A clinical process support system for primary care to address family stress

这项建议涉及儿童权利中心在预防虐待和忽视儿童方面特别关注的重点。 风险人群。虐待和忽视儿童往往会对身体造成短期和长期的损害， 儿童的情绪、认知发展。拟议的项目建立在来自以下方面的有希望的数据之上 先前基于初级保健儿科实践中筛查工具应用的随机对照试验 这确定了家庭压力源和严厉惩罚的使用，众所周知，这会使儿童面临患上 虐待儿童和忽视儿童。儿科检查是早期识别的理想选择，因为它几乎是普遍的和 重复访问。然而，这些探视，也被称为儿童健康监督，被指控犯有 公共卫生负担沉重的早期发现和预防性咨询涉及的问题多种多样 在有限的时间内，促进儿童的健康风险、安全和促进儿童发展。我们之前已经 构建了一个系统，通过将信息收集的负担转移到在线预访来帮助应对这一挑战 这个名为CHADIS的平台已经被100多万名家长使用。然而，当访问时， 范围扩大到解决敏感的家庭压力源，PCP的挑战变成了临床上的挑战之一 面试技巧，在一定程度上，最好是用基于证据的方法来解决，这种方法被称为激励法 访谈(MI)。PCP没有接受过MI培训，通常需要的时间比分配给 参观。这里提出的创新是在访问之前在线收集数据，不仅可以发现问题，还可以 分开面谈过程，以便计算机以一种在访问期间指导PCP的方式收集数据 用细节和建议的词语(“远程提示器”)表达人的同理心和反思性倾听 这可以很短的时间内实现。此外，这项创新还减少了文档负担，并创造了 后续心理教育和跟踪。这一新的家庭压力模块不仅支持单个问题 探视，但也在为所有年龄段的儿童的父母创造心理社会导向方面发挥作用 信任PCP以及“预见性指导”，并用“备忘录”和短信加强。电子学 将创建与当地转介资源(如机构或治疗师)的链接，以便在进行转介时 在父母同意的情况下，促进双向沟通以及跟踪预约的完成情况。 没有其他类似范围的临床过程支持系统，也没有连接到电子设备的 医疗保健系统是医疗和社会领域的桥梁。该项目包括首先与母公司一起完善原型 和医生反馈，然后进行整群随机干预试验。假设的结果是 更低的虐待和忽视儿童报告率，不那么严厉的惩罚，以及改善发展和 干预组的行为结局。家长对改进的临床流程和 还将评估附带好处，如较低的误诊率和延迟接种疫苗。

This proposal addresses the NICHD focus of specific interest for the prevention of child abuse and neglect in at risk populations. Child abuse and neglect often confers short- and long-term impairment of the physical, emotional, and cognitive development of children. The proposed project builds on promising data from previous randomized control trials, based on application of a screening tool in primary care pediatric practice that identifies the Family Stressors and use of harsh punishment, which are known to put children at risk for child abuse and neglect. Pediatric check-ups are ideal for early identification because of nearly universal and repeated access. However, these visits, also known as “child health supervision” have been charged with a heavy public health burden of early detection and preventive counseling for a wide variety of issues related to health risks, safety, and promoting child development during narrow time constraints. We have previously built a system to assist with this challenge by off-loading the burden of information gathering to an online previsit platform called CHADIS that has been used by over one million parents already. However, when the visit scope is broadened to addressing sensitive family stressors, the challenge for PCPs becomes one of clinical interviewing skills, that, in part, is best addressed with the evidence based approach known as motivational interviewing (MI). PCPs have not been trained for MI and it typically takes longer than the time allotted for the visit. The innovation proposed here is to collect data online before visits to not only identify problems, but also divide the interview process so that the computer collects data in a way that guides the PCP during the visit with details and suggested words (“teleprompters”) for the human elements of empathy and reflective listening that can be delivered briefly. In addition, the innovation also reduces documentation burden and creates follow-up psycho-education and tracking. This new Family Stress Module supports not only a single problem visit but also acts across visits in creating the psychosocial orientation for parents of children of all ages to confide in the PCP as well “anticipatory guidance” reinforced by “MemoryBook” and text messages. Electronic linking will be created with local referral resources, such as agencies or therapists, so when a referral is made two way communication is facilitated as well as tracking of appointment completion with the parent’s consent. There are no other clinical process support systems of similar scope and none connected to an electronic system of care bridging medical and social domains. The project involves first refining a prototype with parent and doctor feedback and then conducting a cluster randomized intervention trial. Hypothesized outcomes are lower rates of child abuse and neglect reports, less harsh punishment, as well as improved developmental and behavioral outcome in the intervention group. Parent satisfaction with the enhanced clinical process and collateral benefits, such as lower rates of missed visits and delayed vaccines will also be assessed.