Distance-based partnerships are being increasingly used in health care and have previously been described to facilitate the training of nurses, researchers, and occupational therapists.1–6 In 2013, the Society of Hospital Medicine’s newly published guidelines for pediatric hospital medicine (PHM) programs indicated that strong leadership is critically important to a program’s success. Many smaller children’s hospitals have very few dedicated pediatric hospitalists, and these hospitalists might not have formal leadership or quality improvement (QI) training, resources, or dedicated time for QI work because of their clinical responsibilities. Similarly, pediatric residency programs at smaller institutions might lack robust inpatient QI experiences for their trainees. Leaders at Cincinnati Children’s Hospital Medical Center (Cincinnati) were approached by leaders at Niswonger Children’s Hospital (Niswonger) to complete a needs assessment of Niswonger’s inpatient program. Niswonger is a 69-bed children’s hospital colocated with Johnson City Medical Center, an adult hospital. These hospitals are located in a suburban area with a large rural catchment area. Both the adult and children’s hospitals are part of a larger health system, Mountain States Health Alliance. Niswonger is affiliated with East Tennessee State University (ETSU) Department of Pediatrics, which provided the majority of physician staffing. The needs assessment, completed in 2012, consisted of several site visits, observation of inpatient rounds, interviews with Niswonger faculty and staff, evaluation of available historical data, and collection of new data. Two main gaps in clinical care and training at Niswonger were identified. The first was the need for a dedicated hospitalist program with providers who did not have competing clinical responsibilities. The general pediatric inpatient unit was historically staffed by several ETSU faculty members, all of whom had primary responsibilities in other areas such as intensive care, outpatient primary care, and infectious disease and none of whom were dedicated pediatric hospitalists. These physicians would typically conduct inpatient teaching rounds in the morning and then resume other clinical responsibilities. The second was the need for QI training for the 19 residents in the ETSU pediatric residency program, an Accreditation Council for Graduate Medical Education requirement.

The health care needs of children with hydrocephalus continue beyond childhood and adolescence; however, pediatric hospitals and pediatric neurosurgeons are often unable to provide them care after they become adults. Each year in the US, an estimated 5000–6000 adolescents and young adults (collectively, youth) with hydrocephalus must move to the adult health care system, a process known as health care transition (HCT), for which many are not prepared. Many discover that they cannot find neurosurgeons to care for them. A significant gap in health care services exists for young adults with hydrocephalus. To address these issues, the Hydrocephalus Association convened a Transition Summit in Seattle, Washington, February 17–18, 2017. The Hydrocephalus Association surveyed youth and families in focus groups to identify common concerns with HCT that were used to identify topics for the summit. Seven plenary sessions consisted of formal presentations. Four breakout groups identified key priorities and recommended actions regarding HCT models and practices, to prepare and engage patients, educate health care professionals, and address payment issues. The breakout group results were discussed by all participants to generate consensus recommendations. Barriers to effective HCT included difficulty finding adult neurosurgeons to accept young adults with hydrocephalus into their practices; unfamiliarity of neurologists, primary care providers, and other health care professionals with the principles of care for patients with hydrocephalus; insufficient infrastructure and processes to provide effective HCT for youth, and longitudinal care for adults with hydrocephalus; and inadequate compensation for health care services. Best practices were identified, including the National Center for Health Care Transition Improvement’s “Six Core Elements of Health Care Transition 2.0”; development of hydrocephalus-specific transition programs or incorporation of hydrocephalus into existing general HCT programs; and development of specialty centers for longitudinal care of adults with hydrocephalus. The lack of formal HCT and longitudinal care for young adults with hydrocephalus is a significant health care services problem in the US and Canada that professional societies in neurosurgery and neurology must address. Consensus recommendations of the Hydrocephalus Association Transition Summit address 1) actions by hospitals, health systems, and practices to meet local community needs to improve processes and infrastructure for HCT services and longitudinal care; and 2) actions by professional societies in adult and pediatric neurosurgery and neurology to meet national needs to improve processes and infrastructure for HCT services; to improve training in medical and surgical management of hydrocephalus and in HCT and longitudinal care; and to demonstrate the outcomes and effectiveness of HCT and longitudinal care by promoting research funding.

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The Attachment, Self-Regulation, and Competency (ARC) treatment framework is a “whole-systems” intervention which focuses on children and youth with complex trauma histories and attachment difficulties. ARC encourages intervention in layers to build a safe and secure caregiving system around a child. The layers include the child, caregivers, treatment providers, child welfare workers, teachers, and case managers. We developed an ARC Community Based Learning Collaborative (CBCL) to bring these layers together to create a safe andsupportive group experience and environment in which members of the child’s caregiving system can begin to build a common language and understanding of trauma that results in collaborated and coordinated trauma informed interventions to improve symptoms and decrease disrupted placement for youth in care. The overall goal of the ARC CBLC is to build highly functioning teams whose members have the knowledge and skills to apply the core principles of the ARC framework in accordance with their roles in the child’s caregiving system to promote healing and resiliency. This session will outline the development and implementation of the ARC CBLC, outcomes,and lessons learned.

Purpose: The purpose of this study was to investigate challenges faced by high schools in rural Appalachia in implementing the Healthy, Hunger Free Kids Act of 2010 (HHFKA). Methodology: We used qualitative, secondary analysis to analyze a collection of thirteen focus groups and 22 interviews conducted in 2013-14 among parents, teachers, and high school students in six counties in rural Appalachian Tennessee (n=98). Results: Five basic themes were identified during the thematic analysis: poor food quality prior to implementation of the HHFKA school nutrition reforms; students’ preference for low-nutrient energy-dense foods; low acceptance of healthier options after implementation of the HHFKA school nutrition reforms; HHFKA school nutrition reforms not tailored to unique needs of under-resourced communities; and students opting out of the National School Lunch Program after implementation of the HHFKA school nutrition reforms. Rural communities face multiple and intersecting challenges in implementing the HHFKA school nutrition reforms. Conclusion: As a result, schools in rural Appalachia may be less likely to derive benefits from these reforms. The ability of rural schools to take advantage of school nutrition reforms to improve student health may depend largely on factors unique to each community or school.

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