Academic Pediatrics最新文献

{"title":"Disparities in health insurance and healthcare access for immigrant children with special healthcare needs.","authors":"Katherine E Douglas, Michael C Monuteaux, Katherine R Peeler, Ananya Tadikonda, Catherine G Coughlin, Julie M Linton, Lois K Lee","doi":"10.1016/j.acap.2026.103334","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103334","url":null,"abstract":"<p><strong>Objective: </strong>Our objective was to examine healthcare access disparities for children and youth with special healthcare needs (CYSHCN), comparing immigrant and US-born CYSHCN.</p><p><strong>Methods: </strong>This was a cross-sectional, retrospective study of 2016-2022 National Survey of Children's Health data including CYSHCN. The primary exposure was child nativity. Primary outcomes were adequate health insurance, usual place for primary care, usual place for sick care, foregone medical care, and difficulty with referrals. We calculated descriptive frequencies and performed univariate analyses with the chi square statistic. We then estimated multivariable logistic regression models evaluating each of the five outcomes, adjusting for individual and state-level characteristics.</p><p><strong>Results: </strong>From 2016-2022, 62,391 US-born children and 1,733 immigrant children were identified as CYSHCN [population estimates: US-born 13,518,819 (19.5%), immigrant 462,757 (14.9%)]. Immigrant compared to US-born CYSHCN had higher rates of inadequate insurance, not having a usual place of primary care, and not having a usual place for sick care (p<0.001). In multivariable models, immigrant CYSHCN had lower odds of uninterrupted health insurance (aOR 0.57, 95%CI 0.37, 0.87), usual place for primary care (aOR 0.59, 95%CI 0.37, 0.92), and usual place for sick care (aOR 0.67, 95%CI 0.50, 0.89) compared to US-born CYSHCN. There were no statistically significant differences for foregone medical care or difficulty with referrals.</p><p><strong>Conclusions: </strong>Immigrant compared to US-born CYSHCN in our study had worse access to health insurance, primary care, and sick care. Given the significant healthcare needs of CYSHCN, these health disparities must be addressed to improve their health outcomes.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103334"},"PeriodicalIF":2.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Motivators to Research Participation Among Transgender and Gender-Diverse Youth: A Mixed-Methods Study.","authors":"An Pham, Junpei Tarashi, Hadee Makda, Badi Quinteros Espinoza, Luke Johnson, Paula Peterson, Chloe Sobolewski, Chelsea Williams, Melanie K Bean","doi":"10.1016/j.acap.2026.103336","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103336","url":null,"abstract":"<p><strong>Objective: </strong>This study applied mixed-method techniques to assess facilitators and barriers to research participation among transgender and gender-diverse (TGD) youth.</p><p><strong>Methods: </strong>Fifty-one TGD youth participants completed a one-time, online survey in 2024-2025 with the Pediatric Research Participation Questionnaire (PRPQ) and open-ended questions examining factors that contribute to a TGD youth's decision to participate in research. PRPQ and sociodemographic items underwent descriptive statistical analysis and qualitative analysis were applied to open-ended responses to identify consistent themes.</p><p><strong>Results: </strong>Quantitative and qualitative results revealed that participants have trust in research and are motivated to participate in research if 1) they are compensated; 2) their participation in research has the capacity to help the TGD community; and 3) the research environment is supportive, inclusive, and affirming of TGD people. Qualitatively, participants primarily described concerns with safety as the main barrier to participation in research.</p><p><strong>Conclusion: </strong>Based on the results of this study, our research team has four recommendations to improve the recruitment and retention of TGD youth in research: offer financial support and compensation, include information on how a research study will positively affect TGD youth, create an affirming and inclusive research environment throughout the entire research process, and prioritize confidentiality and data protection.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103336"},"PeriodicalIF":2.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147864747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Studies Concerning Adverse Childhood Experiences and Physical Activity in Adolescents.","authors":"Jason M Nagata, Hasan Alsamman, Zain Memon, Christiane K Helmer, Kyle T Ganson, Alexander Testa, Jinbo He, Claire D Brindis, Julia H Raney","doi":"10.1016/j.acap.2026.103338","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103338","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103338"},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent Advances in Optimizing Care for Autistic Patients in Healthcare Settings.","authors":"Holly K Harris, Carol