Mikelle Key-Solle MD , Bryan Monroe MD , On Behalf of the Association of Pediatric Program Directors Faculty and Professional Development Task Force
{"title":"Facilitating Reflection: Clinical Debriefing","authors":"Mikelle Key-Solle MD , Bryan Monroe MD , On Behalf of the Association of Pediatric Program Directors Faculty and Professional Development Task Force","doi":"10.1016/j.acap.2025.102861","DOIUrl":"10.1016/j.acap.2025.102861","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102861"},"PeriodicalIF":3.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192477","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}
Natalie Grafft PhD , Kirsten K. Davison PhD , Catherine Taylor PhD , Karen S. Lyons PhD , Rebekah Levine Coley PhD
{"title":"Fathers’ Adverse Childhood Experiences, Behavioral Health, and Fathering Stress and Satisfaction","authors":"Natalie Grafft PhD , Kirsten K. Davison PhD , Catherine Taylor PhD , Karen S. Lyons PhD , Rebekah Levine Coley PhD","doi":"10.1016/j.acap.2025.102860","DOIUrl":"10.1016/j.acap.2025.102860","url":null,"abstract":"<div><h3>Objective</h3><div>Using a nationally representative sample, this study examined associations between fathers’ adverse childhood experiences (ACEs) and fathering and whether fathers’ behavioral health mediated this association.</div></div><div><h3>Methods</h3><div>Data from 4814 fathers who were followed from adolescence through early adulthood in the National Longitudinal Study of Adolescent to Adult Health. On average, fathers were 33 years old and self-identified as non-Hispanic White (64%), followed by non-Hispanic Black (17%) or Hispanic (12%). Fathers self-reported on 13 ACEs during waves 1 to 4 and 2 measures of behavioral health (depressive symptoms and alcohol consumption) and fathering (stress and satisfaction), assessed at wave 4 or 5. A multiple mediation model was estimated using a structural equation model to examine direct and indirect pathways between fathers’ ACEs and fathering, through behavioral health.</div></div><div><h3>Results</h3><div>There was a significant direct effect of ACEs on fathering satisfaction (<em>B</em> = −0.04, standard error (SE) = 0.02, <em>P</em> < .01), as well as a significant indirect effect through fathers’ depressive symptoms (<em>B</em> = −0.04, SE = 0.01, <em>P</em> < .001), resulting in a total effect of −0.08 (SE = 0.02, <em>P</em> < .001). Fathers’ ACEs were also linked to heavy drinking (<em>B</em> = 0.01, SE = 0.00, <em>P</em> < .05). ACEs were not associated with fathering stress.</div></div><div><h3>Conclusions</h3><div>Findings indicate the importance of reaching and engaging ACE-exposed fathers in behavioral health and parenting interventions. Given that health promotion in fathers has benefits for their children, leveraging pediatric encounters to identify at-risk fathers has the potential to improve both fathers’ and children’s health.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 7","pages":"Article 102860"},"PeriodicalIF":3.0,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192478","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 Day I Almost Lost My Son","authors":"Chana Richter MD, MEd","doi":"10.1016/j.acap.2025.102862","DOIUrl":"10.1016/j.acap.2025.102862","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 7","pages":"Article 102862"},"PeriodicalIF":3.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144163672","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}
Clara B. Barajas MPH , Dylan H. Roby PhD , Jim P. Stimpson PhD , Ninez A. Ponce PhD , Gabriela E. Lazalde PhD , Maria-Elena De Trinidad Young PhD , Kathryn Kietzman PhD , Arturo Vargas Bustamante PhD , Alexandra C. Rivera-González PhD , Brent A. Langellier PhD , Jan M. Eberth PhD , Mark Stehr PhD , Alexander N. Ortega PhD
{"title":"Equity in Health Care Access, Utilization, and Experiences for Latino Children in California by Parental Citizenship and Household Language, 2021–22","authors":"Clara B. Barajas MPH , Dylan H. Roby PhD , Jim P. Stimpson PhD , Ninez A. Ponce PhD , Gabriela E. Lazalde PhD , Maria-Elena De Trinidad Young PhD , Kathryn Kietzman PhD , Arturo Vargas Bustamante PhD , Alexandra C. Rivera-González PhD , Brent A. Langellier PhD , Jan M. Eberth PhD , Mark Stehr PhD , Alexander N. Ortega PhD","doi":"10.1016/j.acap.2025.102856","DOIUrl":"10.1016/j.acap.2025.102856","url":null,"abstract":"<div><h3>Objective</h3><div>This study examines health care access, utilization, and experiences among Latino children in California by parental citizenship and household language.</div></div><div><h3>Methods</h3><div>Merged data from the 2021–22 California Health Interview Survey and the follow-up Latino Youth Health Study of the same years were analyzed. Primary outcomes were parental reports of children’s health care access, utilization, and experiences in the past year. The main predictors were variables stratified by parental citizenship status (both citizen parents vs 1 citizen and 1 noncitizen parent or both noncitizen parents) and household language (English-only vs English-and-Spanish, or Spanish-only). Multivariable analyses were adjusted for parental education, family income, parent-reported child’s health status, child’s age, and child’s insurance.