Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html.
October 19, 2007
1. Issue Brief
Examines Efforts to Ensure that Children Receive Mandated Oral Health
Services
2. Electronic Resource Updates State Action on HPV
Vaccine
3. Authors Define a Community-Based System of Services
for CYSHCN and Their Families
4. Study Investigates Predictors of Initiation of Alcohol
Use Among Adolescents
5. Article Assesses Quality of Ambulatory Care Delivered
to Children in the United States
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1. ISSUE BRIEF EXAMINES EFFORTS TO ENSURE THAT CHILDREN RECEIVE
MANDATED ORAL HEALTH SERVICES
Assuring Comprehensive Dental Services in Medicaid and Head Start
Programs: Planning and Implementation Considerations addresses efforts
to improve access to required oral health services for children
enrolled in Medicaid and Head Start. The issue brief, published by the
National Oral Health Policy Center, focuses on models or arrangements
that include a limited set of services -- usually oral health screening
and/or prevention services -- often provided by non-dentists outside of
"traditional" oral health care delivery settings. The authors present
and discuss (1) the relationships between the models and federal
regulations and policies requiring comprehensive oral health services,
(2) the potential for unintentional or undesirable consequences, and
(3) approaches for ameliorating adverse consequences and securing
access for children to a full range of oral health services. Topics
include dental caries prevalence, distribution, and consequences in
preschool children; access to oral health services; Medicaid program
purpose, scope of services, and Early and Periodic Screening,
Diagnostic and Treatment (EPSDT) requirements for oral health services;
strategies for improving referrals and access to comprehensive EPSDT
oral health services; unintended and undesirable consequences of
alternative models; and the dental home. A summary of federal
regulations and policies affecting alternative dental practice models
and conclusions are provided. The brief is available at http://www.healthychild.ucla.edu/nohpc/National%20Oral%20Health%20Policy%20Center/OralCenterPubs/Dental_Services_in_Medicaid_&_Head_Start.pdf.
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2. ELECTRONIC RESOURCE UPDATES STATE ACTION ON HPV VACCINE
HPV Vaccine Legislation 2007 presents information on the June 2006
recommendation by the national Advisory Committee on Immunization
Practices (ACIP) for routine vaccination against Human Papillomavirus
(HPV) for girls ages 11-12, as well as on state activity to require,
fund, or educate the public about the HPV vaccine. The electronic
resource, produced by the National Conference of State Legislatures
(NCSL), addresses key issues such as school vaccine requirements and
financing. A table provides a state-by-state summary of 2007
legislation introduced to date. Related resources from NCSL, the
Centers for Disease Control and Prevention, the Journal of the American
Medical Association, and the Kaiser Family Foundation are included. The
electronic resource is available at http://www.ncsl.org/programs/health/HPVvaccine.htm.
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3. AUTHORS DEFINE A COMMUNITY-BASED SYSTEM OF SERVICES FOR CYSHCN AND
THEIR FAMILIES
"The definition of a system of service[s] presented here is intended to
provide a basis for discussion among policy makers, practitioners,
state programs, researchers, and families as they move toward
operationalizing a definition of the 'community-based systems of
services' contained in Title V of the Social Security Act," state the
authors of an article published in the October 2007 issue of Archives of Pediatrics
and Adolescent Medicine. Numerous demonstrations have examined the feasibility,
financing, and effects of various ways of organizing services for children and
youth with special health care needs (CYSHCN). Although these efforts have strengthened
the knowledge base regarding the organization of services, they have not led
to a systematic effort to put into place a universal, equitable, and
sustainable system that adequately meets the needs of CYSHCN. The
article presents and discusses efforts to develop consensus on defining
a system of services that will foster progress toward this goal.
Using MEDLINE, the researchers conducted a search for articles on
systems of services for children with chronic health and mental health
conditions published in key journals in child health, maternal and
child health, child mental health, and education within the past 10
years. A draft definition was developed, and a consensus conference was
convened to involve parent group representatives, health economists,
state and federal program managers, public health experts, and
pediatric clinicians in reviewing and revising the definition.
