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Background: Measuring the acquisition of self-management skills are part of evidence based health care transition practice. Youth with Spina Bifida have significant demands for self-management and high self-care burden. We developed an 11 item Spina-Bifida -TRAQ to assess self-management skills specific for Spina Bifida including urine, stool continence management, and skin and shunt maintenance. A detailed description of the SB-TRAQ, its reliability and criterion validity are presented elsewhere. Objective: To examine the predictive validity of the Spina Bifida-TRAQ among youth with Spina Bifida. Design/Methods: Participants include 90 youth with Spina Bifida who attend a clinic participating in the National Spina Bifida Patient Registry (NSBPR) (see Table1 for demographics). Youth completed the newly developed 11-item SB-TRAQ. De-identified NSBPR data from the electronic medical record (EMR) was linked with participants’ responses from the SBTRAQ. Two separate regressions were conducted using: age, sex, race, ethnicity, insurance, lesion level, lifetime # of shunt revisions, and SB-TRAQ to predict urinary incontinence (UI) episodes/month, and stool incontinence (SI) episodes/month. Results: Two separate multiple linear regressions were calculated to predict frequency (times per month) of UI and SI based on age, sex, race, ethnicity, insurance, having an IEP, spinal cord lesion level, lifetime number of shunt revisions, and SB-TRAQ. For UI, a significant regression equation was found (F(9,77) = 2.44, p<.001), with an R2 of .22. SB-TRAQ and IEP were significant predictors of UI; youths’ UI decreased 1.15 days/month for each point increase in SB-TRAQ; youth with an IEP had .83 more episodes of UI/month than did youth without an IEP. The model for SI had a significant regression equation (F(9,75) = 3.18, p<.001), with an R2 of .28. SB-TRAQ and lesion level were significant predictors of SI; youths SI decreased .58 days for each point increase in SB-TRAQ; each lower lesion levels (.13/level) had fewer SI episodes/month than did those with higher lesion levels. Conclusion(s):

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Background: Measuring the acquisition of self-management and health care utilization skills are part of evidence based transition practice. The Transition Readiness Assessment Questionnaire (TRAQ) is a validated 20-question and 5-factor instrument with a 5-point Likert response set using a Stages of Change Framework. Objective: To improve the performance of the TRAQ and allow more precise measurement across the full range of transition readiness skills (from precontemplation to initiation to mastery). Design/Methods: On data from 506 previously completed TRAQs collected from several clinical practices we used MPlus v.7.4 to apply a graded response model (GRM), examining item discrimination and difficulty. New questions were written and added across all domains to increase the difficulty and discrimination of the overall scale. To evaluate the performance of new items and the resulting factor structure of the revised scale we fielded a new version of the TRAQ (with a total of 30 items) using an online anonymous survey of first year college students (in process). Results: We eliminated the five least discriminating TRAQ items with minimal impact to the conditional test information. After item elimination (k = 15) the factor structure of the instrument was maintained with good quality, ?2 (86) = 365.447, CFI = 0.977, RMSEA = 0.079, WRMR = 1.017. We also found that a majority of items could reliably discriminate only across lower levels of transition readiness (precontemplation to initiation) but could not discriminate at higher levels of transition readiness (action and mastery). Therefore we wrote 15 additional items intended to have higher difficulty. On the new 30 item TRAQ, confirmatory factor analysis, internal reliability and IRT results will be reported from a large sample of college students Conclusion(s): Using IRT and factor analyses we eliminated 5 of 20 TRAQ items that were poorly discriminating. We found that many of the items in the TRAQ could discriminate among those in the early stages of transition readiness, but could not discriminate among those in later stages of transition readiness. To have a more robust measure of transition readiness we added more difficult items and are evaluating the scale’s psychometric properties.

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Research has shown that children who exhibit problem behaviors in early childhood will oftentimes continue to experience these issues into adolescence, leading to an increase in negative social and health outcomes such as substance abuse and delinquency. The Family Check Up (FCU) is a proven, targeted intervention that seeks to address these problems at a young age in order to reduce the risk of these negative behaviors continuing into adolescence. The intervention consists of 3 components: 1) an initial interview in which the behavioral health consultant gets to know the family; 2) an assessment that consists of questionnaires and videotaped family interactions; and 3) a feedback session during which the family is provided with feedback unique to their particular situation, as well as appropriate solutions to these issues. The FCU has been shown to be effective in school-based settings in past studies; this study represents the first to test the feasibility of offering the FCU in a pediatric primary care practice. The aims of the study are based upon the RE-AIM framework (Reach; Effectiveness; Adoption; Implementation; and Maintenance), a Decision and Implementation (DamdI) science model that will assist in the evaluation of the utility of the FCU in the pediatric primary care setting. This particular project is focusing on two elements of the framework, Reach and Adoption. The FCU was implemented at East Tennessee State University’s (ETSU) Pediatrics Clinic beginning on January 19th, 2015. The parents of patients between the ages of 4 and 5 years old are given the Pediatric Symptom Checklist (PSC-17), a screener which helps to identify children who may be at risk for emotional and behavioral problems. If a child scores 15 or higher on the PSC-17, they are invited to participate in the components of the FCU. Research is ongoing, with 23 out of 31 patients (74.2%) completing the PSC-17 at their well-child visit. The results of the screeners thus far show that with the average score on the PSC-17 is 6.57, with the lowest score being 0 and the highest score being 19. Only 1 patient scored ≥ 15 on the PSC-17 thus far, possibly indicating the need for an expansion of the inclusion criteria for the remainder of the study. The final results of the project will indicate the rate of Reach and Adoption within the ETSU Pediatrics Clinic as well as provide evidence as to the most successful way to reach a specific population with an evidence-based intervention.

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No description available.