</div></div><div><h3>Results</h3><div>Findings showed no significant differences in health care access across groups. However, children with both noncitizen parents and from Spanish-only households were more likely to have had well-child visits and general doctor visits than children with both citizen parents and in English-only households. Additionally, parents of children with both noncitizen parents were more likely to feel respected by doctors than those with both citizen parents. Conversely, compared to parents with both citizen parents, parents of children with 1 citizen and 1 noncitizen parent were less likely to report that doctors spent enough time with their children and less likely to express high satisfaction with their children’s health care.</div></div><div><h3>Conclusions</h3><div>Patterns of health care access, utilization, and experiences among Latino children in immigrant families in California are improving, which are likely associated with recent inclusive health policies in the state.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102856"},"PeriodicalIF":3.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144324","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}
Rachel Herbst PhD , Andrea Meisman MA , Francis J. Real MD, MEd
{"title":"The Current State of Behavioral Health Training for Pediatric Residents","authors":"Rachel Herbst PhD , Andrea Meisman MA , Francis J. Real MD, MEd","doi":"10.1016/j.acap.2025.102859","DOIUrl":"10.1016/j.acap.2025.102859","url":null,"abstract":"","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102859"},"PeriodicalIF":3.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144340","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}
Matthew S. Pantell MD, MS , David M. Mosen PhD, MPH , Nathan Tran BS , Laura M. Gottlieb MD, MPH , Matthew P. Banegas PhD, MPH, MS
{"title":"Differences Between Individual Social Risks, Social Needs, and Community-Level Social Risk Among Pediatric Patients","authors":"Matthew S. Pantell MD, MS , David M. Mosen PhD, MPH , Nathan Tran BS , Laura M. Gottlieb MD, MPH , Matthew P. Banegas PhD, MPH, MS","doi":"10.1016/j.acap.2025.102851","DOIUrl":"10.1016/j.acap.2025.102851","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to explore relationships between community-level social determinants/drivers of health (SDOH), individual-level social risk factors, and individual-level social needs—whether families desire help addressing social risk factors—among children’s families in a large, diverse patient population in the Pacific Northwest.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study of children ages 0 to 18 who received care at Kaiser Permanente Northwest, an integrated health care system serving patients in Oregon and Southwest Washington, between December 1, 2017 and December 31, 2019. Social data came from the Your Current Life Situation survey as recorded in patient electronic medical records and included information on housing instability, food insecurity, transportation needs, and financial hardships. We used chi-square tests to compare rates of social risks, social needs, and Neighborhood Deprivation Index (NDI) quartiles.</div></div><div><h3>Results</h3><div>The sample included 2313 children. Among the 59.6% of families endorsing at least 1 social risk, 66.9% desired assistance addressing at least 1 social need. Both individual-level social risks and social needs varied significantly by NDI quartile, with the highest social risk and social needs rates being in the highest NDI quartiles (most social disadvantage). However, among families in the lowest NDI quartile (most social advantage), 42.1% of families endorsed at least 1 risk and 23.3% of families endorsed at least 1 social need.</div></div><div><h3>Conclusions</h3><div>In a diverse sample of pediatric patients, we found that a community-level SDOH index inadequately identified families endorsing social risks and social needs. Our findings support policies that incentivize individual-level social risk and social need data collection in clinical settings.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 7","pages":"Article 102851"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121179","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}
Naveed Rabbani MD , Margaret Fry MD , Louis Vernacchio MD, MSc , Emily Trudell Correa MPH, MS , Susannah Kisvarday MD , Jonathan Hatoun MD, MPH, MS , Michael Day MD , Mark E. Alexander MD