A system of services for CYSHCN was defined as "a family-centered
coordinated network of community-based services designed to promote the
healthy development and well-being of children and their families."
"Building on the efforts of MCHB [the Maternal and Child Health Bureau]
to develop measures of elements of services needed by CYSHCN, this new
definition of a system of services provides opportunities to broaden
measurement and accountability across the system of services," the
authors conclude.
Additional information on underlying principles, some implementation
issues, and topics relating to measuring or assessing the system of
services is provided.
Perrin JM, Romm D, Bloom SR, et al. 2007. A family-centered,
community-based system of services for children and youth with special
health care needs. Archives of Pediatrics and Adolescent Medicine
161(10):933-936. Abstract available at http://archpedi.ama-assn.org/cgi/content/abstract/161/10/933?etoc.
Readers: More information is available from the following MCH Library
resources:
- Children and Adolescents with Special Health Care Needs (knowledge
path) at
http://www.mchlibrary.info/KnowledgePaths/kp_CSHCN.html
- Community Services Locator: Community-Based Services to Support
Children and Families (knowledge path) at
http://www.mchlibrary.info/KnowledgePaths/kp_community.html
- Adolescents with Special Health Care Needs (bibliography) at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_adolshn.html&-MaxRecords=all&-DoScript=auto_search_adolshn&-search
- Children with Special Health Care Needs (bibliography) at
http://www.mchlibrary.info/action.lasso?-database=Biblio&-layout=Web&-response=/databases/BibLists/bib_cshcn.html&-MaxRecords=all&-DoScript=auto_search_cshcn&-search
- Children with Special Health Care Needs (organizations resource list)
at
http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_cshn.html&-MaxRecords=all&-DoScript=auto_search_cshn&-search
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4. STUDY INVESTIGATES PREDICTORS OF INITIATION OF ALCOHOL USE AMONG
ADOLESCENTS
"Parents should be aware that while high social and athletic
self-esteem are positive attributes, they do not protect children from
initiating alcohol use," state the authors of an article published in
the October 2007 issue of the Archives of Pediatrics and Adolescent
Medicine. Alcohol use has been associated with the four leading causes
of death among young people: motor vehicle crashes, unintentional
injury, suicide, and homicide. Identifying precursors of adolescent
alcohol use could be useful in targeting intervention strategies. The
article presents findings from a prospective examination of the
predictors of alcohol initiation and binge drinking in a large,
nationwide cohort of adolescents.
Study participants were drawn from the Growing Up Today Study (GUTS)
sample, which comprises 16,882 children and adolescents who were ages
9-14 in 1996 and which includes annual follow-up questionnaires. In
1998 and 1999, the GUTS follow-up questionnaires included an expanded
section on alcohol use. The questionnaires assessed exposure variables
at the individual level, the family level, and within social context.
Outcome measures included initiation of alcohol use (never had a whole
alcoholic drink, initiators of alcohol use), binge drinking (reported
consuming five or more drinks on at least one occasion), and stage of
uptake. The final sample included 3,283 girls and 2,228 boys who were
ages 11-18 in 1998 who had not yet initiated alcohol use and for whom
complete baseline and follow-up data were available. The analyses
compared the factors influencing alcohol uptake among adolescents by
sex and by age and also examined predictors among adolescents at
varying levels of behavioral progression using a framework based on the
transtheoretical model, which posits multiple stages of change,
including precontemplation and contemplation, before initiating an
action.
The authors found that
- Overall, 611 girls (19%) and 384 boys (17%) who had never
consumed a whole alcoholic drink in 1998 had a first whole alcoholic
drink in 1999.
- Older age, later maturational stage, cigarette smoking, adults
who drink in the home, sibling under age 21 who drinks, peer drinking,
owning or being willing to use alcohol-promotional items, and positive
attitudes toward alcohol were predictive of alcohol initiation among
both girls and boys.
