A Battle Plan for Supporting Military Families, 2018
When the US military began combat operations in Iraq and Afghanistan in 2002, little was known ab... more When the US military began combat operations in Iraq and Afghanistan in 2002, little was known about how military children and families would be affected by combat-related service in an era of prolonged war. The ability of clinicians, policymakers, community service providers, commanders, and researchers to meet the needs of military children was limited by outdated research, inappropriate comparison groups, uneven systems of care, and a lack of evidence-based practices to guide intervention. Fortunately, strategic partnerships grew out of the collaborative efforts of academics, practitioners, and military leadership united in a common mission to support military children and families. This chapter describes the historical context of research on military children and families, identifying challenges to conducting high-quality research, and delineating best practices for scholarship. The following research-related lessons learned are highlighted: understanding and respecting military family culture, building trust within the community, fostering lasting relationships within the community, building collaborative multidisciplinary academic research teams, and sustaining a scientific military family program of research. Recommendations and future directions for researchers, military leaders, policymakers, and funders are also discussed.
Among the various factors influencing child behavioral and developmental outcomes, parental funct... more Among the various factors influencing child behavioral and developmental outcomes, parental functioning, parent-child relationships, and the home environment have consistently emerged as important variables. Being raised in a family where one or both parents experience mental health problems, particularly depression, can result in detrimental cognitive, social-emotional, and behavioral outcomes in their children. Although genetic factors certainly contribute to this relationship, environmental factors also contribute substantially. Most research has looked at maternal depression, with little attention on paternal depression. Additionally, although parent-child influences are bidirectional and having a child with special needs or a difficult temperament affects the emotional functioning of the parent, it is believed that parental functioning more strongly influences child behavior and development than vice versa. Therefore, this article primarily focuses on the effects of maternal versus paternal depression upon the child, and the environmental factors that mediate this association, specifically, the quality of the parent-child relationship and the quality of the home environment. In order to understand the effects of maternal depression on children, it is first important to review adult depression in general. ABOUT THE AUTHORS Patti L. Johnson, PhD, is Director, Pediatric Psychology Fellowship Program, Madigan Army Medical Center, Tacoma, Washington. Eric M Flake, MD, is Major, Medical Corps, U.S. Air Force, and Developmental and Behavioral Pediatrics Fellow, Madigan Army Medical Center. Address correspondence to: Patti L. Johnson, PhD, Madigan Army Medical Center, Attention: MCHJ-P, Tacoma WA 98431; or email: [email protected]. Dr. Johnson and Dr. Flake have disclosed no relevant financial relationships. The opinions and views expressed herein are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States government. EDUCATIONAL OBJECTIVES Explain how maternal depression affects the parent-child relationship. Describe at least one characteristic of maternal depression in infants, toddlers/preschoolers, school-age children, and adolescents. Recommend at least one office-based technique to screen at-risk families, as well an intervention to use with identified families.
Background: Patients with neurodevelopmental disorders are not always provided the quality of med... more Background: Patients with neurodevelopmental disorders are not always provided the quality of medical care they deserve. Medical personnel report limited preparation and education in caring for patients with neurodevelopmental disorders. Aim: The purpose of this systematic review is to summarize the research on medical personnel training programs, identify effective training methods, and provide directions for future application and research. Methods: Thirty-four studies met inclusion criteria. The studies were summarized in terms of training components, the medical personnel trained, and the effectiveness of the training in achieving target outcomes. Results: Seventy-nine percent of studies demonstrated improvement in target outcomes. A variety of training components were used in combination throughout the studies, demonstrating a possibility of significant change to medical personnel's abilities for and attitudes about working with patients with neurodevelopmental disorders. Conclusion: Further research is needed to determine specifically which types of training can affect which target outcomes.