{"title":"Implementing Sudden Cardiac Death Risk Screening Within a Pediatric Primary Care Network","authors":"Naveed Rabbani MD , Margaret Fry MD , Louis Vernacchio MD, MSc , Emily Trudell Correa MPH, MS , Susannah Kisvarday MD , Jonathan Hatoun MD, MPH, MS , Michael Day MD , Mark E. Alexander MD","doi":"10.1016/j.acap.2025.102850","DOIUrl":"10.1016/j.acap.2025.102850","url":null,"abstract":"<div><h3>Objective</h3><div>In 2021, the American Academy of Pediatrics (AAP) recommended universal, history-based sudden cardiac death risk screening, representing an expansion from history- and exam-based screening for sports preparticipation. We studied the implementation of universal cardiac risk screening within a large pediatric primary care network to better understand optimal workflow design, screening positivity rate, and potential system-based effects that may arise from expanded screening.</div></div><div><h3>Methods</h3><div>We adapted the AAP guidelines to a 3-question screener implemented into the electronic health record as a patient portal questionnaire with a back-up paper-based workflow. A noninterruptive alert provided clinical decision support. Screening positivity rates and rates of follow-up actions were measured. Screening rates were compared across patient demographics using a multivariable model.</div></div><div><h3>Results</h3><div>Between March 1, 2024, and February 28, 2025, of 72,037 eligible patients, 41,433 (58%) were screened. Of these, 3463 (8.4%) had a clinically actionable positive screen. Follow-up evaluation was ordered in 31% of cases. A multivariable model demonstrated that inactive patient portal status, teenage patient age, patient race of “Unknown,” and public insurance were associated with lower screening rates.</div></div><div><h3>Conclusions</h3><div>Implementing universal history-based sudden cardiac death risk screening in a pediatric primary care network exhibited an 8.4% positivity rate after clinician review, representing a large potential burden of cardiology referrals. Over half of eligible patients were screened, and follow-up evaluation was ordered in a minority of positive cases, signaling a gap in adoption/adherence. This implementation was associated with lower screening rates in certain disadvantaged populations.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102850"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121227","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}
Marina Masciale MD, MPH , Todd Leroux PhD, MHPA , Karla Fredricks MD, MPH , Jean L. Raphael MD, MPH , Claire Bocchini MD, MS , Hye-Chung Kum PhD , Michelle A. Lopez MD, MPH
{"title":"Health Care Use by Immigrant Generation in Low-Income Children With Special Health Care Needs","authors":"Marina Masciale MD, MPH , Todd Leroux PhD, MHPA , Karla Fredricks MD, MPH , Jean L. Raphael MD, MPH , Claire Bocchini MD, MS , Hye-Chung Kum PhD , Michelle A. Lopez MD, MPH","doi":"10.1016/j.acap.2025.102852","DOIUrl":"10.1016/j.acap.2025.102852","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to describe social stressors and health care access in children with special health care needs (CSHCN) from low-income households by immigrant generation and determine the association between immigrant generation and health care utilization.</div></div><div><h3>Methods</h3><div>This was a retrospective cross-sectional study of CSHCN living at or below 200% of the federal poverty level using the National Survey of Children’s Health from 2018 to 2022. Exposures were demographics, immigrant generation (first-generation, second-generation, or nonimmigrant), social stressors, and health care factors. Outcomes were 1) one or more emergency room (ER) visits and 2) one or more hospitalizations in the past year. We compared variables across generations using chi-square testing and assessed factors associated with our outcomes using logistic regression.</div></div><div><h3>Results</h3><div>We included 16,679 CSHCN (293 first-generation, 2203 second-generation, 14,183 nonimmigrants). Compared to second-generation and nonimmigrants, more parents of first-generation CSHCN identified as Hispanic, lived in non-English speaking households, reduced work hours due to their child’s health, reported poor child health, lacked insurance for their child, and lacked a medical home for their child. ER visits and hospitalization rates were similar across all 3 generation groups. When controlling for covariates, immigrant generation was not associated with ER visits or hospitalizations.</div></div><div><h3>Conclusions</h3><div>Despite having poorer health status and less access to medical homes compared to nonimmigrants, CSHCN from immigrant families do not utilize the ER more often, which is potentially concerning for underutilization. Addressing social drivers of health in immigrant families and expanding public health insurance eligibility to all low-income CSHCN, regardless of immigration status, may ensure appropriate ER use.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102852"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121253","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}