Weitzman","doi":"10.1016/j.acap.2026.103337","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103337","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103337"},"PeriodicalIF":2.8,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Does Care Coordination Do? Profiling a Large Telephone-Based 211 Program Serving Young Children.","authors":"John A Romley, Bergen B Nelson, Rebecca N Dudovitz, Lindsey R Thompson, Sitaram Vangala, Amanda Gulsrud, Abraham Gallegos, Lorena Porras-Javier, Patricia Herrera, Irene Aceves, Paul J Chung","doi":"10.1016/j.acap.2026.103332","DOIUrl":"https://doi.org/10.1016/j.acap.2026.103332","url":null,"abstract":"<p><strong>Background and objective: </strong>Care coordination is recommended to help move patients from screening to services. However, coordination lacks a common meaning, and data on coordination activities needed for children with autism and developmental delays are limited. This could lead to unrealistic healthcare system expectations of coordination feasibility. 211 LA is a telephone-based care coordination program in Los Angeles County shown in a randomized trial to improve receipt of early intervention and developmental support services. We aimed to describe the nature, cost and effectiveness of care coordination activities during the trial.</p><p><strong>Methods: </strong>Observational retrospective cohort analysis of 211 LA's administrative database of children screened for autism and developmental delays during well-child visits and randomized into the care coordination intervention. Coordinators logged contacts, including time, method, and party. We characterized contacts, and explored the cost of coordination as well as service receipt in relation to coordination activity.</p><p><strong>Results: </strong>274 children appeared in the intervention group database. The program made 19.0 contacts per case, and engagement averaged 17.2 months. The adjusted number of contacts was 30.8 for high-risk children versus 14.2 for low risk (P<0.001). Estimated monthly cost was $65.30. Provider referrals were significantly higher for children who received services (2.4 vs. 1.9, P=0.005).</p><p><strong>Conclusions: </strong>At a telephone-based care coordination program in LA County, the amount and duration of engagement by coordinators for children with autism or developmental delays was substantial. There was a significant relationship between the number of service provider referrals and service receipt, but not for total number of contacts.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103332"},"PeriodicalIF":2.8,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147845802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childhood Experiences of Identity-Related Discrimination and Associated Health Risks in the United States, 2021-2023","authors":"Megan S. Schuler PhD ,&nbsp;Aarya Suryavanshi MS","doi":"10.1016/j.acap.2026.103315","DOIUrl":"10.1016/j.acap.2026.103315","url":null,"abstract":"<div><h3>Objective</h3><div>To estimate the prevalence of parent-reported sexual orientation and gender identity (SOGI) discrimination among US children and adolescents and examine associated demographic, health, and adversity-related characteristics.</div></div><div><h3>Methods</h3><div>We analyzed 2021 to 2023 National Survey of Children’s Health (NSCH) data, a cross-sectional, caregiver-reported survey of U.S. children. We compared sociodemographic characteristics, health conditions, adverse childhood experiences (ACEs), co-occurring discrimination, and family context by SOGI discrimination status among children ages 6 to 17. Multivariable logistic regression identified characteristics independently associated with SOGI discrimination. Analyses incorporated survey weights and were stratified by age group.</div></div><div><h3>Results</h3><div>Among 93,982 children ages 6 to 17, 2.2% were reported to have experienced SOGI-based discrimination. Relative to those without reported discrimination, they were more frequently female, older, and less likely to live in 2-parent households. They had significantly higher rates of co-occurring discrimination based on race or health status, bullying, depression, anxiety, ADHD, and learning disabilities, and their caregivers reported greater stress. ACEs—including economic hardship, parental divorce, parental incarceration, and household violence—were significantly more prevalent among those with SOGI-based discrimination. In multivariable regression, co-occurring race- and health-based discrimination, female sex, and older age showed the strongest independent associations; most ACEs and neurodevelopmental conditions did not remain significant after adjustment. Adolescents had higher rates of SOGI-based discrimination (3.5%) compared to children ages 6 to 11 (0.7%).</div></div><div><h3>Conclusions</h3><div>SOGI-based discrimination is strongly associated with co-occurring adversity and mental health concerns beginning in childhood. These findings highlight the importance of early, trauma-informed, and affirming approaches within pediatric settings.