Introduction: This study aims to describe the quantity and satisfaction current residents and exp... more Introduction: This study aims to describe the quantity and satisfaction current residents and experienced pediatricians have with graduate medical education on transitioning medically complex patients to adult care. There is an increasing need for transitioning medically complex adolescents to adult care. Over 90% now live into adulthood and require transition to adult healthcare providers. The 2010 National Survey of Children with Special Health Care Needs found that only 40% of youth 12-17 yr receive the necessary services to appropriately transition to adult care. Materials and Methods: Prospective, descriptive, anonymous, web-based survey of pediatric residents and staff pediatricians at Army pediatric residency training programs was sent in March 2017. Questions focused on assessing knowledge of transition of care, satisfaction with transition training, and amount of education on transition received during graduate medical education training. Results: Of the 145 responders (310 potential responders, 47% response rate), transition was deemed important with a score of 4.3 out of 5. The comfort level with transition was rated 2.6/5 with only 4.2% of participants receiving formal education during residency. The most commonly perceived barriers to implementing a curriculum were time constraints and available resources. Of the five knowledge assessment questions, three had a correct response rate of less than 1/3. Conclusions: The findings show the disparity between the presence of and perceived need for a formal curriculum on transitioning complex pediatric patients to adult care. This study also highlighted the knowledge gap of the transition process for novice and experienced pediatricians alike. IMPLICATIONS AND CONTRIBUTION This study describes the quantity and satisfaction residents and experienced pediatricians have with graduate medical education (GME) training on transitioning medically complex patients to adult care. Additionally, perceived barriers were assessed which is a starting point for developing a formal curriculum.
Journal of Developmental & Behavioral Pediatrics
: Objective: Pediatricians feel inadequately prepared to diagnose and manage autism spectrum diso... more : Objective: Pediatricians feel inadequately prepared to diagnose and manage autism spectrum disorders (ASDs). We developed a curriculum that trains pediatric residents in the Screening Tool for Autism in Toddlers and Young Children (STAT), a tool used to diagnose ASD, and assessed its impact. Methods: Pediatric residents completed training in the STAT that included interactive video and practice-based elements. Residents completed pretraining and posttraining surveys assessing comfort with diagnosing and treating ASD, knowledge-based pretests and posttests, posttraining interviews, and follow-up assessments at 6 and 12 months after training. Results: Thirty-two residents completed the training. Posttest scores significantly increased [M (SD) 9.8 (2.4) vs 11.7 (2), p < 0.0001]. Knowledge gains were not maintained at 6-month follow-up. Residents reported increased comfort with several ASD management methods and an increased likelihood of using the STAT. More residents reported using the STAT at follow-up: 2 of 29 before training, 5 of 11 at 6 months, and 3 of 13 at 12 months. We identified 4 themes in interview responses: (1) increased sense of empowerment in managing patients with ASD but ongoing reluctance to make a formal diagnosis, (2) logistical barriers affected successful implementation of the STAT, (3) access to developmental pediatricians played an essential role in comfort levels, and (4) the main educational value of the STAT training came from interactive components. Conclusion: An ASD curriculum including training in the STAT increased resident knowledge and comfort in diagnosing and managing ASD. Although logistical barriers continue to affect the ability of general pediatricians to diagnose ASD, use of this curriculum has potential to improve long-term outcomes.
Introduction Military families face many unique challenges, including frequent separations, deman... more Introduction Military families face many unique challenges, including frequent separations, demanding work hours, and relocations. The HealthySteps (HS) program may offset these challenges utilizing the expertise of a nonclinical child development specialist called a HS specialist who offers enhanced well-child visits (WCVs), support between visits, and connections to community resources. Our study sought to identify the impact of the military HS pilot program on the timeliness of WCVs, immunizations, routine behavioral and developmental screenings, and referrals to community resources within the first 15 months of life (MOL). Materials and Methods We retrospectively reviewed charts of 26 HS-enrolled and 26 randomly selected age-matched non-HS–enrolled children from age 2 to 15 MOL. Demographic variables obtained include child’s gender, child’s birth order, mother’s age, active duty parent’s rank classification, and active duty parent’s gender. We examined five outcomes measures ali...