Jaime W. Peterson MD, MPH , Veronica Ilene Underwood Carrasco BA , Maya Postigo BA , Alejandro Robles BS, BA , Nelda Reyes MA , Ellen Stevenson MD, MPH , Katharine E. Zuckerman MD, MPH
{"title":"The Latino School Readiness Gap: Engaging Families in Design Thinking for Primary Care Interventions","authors":"Jaime W. Peterson MD, MPH , Veronica Ilene Underwood Carrasco BA , Maya Postigo BA , Alejandro Robles BS, BA , Nelda Reyes MA , Ellen Stevenson MD, MPH , Katharine E. Zuckerman MD, MPH","doi":"10.1016/j.acap.2025.102849","DOIUrl":"10.1016/j.acap.2025.102849","url":null,"abstract":"<div><h3>Objective</h3><div>Among Latino families with a recent kindergartener, we 1) qualitatively explored school readiness (SR) journeys and 2) used design thinking to understand their preferences, usability, and acceptability of primary care–based SR interventions (checklist, coordinator, coaching, texting, preschool, library referrals, parenting groups, and Reach out and Read).</div></div><div><h3>Methods</h3><div>Focus groups and interviews were completed at 4 Oregon pediatric clinics over 2 sessions: 1) narrative inquiry of SR stories through journey maps and 2) SR intervention assessment through design thinking. Sessions were led by an English/Spanish bilingual-bicultural facilitator, recorded, and transcribed. Iterative team–based coding with inductive analysis was conducted in the source language.</div></div><div><h3>Results</h3><div>Participants (N = 33) were primarily Spanish-speaking (58%) mothers (76%) born in Mexico (64%) with at least a high school degree (69%), with US-born children (55%) who attended preschool (81%). Journey maps revealed a positive educational foundation of teaching values, culture, and language for kindergarten preparation, with strong beliefs that school will teach life skills. Compared to English-speaking parents, Spanish-speaking parents focused more on social-emotional development than specific early literacy or math activities, reporting less confidence in teaching cognitive skills. Parents identified a longitudinal model with SR interventions at multiple points. Themes regarding targeted SR support, hesitancy to request help, and bilingualism were integrated into a prior framework to promote SR (Figure).</div></div><div><h3>Conclusions</h3><div>Participating families encouraged school success in their children before kindergarten and focused on social-emotional, cultural, and linguistic development. Caregivers identified a variety of acceptable and feasible clinic–based SR interventions that build on Latino families’ social strengths.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102849"},"PeriodicalIF":3.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121230","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}
Taylor A. Merritt MD , Sanjna Bhatia BS , Courtney Solomon MD , Andrew Yu MD
{"title":"Heat-Related Illness Trends at a Pediatric Health Care System, 2012 to 2023","authors":"Taylor A. Merritt MD , Sanjna Bhatia BS , Courtney Solomon MD , Andrew Yu MD","doi":"10.1016/j.acap.2025.102855","DOIUrl":"10.1016/j.acap.2025.102855","url":null,"abstract":"<div><div>As extreme summer temperatures become more frequent due to a changing climate, there is an increased risk of heat-related morbidity and mortality, particularly in vulnerable populations such as children. We aimed to examine trends in heat-related illness over time and describe differences in patient characteristics and outcomes for children with “heat-specific” diagnoses compared to rhabdomyolysis, a severe form of heat-related illness. We conducted a retrospective study at a pediatric health care system with 2 large children’s hospitals to identify emergency department (ED) encounters with a heat-related ED diagnosis from May to September from 2012 to 2023. Aggregate heat-related illness encounters, as a proportion of total ED encounters, increased 170% from 2012 (4.3 per 10,000) to 2023 (11.6 per 10,000) (<em>P</em> = .01). Summer months with higher peak temperatures had higher heat-related ED volume (R<sup>2</sup> = 0.44, <em>P</em> < .001). Most heat-specific encounters resulted in ED discharge (96%), while most rhabdomyolysis encounters resulted in admission (63%). We found that ED volume for heat-related illness is associated with higher temperature and is increasing over time. Heat-specific diagnoses are more common than rhabdomyolysis. Given the rise in health care utilization from heat-related illness, it is essential for all pediatricians to understand the health implications of our changing climate.</div></div>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":"25 6","pages":"Article 102855"},"PeriodicalIF":3.0,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103059","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}