Community (hospital)

Population of Focus: Parents who smoke of a hospitalized children

Data Source: Telephone interview at 2 months and self-report of quit status

Sample Size: 62 parents randomized; 41 completed study

Age Range: Not specified

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

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

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

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

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

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

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

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

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

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

Intervention Description: We aimed to test the feasibility of co-locating dermatology services within primary care and increase the proportion of patients treated for basic skin complaints within the medical home while decreasing wait times.

Intervention Results: Fifty-eight percent of patients referred for a dermatologic complaint were scheduled in RASH clinic. Wait times for new patient appointments in RASH clinic were significantly shorter than for new dermatology appointments in the previous 12 months (mean 36 days vs 65 days, P < .001). The monthly number of referrals to dermatology also decreased significantly after the RASH clinic opened (24/month vs 12/month, P < .001). Ten percent of RASH patients were referred on to dermatology. In a survey of PCPs (N = 67), 76% said the RASH clinic was “extremely/very helpful.”

Conclusion: Providing dermatologic care to low or moderate complexity patients within the medical home is feasible and leads to better access to care. This innovative model could be spread to other clinics and subspecialties.

Intervention Components (click on component to see a list of all articles that use that intervention): SCHOOL, School-Based Health Centers, PROVIDER/PRACTICE, Patient-Centered Medical Home, Nurse/Nurse Practitioner, PATIENT/CONSUMER, Referrals, Peer Counselor

Intervention Description: We describe the implementation of an "expanded medical home" partnering a primary care practice (the Ypsilanti Health Center [YHC]) with local school-based health centers (the Regional Alliance for Healthy Schools [RAHS]), and to assess whether this model improves access to and quality of care for shared patients.

Intervention Results: At baseline, patients seen at YHC/RAHS had higher compliance with most quality metrics compared with those seen at YHC only. The proportion of shared patients significantly increased because of the intervention (P < .001). Overall, patients seen in the expanded medical home had a higher likelihood of receiving quality metric services than patients in YHC only (odds ratio, 1.8; 95% confidence interval, 1.57-2.05) across all measures.

Conclusion: Thoughtful and intentional implementation of an expanded medical home partnership between primary care physicians and school-based health centers increases the number of shared high-risk adolescent patients. Shared patients have improved compliance with quality measures, which may lead to long-term improved health equity.

Study Design: Quasi-experimental: Nonequivalent control group; Qualitative

Setting: Michigan primary care and consortium of school-based health centers

Population of Focus: Adolescents

Data Source: • Record review of preventive health measures • University of Michigan Health System Quality Management Program quality measures • Qualitative data

Sample Size: n=2200 adolescents; 9338 visits

Age Range: Not specified

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

Intervention Description: The purpose of this study is to decrease wait time and improve access to developmental-behavioral pediatric (DBP) evaluation in children 4 years of age and younger as part of a quality improvement (QI) initiative in an urban safety-net hospital. A primary care pediatrician received DBP minifellowship training 6 hours per week for 1 year to become a developmentally-trained primary care clinician (DT-PCC). DT-PCCs then conducted developmental evaluations that consisted of using a Childhood Autism Rating Scale and Brief Observation of Symptoms of Autism to evaluate children 4 years and younger referred within the practice. Baseline standard practice involved a 3-visit model: DBP advanced practice clinician (DBP-APC) intake visit, neurodevelopmental evaluation by a developmental-behavioral pediatrician (DBP), and feedback by a developmental-behavioral pediatrician. Two QI cycles were completed to streamline the referral and evaluation process.

Intervention Results: Seventy patients with a mean age of 29.5 months were seen. The average days to initial developmental assessment decreased from 135.3 days to 67.9 days with a streamlined referral to the DT-PCC. Of the 43 patients who required further evaluation by a DBP, the average days to developmental assessment reduced from 290.1 to 120.4 days.

Conclusion: Developmentally-trained primary care clinicians allowed for earlier access to developmental evaluations. Further research should explore how DT-PCCs can improve access to care and treatment for children with developmental delays.

Study Design: Program evaluation

Setting: An urban safety-net hospital

Population of Focus: Children aged 4 years and younger who were referred for developmental assessment within the practice setting

Sample Size: 70 children

Age Range: Children ages 0 to 4 years

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Referrals, Educational Material,

Intervention Description: To identify the diverse services required by families of children with special health care needs (CSHCN) and identify the specific care coordination (CC) efforts associated with the most common types of observed diagnoses. Requested services were categorized into specific sectors, and CC efforts were quantified by observed diagnoses and defined sectors. CC service data were extracted and analyzed from patient encounters over 4 years (2009-2013) in a department database. This included descriptive information about referrals and linkages to medical, dental, and behavioral health providers and to state, private, and community agencies. Diagnostic classifications and CC sectors were defined to enable categorization.

Intervention Results: A total of 2682 CSHCN records were reviewed. The majority (59%) required services/resources in 1 to 2 sectors, 24% required services/resources in 3 to 5 sectors, and 17% required services/resources in 6 or more sectors. Including informational service, the most frequently required sectors across the study population were education, financial, medical/dental, social connections, and advocacy. Children diagnosed with autism spectrum disorder had the highest needs across all sectors.