Demographic factors, social determinants of health, and other related factors that have been stud... more Demographic factors, social determinants of health, and other related factors that have been studied to date in families with a child with autism spectrum disorder (ASD) include parents' pre-existing history of mental health problems, socioeconomic status, ethnicity, educational level of the parent or parents, gender of parent, marital status of parent, degree of child's social relatedness, functional impairments of the child, severity of ASD symptoms, presence of other emotional and behavioral problems and neurodevelopmental diagnoses, degree of self-regulation skills for the child with ASD, and presence of a social support system for parents (
A Battle Plan for Supporting Military Families, 2018
When the US military began combat operations in Iraq and Afghanistan in 2002, little was known ab... more When the US military began combat operations in Iraq and Afghanistan in 2002, little was known about how military children and families would be affected by combat-related service in an era of prolonged war. The ability of clinicians, policymakers, community service providers, commanders, and researchers to meet the needs of military children was limited by outdated research, inappropriate comparison groups, uneven systems of care, and a lack of evidence-based practices to guide intervention. Fortunately, strategic partnerships grew out of the collaborative efforts of academics, practitioners, and military leadership united in a common mission to support military children and families. This chapter describes the historical context of research on military children and families, identifying challenges to conducting high-quality research, and delineating best practices for scholarship. The following research-related lessons learned are highlighted: understanding and respecting military family culture, building trust within the community, fostering lasting relationships within the community, building collaborative multidisciplinary academic research teams, and sustaining a scientific military family program of research. Recommendations and future directions for researchers, military leaders, policymakers, and funders are also discussed.
Among the various factors influencing child behavioral and developmental outcomes, parental funct... more Among the various factors influencing child behavioral and developmental outcomes, parental functioning, parent-child relationships, and the home environment have consistently emerged as important variables. Being raised in a family where one or both parents experience mental health problems, particularly depression, can result in detrimental cognitive, social-emotional, and behavioral outcomes in their children. Although genetic factors certainly contribute to this relationship, environmental factors also contribute substantially. Most research has looked at maternal depression, with little attention on paternal depression. Additionally, although parent-child influences are bidirectional and having a child with special needs or a difficult temperament affects the emotional functioning of the parent, it is believed that parental functioning more strongly influences child behavior and development than vice versa. Therefore, this article primarily focuses on the effects of maternal versus paternal depression upon the child, and the environmental factors that mediate this association, specifically, the quality of the parent-child relationship and the quality of the home environment. In order to understand the effects of maternal depression on children, it is first important to review adult depression in general. ABOUT THE AUTHORS Patti L. Johnson, PhD, is Director, Pediatric Psychology Fellowship Program, Madigan Army Medical Center, Tacoma, Washington. Eric M Flake, MD, is Major, Medical Corps, U.S. Air Force, and Developmental and Behavioral Pediatrics Fellow, Madigan Army Medical Center. Address correspondence to: Patti L. Johnson, PhD, Madigan Army Medical Center, Attention: MCHJ-P, Tacoma WA 98431; or email: [email protected]. Dr. Johnson and Dr. Flake have disclosed no relevant financial relationships. The opinions and views expressed herein are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the United States government. EDUCATIONAL OBJECTIVES Explain how maternal depression affects the parent-child relationship. Describe at least one characteristic of maternal depression in infants, toddlers/preschoolers, school-age children, and adolescents. Recommend at least one office-based technique to screen at-risk families, as well an intervention to use with identified families.
Background: Patients with neurodevelopmental disorders are not always provided the quality of med... more Background: Patients with neurodevelopmental disorders are not always provided the quality of medical care they deserve. Medical personnel report limited preparation and education in caring for patients with neurodevelopmental disorders. Aim: The purpose of this systematic review is to summarize the research on medical personnel training programs, identify effective training methods, and provide directions for future application and research. Methods: Thirty-four studies met inclusion criteria. The studies were summarized in terms of training components, the medical personnel trained, and the effectiveness of the training in achieving target outcomes. Results: Seventy-nine percent of studies demonstrated improvement in target outcomes. A variety of training components were used in combination throughout the studies, demonstrating a possibility of significant change to medical personnel's abilities for and attitudes about working with patients with neurodevelopmental disorders. Conclusion: Further research is needed to determine specifically which types of training can affect which target outcomes.