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 4","pages":"Article 103315"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147618863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mind the Gap: Adolescent/Caregiver Adverse Childhood Experience Reporting Differences and Association With Adolescent Mental Health","authors":"Tatiana Ndjatou MD ,&nbsp;Ellen J. Silver PhD ,&nbsp;Ruth E.K. Stein MD ,&nbsp;Suzette Oyeku MD, MPH ,&nbsp;Jessica Rieder MD, MS","doi":"10.1016/j.acap.2026.103286","DOIUrl":"10.1016/j.acap.2026.103286","url":null,"abstract":"<div><h3>Objective</h3><div>Adverse childhood experiences (ACEs) are associated with poor mental health outcomes, yet little is known about discrepancies between adolescent and caregiver reports of ACE exposure. This study examines differences between adolescent self-reported and caregiver-reported ACEs and evaluates how reporting discrepancies are associated with depressive and anxiety symptoms among hospitalized adolescents.</div></div><div><h3>Methods</h3><div>We recruited 250 adolescent-caregiver dyads from an inpatient adolescent unit in Bronx County, New York. Adolescents and caregivers independently completed ACE questionnaires, assessing traditional (eg, abuse, neglect) and nontraditional (eg, community violence, discrimination) ACEs experienced by the adolescent. Adolescent self-reported depression and anxiety were measured using the Patient Health Questionnaire Modified for Adolescents and Generalized Anxiety Disorder-7, respectively. Descriptive statistics and Pearson correlations were used to analyze the data.</div></div><div><h3>Results</h3><div>Adolescents reported higher mean ACE scores than caregivers for both traditional (1.66 vs 1.24, <em>P</em> &lt; .001) and nontraditional (1.36 vs 0.89, <em>P</em> &lt; .001) ACEs. Discrepancies in reporting were positively correlated with adolescent depression (<em>r</em> = 0.357, <em>P</em> &lt; .001) and anxiety (<em>r</em> = 0.241, <em>P</em> &lt; .001). Gender-diverse adolescents reported the highest ACE scores, and larger score differences were noted among Hispanic and multiracial and multiethnic dyads.</div></div><div><h3>Conclusion</h3><div>These findings highlight discrepancies between adolescent and caregiver reports of adolescent adversity and underscore the importance of adolescent self-report in clinical assessment. Future research should focus on evaluating interventions that support caregiver awareness, particularly in diverse populations.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 4","pages":"Article 103286"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147460853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental Health Diagnoses, Dispositions, and Changes Over Time of Children and Early Adolescents Presenting to Emergency Departments in the United States: A Scoping Review","authors":"Lenka Hellerova MPhil, MS, RN ,&nbsp;Arlene M. Smaldone PhD, CPNP-PC, CDCES, FAAN ,&nbsp;Jean-Marie Bruzzese PhD","doi":"10.1016/j.acap.2026.103316","DOIUrl":"10.1016/j.acap.2026.103316","url":null,"abstract":"<div><h3>Background</h3><div>More 2- to 14-year-olds are seeking crisis mental health care in emergency departments (EDs) than ever before, yet research has predominantly focused on older adolescents.</div></div><div><h3>Objectives</h3><div>Synthesize existing literature on children aged 2 to 14 years who sought mental health care in EDs in the United States, and examine their ED diagnoses, dispositions, and trends over time.</div></div><div><h3>Data Sources</h3><div>CINAHL, PubMed, PsycINFO, Web of Science</div></div><div><h3>Study Eligibility Criteria</h3><div>Conducted in the US; reported ED diagnoses, dispositions, or trends over time for youth 2.0 to 14.0 years presenting for mental health complaints.</div></div><div><h3>Study Appraisal and Synthesis Methods</h3><div>We followed the Joanna Briggs Institute and PRISMA-ScR guidelines and synthesized results within tables.</div></div><div><h3>Results</h3><div>Forty-three studies, published between 1967 and 2025, met inclusion criteria. Fifteen focused exclusively on children aged 2.0 to 14.0 years; the rest stratified findings by widely varying age groups. Over half of the studies focused on suicidality-related diagnoses, and over 70% were published since 2009. Studies show young children and early adolescents presenting to EDs with increasing volume and frequency. While most children were discharged home, admissions rose among those presenting with suicide-related thoughts and behaviors.</div></div><div><h3>Limitations</h3><div>Variation in age group stratifications impeded some further analyses. Diagnoses assigned in EDs may be inconsistent and provider dependent.</div></div><div><h3>Conclusions and Implications of Key Findings</h3><div>This review emphasizes the need for focused attention to this growing subpopulation seeking crisis care in EDs as a distinct entity separate from adolescents, while also encouraging innovative methods for equitable early identification and treatment.