Conclusion: Most CSHCN and their families use a substantial amount of CC time and effort to secure services from diverse sectors. High-quality and efficient CC requires an understanding of the specific needs of these CSHCN and their families and how to link them to a diverse array of services and resources.

Study Design: Retrospective observational study

Setting: Center for Care Coordination at Connecticut Children's Medical Center in Hartford, Connecticut

Population of Focus: Children and youth aged 0 to 21 years who were identified as having special health care needs and were served by the MHI program at the Center

Sample Size: 2682 CYSHCN

Age Range: CYSHCN aged 0 to 21 years

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

Intervention Description: To determine, among a sample of young CSHCN with developmental conditions, (1) characteristics associated with receipt of both patient-centered medical home (PCMH) and Part C early intervention, (2) the association between each PCMH criterion and receipt of Part C generally, and (3) for CSHCN with disabilities versus delays.

Intervention Results: 19% of our sample received both PCMH and Part C. Black, non-Hispanic children had lower odds [OR 0.44, 95% CI (0.20, 0.97)] and CSHCN with more severe developmental conditions had higher odds [OR 2.13, 95% CI (1.22, 3.17)] of receiving both services. CSHCN with a PCMH were no more likely to be receiving Part C than those without a PCMH [OR 0.85, 95% CI (0.49, 1.49)]. Receiving any one of the PCMH criterion was not associated with receiving Part C, with one exception. Among CSHCN with delays, effective care coordination was associated with lower odds of Part C [OR 0.46, 95% CI (0.21, 0.97)].

Conclusion: Concurrent PCMH and Part C access was low for young CSHCN with developmental conditions affecting their function. Given the overlapping mandates for PCMH and Part C, integrated efforts are warranted to identify if lack of concurrent services in fact reflects unmet service needs.

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation (Parent/Family), Financial Incentives, Referrals,

Intervention Description: Poverty is a common root cause of poor health and disrupts medical care. Clinically embedded antipoverty programs that address financial stressors may prevent missed visits and improve show rates. This pilot study evaluated the impact of clinic-based financial coaching on adherence to recommended preventive care pediatric visits and vaccinations in the first 6 months of life. In this community-partnered randomized controlled trial comparing clinic-based financial coaching to usual care among low-income parent-infant dyads attending pediatric preventive care visits, we examined the impact of the longitudinal financial intervention delivered by trained coaches addressing parent-identified, strengths-based financial goals (employment, savings, public benefits enrollment, etc.). We also examined social needs screening and resource referral on rates of missed preventive care pediatric visits and vaccinations through the 6-month well-child visit.

Intervention Results: Eighty-one parent-infant dyads were randomized (35 intervention, 46 control); nearly all parents were mothers and more than one-half were Latina. The rate of missed visits among those randomized to clinic-based financial coaching was half that of controls (0.46 vs 1.07 missed of 4 recommended visits; mean difference, 0.61 visits missed; P = .01). Intervention participants were more likely to have up-to-date immunizations each visit (relative risk, 1.26; P = .01) with fewer missed vaccinations by the end of the 6-month preventive care visit period (2.52 vs 3.8 missed vaccinations; P = .002).

Conclusion: In this pilot randomized trial, a medical-financial partnership embedding financial coaching within pediatric primary care improved low-income families' adherence to recommended visits and vaccinations. Clinic-based financial coaching may improve care continuity and quality in the medical home.

Study Design: Randomized controlled trial

Setting: Pediatric primary care clinic at Harbor-UCLA, an academically affiliated safety net medical center and second largest in Los Angeles County’s Department of Health Services

Population of Focus: Low-income parent-infant dyads presenting to pediatric primary care clinics for scheduled, non-acute primary care visits

Sample Size: 81 parent-infant dyads, with 35 dyads assigned to the intervention group receiving clinic-based financial coaching and 46 dyads assigned to the control group receiving usual care

Age Range: The participants included English- and Spanish-speaking adult parents and their infants younger than 4 months of age

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

Intervention Description: Universal school-based depression screening compared to targeted screening based on concerning behaviors

Intervention Results: A total of 12 909 students were included (median age, 16 years [range, 13-21 years]; 6963 male [53.9%]), of whom 2687 (20.8%) were Hispanic, 2891 (22.4%) were non-Hispanic Black, 5842 (45.3%) were non-Hispanic White, and 1489 (11.5%) were multiracial or of other race or ethnicity. A total of 6473 students (50.1%) were randomized to universal screening, and 6436 (49.9%) were randomized to targeted screening. Adolescents in the universal screening group had 5.92 times higher odds (95% CI, 5.07-6.93) of being identified with MDD symptoms, 3.30 times higher odds (95% CI, 2.49-4.38) of SAP confirming follow-up needs, and 2.07 times higher odds (95% CI, 1.39-3.10) of initiating MDD treatment. No differences were identified in initiation for planned subgroup analyses by sex or race and ethnicity.

Conclusion: In this randomized clinical trial, universal school-based MDD screening successfully increased identification of MDD symptoms and treatment initiation among adolescents, confirming the value of this approach to address this rising public health concern.