Introduction: This study aims to describe the quantity and satisfaction current residents and exp... more Introduction: This study aims to describe the quantity and satisfaction current residents and experienced pediatricians have with graduate medical education on transitioning medically complex patients to adult care. There is an increasing need for transitioning medically complex adolescents to adult care. Over 90% now live into adulthood and require transition to adult healthcare providers. The 2010 National Survey of Children with Special Health Care Needs found that only 40% of youth 12-17 yr receive the necessary services to appropriately transition to adult care. Materials and Methods: Prospective, descriptive, anonymous, web-based survey of pediatric residents and staff pediatricians at Army pediatric residency training programs was sent in March 2017. Questions focused on assessing knowledge of transition of care, satisfaction with transition training, and amount of education on transition received during graduate medical education training. Results: Of the 145 responders (310 potential responders, 47% response rate), transition was deemed important with a score of 4.3 out of 5. The comfort level with transition was rated 2.6/5 with only 4.2% of participants receiving formal education during residency. The most commonly perceived barriers to implementing a curriculum were time constraints and available resources. Of the five knowledge assessment questions, three had a correct response rate of less than 1/3. Conclusions: The findings show the disparity between the presence of and perceived need for a formal curriculum on transitioning complex pediatric patients to adult care. This study also highlighted the knowledge gap of the transition process for novice and experienced pediatricians alike. IMPLICATIONS AND CONTRIBUTION This study describes the quantity and satisfaction residents and experienced pediatricians have with graduate medical education (GME) training on transitioning medically complex patients to adult care. Additionally, perceived barriers were assessed which is a starting point for developing a formal curriculum.
Journal of Developmental & Behavioral Pediatrics
: Objective: Pediatricians feel inadequately prepared to diagnose and manage autism spectrum diso... more : Objective: Pediatricians feel inadequately prepared to diagnose and manage autism spectrum disorders (ASDs). We developed a curriculum that trains pediatric residents in the Screening Tool for Autism in Toddlers and Young Children (STAT), a tool used to diagnose ASD, and assessed its impact. Methods: Pediatric residents completed training in the STAT that included interactive video and practice-based elements. Residents completed pretraining and posttraining surveys assessing comfort with diagnosing and treating ASD, knowledge-based pretests and posttests, posttraining interviews, and follow-up assessments at 6 and 12 months after training. Results: Thirty-two residents completed the training. Posttest scores significantly increased [M (SD) 9.8 (2.4) vs 11.7 (2), p < 0.0001]. Knowledge gains were not maintained at 6-month follow-up. Residents reported increased comfort with several ASD management methods and an increased likelihood of using the STAT. More residents reported using the STAT at follow-up: 2 of 29 before training, 5 of 11 at 6 months, and 3 of 13 at 12 months. We identified 4 themes in interview responses: (1) increased sense of empowerment in managing patients with ASD but ongoing reluctance to make a formal diagnosis, (2) logistical barriers affected successful implementation of the STAT, (3) access to developmental pediatricians played an essential role in comfort levels, and (4) the main educational value of the STAT training came from interactive components. Conclusion: An ASD curriculum including training in the STAT increased resident knowledge and comfort in diagnosing and managing ASD. Although logistical barriers continue to affect the ability of general pediatricians to diagnose ASD, use of this curriculum has potential to improve long-term outcomes.
Introduction Military families face many unique challenges, including frequent separations, deman... more Introduction Military families face many unique challenges, including frequent separations, demanding work hours, and relocations. The HealthySteps (HS) program may offset these challenges utilizing the expertise of a nonclinical child development specialist called a HS specialist who offers enhanced well-child visits (WCVs), support between visits, and connections to community resources. Our study sought to identify the impact of the military HS pilot program on the timeliness of WCVs, immunizations, routine behavioral and developmental screenings, and referrals to community resources within the first 15 months of life (MOL). Materials and Methods We retrospectively reviewed charts of 26 HS-enrolled and 26 randomly selected age-matched non-HS–enrolled children from age 2 to 15 MOL. Demographic variables obtained include child’s gender, child’s birth order, mother’s age, active duty parent’s rank classification, and active duty parent’s gender. We examined five outcomes measures ali...
Demographic factors, social determinants of health, and other related factors that have been stud... more Demographic factors, social determinants of health, and other related factors that have been studied to date in families with a child with autism spectrum disorder (ASD) include parents' pre-existing history of mental health problems, socioeconomic status, ethnicity, educational level of the parent or parents, gender of parent, marital status of parent, degree of child's social relatedness, functional impairments of the child, severity of ASD symptoms, presence of other emotional and behavioral problems and neurodevelopmental diagnoses, degree of self-regulation skills for the child with ASD, and presence of a social support system for parents (
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