- Among adolescents who had never consumed a whole alcoholic drink
in 1998, 149 girls (5%) and 112 boys (5%) engaged in binge drinking in
1999. These 261 binge drinkers comprised 24% of girls and 29% of boys
who first initiated alcohol use in 1999.
- Among both girls and boys, positive attitudes toward alcohol were
associated with binge drinking.
"Adolescents with higher AEQ-A scores [a measure of attitudes and
beliefs about alcohol], irrespective of sex, age, or stage of uptake,
were more likely to initiate alcohol use and binge drink," suggesting
that AEQ-A score may be a good tool for predicting this behavior.
Fisher LB, Miles IW, Austin SB, et al. 2007. Predictors of initiation
of alcohol use among US adolescents. Archives of Pediatrics and
Adolescent Medicine 161(10):959-966. Abstract available at http://archpedi.ama-assn.org/cgi/content/abstract/161/10/959.
Readers: More information is available from the following MCH Library
resource:
- Substance Use (organizations resource list) at
http://www.mchlibrary.info/action.lasso?-database=Organizations&-layout=Web&-response=/databases/OrgLists/orgs_subuse.html&-MaxRecords=all&-DoScript=auto_search_subuse&-search
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5. ARTICLE ASSESSES QUALITY OF AMBULATORY CARE DELIVERED TO CHILDREN IN
THE UNITED STATES
"On the basis of medical record documentation, deficits in the delivery
of indicated care to children (for which the overall adherence rate was
46.5%) are similar in magnitude to those previously reported for adults
(for which the overall adherence rate was 54.9%)," write the authors of
an article published in the October 11, 2007, issue of The New England
Journal of Medicine. Problems with the quality and safety of health
care in the United States have been widely documented, but this
evidence comes mainly from studies focused on adults and the elderly.
In the study described in this article, the authors sought to answer
five questions: (1) how good is the quality of care for children
overall?, (2) does quality of care vary according to type of care (care
for acute or chronic medical problems or preventive care)?, (3) does
quality vary across the continuum of care functions (screening,
diagnosis, treatment, and follow-up)?, (4) does quality vary according
to mode of care (history taking, physical examination, laboratory
testing or radiology, medication, immunization, encounter, education,
or counseling)?, and (5) does quality vary according to type of
clinical area?
The authors collaborated with the Community Tracking Study (CTS),
conducted by the Center for Studying Health System Change. The CTS
recruited households in 12 metropolitan areas from across the country.
The communities were randomly selected to represent metropolitan areas
with a population of more than 200,000. Researchers telephoned
participating households that had a child enrolled in the CTS and
interviewed the adult in the household who was most familiar with the
child's medical history to obtain medical information and consent to
request copies of the child's medical records from all health
professionals seen during the 2-year period before the date of
interview. A total of 1,553 children were included in the analysis.
The authors found that
- On average, children received 46.5% of the indicated care for
acute medical problems, 53.4% of the indicated care for chronic medical
conditions, and 40.7% of the indicated preventive care.
- Adherence rates for the continuum of care functions ranged from
37.8% of the indicated screening processes to 65.9% of indicated
treatment processes.
- In the group of 11 clinical areas for which data for at least 50
children were included in the composite-score calculation, the rates of
documented adherence ranged from 92.0% for indicated care for upper
respiratory tract infection, to 34.5% for indicated preventive care for
adolescents.
The authors conclude that "expansion of access to care through
insurance coverage, which is the focus of national health care policy
related to children, will not, by itself, eliminate the deficits in the
quality of care."
Mangione-Smith R, DeCristofaro AH, Setodji CM, et al. 2007. The quality
of ambulatory care delivered to children in the United States. The New
England Journal of Medicine 375(15):1515-1523. Abstract available at http://content.nejm.org/cgi/content/full/357/15/1515.
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and
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