Study Design: Randomized clinical trial

Setting: Public high schools in Pennsylvania, US

Population of Focus: High school students grades 9-12

Sample Size: 12909

Age Range: 13-21 years

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

Intervention Description: The Iowa Department of Public Health’s 1st Five Healthy Mental Development Initiative is bridging public and private health care systems to improve early detection of social-emotional delays and prevention of mental health problems among young children and their families. Key features of the 1st Five model include: user-friendly mental and developmental health screening and referral forms; ongoing education and support for medical office staff on healthy development and use of screening and referral tools; specially trained care coordinators to identify and address a wide range of children’s and families’ needs; relationships with community resources that provide early intervention; and timely notification of outcomes to the referring physician offices.

Intervention Results: With an evaluation under way, early 1st Five experience indicates that families identified through the program have a range of unmet needs: each physician referral results in an average of three to five follow-up referrals for services.

Conclusion: The early experience in Iowa indicates that there are substantial opportunities to improve early detection of social–emotional delays and problems and prevention of mental health problems by strengthening the connection between physicians and the public health system and providing comprehensive care coordination. This requires building relationships and changing mindsets and practices at the community and clinic level. It requires modest funding and does not happen overnight. An ongoing evaluation of the 1st Five initiative will yield important evidence about the benefits and challenges of this approach. If early indications are borne out, adoption and replication in other communities and states may be warranted. The Iowa model itself is adapted from similar programs in North Carolina and Connecticut. The model can be a “win-win-win” situation. It can provide overburdened primary care physicians and their staff with the knowledge and tools to identify at-risk patients and make easy, fast referrals, with the assurance that they will be informed of the outcomes. It can also allow the public health system to better perform its surveillance and early intervention functions. Finally, it can provide critical treatment and relief to young children and their families, alleviating or avoiding exacerbation of early developmental problems and other family crises and enhancing the likelihood of a healthy, productive future.

Study Design: N/A

Setting: Iowa

Data Source: the Child and Family Policy Center,

Sample Size: N/A

Age Range: young children ages 0 to 5 years and their families,

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): Screening Tool Implementation, Referrals,

Intervention Description: The intervention involved the integration of an algorithm in the electronic health record (EHR) to determine eligibility for a PHQ-2 screening. Eligible patients were prompted for screening, and if the PHQ-2 score was ≥ 3, the PHQ-9 was integrated into the primary care provider workflow. For PHQ-9 scores ≥ 10, the EHR prompted the primary care provider with a referral order. A care manager then contacted the patient within 7 days to discuss symptoms and treatment options beyond medication. The care manager also provided brief cognitive behavioral therapy (CBT) or a community referral as well as case management while the patient was engaged in treatment. The primary care provider asked the patient to return for a follow-up visit in 6 to 8 weeks.

Intervention Results: Screenings, referrals, and uptake occurred proportionately across subgroups except for patients ages 12-17. Adolescent age was associated with disproportionate Patient Health Questionnaire-9 screenings and with treatment disengagement.

Conclusion: Yes, the study reports several statistically significant findings. For example, the study found that rates of screening, referrals, and uptake occurred proportionately across subgroups except for patients ages 12–17, where adolescent age was associated with disproportionate PHQ-9 screenings and with treatment disengagement. Additionally, the study found that although adolescents were disproportionately screened for the PHQ-9, they are not engaging in treatment (11%) compared to referred (21%) proportions of the sample (Cohen’s h = 0.28). The study also found that there were no meaningful differences across all demographic categories between proportions of eligible patients compared to screened patients, except for 12 to 17 year-olds.

Study Design: The study design is a retrospective analysis of electronic health record (EHR) data from primary care clinics where PHQ-2 and PHQ-9 screenings took place during routine office visits between November 2016 and December 2017,.

Setting: The study was conducted across 10 primary care clinics in a Chicago academic health center,.

Population of Focus: The target audience for the study includes healthcare professionals, researchers, and policymakers interested in collaborative care for depression in adults and adolescents, as well as those interested in addressing disparities in screening and treatment uptake for depression in primary care settings.

Sample Size: The study included a sample of 25,369 patients who were eligible for screening from November 2016 to December 2017.

Age Range: The age group mentioned in the study includes patients aged 12 and above. The study specifically highlights disparities in screening and treatment engagement for adolescent patients aged 12-17,.

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing, Pharmacotherapy (Nicotine), Referrals, PATIENT_CONSUMER

Intervention Description: We tested the efficacy of a smoking cessation intervention for parents of hospitalized children.

Intervention Results: Of 1641 eligible families approached, 252 were randomized (15%); 149 families had follow-up data at 12 months (59%). In the adjusted analysis, there was no difference between the groups in smoke free home rules, or child cotinine level; in an intention-to-treat analysis, 15% in the intervention group versus 8% of controls reported quit (p=0.07).

Conclusion: A smoking cessation intervention can be delivered to parents of hospitalized children. While hospitalization provides an opportunity to help parents quit smoking, more efficient and effective engagement strategies are needed to optimize tobacco control success.