</div></div><div><h3>Scoping Review Registration Number</h3><div>DOI 10.17605/OSF.IO/7UMC5</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 4","pages":"Article 103316"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147640302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Path to Partnership: Improving Family Engagement Strategies in the North Carolina Integrated Care for Kids Model","authors":"Alexandra Wynn PhD ,&nbsp;Jeylan Close MD ,&nbsp;Sarah Allin MPP ,&nbsp;Ashley Saunders ,&nbsp;Eleanor Wertman MPH ,&nbsp;Chelsea Swanson MPH ,&nbsp;Richard J. Chung MD ,&nbsp;Michael J. Steiner MD, MPH ,&nbsp;Kori B. Flower MD, MS, MPH ,&nbsp;Rushina Cholera MD, PhD","doi":"10.1016/j.acap.2026.103295","DOIUrl":"10.1016/j.acap.2026.103295","url":null,"abstract":"<div><h3>Objective</h3><div>Pediatric care management has the potential to streamline care delivery across fragmented child-serving sectors, but successfully engaging families is challenging. This study aimed to understand barriers and facilitators to family engagement from the perspectives of care managers in a pediatric integrated service delivery model for children with health and social needs.</div></div><div><h3>Methods</h3><div>Three virtual focus groups were conducted with care managers from North Carolina Integrated Care for Kids (NC InCK), a federal demonstration model to integrate cross-sector care for Medicaid-enrolled children under 21 years. The focus group questions were developed using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Rapid qualitative analysis methods were used for analysis.</div></div><div><h3>Results</h3><div>Eleven care managers were included across 3 focus groups. Four themes emerged as follows: 1) Rapport Building Strategies; 2) Simplifying Program Detail and Providing Information One Step at a Time; 3) Firewalls—Barriers in Technology and Information; and 4) Retention: One and Done. Care managers identified several barriers to engaging families, including effectively communicating the program’s benefits, building trust via cold calls, and facilitating long-term retention beyond an initial encounter. They revealed that rapport-building strategies could enhance family engagement by providing tangible resources early in the engagement and offering basic needs assistance to support the whole family, such as rent assistance.</div></div><div><h3>Conclusion</h3><div>This study illuminated barriers and facilitators to the family engagement process through the lens of care managers. Our findings support evidence to inform family engagement strategies for children with multisector needs, filling a gap in the pediatric care management literature.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 4","pages":"Article 103295"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147470254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder-Informed Needs Assessment for Open Notes Curriculum in Inpatient Pediatrics","authors":"Nicholas Kuzma MD ,&nbsp;Angie Alegria DO, MPH ,&nbsp;Stephanie Berger MD ,&nbsp;Beth Harper MD ,&nbsp;Andrea Ibarra Toro MD ,&nbsp;Madeline Kieren MSS ,&nbsp;Kamakshya Patra MD ,&nbsp;Cassi Smola MD ,&nbsp;Michelle M. Kelly MD, PhD","doi":"10.1016/j.acap.2026.103302","DOIUrl":"10.1016/j.acap.2026.103302","url":null,"abstract":"<div><h3>Objective</h3><div>The 21st Century Cures Act mandates real-time patient access to clinical notes, introducing challenges in medical education, particularly in inpatient pediatrics, where issues of confidentiality, proxy access, and sensitive topics are common. Despite this shift in practice, medical students receive little formal preparation in writing notes that patients and caregivers can read, known as Open Notes. The objective of this study was to conduct a stakeholder-informed needs assessment to inform curricula for medical student documentation in inpatient pediatrics in the Open Notes era.</div></div><div><h3>Methods</h3><div>We conducted a multisite qualitative study using focus groups with key stakeholders involved in medical student documentation and supervision; third- and fourth-year medical students, Pediatrics residents, and pediatric hospital medicine fellows and faculty, across 4 US academic institutions. Transcripts were analyzed using inductive thematic analysis by a research team representing multiple levels of medical training.</div></div><div><h3>Results</h3><div>Seventy-six participants across 12 focus groups identified 4 core content domains for Open Notes curricula as follows: 1) adapting documentation for diverse audiences; 2) using respectful, patient-centered language; 3) documenting diagnostic uncertainty and differing perspectives among stakeholders; and 4) managing confidentiality and proxy access. Participants supported a longitudinal curriculum beginning prior to clerkships that is reinforced throughout clinical training, with low-stakes practice opportunities, structured feedback, institutional guidance, and use of electronic health record tools to support learning.</div></div><div><h3>Conclusions</h3><div>Medical students require intentional training to document effectively in the Open Notes era. This study provides a stakeholder-informed framework to guide the development of undergraduate medical education curricula for inpatient pediatrics documentation.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"26 4","pages":"Article 103302"},"PeriodicalIF":2.8,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147515695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}